Overpronation, also called pes planus or flexible flatfoot, is relatively common in children and often goes away on its own. Treatment may be necessary if your child doesn’t outgrow their flat feet or complains of foot pain.
Here’s what you need to know about recognizing, monitoring, and treating overpronation in kids.
When you walk, your feet naturally move from side to side. This directional movement is called pronation, and it determines how well your feet absorb the shock and impact of your movements.
Your feet are supposed to stay aligned in a fairly straight position while you walk, though a slight rolling inward or outward — up to about 15 percent in either direction — is typical.
There are three types of pronation:
- Normal (or neutral). Your feet stay mostly upright except for a small percentage of inward or outward rolling.
- Underpronation. Your feet roll outward more than 15 percent. This is also called supination.
- Overpronation. Your feet roll inward more than 15 percent.
Having feet that are underpronated or overpronated isn’t usually too serious, but it can lead to other health concerns if left untreated. These may include shin splints, bunions, or pain.
Flat feet are often obvious in younger kids. This is in part because their arches aren’t fully developed yet.
According to the American Academy of Orthopaedic Surgeons (AAOS), children aren’t born with arches. Instead, arches develop as kids start to walk and the muscles along the soles of their feet strengthen and tighten. In fact, per the AAOS, some kids don’t develop arches until they’re age 5 or older.
Because flexible flatfoot is part of many kids’ natural development, it’s typical to see your child outgrow their overpronation without any intervention.
However, it’s important to keep an eye on your child’s foot development. Treatment may be needed if they are experiencing movement irregularities or pain because of flat feet.
Very young children don’t usually have any symptoms other than visibly flat feet.
This means that when you look at the inside of your child’s feet when they are standing up, there may not be much of a gap, or arch shape, between the sole of their feet and the floor. You may also notice that when you look at the back of your child’s ankles while they are standing, they appear slightly turned in toward one another.
However, if your child doesn’t outgrow their flatfoot as they get older, they may start complaining of some symptoms. Any foot pain, frequent discomfort, or unusual style of walking (gait) is a sign that it’s time to make an appointment with your child’s doctor.
According to the Children’s Hospital of Philadelphia, symptoms of overpronation can include:
- arch pain
- heel pain
- foot pain that gets worse with physical activity
- tightness in the foot, especially the heel cord along back of ankle (Achilles tendon)
Your child might also have other common signs of overpronation, including:
- frequent corns or calluses on their feet
- knee or back pain
- hammer toes
If you have noticed that your child has flatfoot, you can mention it to their doctor at their next visit. It isn’t an urgent issue unless your child is having any pain or discomfort. If they are, schedule an appointment to have your child’s feet examined.
Many pediatricians are skilled at identifying overpronation in kids, though your child’s doctor may also refer you to a podiatrist (foot specialist) for an expert opinion.
Per the AAOS, during a physical exam for flatfoot, a healthcare professional may:
- ask questions about family medical history
- inspect your child’s feet
- look at the wear-and-tear patterns on their shoes
- observe them while they perform basic movements (walking, running, standing on tiptoes)
If your child’s doctor needs more information, they may order some diagnostic tests to get a better look at your child’s foot structure. This might includeX-rays, CT scans, or even an MRI scan.
If your child’s overpronation isn’t bothering them, you probably don’t need to do anything to “fix” it.
But if your child is a candidate for flatfoot treatment because they are having symptoms, you can discuss several different options with their doctor. While surgery is sometimes required for adults and adolescents, the AAOS says young children are almost never referred for surgery for flatfoot.
Most likely, you’ll be encouraged to try one or more nonsurgical treatments to help address your child’s overpronation.
Let’s review some of these options.
Heel cord stretching is one of the most popular types of treatment for flatfoot. It involves gently stretching the Achilles tendon three times on each leg every day or when your child has pain or aching in their feet. It’s a straightforward approach that is generally safe for kids, per
There are several other easy-to-perform stretches that can help correct an improper gait and strengthen the arch muscles. You may need to do these alongside your child at first, to make sure they’re learning the right form and posture.
Flat shoes can make foot pain worse if you have overpronation. Making sure your child has shoes with a supportive, cushioned footbed, and extra arch support can help lessen foot pain.
While children may be especially attached to a favorite pair of shoes, it’s important they don’t continue to use shoes that are too old or worn down. Check out the AAOS’s recommendations for choosing the right shoes.
If you can’t find shoes that are supportive enough on their own, you can add orthotic devices to your child’s regular shoes for extra relief. These inserts are designed to fit the contours of your child’s feet and are sold over-the-counter or available custom made.
The AAOS says that in most cases OTC supports work just as well — and are much less expensive — than custom-made orthotics.
Parents should aim to choose or order orthotics according to a podiatrist or doctor’s recommendation. Making sure children’s feet are properly measured and fitted for the right insert can improve effectiveness and reduce chance of irritation.
Kid-safe pain relievers
If your child is complaining about their aching feet, ask their doctor about safe use of a pain reliever, like acetaminophen or ibuprofen, to help in the short term, according to Children’s Health of Orange County.
Make sure you always keep medications out of children’s reach or safety-locked. Children should take medications only under adult supervision and according to doctor’s instructions.
Children with sore feet also might benefit from putting ice or heat on their feet at the end of the day or using a manual foot massage roller to release some of the muscle tension.
If you cannot figure out what your child needs for their flatfoot pain, a physical therapist can give you advice about footwear and stretching. Physical therapists specialize in identifying and treating a wide variety of musculoskeletal problems, whether caused by an injury or a chronic condition.
Even just one or two sessions with a physical therapist can set you and your child up for success treating their overpronation at home.
The therapist will likely give your child stretches to complete on a daily basis. Some children may need adult supervision to complete their routine, while others may be able to handle it on their own after guidance and practice.
Overpronation, or flexible flatfoot, is quite common in children under age 5 because their arches aren’t fully developed yet. Once they start walking, most kids naturally develop an arch and go on to have typical pronation.
If your child is over the age of five and still has flatfoot — or if their flatfoot is causing pain, discomfort, or an unusual walking style — be sure to make an appointment with your child’s doctor to have their feet examined.
Conservative treatments such as ice, stretching, or orthotic inserts may be required.