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Paediatric Flat foot

child with flat feet

The treatment of asymptomatic children with flat feet is often seen as controversial with some clinicians advocating treatment with insoles and others against intervention.

Flat feet is a normal characteristic in young children and the arch will slowly form as the child develops until a more adult foot posture is achieved normally by around the age of 10.

In January 2022 the Cochran review updated its previous review titled ‘Foot orthoses for treating flat feet in children’

The review concludes ‘We conclude that there is no evidence to support the efficacy of foot orthoses (FO) for children with asymptomatic (painless) flat feet.’ and that future research should be focused on children with painful feet. 

The author Angela Evans goes on to state in her comments ‘The agenda for researching asymptomatic flat feet in healthy children is now firmly closed, as there is no justification for wasting research and healthcare resources on flat feet in healthy children that do not hurt.'

We would thoroughly recommend reading Angela Evans's body of work as it contains great insight into the problem of whether you should treat or not treat a child with flat feet. 

In general children with painless bilateral flat feet under the age of around 10 should not be treated with foot orthoses. 

Pre walking childs foot position

Typical feet in a prewalking child

Children who are reporting pain in their feet are a different matter especially if they are of preschool age.

The children who require treatment have at least one of the following:

  • Pain in the foot or leg
  • Asymmetry between foot or leg posture
  • Delayed walking (over 18 months)
  • Significant deformity
  • Rigid flat foot 
  • Conditions such as JIA, CMT, CP or hypermobility syndromes (e.g. Downs syndrome, Ehlers‐Danlos, Marfan)

Any of these symptoms would require a thorough assessment by a suitably qualified clinician.

While it is not an absolute indication that treatment is required it is important to take family history into account such as multiple family members having painful flat feet.

Flat foot treatment options

It is generally recommended that children with symptomatic flat feet are treated with stock insoles as they are significantly cheaper and report similar outcomes to custom insoles in this group. There are a huge number of stock insoles available which we will cover below but it is important to remember that not every foot will fit a stock device and sometimes a custom made device is required. 

Twin Cheek insoles

  • Full length or three-quarter length available
  • Size 19 - 42
  • Low heel cup at the back
  • High Lateral Flange
  • Rounded heel

Shell like arch support

  • Full length or three-quarter length available
  • Size 19 - 42
  • Full Heel cup
  • Higher Arch then Twin Cheeks


What is the difference between the Twin Cheeks and Shell Like Arch support?

The Shell Like arch support has a higher heel cup at the back with a higher arch. 

The Twin Cheek is lower profile with it being lower at the back of the heel with a higher lateral flange. The lateral wall does not extend as far down the insole as the shell like arch support. 


  • Full length or three-quarter length available
  • Size 19 - 42
  • High reinforced Lateral Flange
  • Flat heel base for increased stability
  • Slight met rise
  • Multiple colours 

The Supinara is significantly reinforced over the twin cheek and Shell Like arch support down the lateral side with a high lateral flange. The Supinara insole is good when increased support is required with the flat rather than rounded heel providing increased stability.

Heel Plateau

  • Flat base at the heel
  • Size 19 - 48
  • Ability to grind in wedging
  • Narrow, medium or Broad
  • Heat moldable 
  • Full heel cup

The newest addition to our paediatric range the heel plateau insole can be adapted to grind in wedging at the heel. Like the Supinara it has a flat base but the heel plateau is curved inside to cup the heel. We have a guide on the heel Plateau insole here. 

Do you see children with flat feet privately?

Our Clinic will assess children in both Edinburgh and Glasgow and appointments can be booked via the clinic site.