Flat Feet and Pigeon Toes in Kids: What’s Normal and When to Get Them Checked

Maybe your toddler’s feet look completely flat when they stand. Or your preschooler’s toes point in toward each other when they run, and they seem to trip a lot. Both are things parents notice all the time. The good news is that in most young children, flat feet and in-toeing (often called “pigeon toes”) are normal parts of growing up.^1,5

Here’s what’s typical, what tends to happen as kids grow, and the signs that mean it’s worth having a child’s feet checked.

Is It Normal for My Child to Have Flat Feet?

Usually, yes. Most children are born with very little arch. As they grow and walk, the soft tissues on the bottom of the feet tighten and slowly shape the arch.¹ Babies can also look flat-footed because of soft fat pads and how they were positioned in the womb.^2,3

Flat feet are very common in young kids. One 2023 review reported rates as high as 44% in preschool-aged children.³ Many children don’t develop arches until age 5 or later, and some never do.¹ The same review notes the arch keeps maturing until around age 9 or 10, and sometimes into the teen years.³

What’s the Difference Between Flexible and Rigid Flat Feet?

Doctors sort children’s flat feet into two main types:

• Flexible flatfoot. This is the common kind. The arch disappears when your child stands but shows up again when they sit or rise up on tiptoes.^1,2 The American Academy of Orthopaedic Surgeons (AAOS) calls it a variation of a normal foot. It’s usually painless and doesn’t get in the way of walking or sports.¹
• Rigid flatfoot. Here the arch stays flat and stiff whether your child is sitting or standing, and children usually have symptoms.² AAOS notes this “may be a more serious condition.”¹ One possible cause is a tarsal coalition, where two or more foot bones are abnormally joined. It often shows up around ages 8 to 12, sometimes with stiffness, pain or frequent ankle sprains.³

A quick check at home: look at your child’s feet while they stand, then while they sit or stand on tiptoes. That doesn’t replace an exam, but it’s a useful thing to mention at a visit.

Why Do My Child’s Toes Point Inward?

In-toeing means the feet point in toward each other instead of straight ahead when a child stands or walks. ItIt’s one of the most common reasons kids’ walking catches a parent’s eye.⁵rsquo;s a very common walking pattern in young children.⁵ It usually comes from one of three normal variations, and each tends to show up at a different age:^4,6

• Curved foot (metatarsus adductus), in infants. The front of the foot turns in, giving it a “C” shape.⁵ It’s often linked to the baby’s position in the womb.⁴ Most mild cases improve by the first birthday.^4,6
• Inward-twisted shinbone (internal tibial torsion), in toddlers. This is the most common cause between about ages 1 and 4,⁶ and it tends to run in families.⁴ StatPearls notes it typically resolves between ages 4 and 7.⁶
• Inward-turned thighbone (femoral anteversion), in older kids. It’s usually noticed after age 3⁶ and can show up in children ages 3 to 10.⁴ It takes the longest to improve, often around age 11.⁶

Kids who in-toe may trip and fall more, especially when running, and their shoes may wear unevenly.⁵ Less often, in-toeing is linked to another condition such as clubfoot, hip dysplasia or cerebral palsy.^5,6 That’s one reason a professional look is worthwhile.

Do Special Shoes, Inserts or Braces Help?

For most kids, probably not. This is one area where well-meaning fixes often don’t live up to their promise.

• Flat feet without pain: AAOS says no treatment is needed if flexible flatfoot isn’t causing pain or discomfort.¹ ACFAS notes that children without symptoms are usually monitored and rechecked over time instead.² The 2023 review found that orthotics for flat feet that don’t hurt aren’t supported by evidence.³
• Flat feet that hurt: Options may include heel-cord stretches, physical therapy, supportive shoes or shoe inserts.^1,2 AAOS notes over-the-counter arch supports are often as effective as custom ones, and cheaper to replace as kids grow.¹ Whether inserts actually change how the arch develops is still debated.³ AAOS adds that children almost never need surgery.¹
• In-toeing: Watching and waiting is the main approach.⁶ The American Academy of Pediatrics (AAP) advises against non-prescribed devices like corrective shoes, twister cables, daytime braces and shoe inserts. It says they don’t fix the problem and may cause harm. It also notes that night braces haven’t proven effective.⁴ A stiff or severe curved foot in a baby may be treated with a series of casts, ideally before the child walks.^4,6 Surgery is rare and reserved for older children with problems that don’t improve.^4,5,6

What about W-sitting or sleeping positions? StatPearls says these myths don’t make the twist worse.⁶

When Should My Child’s Feet Be Checked?

Sources differ a bit on timing. Cleveland Clinic suggests seeing a provider when you first notice in-toeing, even if no treatment is expected, so it can be watched as your child grows.⁵ Either way, these signs are a good reason to make an appointment:

• Foot, leg or knee pain, tenderness or cramping^1,2
• A foot that is stiff, or flat even when your child sits^2,3
• Trouble keeping up with playmates, tiring easily, or pulling back from activities²
• Awkward or clumsy walking, trouble walking, or the heel tilting outward^2,4
• A baby’s curved foot that lasts past about 6 months or is stiff and hard to straighten⁴
• In-toeing still present around age 9 or 10^4,5
• Trouble fitting into shoes²

A visit usually starts with a physical exam. The provider watches your child walk and checks the feet standing and sitting, and sometimes the hips and knees.² X-rays usually aren’t needed for in-toeing.⁵ Our podiatrists see patients of all ages, including kids. Our new patient page explains what to bring.

If your older child or teen has heel pain, our article on Sever’s disease may help. Adults with flat feet can read about managing flat-foot pain.

The Bottom Line

Flat feet and pigeon toes are common in young children, and most kids grow out of them without special shoes or braces. Pain, stiffness, trouble keeping up, or in-toeing that lingers into the later grade-school years are the signs worth a closer look. If you’re unsure, a quick check can give you peace of mind.

To have your child’s feet looked at, request an appointment and our team will follow up within one business day. You can find the office nearest you on our locations page.

This article is for general education and isn’t a substitute for medical advice. Talk with a podiatrist or your child’s doctor about your child’s feet.

Sources

1. Flexible Flatfoot in Children. OrthoInfo, American Academy of Orthopaedic Surgeons (AAOS). www.orthoinfo.org
2. Flatfoot (Pediatric). American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
3. Vergillos Luna M, Khal AA, Milliken KA, Solla F, Rampal V. Pediatric Flatfoot: Is There a Need for Surgical Referral? Journal of Clinical Medicine. 2023;12(11):3809. pmc.ncbi.nlm.nih.gov
4. Pigeon Toes (Intoeing). HealthyChildren.org, American Academy of Pediatrics. www.healthychildren.org
5. Pigeon Toes (Intoeing). Cleveland Clinic. my.clevelandclinic.org
6. Gonzales AS, Ampat G, Dixon M. Intoeing. StatPearls, National Library of Medicine. www.ncbi.nlm.nih.gov