Flat Feet: Diagnosis


Alternative names

Pes planus; Pes planovalgus; Fallen arches; Pronation of feet


Pes planus is a condition where the arch or instep of the foot collapses and comes in contact with the ground. In some individuals, this arch never develops.

Causes, Incidence and Risk Factors

Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches.

When flat feet persist, the majority are considered variations of normal. Most feet are flexible and an arch appears when the person stands on his or her toes. Stiff, inflexible, or painful flat feet may be associated with other conditions and require attention.

Painful flat feet in children are often caused by a condition called tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together limiting motion and often leading to a flat foot.

Most flat feet do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean towards each other (after they have been worn long enough for the foot position to remodel their shape).


  • absence of longitudinal arch of foot when standing
  • foot pain
  • heel tilts away from the midline of the body more than usual

Signs and Tests

Examination of the foot is sufficient for the health care provider to make the diagnosis of flat foot. However, the underlying cause must be determined. If an arch develops when the patient stands on their toes, then the flat foot is called flexible and no treatment or further work-up is necessary.

If there is pain associated with the foot or if the arch does not develop with toe-standing, X-rays are necessary. If a tarsal coalition is suspected, a CT scan is often ordered. If a posterior tibial tendon injury is suspected, your health care provider may recommend an MRI.


Most cases are not preventable.

Updated 5/2/2002 by Benjamin D. Roye, M.D., M.P.H., Department of Orthopaedics, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Used Courtesy of U.S. National Libray of Medicine and the National Institutes of Health.