Choosing Wisely:

Don’t order custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet.

Rationale and Comments: Flexible flat feet are normal physiologic variants commonly found in children and adults. Unlike a painful or rigid flatfoot that requires further workup, if an arch is present when standing on tiptoe, the foot can be managed with observation or over-the-counter orthotics. The use of custom orthotic devices to provide support for the foot does not aid in the development of the arch.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North America
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Orthopedic
  • References: • Wenger DR, Mauldin D, Speck G. Morgan D, Lieber RL. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am. Jul;71(6):800-810.
    • Staheli LT, Chew DE, Corbett M. The longitudinal arch: A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426-428.

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