A flat-looking foot in a sixteen-month-old is the rule, not a verdict. The Indian Academy of Pediatrics (IAP) Standard Treatment Guidelines 2022 put it plainly: "All children are born with flatfoot due to normal joint hypermobility and normal infant fat pad at the medial longitudinal arch," and "Between 3 and 5 years of age, most children develop the normal longitudinal arch."

So the flatness you are looking at is not yet a finding about his adult feet. A 2025 consensus guideline built on a systematic review of paediatric flatfoot states it even more bluntly: "In preschool-aged children, flatfoot is nearly universal."

Not medical advice — your paediatrician has examined your child and we have not. This is background for the conversation, not a second opinion.

Your paediatrician is probably not wrong

Two things can be true at the same time, and they usually are in this situation.

A family tendency is real. West Suffolk NHS Foundation Trust's orthopaedic leaflet notes that "Flat feet often occur in more than one member of a family," and Cleveland Clinic puts it as "Some families just have flatter arches than others." The honest version of "he gets it from his father" is an association, not a prophecy.

And "nothing can be done" is close to what the guidelines say — for a reassuring reason, not a resigned one. The IAP's guidance is that "Asymptomatic flexible flatfoot does not require treatment," that it "is considered a variant of a normal foot," and that "Reassurance of parents is all that needs to be done." A review of flexible flatfoot in the Journal of Children's Orthopaedics says it in one line: "There is no reason to treat that which is normal."

Your doctor may well have meant exactly that. So the question worth bringing to the next visit is not whether the arch can be fixed. It is whether this foot is flexible and painless — the distinction everything else hangs on.

Why almost every toddler looks flat-footed

Two things hide the arch at this age, and neither is a defect.

A fat pad. The American Academy of Pediatrics (AAP) explains that "Young babies also have a fat pad on the inner border of their feet that hides the arch."

Loose joints. West Suffolk's leaflet is direct about it: a missing arch in standing "is normal in nearly all infants and many young children," and "Young children have flat feet because they are loose jointed."

The arch then arrives slowly, and the published ranges are wide rather than sharp. The NHS says most children have flat feet when they are young and "usually develop arches on the inner sides of their feet between 3 and 10 years of age." Gloucestershire Health and Care NHS Foundation Trust's paediatric physiotherapy factsheet dates the start to "around the age of three to four years," with "most of its development" complete "by around seven or eight years." The Journal of Children's Orthopaedics review frames the whole window as a decade: "The arch elevates spontaneously in most children during the first decade of life."

Notice what nobody promises: that every child ends up with a visible arch. West Suffolk's figure is that "Most children develop an arch in standing by around age six," but "about one in five children never develop an arch" — and on the same page, "Most adults with flat feet have no long-term problems or pain." The AAP's number is similar: flat feet "normally disappear by age 6," and "Only about 1 or 2 out of every 10 children will continue to have flat feet into adulthood." Gloucestershire adds the point that gets lost in all of this: "There is a normal variation in arch height across the population."

Indian data points the same way. In a cross-sectional study of 853 school children aged 5 to 15 across seven schools in Vellore district, measured flat-foot prevalence ranged from 9 percent to 18.8 percent depending on the index used, and "In all three methods, flat foot prevalence decreased with increasing age."

Flexible or rigid: the distinction that matters

A flat foot is not one thing, and the test is simple enough that your paediatrician has very likely already done it in ten seconds.

The IAP describes it as the differentiator: "'Tip-toe walking' helps to differentiate flexible flatfoot from the rigid flatfoot. In a flexible flatfoot, even though the medial longitudinal arch is collapsed during the stance phase; on tip-toeing, the arch is formed and the heel swings into varus. If not, it is a rigid flatfoot." West Suffolk gives parents the home version: "Flat feet are normally flexible. This means that you can see an arch when the feet are off the ground or when the child stands on tip-toes." Gloucestershire puts the same thing a third way: the arch "often 'reappears' when sitting with the weight off the foot."

Flexible flat footThe kind that gets looked at again
Arch on tiptoe or off the groundAppearsStays flat
Pain, stiffness, limited motionAbsent — and without them it "should not be considered pathological"Present — "stiff or painful flatfoot" is what referral is for
One foot onlyNoOn the IAP's list for orthopaedic consultation
How common at this ageThe most common typeRigid flat foot is "seldom seen in an infant or very young child"

As the Journal of Children's Orthopaedics review summarises it: "The flexibility of flatfoot is a more important feature than the static shape." The rarer form is a different animal — the IAP notes that "Rigid flatfoot is always pathological and needs further evaluation," and that "The most common cause of rigid flatfoot is tarsal coalition," an abnormal fusion between bones. That is not what a loose-jointed, painless, happily walking toddler usually has.

Insoles and arch-support shoes: what the trials show

This is where money changes hands, so it is worth being precise about what is known.

The 2022 Cochrane review pooled 16 trials covering 1,058 children aged 11 months to 19 years, and the Cochrane summary of it is unambiguous: "there is no evidence to support the efficacy of foot orthoses (FO) for children with asymptomatic (painless) flat feet," and "the evidence across four decades remains very limited." The same summary is candid about quality: "None of the included studies provided high quality evidence for any outcome."

On the specific claim that an insole builds an arch, the sources line up:

None of that makes orthotics useless. It relocates them. The NHS says insoles "will not change the shape of your feet but can help with things like pain or stiffness," and the Cochrane summary notes that children with painful flat feet "are directed to use low-cost prefabricated FOs with well-selected footwear" — prefabricated and low-cost, not custom. The consensus guideline draws the line for children like yours: "Routine use of orthoses or corrective footwear in asymptomatic children is not supported by evidence," with "observation and parental reassurance as the standard approach."

Which is useful to hold on to at the school-shoe counter and the chemist's orthotic rack. "Arch support" is marketed here as arch-building for a growing foot — and arch-building is precisely the claim with no evidence that orthoses alter the structural development of the medial longitudinal arch behind it.

Footwear comes off at the door in most Indian homes anyway, and the IAP's own note is that "Barefoot walking facilitates the development of the medial arch". We covered barefoot walking, when shoes become necessary and how to judge fit in our first shoes guide, so we will not repeat it here.

Three things to ask at the next visit

Take these rather than a printout of this page.

  1. Is this a flexible flat foot — does an arch appear when he is on tiptoe or when the foot is off the ground? That is the standard way to separate the two, and it is the single most useful fact about his feet.
  2. Is it painless, symmetrical and not limiting him? A 2023 review in the Journal of Clinical Medicine frames it as the threshold: a flat foot "should not be considered pathological unless stiffness or functional limitation are present."
  3. What would make you want to look at this again? Ask which specific changes should bring you back — and whether, if pain, stiffness or a difference between the two feet ever shows up, a paediatric orthopaedic opinion is the next step. The same review notes that "simple observation is indicated for flexible, asymptomatic flatfeet" and that "Specialized consultation should be avoided for flexible flatfoot before the age of 5," so a doctor who sends you home without a referral is following the guidance, not dismissing you.

When it becomes a doctor's question

We cannot tell you anything about your son's feet — only what the published lists say. These belong with your paediatrician rather than with a search box. The IAP's trigger list is: "Feet which are painful, stiff, weak, or numb," "Repeated feet or ankle injuries," "Problems with walking or balance," "A patient who did not have flatfeet before," and "When only one foot is flat (unilateral)." West Suffolk's shorter version for parents is pain, activity being limited, or only one foot being affected.

In plain language: pain, a limp, refusing to walk, one foot that looks different from the other, stiffness, or walking that seems to be going backwards. Problems with walking or balance sit on the referral list for a reason — that is a phone call, not a forum post.

Frequently Asked Questions

Will he grow out of it? Most children do, and the window is years rather than months. The arch "elevates spontaneously in most children during the first decade of life," and only "1 or 2 out of every 10 children will continue to have flat feet into adulthood" — where "Most adults with flat feet have no long-term problems or pain." Staying flat is one of the normal outcomes, not a failure of one.

His father is flat-footed. Does that change what we do? Not the plan. Flat feet "often occur in more than one member of a family," and that is as far as the evidence goes — an association, with no mechanism anyone can pin on your son. The thing that decides management is whether the foot is flexible and painless, not whose feet it resembles.

Should we buy arch-support shoes or custom insoles now? There is no evidence basis for it in a painless foot. The Cochrane review found "no evidence to support the efficacy of foot orthoses (FO) for children with asymptomatic (painless) flat feet," and routine orthoses or corrective footwear in asymptomatic children "is not supported by evidence." If pain ever appears, that is a different conversation with your paediatrician — and the evidence points at low-cost prefabricated supports rather than expensive custom ones.

My mother-in-law suggests oil massage and arch exercises. Any harm? Massage is affection and there is no reason to stop it; just do not expect an arch from it. Gloucestershire's position is that "Unless your child experiences pain, current research indicates no treatments such as insoles or exercises are required," and no external force or device has been shown to create a longitudinal arch in a child's foot.

Our doctor offered no treatment and no referral. Should we see someone else? What was offered matches the published guidance. Observation with parental reassurance is "the standard approach for asymptomatic flexible flatfoot," and specialist consultation "should be avoided for flexible flatfoot before the age of 5." Rather than going around your paediatrician, go back with the flexible-and-painless question, and ask what would change the answer.

At what age will we actually know? There is no single moment, and the published ranges differ: most children "between 3 and 5 years of age", most development done "by around seven or eight years", the NHS's "between 3 and 10 years of age." Sixteen months is too early for the question to have an answer.