Q: What treatment does a child need if a parent suspects flat feet?

A: It depends on the age of the child and the severity of the problem, says Dr. Michael Pliskin, chief of podiatry at North Shore University Hospital in Manhasset.

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All healthy babies are born with flat feet, Pliskin says, so they all initially have the appearance of a flat inside of the foot. That’s why new baby footprints are so full and cute, he says. If, as the baby becomes a preschooler, no arch appears, parents should either point it out to their pediatrician, who may recommend a consultation with a podiatrist, or make an appointment directly with a podiatrist, he says.

A podiatrist might suggest a custom-made orthotics device be placed in the child’s shoes, depending on whether the child is experiencing symptoms such as pain or the beginning of other foot deformities. Or he may just watch the child periodically or suggest physical therapy, Pliskin says.

“I don’t usually recommend orthotics devices until they are about 4 years old,” he says. “That’s when they start doing that heel/toe gait, putting the heel down, passing through the arch and propulsing on the toes.”

Leaving severe flat feet untreated predisposes kids to develop other foot problems, such as bunions, hammer toes or plantar fasciitis, he says. “Kids definitely get bunions. I’ve done surgery on patients who are 11 years old,” Pliskin says.

Pliskin finds custom-made, fitted orthotics devices more effective than generic ones purchased over the counter, though the custom-made devices can be expensive and aren’t always covered by insurance. “By putting an orthotics device in, it doesn’t create an arch again, but it slows down the flattening and other deforming forces,” he says.