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Flat feet, Intoeing, Bow Legs and Knock Knees

*Disclaimer: This information is for education purposes only. Always check with your doctor or other health care professional to make sure this information is right for your child.

Flat Feet

Flat feet are normal in infants, children, teenagers, and adults. One in five children never develops an arch in their foot. Most people with flexible flat feet have strong, pain-free feet. Most children have low arches because their joints are loose. The arch flattens when they stand, and their feet seem to be rolled in with the toes pointing outward. The arch can be seen again when the feet are hanging free, or when the child stands on tippy-toes.

Flat feet are only a concern if the foot is stiff, painful, or very severely flat. Wearing an insert or a pad in the arch of a flexible flat foot is not recommended. It is uncomfortable, will not help create an arch, and is a waste of money.


Intoeing (toes pointed inward) is very common in childhood, and is usually outgrown. There are 3 causes for intoeing:

1. Hooked foot (metatarsus adductus)

This is usually caused by the position the child was in when he/she was growing inside the mother (before birth). Most hooked feet get better without treatment during the first few months of life. Improvement will continue throughout the first few years of life. Sometimes a hooked foot is stiff and does not get better. In these cases, a cast or splint may be needed. Special shoes do not help this condition.

2. Lower leg twist (tibial torsion)

Sometimes intoeing is due to a twist in one of the bones of the lower leg. It is a normal variation that is very common during infancy and childhood. Most legs will straighten without treatment. Special splints, braces, or shoes do not correct the twist, and may in fact be harmful.

3. Thigh bone twist (femoral torsion)

Twisting of the thigh bones (femur) can also cause an inward rotation of the legs resulting in intoeing. Many children have femoral torsion, and it is most severe at the age of 5 or 6. Most children outgrow this condition by the age of 10. Shoe inserts, splints, and braces do not help this condition, make playing difficult, and can make the child uncomfortable and self-conscious.

Bow Legs & Knock Knees

Having bow legs and knock knees is a normal part of development. Most infants are bow-legged until they are about 18 months old, at which point they become knock-kneed. As they grow, this usually goes away. Special shoes, wedges, inserts or exercises do not change the condition, and can make the uncomfortable and self-conscious.

If the condition only occurs in one leg, is especially severe, or runs in the family, a more thorough examination and assessment may need to be done.