I spent years buying the most cushioned, structured shoes I could find. Then a physiotherapist said something that changed everything.
My daughter Maya has always had flat feet. Or at least, that's what I thought. Every time I bought her shoes, I followed the same rule: the more arch support, the better. I spent a small fortune on orthotics, structured sneakers, and "corrective" footwear.
Then, at a routine check-up, our physiotherapist said something I wasn't expecting: "The arch support might actually be preventing her feet from developing properly."
I went home and spent three hours reading every study I could find. Here's what I learned.
Almost all toddlers have flat feet — and that's normal
Flat feet in young children are incredibly common. Studies estimate that 8 to 9 in every 10 babies born in North America have flatfoot,[1] and research consistently confirms that all typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of life.[2]
The arch doesn't fully develop until around age 6 — and in many kids, the process continues into early adolescence.[3] Flat feet in toddlers and preschoolers are not a medical condition — they're a developmental stage.
8–9 in 10 babies are born with flatfoot
44% of 3–6 year olds have flexible flat feet
>90% of treatments at time of study were unnecessary
That last number is striking. In an 835-child study published in Pediatrics — the journal of the American Academy of Pediatrics — researchers found that the prevalence of pathological flat foot was less than 1%, yet more than 90% of treatments being administered were unnecessary.[4]
The problem with over-structured shoes
Here's the core issue: when a shoe provides all the arch support externally, the small intrinsic muscles of the foot don't have to work. Over time, those muscles weaken. The foot becomes dependent on the shoe rather than building its own strength.
Think of it like wearing a back brace every day. Short term it relieves discomfort. Long term, the back muscles atrophy because they're never asked to do the job themselves. The same principle applies to children's feet.
This doesn't mean all structured shoes are harmful for all kids. Children with certain conditions — true rigid flat feet, hypermobility, or neurological differences — may genuinely benefit from orthotics.[5] But for the majority of children with typical flexible flat feet, less structure is often more beneficial.
Notably, Nationwide Children's Hospital's pediatric physical therapy team states directly that the best way to help a child develop their medial plantar arch is to encourage walking in safe environments with bare feet, as this allows foot muscles to respond to different surfaces and help develop the arch naturally.[3]
What physiotherapists actually recommend
Current clinical guidance and research supports prioritizing three things in children's footwear:
Flexibility. The sole should bend easily at the ball of the foot, allowing natural toe-off movement with every step.
Wide toe box. Toes need room to splay and grip the ground. Narrow shoes compress the toes and reduce proprioceptive feedback from the ground.
Thin, flat sole. A low or zero heel-to-toe drop allows the foot to land more naturally and keeps the ankle in a neutral position during gait.
The American Academy of Pediatrics confirms that for children with flexible flat feet and no other foot problems, orthotics are not necessary, and that a child's foot development will be the same whether arch supports are worn or not.[5]
What changed for Maya
We switched Maya to a flexible, wide-toe-box shoe for everyday use and started letting her go barefoot at home more often. Six months later, her physio noted measurable improvement in her gait and a reduction in the frequency of tripping. Her posture improved noticeably.
I'm not saying this will work for every child. But I wish someone had told me earlier that the solution might be less shoe, not more.
Frequently asked questions
At what age should I worry about flat feet?
Before age 6, flat feet are almost always a normal part of development. After 6, if the arch hasn't started forming or if your child experiences pain, consult a pediatric physiotherapist or podiatrist. The AAP recommends treatment only if the foot is stiff or painful.[5]
Can minimalist shoes hurt a child's feet?
Transitioning too fast can cause muscle soreness. Start with short periods and build up gradually — particularly if your child has worn heavily cushioned shoes for a long time.
What's the difference between flexible and rigid flat feet?
Flexible flat feet — the vast majority of cases — show an arch when the child stands on tiptoe or lets the foot hang. Rigid flat feet show no arch in any position and may require medical evaluation. Pathological flat foot affects less than 1% of children.[4]
Is barefoot time actually beneficial?
Yes, according to pediatric physical therapists at Nationwide Children's Hospital. Walking barefoot on varied surfaces activates the small muscles of the foot and supports natural arch development.[3]
Want help choosing the right shoe for your child's foot type and age?
Sources
[1] Seattle Children's Hospital. Flatfoot. Accessed April 2026.
[2] Without M, et al. The typically developing paediatric foot: how flat should it be? A systematic review. Journal of Foot and Ankle Research. 2017.
[3] Brock J, DPT, PCS. Flat feet: why kids should go barefoot this summer. Nationwide Children's Hospital. 2016.
[4] Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M. Prevalence of flat foot in preschool-aged children. Pediatrics. 2006;118(2):634–639.
[5] American Academy of Pediatrics. Flat feet and fallen arches: when is treatment needed? HealthyChildren.org. Accessed April 2026.
