Experts do not usually recommend special footwear (such as shoes with ankle or arch supports, or wearing a pad under the arch) because these treatments do not really affect arch development and may make the child uncomfortable. For children up to age three with flexible flatfeet, prescribing expensive shoe modifications and inserts is not necessary unless there is a strong family history of flatfeet persisting into adulthood. Even then, a prescription for orthopedic shoes probably treats the parents more than the child. Treatment is usually considered only if the condition becomes painful, in which case the pediatrician may recommend a heel cup or a shoe insert.
Surgery is not helpful for most children with flat-feet. Rarely, surgery may be considered if a child's flatfeet are caused by fused foot bones, and if shoe inserts and casts have not helped. However, a fixed or semirigid flatfoot usually involves bony and soft tissue structural changes that do not improve by simply altering footwear to relieve symptoms, and surgery is indicated in these children.
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