Q: My son who is 4 year old has flat foot (the surface which touches the ground while walking, standing, is absolutely flat). What can done to get a curve on the foot?

A:Flatfeet are very common in children under the age of three and and may continue for a couple of more years in other children. The condition can also be due to ligamentous laxity (double-joints) and/or out-turned feet; in which case, there is a natural resolution by the age of around 4-5 yrs. More importantly, bilateral flexible and painless flat-feet do not require treatment. This is assuming that the child is neurologically intact and is not suffering from any other associated medical problem. Comparative studies have shown that no special shoes or any particular shoe inserts help in forming the arch and thus are unnecessary. If your sons condition falls in the above category, let him go barefoot at home as there is no evidence that shoes help them to walk better. Soft, flexible-soled leather shoes would be great for outdoors. There is every reason to believe that your son will grow up as any other normal boy. On the other hand, if his feet are not supple or if the condition is painful or if it involves only one foot; or he has a neurological problem or any other ailment, this would require further imaging and investigations. Use of shoe-inserts are justified under these circumstances. Surgical management is almost never required in a child and would be considered only in a symptomatic adolescent under extreme circumstances.