Explained: Foot Types and Ankle Positions

"My child has flat feet. Is that a problem?" "The podiatrist said my daughter overpronates. What does that actually mean?" "My son walks strangely. What should I look out for?"

These are questions many parents ask — often with a touch of concern. And rightly so: you want your child to grow up healthy and comfortable, without unnecessary suffering or limitations.

The good news: many foot problems in children are easier to understand and manage if you know what to look for.

The less good news: many parents miss signals because they don't know exactly what type of foot their child has, or what is normal and what is not.

This guide is made for parents who want to better understand their child. We discuss:

• The three foot types and how they look in children
• What pronation and supination mean (and why it matters)

FOOT TYPES: NEUTRAL FOOT, FLAT FOOT, HIGH ARCH FOOT

1. NEUTRAL FOOT

A neutral foot has a well-balanced arch that functions optimally. This foot type is considered the standard against which other foot types are measured. The foot is stable and symmetrical, without significant inward or outward deviations.

Anatomical characteristics:

• The arch (also called the medial arch) maintains its normal, semi-circular shape
• Weight is distributed evenly over multiple support points: the heel, the ball of the foot (under the toes), and the outer edge
• The ankles are vertically aligned under the shin, without tilting
  

Recognition in practice:

• When standing: the foot feels stable and touches the ground with natural contact
• When walking: the pattern is symmetrical left and right
• Shoe wear: wears normally and evenly
• Footprint: shows a normal arch with a clearly visible arch

Biomechanical advantages:

• Shock absorption is efficient — the foot can store and release energy
• The joint line in the ankle, knee, and hip is optimally balanced
• Normal forces on tendons, ligaments, and joints
• Energy efficiency when walking and running

When attention is needed: Even with a neutral foot type, children can experience complaints due to overuse, poor footwear, or sudden growth spurts. A neutral foot is favorable, but no guarantee against foot problems.

2. FLAT FOOT (PES PLANUS)

With a flat foot, the arch is weakened or completely gone. The inner edge of the foot touches the ground more or even completely. In children, this is a common foot type — important to know: not every flat foot is a problem. All babies are born with flat feet. The arch forms until the child is 10 years old.

Anatomical characteristics:

• The medial arch (arch on the inside) is low, weakened, or completely gone
• The talus (ankle bone) drops inward
• The navicular is lower than normal
• With a completely flat foot, the entire inner edge of the midfoot touches the ground
• The foot is in pronation — the inside bears more weight compared to a neutral foot

Recognition in practice (2 types):

Flexible flat foot (most common in children):

• The arch appears when your child stands on their toes or lifts their big toe
• When sitting or lying down, the arch is visible
• This is usually benign and often causes no complaints
• Many children "grow out of this" as their muscles and tendons strengthen

Rigid flat foot (less common):

• The arch remains absent, even when your child stands on their toes
• The foot feels stiff and is less mobile
• More often associated with underlying causes
• Requires earlier professional assessment

Biomechanical consequences:

• The foot is more flexible than normal — there is more movement in the joints
• Shock absorption happens differently: instead of through the arch, energy is dispersed
• The foot tilts more inward when loaded
• Tendons and ligaments are loaded abnormally
• Weight is concentrated more on the medial side (inside) of the foot
• The knee and hip must compensate for the abnormal foot position

Signals that deserve attention:

• Your child frequently complains of foot pain or getting tired
• Your child doesn't want to participate in sports or activities they normally enjoy
• Complaints in ankles, knees, hips, or back
• Heel pain — especially in active children between 8 and 14 years old
• Asymmetry: one foot clearly different from the other
• The foot is stiff instead of flexible

3. HIGH ARCH FOOT (PES CAVUS)

A high arch foot is the opposite of a flat foot — here the arch is high. The foot touches the ground at only a few points: mainly the heel and the ball of the foot. In children, this foot type is less common than flat feet, and therefore deserves extra attention.

What you as a parent can look out for:

• A strikingly high and clear arch when your child stands
• Plenty of space between the foot and the ground in the middle
• The footprint on a damp surface shows only the heel and ball — with a large empty space in between
• The outside of the shoes wears out faster than the inside
• The ankles appear to tilt outward when viewed from behind
• Toes that are sometimes curled (hammer toes)
• Calluses or hard spots on specific points of the foot (heel, ball of the foot)

How it develops: A high arch foot is often hereditary. In some cases, it can be associated with an underlying neurological condition — which is why it's important to have a child's high arch foot professionally assessed, especially if it develops suddenly or becomes more pronounced as the child grows.

What this means for your child:

• The foot is stiffer and less flexible than normal
• Shocks are absorbed less effectively — energy is concentrated on small contact points
• The foot tilts more easily outward when walking and running
• Increased risk of sprained ankles
• Load is concentrated on the heel and ball of the foot and is not evenly distributed
• Knees and hips must compensate for the abnormal foot position

Signals that deserve attention:

• Frequent ankle sprains
• Pain on the outside of the foot or ankle
• Heel pain in active children
• Painful calluses on specific points
• Clumsy or unstable walking, especially on uneven terrain
• Sudden development or worsening of the high arch foot

With a high arch foot — and certainly with these signals — professional assessment is more important than with other foot types. A high arch foot rarely improves on its own, and the cause may extend beyond just the foot.

ANKLE POSITIONS: PRONATION AND SUPINATION

PRONATION

Pronation is a natural movement where the foot and ankle tilt inward during walking. Important to know: pronation is normal and even necessary. It's how the foot absorbs shock and adapts to the terrain. It only becomes a concern if pronation is excessive or prolonged — then we speak of overpronation.

What you as a parent can look out for:

• Your child's ankles clearly tilt inward when viewed from behind
• The inner edge of the foot is lower than the outer edge
• The inside of the shoes wears out faster
• Your child appears to walk "on the inner edge of their feet"
• When barefoot, you can see that the ankle is clearly not straight under the lower leg
• The knees may be slightly turned inward ("knock-knees")

Connection to foot type: Overpronation is most common in children with flat feet. The weakened arch allows the foot to tilt inward more easily. Children with a neutral foot can also overpronate, but this is less common.

What this means for your child:

• The Achilles tendon and plantar fascia (tendon plate under the foot) are under extra tension
• Especially the tibialis posterior (the tendon behind the inner ankle) becomes overloaded
• The Achilles tendon is loaded at an oblique angle instead of straight
• The plantar fascia (the tendon plate under the foot) is stretched excessively
• Knees are pulled inward, which can cause complaints
• The body has to work harder to stay balanced during walking and running

Signals that deserve attention:

• Pain on the inside of the ankle, foot, or knee
• Heel pain — especially in active children between 8 and 14 years old
• Tired feet during or after sports
• Not wanting to participate in activities your child previously enjoyed
• Complaints of sore legs after a day of playing or sports
• A clear difference in foot position between left and right

For overpronation, podiatric advice is often valuable. Orthotics, exercises, or adapted footwear can significantly improve the situation.

SUPINATION

Supination is the opposite movement: the foot and ankle tilt outward during walking. Supination is also a natural movement — some supination is normal when pushing off the foot (the last phase of the step). It only becomes a problem when the foot supinates too much or too early — then we speak of oversupination or underpronation.

What you as a parent can look out for:

• Your child's ankles clearly tilt outward when viewed from behind
• The outer edge of the foot is lower than the inner edge
• The outside of the shoes wears out faster
• Your child appears to walk "on the outer edge of their feet"
• The knees may be slightly turned outward ("bow-legs")
• Your child sprains their ankles more often

Connection to foot type: Oversupination is most common in children with high arch feet. The high arch and stiffer foot make it harder to pronate — the foot remains in supination. Oversupination is much less common in children with flat feet or neutral feet.

What this means for your child:

• Shocks are absorbed less effectively — the foot is too stiff to flex
• Load is concentrated on the outside of the foot and ankle
• Tendons on the outside (especially the peroneal tendons) become overloaded
• The ankle is less stable — increased risk of sprains
• Knees and hips must compensate for the stiff foot position
• Increased risk of stress fractures due to poor shock absorption

Signals that deserve attention:

• Frequent ankle sprains — especially outward
• Pain on the outside of the foot or ankle
• Unstable walking, especially on uneven terrain
• Painful calluses on the ball or heel
• Heel pain in active children
• Avoiding running, jumping, or fast movements

Oversupination almost always requires professional assessment. Unlike flexible flat feet, oversupination rarely "grows out" on its own.

WHAT NOW?

Now that you have a better understanding of foot types and ankle positions, you can observe your own child's feet more specifically. Here's a simple approach:

Observe consciously:

• How does your child stand when upright?
• What does their footprint look like after showering on a dry tile?
• How do their shoes wear — evenly or asymmetrically?
• Do their ankles tilt inward or outward when viewed from behind?

Ask questions:

• Do you have pain after sports?
• Do you get tired faster than before?
• Is there a shoe that doesn't fit well?

A first consultation takes little time and provides much clarity. Better to check now than wait years wondering if it was more important than you thought.

Your child is growing fast. Their feet are developing now. Attention at the right moment can mean a lot.

 

Disclaimer: This information is intended to help parents recognize foot types and ankle positions in their child. It does not replace professional examination or diagnosis. If your child has complaints or you are unsure about their foot position, make an appointment with a podiatrist, orthopedist, or (sports) doctor.