Specialista in Ortopedia Pediatrica
Symptomatic flatfoot / hindfoot valgus
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Calf stretch (gastrocnemius and soleus)
Essential exercise to improve calf flexibility and ankle mobility
Stand facing a wall with hands at shoulder height. Bring the leg to stretch behind, keeping the heel firmly on the ground and toes pointing forward. Keep knee completely straight to stretch gastrocnemius, then slightly bend for soleus. Gently push hips forward until you feel a pleasant tension (not pain!) in the back of the leg. Hold position while breathing normally.
3 sets × 30 seconds each side, twice daily (morning and evening)
2.Heel-down squat (heels-down squat)
Improves ankle dorsiflexion and overall lower limb mobility
Stand with feet shoulder-width apart. Slowly squat down trying to keep both heels completely on the ground. If needed, hold onto stable support (chair, table, wall) for balance. Go down as far as possible while keeping heels grounded - it's okay if you can't go very deep initially. Mobility will improve over time. Rise slowly.
10 slow repetitions, 2-3 sets. If difficult, start by holding position for 10 seconds
3.Toe yoga (toe control)
Improves neuromuscular control and intrinsic foot muscle strength
Sit on a chair with feet flat on the floor. First movement: lift ONLY the big toe while keeping the other 4 toes pressed down. Second movement: reverse - lower big toe and lift other 4 toes. Alternate with control, without rushing. Initially it may be difficult and toes might not respond as desired - that's normal! With practice, control will significantly improve.
10 repetitions per movement, twice daily. Start seated, then try standing
4.Short-foot (active arch)
Key exercise to activate and strengthen the plantar arch without using toes
Standing or seated, with foot flat on floor. Imagine "shortening" the foot by bringing the toe base toward the heel, creating a dome with the arch. IMPORTANT: toes must stay flat and relaxed, not curled! The arch lifts, toes don't bend. If toes curl, you're using wrong muscles. Initially isolating this movement is difficult - be patient.
10 reps × 5-10 second holds, 2-3 times daily
5.Posterior tibial strengthening (inversion with band)
Strengthens posterior tibial muscle, essential for arch support
Sit with legs extended. Wrap band around forefoot, securing other end to a lateral fixed point (table leg, or hold with other hand outward). Foot starts in neutral. Rotate foot INWARD (inversion) against band resistance, then slowly return to start. Movement comes from ankle, not knee or hip.
15 reps × 3 sets per foot. Use appropriate resistance band
6.Calf raises (heel raises)
Strengthens calf muscles and improves ankle stability
Stand, lightly supported for balance. Slowly rise onto toes, going as high as possible. Hold top position for 2 seconds, then lower with control (lowering phase is as important as rising!). Start with both feet. When easy (3 sets of 20 without fatigue), progress to single leg.
Start: 15-20 reps × 3 sets (bilateral). Progress: 10-15 × 3 sets (single leg)
7.Single-leg balance (proprioception)
Improves proprioception and postural control, essential for foot stability
Stand near support (but without touching if possible). Lift one foot and balance on the other. Keep knee slightly bent, not locked. Focus on a fixed point ahead. PROGRESSION: Level 1 - eyes open, normal floor. Level 2 - eyes closed. Level 3 - soft surface (cushion). Level 4 - eyes closed on soft surface. Progress to next level only when previous is stable.
30-60 seconds each side × 3 sets. Progress when stable for 60 sec
8.Heel and toe walking
Strengthens leg muscles and improves gait control
HEEL WALKING: Lift toes and walk only on heels for 10-15 meters. Keep toes up throughout. TOE WALKING: Rise onto toes and walk for 10-15 meters without lowering heels. In both cases: maintain good upright posture, look ahead (not at feet), take small controlled steps.
2-3 laps of 10-15 meters each type, once daily
9.Toe pick-up exercise
Strengthens intrinsic foot muscles through functional movements
Scatter small objects on floor: pencils, marbles, small balls, fabric pieces or small socks. Standing (or seated initially), pick up objects one by one using ONLY toes. Place them in a container or move to another area. Focus on actively curling toes to grasp. Variation: try passing object from one foot to the other. Fun exercise ideal for children.
10-15 objects per foot, 1-2 times daily
10.Balance board training
Improves proprioception and dynamic balance, engaging foot stabilizer muscles
Stand on a balance board (wobble board) or alternatively an unstable cushion. Maintain balance trying to keep board parallel to floor. PROGRESSION: Level 1 - with support (wall or chair). Level 2 - no support, feet parallel. Level 3 - slowly move board forward-backward and sideways. Level 4 - single-leg balance on board. Always near safety support.
3-5 minutes, twice daily. Progress when stable for 2 consecutive minutes11.Uneven surface walking
Stimulates proprioception through varied sensory input
Have child walk barefoot on different surfaces: grass, sand, smooth pebbles, textured rugs, soft mats. Create a "sensory path" at home with cushions, rolled towels, mats of different textures. Walk slowly, feeling the ground underfoot. This stimulates plantar receptors and improves foot awareness.
5-10 minutes of sensory walking, 3-4 times weekly12.Towel scrunches (towel curls)
Strengthens toe flexors and intrinsic foot muscles in a simple, fun way
Lay a small towel flat on the floor. Place foot on the nearest part of towel. Using only toes, "scrunch" towel pulling it toward you, then flatten and restart. Keep heel firmly on ground throughout. When easy, add light weight (water bottle) on towel end.
3 complete sets (pull entire towel) per foot, once daily
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
Versione Web
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MioDottoreBefore You Start
Who is this guide for?
Children aged 6+ with symptomatic flatfoot (pain, fatigue). Not indicated for asymptomatic physiological flatfoot.
What you need
Mat, towel, small objects to pick up (marbles, pencils), optionally resistance band.
Suggested frequency
Twice daily, ideally morning and evening. Short-foot exercises require consistency to see results.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
Detailed Exercises
- 1
Calf stretch (gastrocnemius and soleus)
Essential exercise to improve calf flexibility and ankle mobility
Stand facing a wall with hands at shoulder height. Bring the leg to stretch behind, keeping the heel firmly on the ground and toes pointing forward. Keep knee completely straight to stretch gastrocnemius, then slightly bend for soleus. Gently push hips forward until you feel a pleasant tension (not pain!) in the back of the leg. Hold position while breathing normally.
3 sets × 30 seconds each side, twice daily (morning and evening) - 2
Heel-down squat (heels-down squat)
Improves ankle dorsiflexion and overall lower limb mobility
Stand with feet shoulder-width apart. Slowly squat down trying to keep both heels completely on the ground. If needed, hold onto stable support (chair, table, wall) for balance. Go down as far as possible while keeping heels grounded - it's okay if you can't go very deep initially. Mobility will improve over time. Rise slowly.
10 slow repetitions, 2-3 sets. If difficult, start by holding position for 10 seconds - 3
Toe yoga (toe control)
Improves neuromuscular control and intrinsic foot muscle strength
Sit on a chair with feet flat on the floor. First movement: lift ONLY the big toe while keeping the other 4 toes pressed down. Second movement: reverse - lower big toe and lift other 4 toes. Alternate with control, without rushing. Initially it may be difficult and toes might not respond as desired - that's normal! With practice, control will significantly improve.
10 repetitions per movement, twice daily. Start seated, then try standing - 4
Short-foot (active arch)
Key exercise to activate and strengthen the plantar arch without using toes
Standing or seated, with foot flat on floor. Imagine "shortening" the foot by bringing the toe base toward the heel, creating a dome with the arch. IMPORTANT: toes must stay flat and relaxed, not curled! The arch lifts, toes don't bend. If toes curl, you're using wrong muscles. Initially isolating this movement is difficult - be patient.
10 reps × 5-10 second holds, 2-3 times daily - 5
Posterior tibial strengthening (inversion with band)
Strengthens posterior tibial muscle, essential for arch support
Sit with legs extended. Wrap band around forefoot, securing other end to a lateral fixed point (table leg, or hold with other hand outward). Foot starts in neutral. Rotate foot INWARD (inversion) against band resistance, then slowly return to start. Movement comes from ankle, not knee or hip.
15 reps × 3 sets per foot. Use appropriate resistance band - 6
Calf raises (heel raises)
Strengthens calf muscles and improves ankle stability
Stand, lightly supported for balance. Slowly rise onto toes, going as high as possible. Hold top position for 2 seconds, then lower with control (lowering phase is as important as rising!). Start with both feet. When easy (3 sets of 20 without fatigue), progress to single leg.
Start: 15-20 reps × 3 sets (bilateral). Progress: 10-15 × 3 sets (single leg) - 7
Single-leg balance (proprioception)
Improves proprioception and postural control, essential for foot stability
Stand near support (but without touching if possible). Lift one foot and balance on the other. Keep knee slightly bent, not locked. Focus on a fixed point ahead. PROGRESSION: Level 1 - eyes open, normal floor. Level 2 - eyes closed. Level 3 - soft surface (cushion). Level 4 - eyes closed on soft surface. Progress to next level only when previous is stable.
30-60 seconds each side × 3 sets. Progress when stable for 60 sec - 8
Heel and toe walking
Strengthens leg muscles and improves gait control
HEEL WALKING: Lift toes and walk only on heels for 10-15 meters. Keep toes up throughout. TOE WALKING: Rise onto toes and walk for 10-15 meters without lowering heels. In both cases: maintain good upright posture, look ahead (not at feet), take small controlled steps.
2-3 laps of 10-15 meters each type, once daily - 9
Toe pick-up exercise
Strengthens intrinsic foot muscles through functional movements
Scatter small objects on floor: pencils, marbles, small balls, fabric pieces or small socks. Standing (or seated initially), pick up objects one by one using ONLY toes. Place them in a container or move to another area. Focus on actively curling toes to grasp. Variation: try passing object from one foot to the other. Fun exercise ideal for children.
10-15 objects per foot, 1-2 times daily - 10
Balance board training
Improves proprioception and dynamic balance, engaging foot stabilizer muscles
Stand on a balance board (wobble board) or alternatively an unstable cushion. Maintain balance trying to keep board parallel to floor. PROGRESSION: Level 1 - with support (wall or chair). Level 2 - no support, feet parallel. Level 3 - slowly move board forward-backward and sideways. Level 4 - single-leg balance on board. Always near safety support.
3-5 minutes, twice daily. Progress when stable for 2 consecutive minutes - 11
Uneven surface walking
Stimulates proprioception through varied sensory input
Have child walk barefoot on different surfaces: grass, sand, smooth pebbles, textured rugs, soft mats. Create a "sensory path" at home with cushions, rolled towels, mats of different textures. Walk slowly, feeling the ground underfoot. This stimulates plantar receptors and improves foot awareness.
5-10 minutes of sensory walking, 3-4 times weekly - 12
Towel scrunches (towel curls)
Strengthens toe flexors and intrinsic foot muscles in a simple, fun way
Lay a small towel flat on the floor. Place foot on the nearest part of towel. Using only toes, "scrunch" towel pulling it toward you, then flatten and restart. Keep heel firmly on ground throughout. When easy, add light weight (water bottle) on towel end.
3 complete sets (pull entire towel) per foot, once daily
Frequently Asked Questions
How long does it take to see improvements with flatfoot exercises?
First improvements in strength and proprioception are usually noticed after 4-6 weeks of regular exercises. Targeted exercises are important for strengthening foot muscles and improving proprioception.
Can my child do sports with flatfoot?
Absolutely yes! Sports are recommended and not contraindicated in flatfoot. Activities like swimming, soccer, basketball and running help strengthen foot muscles. Only if pain occurs during activity should you consult a specialist.
Are orthotics needed along with flatfoot exercises?
The decision to combine orthotics with exercises depends on the clinical evaluation of each case. Orthotics may help if there's pain or fatigue. The optimal therapeutic strategy is defined during the specialist visit.
Short-foot exercises are difficult: is this normal?
Yes, it's absolutely normal! The short-foot exercise requires fine neuromuscular control that many children (and adults) have never developed. With consistent practice, control will significantly improve in 2-4 weeks.