Pronation is transient in most children, usually disappears before 2½ years of age, and requires no treatment. In children in whom it persists, treatment is not necessary unless symptoms occur. Most cases of physiologic, flexible pes planus only require parental reassurance.

When symptoms do occur, they may be alleviated by use of corrective shoes that have a long medial counter and a Thomas heel. Support to the medial longitudinal arch with a flexible felt, rubber, or leather pad placed beneath the inner sole may help. Wedges that are ⅛- to 3/16-inch thick applied to the medial aspect of the heel and the lateral aspect of the sole of the shoe are sometimes helpful. Steel arch supports placed within the shoe rarely are required. If neuromuscular disorders (eg, tight heel cords) are present, then heel cord–stretching exercises may be beneficial in reducing discomfort.

Treatment in most cases of pes planovalgus is symptomatic with orthopedic shoes. Surgical correction is required only for accessory tarsonavicular or tarsal coalition if symptoms cannot be relieved through conservative means (only approximately 10% of cases) and is usually performed in adulthood. Vertical talus usually requires surgical correction early in infancy.[7]