Most toddlers experience a flattening of their arches during weight-bearing and the arch naturally develops over time. Most children who continue to have flexible flat feet typically do not encounter functional problems. Shoes, shoe inserts, and orthoses do not influence arch development and may, in fact, hinder it. While orthoses may provide some benefit to children with conditions such as Trisomy 21 by improving gait and gross motor function, the long-term effects on deformity and pain are still uncertain. Surgery may be considered for children with pain, tight Achilles tendons, or rigid flat feet. However, the most important strategy is to allow the feet to develop naturally and intervene only if symptoms develop.