Background: Down syndrome is a genetic condition that has an impact on a person's health and development on many levels, including their feet. Children with Down syndrome frequently have flat feet and other foot deformities, which can make walking painful, uncomfortable, and challenging. Objective: The aim of the current study was to evaluate the foot alignment and its impact on quality of life in children with Down syndrome. Subjects and methods: This retrospective study included a total of 40children with Down syndrome from both genders with ages ranged from 8 to12 years old recruited from Alfolk Charity Institution, Outpatient Clinic, Intellectual Educational Schools, in Al Gharbia and Cairo Governorates. Foot arch angels were assessed by X-ray radiological assessment whereas; health status for children with foot and ankle problem, Quality of life of children with Down syndrome were assessed by the Oxford ankle foot questionnaire. Results: There was a significant increase in Talo-calcneal angle of the right foot of study group compared to the reference value (p = 0.001).There was a significant increase in Talo-calcneal angle of the left foot of study group compared to the reference value (p = 0.001).There was a significant increase in Bohler's angle of the right foot of study group compared to the reference value (p = 0.001).There was a significant increase in Bohler's angle of the left foot of study group compared to the reference value (p = 0.02).There was a significant decrease in school & play score of study group compared to the reference value (p = 0.001). Conclusion: This study concluded that children with Down syndrome haveproblems in their feet that affect directly their quality of life.