Flat Feet: Assessment and Treatment
Flat feet are common in both children and adults. Some people naturally have low arches and never develop symptoms. Others may experience foot fatigue, arch pain, ankle discomfort, difficulty with certain activities or progressive changes in foot shape.
At HealthiClinic Podiatry in Greenwich, our podiatrists assess flat feet in the context of the whole person. The important question is not simply: “Do I have flat feet?” It is: “Are my flat feet causing symptoms or affecting function?”
Not everyone with flat feet requires treatment. When treatment is appropriate, it may include footwear advice, exercise, rehabilitation,
load management and orthotics where clinically indicated.
What are flat feet?
Flat feet describe a foot shape in which the arch along the inside of the foot is relatively low or appears to flatten when standing. The medical term commonly used is pes planus or pes planovalgus, depending on the pattern of the foot.
Some people have had low arches for most of their lives.
Others notice the arch becoming lower over time.
The appearance of the foot alone does not determine whether there is a problem.
Are flat feet normal?
Often, yes.
There is a wide range of normal foot shapes.
Some people naturally have high arches, some have medium arches and others have low arches.
Flat feet are not automatically a disease or deformity.
Treatment is usually considered when there are symptoms, functional limitations or evidence of a progressive structural problem.
What is a flexible flat foot?
A flexible flat foot is one in which the arch appears lower when standing but may partially or completely return when the foot is unloaded. Flexible flat feet are particularly common in children. Many flexible flat feet are painless and do not require treatment.
What is a rigid flat foot?
A rigid flat foot remains relatively flat whether the person is standing or not.
- Rigid flat feet are less common and may be associated with:
- Joint restriction
- Structural abnormalities
- Arthritis
- Previous injury
- Tarsal coalition in some younger patients
- Other musculoskeletal conditions
Rigid, painful or asymmetrical flat feet are more likely to warrant further assessment.
Flat feet in children
Flat feet are extremely common in children.
- Young children naturally tend to have lower-looking arches because of:
- Foot development
- Ligament flexibility
- Normal fat padding beneath the arch
- Developing muscle control
The arch often becomes more visible as a child grows.
A child with flexible, painless flat feet who is active and functioning normally may not require treatment.
The presence of a low arch alone is not a reason to automatically prescribe orthotics.
When should a child’s flat feet be assessed?
- Assessment may be useful when a child has:
- Foot or ankle pain
- Difficulty keeping up with peers
- Repeated tripping
- Significant asymmetry
- A rigid foot
- Difficulty with footwear
- Symptoms during sport
- Progressive change
- A strong parental concern about function rather than appearance alone
The objective is to determine whether the foot shape is simply a normal variant or is contributing to symptoms.
Flat feet in adults
Adults may have flat feet that have been present since childhood.
Others may develop increasing flattening over time.
When the shape of an adult foot changes progressively, particularly if accompanied by pain or weakness, assessment is appropriate.
Adult-onset flatfoot can sometimes involve structures that support the arch, including
the posterior tibial tendon.
What causes flat feet?
There is no single cause.
- Possible contributing factors include:
- Genetics
- Natural foot shape
- Ligament flexibility
- Joint alignment
- Muscle function
- Previous injury
- Tendon dysfunction
- Arthritis
- Increasing age
- Body weight
- Pregnancy-related ligament changes
- Certain neurological or musculoskeletal conditions
The cause and significance vary considerably between individuals.
What symptoms can flat feet cause?
Some people have no symptoms at all.
- When symptoms occur, they may include:
- Aching through the arch
- Heel discomfort
- Ankle pain
- Foot fatigue
- Pain after prolonged standing
- Difficulty with walking or running
- Lower-limb fatigue
- Shoe wear problems
- Pain along the inside of the ankle
- Difficulty with certain sporting activities
Importantly, not every symptom in someone with flat feet is necessarily caused by the foot shape.
Assessment should look at the whole clinical picture.
Can flat feet cause knee or leg pain?
Foot mechanics can influence the way load is transferred through the lower limb.
In some people, foot posture may contribute to symptoms elsewhere.
However, it is too simplistic to assume that every knee, hip or leg symptom is caused by flat feet.
Our podiatrists assess whether there is a plausible mechanical relationship rather than
automatically attributing symptoms to arch height.
When should flat feet be assessed?
Consider podiatry assessment if:
- The feet are painful
- Symptoms interfere with walking or sport
- One foot looks significantly different from the other
- The arch appears to be progressively collapsing
- There is pain or swelling along the inside of the ankle
- The foot has become more difficult to move
- Footwear is becoming increasingly difficult
- A child is having pain or difficulty with normal activity
- Previous orthotics are no longer comfortable
- You are unsure whether treatment is actually required
How our podiatrists assess flat feet
- Foot posture
- Arch behaviour when standing
- Joint movement
- Flexibility
- Muscle strength
- Tendon function
- Ankle range of motion
- Heel alignment
- Walking pattern
- Footwear
- Activity level
- Pain location
- Relevant medical history
Do I need X-rays or scans?
Not always.
Many flat feet can be assessed clinically.
Imaging may be considered when there is:
- Significant pain
- Suspected arthritis
- A rigid foot
- Trauma
- Progressive structural change
- Concern about tendon pathology
- Suspected tarsal coalition
- Uncertainty about the diagnosis
The type of imaging depends on what the podiatrist or medical practitioner is
investigating.
How are flat feet treated?
Treatment depends on symptoms rather than appearance alone.
For many people, no treatment is required.
When symptoms are present, management may include:
- Footwear advice
- Activity and load modification
- Exercise
- Strengthening
- Mobility work
- Rehabilitation
- Orthotics where appropriate
- Treatment of associated conditions
The goal is usually to improve comfort and function rather than attempt to create a
visually “perfect” arch.
Footwear for flat feet
Suitable footwear can make a meaningful difference for some patients.
Useful features may include:
- Appropriate width
- Secure heel fit
- Adequate cushioning
- Suitable support for the intended activity
- Enough internal space if orthotics are being used
No single shoe is ideal for everyone with flat feet.
The shoe should match the patient, activity and symptoms.
Exercise and rehabilitation
Exercise may be useful where strength, endurance, mobility or load tolerance contributes to symptoms.
Depending on the assessment, exercises may focus on:
- Calf strength
- Foot and ankle strength
- Posterior tibial muscle function
- Balance
- Lower-limb control
- Ankle mobility
- Gradual return to activity
Exercise should be individualised rather than based solely on the appearance of the
arch.
Where broader rehabilitation is appropriate, care may also involve the wider HealthiClinic musculoskeletal team.
What is a biomechanical assessment?
A biomechanical assessment looks at how the foot and lower limb function during standing and movement.
It may include assessment of:
- Foot posture
- Joint movement
- Lower-limb alignment
- Walking pattern
- Areas of pressure
- Activity demands
- Footwear
This can help determine whether the patient’s mechanics appear relevant to their
symptoms and whether intervention is likely to be useful.
Do flat feet need orthotics?
Not always. Orthotics may be useful for selected patients when symptoms are related to foot mechanics or when additional support or pressure redistribution may improve function.
They can be used to:
- Improve comfort
- Modify load
- Support certain structures
- Improve footwear tolerance
- Assist rehabilitation
However, orthotics should not be prescribed simply because a foot looks flat.
The decision should be based on symptoms, examination findings and functional needs.
Do orthotics permanently correct flat feet?
In most adults, orthotics are not intended to permanently change the underlying bone structure of the foot.
Their role is generally to influence load, support the foot where needed and improve comfort or function.
In children, orthotics should also not be marketed as a way to “build an arch” in an otherwise normal painless flexible flat foot.
Custom or prefabricated orthotics?
Both can be appropriate depending on the patient. Some patients do well with a quality prefabricated device.
Others may benefit from custom orthotics when:
- Foot shape is unusual
- Symptoms are complex
- Greater modification is required
- Standard devices do not fit appropriately
- There are specific pressure or structural concerns
Our podiatrists can advise which approach is appropriate after assessment.
What if flat-foot symptoms continue?
Persistent symptoms should prompt review rather than simply continuing the same treatment indefinitely.
Our podiatrists may reassess:
- The diagnosis
- Footwear
- Orthotic fit
- Exercise progression
- Activity load
- Tendon function
- Joint mobility
- Whether imaging is required
- Whether another condition is contributing
A progressive adult flat foot deserves particular attention if shape and function are continuing to change.
What is adult acquired flatfoot?
Some adults develop increasing flattening of the foot over time. One possible cause is dysfunction of the posterior tibial tendon, which plays an important role in supporting the arch.
Symptoms can include:
- Pain along the inside of the ankle
- Swelling
- Increasing flattening of the arch
- Difficulty performing a single-leg heel raise
- Progressive change in foot shape
This is different from simply having naturally low arches.
Early assessment can be useful where a progressive structural change is suspected.
When may specialist or surgical assessment be considered?
Most people with flat feet do not require surgery.
However, specialist or surgical assessment may be considered in selected patients when there is:
- Significant persistent pain
- Progressive structural collapse
- Severe deformity
- Arthritis
- Rigid flatfoot
- Tendon dysfunction
- Failure of appropriate conservative management
- Significant limitation of walking or everyday function
Surgery is not undertaken simply because someone has a low arch.
It is a later-stage option for specific structural problems where symptoms and functional impairment justify further assessment.
FREQUENTLY ASKED QUESTIONS
Are flat feet normal?
Yes.
Flat feet are common, and many people with low arches have no pain or functional problems.
Treatment is generally based on symptoms rather than appearance alone.
Do all flat feet need treatment?
No.
Painless flexible flat feet often require no treatment.
Assessment is more useful when pain, fatigue, progressive change or functional difficulty is present.
Are flat feet normal in children?
Yes.
Many children naturally have low arches, particularly at younger ages.
A painless, flexible flat foot in an active child often represents normal development.
Does my child need orthotics because they have flat feet?
Not necessarily.
Orthotics should not be prescribed automatically because a child’s arch looks low.
They may be considered when there are symptoms or specific functional concerns.
Can flat feet cause pain?
They can in some people.
Symptoms may include arch pain, ankle discomfort, fatigue or difficulty with prolonged standing and activity.
Many people with flat feet remain completely symptom-free.
Why is one foot flatter than the other?
Some asymmetry is common, but a new or progressive difference can sometimes indicate tendon dysfunction, injury or another structural problem.
Assessment is appropriate if there is pain or a noticeable change.
Can adults suddenly develop flat feet?
Yes.
Some adults experience progressive flattening associated with tendon dysfunction, arthritis, injury or other structural change.
A newly changing foot shape should be assessed.
Can flat feet cause knee pain?
Foot mechanics may contribute to lower-limb loading in some people, but flat feet are not automatically the cause of knee pain.
A proper assessment can help determine whether there is a meaningful relationship.
Do orthotics help flat feet?
Orthotics can help selected patients by modifying load, improving comfort and supporting the foot during activity.
They are not necessary for everyone with low arches.
Will orthotics permanently fix my arch?
Usually not.
In adults, orthotics primarily influence support and load rather than permanently changing the underlying bone structure.
Can exercises help flat feet?
Exercises can help some patients when muscle strength, endurance, balance, mobility or load tolerance is contributing to symptoms.
The exercise program should be based on individual assessment.
What is the difference between flexible and rigid flat feet?
A flexible flat foot changes shape depending on whether weight is placed through it.
A rigid flat foot remains relatively flat even when unloaded and may have more restricted joint movement.
Do flat feet need surgery?
Usually not.
Surgery is generally reserved for selected painful, progressive or rigid structural problems that have not responded adequately to appropriate conservative treatment.
Should I see a podiatrist for flat feet?
Consider assessment if there is pain, fatigue, reduced function, progressive change, asymmetry or concern about a child’s ability to participate normally in activity.
Book a Flat Feet Assessment
Whether you need routine foot care, help with a new problem or a further assessment of symptoms that have persisted, the first step is to book a podiatry consultation.