Do children with flat feet need treatment?

Usually not. Flat feet are normal in young children and most develop an arch by school age. Treatment is only considered if the foot is painful, stiff, or the child is having trouble walking or playing. Special shoes and insoles do not help a painless flexible flatfoot develop an arch any faster.

Can exercises fix flat feet?

Exercises cannot build an arch that never formed, but strengthening the muscles that support the arch and stretching tight calves can reduce pain, improve function and slow the progression of adult-acquired flatfoot. Combined with supportive footwear or orthotics, this is the main treatment for symptomatic flat feet.

Are flat feet linked to knee and back pain?

They can be. When the arch collapses, the foot rolls inward, which can alter the alignment of the ankle, knee and hip and contribute to pain further up the leg in some people. Correcting foot alignment with orthotics often helps when this is the case.

MusculoskeletalICD-10: M21.4Very common; normal in young children and present in a sizeable minority of adults, most without symptoms

Flat Feet

Also known as: Pes planus, Fallen arches, Flatfoot

Flat feet, or pes planus, means the arches of the feet are low or absent so that the entire sole touches the ground when you stand. Nearly all babies and toddlers have flat feet because the arch has not yet developed, and most form a normal arch by about age 6; some people simply never develop one and have no problems at all. Flat feet can also develop in adulthood when the tendon that supports the arch (the posterior tibial tendon) weakens or tears, or as a result of arthritis, injury, obesity or diabetes. Flat feet only need treatment when they cause pain, fatigue in the feet or legs, or problems with walking, and in those cases supportive shoes, orthotics and exercises usually help.

At a Glance

Common symptoms: Often no symptoms at all, Pain in the arch, heel or inside of the ankle, particularly after standing or walking for long periods, Tired or aching feet and legs
Main treatments: No treatment for painless, flexible flat feet, Supportive shoes with a firm heel counter and good arch support, Over-the-counter or custom orthotic insoles to support the arch and reduce strain
Category: Musculoskeletal · Very common; normal in young children and present in a sizeable minority of adults, most without symptoms
See a doctor if: Foot or ankle pain that does not improve with supportive shoes and rest

Symptoms

Often no symptoms at all

Pain in the arch, heel or inside of the ankle, particularly after standing or walking for long periods

Tired or aching feet and legs

Swelling along the inside of the ankle

Shoes that wear unevenly, especially on the inner edge

Pain in the knees, hips or lower back related to altered alignment

Difficulty standing on tiptoe in adult-acquired flatfoot

Causes

Normal development: the arch simply never forms in some people (flexible flatfoot)
Weakening or tearing of the posterior tibial tendon, which supports the arch, usually in middle-aged adults
Inherited loose ligaments or conditions such as Ehlers-Danlos syndrome
Arthritis affecting the foot joints
Injury to the foot or ankle
Abnormal joining of foot bones present from birth (tarsal coalition), which causes a rigid flatfoot

Risk Factors

Family history of flat feet
Obesity, which overloads the tendon and ligaments supporting the arch
Diabetes and high blood pressure, which are linked to posterior tibial tendon dysfunction
Age over 40, particularly in women
Rheumatoid arthritis
Previous foot or ankle injury

Diagnosis

Examination of the feet while standing, walking and rising onto the toes to see whether the arch re-forms
Checking the wear pattern on your shoes and the flexibility of the foot
X-rays if pain is present to assess bone alignment and arthritis
MRI or ultrasound if a posterior tibial tendon injury is suspected
CT scan if a rigid flatfoot suggests tarsal coalition

Treatment

No treatment for painless, flexible flat feet
Supportive shoes with a firm heel counter and good arch support
Over-the-counter or custom orthotic insoles to support the arch and reduce strain
Stretching tight calf muscles and the Achilles tendon, and exercises to strengthen the arch and posterior tibial muscle
Rest, ice and anti-inflammatory medication for flare-ups of pain
A walking boot or brace for acute posterior tibial tendon inflammation
Surgery to repair the tendon, realign bones or fuse joints for rigid or progressive painful flatfoot that fails conservative care

Prevention

Maintain a healthy weight to reduce load on the arches
Wear supportive shoes and replace them when the soles are worn
Avoid walking barefoot for long periods on hard surfaces if you have painful flat feet
Keep the calf muscles flexible and the foot muscles strong
Address ankle or foot pain early, before a tendon problem progresses
Keep diabetes and blood pressure well controlled

When to See a Doctor

Foot or ankle pain that does not improve with supportive shoes and rest
A flat foot that has developed recently in adulthood, especially on one side
Swelling on the inside of the ankle or an inability to stand on tiptoe
A child with a rigid, painful flat foot or one who limps or tires easily
Numbness, weakness or difficulty walking

Frequently Asked Questions

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