Health guide · Podiatry
Flat feet (fallen arches): when to worry and how a podiatrist can help
Flexible vs rigid flat feet in adults and children, the signs that need a checkup, and the shoes, supports, exercises and treatments that help.
The short answer
Flat feet are common and often harmless. If your feet don’t hurt and an arch appears when you sit or stand on tiptoe (a flexible flat foot), you usually don’t need treatment. Most young children look flat-footed, and the arch develops as they grow.
See a podiatrist if flat feet are painful, stiff, getting flatter or on one side only, if the inside of your ankle swells, or if a child has foot pain, a limp or repeated ankle sprains. Supportive shoes, arch supports and stretching help most painful flat feet, and surgery is rarely needed.
Want it checked? Find an Evolve Health podiatrist near you
This guide is for general information and is not a diagnosis. Some services may not be offered at every office; your provider will go over your treatment options at your appointment.
What are flat feet?
Having flat feet, also called fallen arches or pes planus, means the arch along the inside of your foot is low or touches the ground when you stand. It can affect one foot or both. Many people are born with flat feet, and others develop them as adults.
There are two main types:
- Flexible flat feet: the arch flattens when you stand, but reappears when you sit or stand on tiptoe. This is by far the most common type, and it usually doesn’t hurt.
- Rigid flat feet: the arch stays flat even when your foot is off the ground, and the foot feels stiff. This type is less common, more likely to be painful, and worth having checked.
The tiptoe test: check your own feet
- Stand barefoot and look at the inside of your feet. A flat foot has little or no gap under the arch.
- Rise onto your toes. If an arch appears and your heels tilt inward, your flat feet are flexible.
- Sit with your feet hanging. An arch that appears now is another sign of a flexible flat foot.
- For a footprint, step onto paper or cardboard with wet feet. A print that is almost as wide in the middle as at the ball of the foot suggests a flat arch.
If the arch doesn’t appear on tiptoe, or you can’t rise onto your toes on one foot, see a podiatrist.
When to worry about flat feet
Flat feet that don’t hurt usually need no treatment. These signs are worth a checkup:
- pain in the arch, heel or along the inside of the ankle after standing or walking
- one foot flatter than the other, or an arch that is getting flatter
- swelling along the inside of the ankle
- trouble rising onto your toes on one foot
- a stiff foot, or an arch that doesn’t appear on tiptoe
- pain on the outside of the ankle, which can happen as a flat foot gets worse
- feet that tire quickly, or shoes that wear down fast on the inside edge
- burning, tingling or numbness in the sole
If flat feet are causing pain along the inside of your foot, our guide to inner arch foot pain explains the common causes in more detail.
Why flat feet develop in adults
When an arch drops in adulthood, it’s called adult-acquired flat foot. Common causes:
- Posterior tibial tendon dysfunction: the most common cause. This tendon runs behind the bony bump on the inside of the ankle and holds up the arch. When it weakens or tears, the arch slowly collapses, usually on one side. It often starts with pain and swelling along the inside of the ankle, and it’s most common in women over 40.
- Arthritis, including rheumatoid arthritis and wear-and-tear arthritis in the joints of the midfoot and hindfoot.
- Injury, such as a fracture or a sprain of the midfoot.
- Diabetes with nerve damage, which can lead to Charcot foot, where the bones of the arch weaken and collapse. A foot that suddenly becomes swollen, warm and red needs same-day care. See our guide to diabetic foot care.
- Pregnancy, when hormones loosen the ligaments. The arch can drop and the feet may get a little longer, sometimes for good.
- Tight calf muscles, excess weight and aging, which all add strain to the arch.
Flat feet in children
Babies and toddlers almost always look flat-footed. A pad of fat fills the arch and their ligaments are loose, and the arch develops gradually through childhood. Many children keep flexible flat feet into adulthood without any trouble.
What parents should know:
- A painless, flexible flat foot in a child doesn’t need treatment.
- Studies have found that special shoes and inserts don’t change how a child’s arch develops. Inserts can still help a child whose feet ache.
- Flexible flat feet don’t generally hold children back in sport.
Take your child to a podiatrist if they have:
- foot, ankle or leg pain, or they tire much sooner than other children
- a limp, or they avoid running and sports
- a stiff foot, or an arch that doesn’t appear when they stand on tiptoe
- a flat foot on one side only
- repeated ankle sprains
- trouble flexing the ankle, which can be a sign of a tight calf or Achilles tendon
In older children and teenagers, a painful, stiff flat foot can be a sign of a tarsal coalition, where two bones in the back of the foot are joined by bone or tough tissue. It often shows up between about 9 and 16 years old, sometimes with repeated sprains. It’s treated with rest, a boot or cast, and inserts, with surgery if the pain continues. Our guide to children’s foot health covers other common problems.
How a podiatrist checks flat feet
A podiatrist will look at your feet standing, sitting and walking, and check:
- whether the arch returns on tiptoe, and whether you can rise onto your toes on one foot
- where it hurts, including along the tendon on the inside of the ankle
- how far your ankle bends, since tight calves are common with flat feet
- your shoes, for signs of uneven wear
X-rays taken while you stand show how the bones line up and reveal arthritis or joined bones. Evolve Health podiatrists have digital X-ray on site. An MRI or ultrasound may be used to look at a tendon, and a CT scan to look for a tarsal coalition.
Treatment for painful flat feet
Most painful flat feet get better without surgery. Treatment aims to support the arch, ease strain on the tissues around it and strengthen the muscles that hold it up.
Shoes and arch supports
- Choose supportive shoes with a firm heel, a sole that bends only at the toes, and built-in arch support. Avoid flat, flimsy shoes and replace shoes once they wear down on the inside edge.
- Try a store-bought arch support first. For many people it’s enough.
- Custom orthotics are worth considering when store-bought inserts haven’t helped, or for adult-acquired flat foot, arthritis or diabetes. Learn more about custom orthotics at Evolve Health, and see our guide to whether you need orthotics.
Arch supports work while you wear them. They ease pain and strain, but they don’t permanently rebuild an arch.
Stretching and strengthening
- Calf stretch: hands on a wall, one foot back, heel down and knee straight. Lean in until you feel a stretch in the calf. Hold for 30 seconds, then repeat with the back knee slightly bent. Do each 3 times, twice a day. Tight calves pull the foot into a flatter position.
- Short-foot exercise: sitting with your foot flat, gently draw the ball of your foot toward your heel so the arch lifts, without curling your toes. Hold for 5 seconds, 10 times.
- Towel scrunches: use your toes to pull a towel toward you across the floor.
- Heel raises: rise onto your toes on both feet and lower slowly, 10 to 15 times, working up to one foot at a time. Stop if the inside of your ankle hurts.
A physical therapist can check your technique and build a program around your goals. See our therapeutic exercise programs.
Other things that help
- Ease off the activities that bring on pain for a while, and use ice after activity for comfort.
- Keep a healthy weight, which lowers the load on your arches.
- An ankle brace or a short time in a walking boot can rest an irritated tendon.
- An over-the-counter pain reliever can help if it’s safe for you. Check with your doctor first if you have kidney disease, heart disease or stomach ulcers, or take a blood thinner.
Surgery
Surgery is considered only when a flat foot stays painful after months of other treatment, or when a tendon is torn, the foot has become stiff and misshapen, or a tarsal coalition keeps causing pain. Depending on the cause, a surgeon may:
- repair a damaged tendon or replace it with a nearby tendon
- cut and realign a bone, often the heel bone, to rebuild the arch
- remove a tarsal coalition
- fuse stiff, arthritic joints in severe cases
Recovery usually means several weeks without putting weight on the foot, and full recovery can take many months to a year. Learn more about reconstructive foot surgery.
When to see a podiatrist
Get seen the same day if:
- you have diabetes and your foot suddenly becomes swollen, warm, red or changes shape
- your arch suddenly flattens after an injury, or you can’t put weight on the foot
Book a visit if:
- your feet hurt after standing or walking, even with supportive shoes and inserts
- one foot is flatter than the other, or your arch is getting flatter
- the inside of your ankle is swollen, or you can’t rise onto your toes on one foot
- your foot is stiff, or the arch doesn’t appear on tiptoe
- your child has foot pain, a limp, a stiff foot or repeated ankle sprains
- you have burning, tingling or numbness in your feet
Flat feet that don’t hurt are usually nothing to worry about. If yours do, or they’re changing, you can find a podiatrist near you and book online.
Questions, answered
Usually not. Many people have flexible flat feet all their lives with no pain and no problems, and they don’t need treatment. Flat feet are worth checking when they hurt, feel stiff, are getting flatter, or affect only one foot, because those can be signs of a tendon problem, arthritis or a bone problem.
See a podiatrist if your flat feet ache after standing or walking, one foot is flatter than the other, the arch is getting flatter, the inside of your ankle swells, or you can’t rise onto your toes on one foot. In children, pain, a limp, a stiff foot or repeated ankle sprains are reasons for a checkup. If you have diabetes and your foot suddenly swells, feels warm or changes shape, get seen the same day.
In a flexible flat foot, the arch flattens when you stand but reappears when you sit or rise onto your toes. It’s the most common type and usually painless. In a rigid flat foot, the arch stays flat even off the ground, and the foot is stiff. Rigid flat feet are more likely to hurt and should be checked by a podiatrist.
Yes. Babies and toddlers almost always look flat-footed, because of a pad of fat in the arch and loose ligaments, and the arch develops gradually through childhood. Many children keep flexible flat feet without any problems. A child with foot pain, a limp, a stiff foot or flat feet on one side only should see a podiatrist.
Painless flat feet don’t need fixing. For painful flat feet, shoes, arch supports and exercises relieve symptoms well, but they support the foot rather than permanently change the arch. Surgery can realign the foot when pain is severe and other treatment hasn’t helped, but it’s rarely needed.
Yes. Adult-acquired flat foot, sometimes called fallen arches, most often happens when the posterior tibial tendon along the inside of the ankle weakens or tears. Arthritis, injuries, diabetes with nerve damage, pregnancy, excess weight and aging can also make the arch drop. An arch that is flattening on one side should be checked.
They can play a part in some people, because a foot that rolls in more changes how the leg lines up as you walk. But many people with flat feet have no knee, hip or back pain, and research on the link is mixed. If you have both, arch supports and strengthening exercises may help, alongside treatment for the joint that hurts.
Not always. Many people wear them only for long days on their feet or for sport. Strengthening exercises and supportive shoes may reduce how much you need them. People with adult-acquired flat foot or arthritis often do best wearing them most of the time.
Yes. Most people with flexible flat feet can run and play sports normally, and flat feet don’t generally hold children back in sport. Supportive shoes suited to your sport help, and arch supports can make a difference if your feet tire or ache. See a podiatrist if exercise brings on pain that doesn’t settle.
This guide is for general education and doesn’t replace advice from your own doctor. Everyone’s situation is different, so talk to a healthcare provider about symptoms that are new, getting worse or worrying you. If you think you may have a medical emergency, call 911. Reading this guide doesn’t make you a patient of Evolve Health.
Want a specialist to take a look?
A guide can explain, but it can’t examine you. Evolve Health providers see patients across Florida and Texas, and you can book online any time.
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