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What does the arch do?
The arch is the curve beneath the inner foot edge. Its height varies naturally. Bones, ligaments, fascia and muscles work together to support and adapt the foot. A low arch alone is therefore not a disease.
Some people have always had flat feet and walk comfortably. Others notice a new change in shape or ability. This article mainly concerns adults with symptoms; it does not provide treatment for children’s flat feet, where development and indications differ.
Understand the picture
Several tissues support the arch
Inner ankle bone
The tendon passes behind this prominence.
Posterior tibial tendon
It contributes to loading control and active support.
Arch and ligaments
Several tissues contribute to shape and stability.
What is the posterior tibial tendon’s role?
This tendon passes behind the inner ankle bone and continues into the foot. It helps control loading and supports the arch while walking. Pain can develop along its path.
When the foot progressively changes shape, other ligaments and joints may also be involved. Reducing the whole problem to one tendon would be too simple. Assessment considers flexibility, changes over time and remaining abilities.
Chapter sources [2]
Which symptoms should you describe?
Pain or swelling inside the ankle, walking fatigue and difficulty pushing off may occur. You may notice different shoe wear or a lower-looking arch. Later, other areas, including the outer side, may become painful.
These signs alone do not confirm tendon involvement. Describe onset, progression and differences between feet. Do not repeatedly attempt a single-leg heel raise to diagnose yourself if it hurts or risks a fall.
Why might an arch change?
Supporting tissues may gradually lose capacity to manage demands. Previous injuries, some diseases and loading may contribute. It is not always possible to identify one factor or responsible movement.
Weight or activity changes may be relevant without being the only explanation or a reason for blame. The aim is to understand current needs and changeable demands. A photograph or wet footprint is not enough to select treatment.
When should you seek prompt advice?
A recently changing arch, especially one-sided and painful, warrants assessment. Sudden onset after trauma, inability to bear weight, marked redness or fever needs quicker evaluation.
With diabetes, a newly hot, red and swollen foot can represent a serious problem despite little pain. Limit weight-bearing and obtain medical advice the same day. Do not assume a simple flat foot or an unsuitable shoe.
Chapter sources [3]
How is the foot examined?
Assessment looks at walking, alignment under load, movement and strength. The clinician checks tenderness along the tendon, flexibility of the deformity and joints. Tests are selected for your abilities and safety.
Standing X-rays may clarify alignment. Ultrasound or MRI can help with a tendon question or specific decision. Not every person needs every investigation; usefulness depends on whether it could change care.
How can shoes and supports help?
Comfortable stable footwear may make walking easier. An insole or more supportive brace may help the foot and reduce particular demands. More substantial temporary protection may sometimes be prescribed for very painful tissues.
Aids do not guarantee a lasting change in arch shape. Their value is assessed through comfort, walking and skin. Have painful pressure, numbness or irritation checked. Gradual adaptation may be needed.
In everyday life
A newly painful arch on one side
Notice
Record when shape and walking changed.
Support
Use advised footwear and aids without forcing loading.
Follow
Review pain, function and any further deformity.
What is the place of exercise?
Strengthening foot and leg control, balance and suitable movement may form part of care. Dose depends on pain, flexibility and the stage of the problem. Do not try to hold your arch artificially raised throughout the day.
Standing exercise may be too demanding initially and need a more protected version. Heel raises and single-leg tasks do not automatically suit everyone. The physiotherapist checks your response and adjusts the plan with medical follow-up.
Chapter sources [2]
Adapting walking, work and sport
Temporarily reduce long standing periods or surfaces that cause substantial symptoms. Break up permitted journeys and use advised aids. You might keep a short essential journey while postponing a long uneven walk.
For sport, restore one manageable demand before combining duration, speed and changes of support. Earlier pain on each outing, continued shape change or increasing limping needs review. Do not compensate by forcing a rigid gait along the outer foot edge.
When should a specialist be considered?
Persistent pain, progressive deformity or insufficient function despite supports and rehabilitation may warrant specialist advice. Options depend partly on whether the foot remains flexible or becomes rigid and on joint condition.
Not every flat foot needs surgery. If discussed, ask about goals, risks and postoperative loading restrictions. Follow-up may aim for more comfortable walking without promising a perfect shape or identical return to every activity.
Your questions
Does a painless flat foot need treating?
Not automatically. A longstanding stable shape without limitation may need no treatment. Pain or a recent change warrants assessment.
Chapter sources [1]
Do insoles rebuild the arch?
They may support the foot and improve some symptoms but do not guarantee lasting shape change. Function and comfort determine usefulness.
Can I follow advice written for children?
Not as a treatment programme. Growth and causes differ from a painful adult change.
Sources and references
- [1] Flat feet - NHS
- [2] Uniklinik Freiburg — platvoet, met afzonderlijke uitleg voor volwassenen
- [3] Recommendations | Diabetic foot problems: prevention and management | Guidance | NICE
Text updated on
Medical review: awaiting Hasib Selimovic.