Flat Feet

Overview

Flat feet (also called fallen arches) means that when you stand, the whole sole of your foot rests on the ground. Most feet have an arch — a curve in the middle of the foot that lifts it slightly off the floor. If you have flat feet, that curve is low or missing. Flat feet are very common and are often completely normal. Many people have them for their whole lives with no pain or problems at all. Others may get aches in the feet, ankles, knees or lower back, especially after standing or walking a lot.

Yes, flat feet are very common. Roughly 1 in 4 adults has flat feet to some degree, and almost all young children do. Most people never need any treatment for them.

Flat feet can affect anyone. They are normal in babies and young children. In adults they may be lifelong or develop later, and they become more common with age. They can also appear or become more noticeable during pregnancy, after an injury, or with weight gain.

Symptoms

Common symptoms

• The whole sole of the foot touching the floor when you stand
• Feet that look flat when you stand but show an arch when you sit or lift your toes (called flexible flat feet)
• Tired or aching feet, especially after standing or walking for a long time
• Pain or tenderness along the inside of the ankle or in the arch
• Shoes wearing down unevenly, often more on the inner side
• Feet that turn outward more than usual when you walk
• Swelling along the inner ankle, which may get worse through the day
• Finding it hard to stand on tiptoes on one foot
• Sometimes discomfort in the knees, hips or lower back because of how you walk

Symptoms in children

• Most children under about 5 have flat feet and this is normal
• The arch usually appears gradually as the foot grows and strengthens
• Most children with flat feet have no pain and do not need treatment
• Some children complain of tired legs or mild foot ache after a busy day of playing
• A child who avoids running or playing, or who limps, should be checked by a doctor

Symptoms in older adults

• Flat feet that develop in adulthood (sometimes called adult-acquired flat foot)
• Pain and swelling on the inside of the ankle that gets worse over weeks or months
• One foot becoming noticeably flatter than the other
• The foot turning outward and the ankle rolling inward
• Stiff, achy feet, especially first thing in the morning
• Arthritis in the foot or ankle making the foot stiffer and flatter
• A higher chance of trips and falls if the foot becomes unstable

Causes

Main causes

• Genetics — flat feet often run in families
• Loose or flexible ligaments and tendons that allow the arch to collapse when standing
• Foot bones that formed with a low arch
• Wear or damage to the tendon that supports the arch (the posterior tibial tendon), which is a common cause of flat feet in later life
• Injury or fracture of the foot or ankle
• Arthritis, which can change the shape and stiffness of the foot
• Nerve or muscle conditions that affect how the foot moves

Risk factors

• Having a family member with flat feet
• Being older — the tendons and ligaments in the foot can weaken with age
• Being pregnant, when hormones soften ligaments and weight increases
• Carrying extra weight, which puts more load on the feet
• Standing or walking a lot at work
• Previous foot or ankle injury
• Conditions such as diabetes, rheumatoid arthritis or high blood pressure
• Wearing shoes with little support for long periods

When to see a doctor

See a doctor urgently if:

• One foot suddenly becomes flat, or the shape of your foot changes quickly
• You cannot put weight on the foot, or walking has become very painful
• There is new swelling, redness or warmth around the ankle or foot
• You have diabetes and notice a new blister, cut or sore on your foot
• You have numbness, tingling or loss of feeling in the foot

Book a routine appointment if:

• Foot or ankle pain that has lasted more than a few weeks
• Pain that keeps coming back after standing, walking or exercise
• Your shoes are wearing unevenly or you keep rolling your ankle
• You feel unsteady on your feet or have had a fall
• A child over 6 still has flat feet, or a child complains of foot pain
• You are worried about how your feet look or how you walk

Diagnosis

A doctor or foot specialist (podiatrist) can usually tell whether you have flat feet just by looking at and feeling your feet. They will watch you stand and walk, and ask you to stand on tiptoes and to lift your toes. This helps show whether your arch appears when the foot is not bearing weight. They will also ask about your pain, your health history and your family history. You will be asked to take off your shoes and socks, so it can help to wear something easy to remove. In many cases no further tests are needed.

Tests that may be done

• A physical exam of the feet, ankles and how you walk
• The 'wet footprint' test — wet feet leave a print showing how much of the sole touches the floor (you can try this at home)
• Standing on tiptoes to see whether an arch forms (the tiptoe test)
• Checking how your shoes have worn
• X-rays if the doctor wants to look at the bones and joints
• Ultrasound or MRI scans if a tendon injury or tear is suspected
• Blood tests if an inflammatory condition such as arthritis is suspected

What to expect at your appointment

The appointment is quick and painless. Your doctor will look at your bare feet, watch you stand and walk, and gently feel around the arch and ankle. They may ask you to do a few simple movements. Most people are told at the same visit whether they have flat feet and whether anything needs to be done. Often the answer is that no treatment is needed — just comfortable shoes and keeping active.

Treatment

Most people with flat feet do not need any treatment at all. If your feet are painful or you feel unsteady, treatment starts with simple things you can do yourself: supportive shoes, arch supports, gentle foot exercises and keeping to a healthy weight. If these are not enough, your doctor may refer you to a podiatrist (a foot specialist) or a physiotherapist. Surgery is only considered in a small number of cases.

Self-care at home

• Choose shoes with a firm heel counter, a supportive sole and room for your toes — avoid very flat, thin or worn-out shoes
• Try over-the-counter arch supports or insoles; a pharmacist or shoe shop can help you choose
• Build up slowly if you have been less active, rather than going straight back to long walks or runs
• Rest the feet and use a cold pack wrapped in a cloth for 10 to 15 minutes if they ache after activity
• Practise simple foot exercises such as picking up a towel with your toes, heel raises and calf stretches
• Keep to a healthy weight, which lowers the load on your feet
• Replace worn-out shoes, and rotate between pairs if you walk a lot
• If one foot is painful, ask about a temporary insole or support for that side

Medical treatments

If self-care is not enough, a podiatrist can assess your feet and may suggest custom-made insoles (orthotics), an ankle brace, or a period in a supportive boot or cast if a tendon is inflamed. A physiotherapist can teach you exercises to strengthen the muscles around the foot and ankle. Your doctor may also discuss pain relief — always ask your pharmacist or doctor which option is safe for you, especially if you have other health conditions or take other medicines. If an underlying condition such as arthritis or diabetes is involved, treating that condition is an important part of looking after your feet.

When is surgery considered?

Surgery is rarely needed for flat feet. It may be discussed if there is a damaged or torn tendon, the foot shape is changing quickly, pain is severe and does not improve with shoes, insoles and physiotherapy, or if the foot is badly affecting your ability to walk. Your doctor would refer you to an orthopaedic foot and ankle specialist, who would explain the benefits and risks in detail.

Living with this condition

Most people with flat feet simply get on with life as normal. The main day-to-day focus is comfortable footwear and listening to your feet — resting when they ache and building up activity gradually. Check your feet regularly, especially if you have diabetes, and look for blisters, cuts or sore spots. If a particular activity makes your feet sore, try shorter sessions, better shoes or a different surface such as grass instead of pavement.

Lifestyle tips

• Stay active — walking, swimming and cycling are all good options that keep the feet and legs strong
• Wear supportive shoes for everyday walking and for exercise
• Alternate your footwear so shoes have time to dry out and keep their shape
• Keep to a healthy weight to reduce strain on the feet
• Check your feet every week, and more often if you have diabetes or reduced feeling in your feet
• Warm up gently before exercise and stretch your calves afterwards
• Avoid standing in one place for very long periods if you can, and take short walking breaks

Diet and exercise

There is no special diet for flat feet, but eating a balanced diet helps keep your bones, muscles and joints healthy — including enough calcium and vitamin D, which you can ask your pharmacist or doctor about. Exercise is helpful rather than harmful: strong calf and foot muscles support the arch. Try heel raises, calf stretches, toe curls and simple balance exercises such as standing on one leg near a counter for support. Low-impact activities like swimming and cycling are gentle on the feet. Build up slowly and stop if pain gets worse.

Mental health and emotional wellbeing

Foot pain can wear you down. It may limit the activities you enjoy, affect your sleep, or make you worry about how you walk or what you can wear. Children with flat feet can sometimes feel self-conscious too. These feelings are normal and worth mentioning to your doctor — there is often more that can be done than people expect. If you ever feel overwhelmed or unable to cope, please reach out: speak to your doctor, or contact your local mental health or crisis support service. If you feel at risk of harming yourself, call your local emergency number straight away.

Prevention

You cannot prevent flat feet that you are born with, and flat feet in young children are a normal part of growing up — they usually improve on their own. You can lower your chance of foot problems later in life by wearing supportive shoes, keeping to a healthy weight, staying active, and getting foot or ankle injuries checked and treated properly. If you have a job that involves a lot of standing, good footwear and regular breaks make a real difference.

Screening programmes

There is no routine screening programme for flat feet. Feet are usually checked as part of a general health check or when you see a doctor about pain. If you have diabetes, you should have your feet checked at least once a year as part of your diabetes care.

Complications

If left untreated

• Ongoing aching or pain in the feet, ankles, knees or lower back
• Wear or damage to the tendon that supports the arch, which can make the foot flatter over time
• Stiffness and arthritis in the foot and ankle
• Hard skin, calluses and corns from pressure points
• Changes in how you walk, which can strain other joints
• Problems finding comfortable shoes
• An increased risk of trips and falls, particularly in older adults
• Finding exercise harder, which can affect overall health

Long-term outlook

The outlook for most people with flat feet is very good. Many people have flat feet for their whole lives with no pain or limits at all, and children's arches usually develop naturally. For those who do get discomfort, good shoes, simple exercises and, if needed, insoles or physiotherapy help a great deal. Only a small number of people ever need surgery. With a little care, most people stay active and comfortable on their feet.

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