Flat Feet Pes Planus

Overview

Flat feet means the arch on the inside of your foot is low or missing. When you stand up, more of your sole touches the ground than usual. 'Pes planus' is simply the medical name for a flat foot. Many people with flat feet have no pain at all and never need any treatment. Others get tired, achy feet, especially after standing or walking a lot.

Yes, it is very common. Most young children have flat feet, and a large share of adults have low or no arches too. Only a small number of people with flat feet ever get pain or need medical care for them.

It affects people of all ages. All babies and toddlers have flat-looking feet because their arches are padded with baby fat and their ligaments are loose. Some children keep flat feet into adulthood. In adults, flat feet can appear or get worse after an injury, during pregnancy, with weight gain, with ageing, or with conditions such as arthritis or diabetes.

Symptoms

Common symptoms

• No symptoms at all — many people only find out they have flat feet during a routine check
• Tired or aching feet, especially after standing or walking for a long time
• Pain along the arch of the foot or in the heel
• Pain on the inside of the ankle
• Feet that feel 'heavy' or tire quickly
• Shoes that wear down unevenly, often more on the inner side
• Finding it hard to stand on tiptoes, or one heel that does not lift off the floor
• The foot looks flat when you stand but an arch appears when you sit or lift your foot

Symptoms in children

• Feet that look flat when standing — this is normal in young children
• An arch that appears when your child stands on tiptoes or when the foot is off the ground (called flexible flat feet)
• Usually no pain and no problems walking, running or playing
• Sometimes the feet turn out slightly or the shoes wear unevenly
• Very rarely, a stiff flat foot that hurts and does not bend — this should be checked

Symptoms in older adults

• A flat foot that develops slowly in adulthood, often in one foot first
• Pain and swelling on the inside of the ankle that gets worse with activity
• The foot getting flatter over months, and the heel turning outward
• Trouble standing on tiptoes on the affected side
• Aching after walking, and less able to walk long distances
• Stiff, painful feet linked to arthritis
• Poor balance, which can raise the risk of falls

Causes

Main causes

• Normal development — babies and young children have soft, flexible feet and loose ligaments, so the arch has not formed yet
• Genetics — flat feet often run in families
• Loose or stretchy ligaments (sometimes called hypermobility)
• Weakness, wear or a tear of the tendon that supports the arch (the posterior tibial tendon), which is a common cause of adult-acquired flat feet
• Injury or fracture of the bones in the foot or ankle
• Arthritis, including osteoarthritis and inflammatory types such as rheumatoid arthritis
• Nerve damage, such as in diabetes, which can change the shape of the foot over time
• Pregnancy and weight gain, which put extra load on the feet
• Ageing — the tendons and ligaments naturally lose some strength and spring

Risk factors

• A family history of flat feet
• Being overweight or obese
• Diabetes, especially with long-standing nerve damage
• High blood pressure
• Inflammatory arthritis or other joint conditions
• Previous injury or surgery to the foot or ankle
• Jobs that involve long hours of standing or walking on hard floors
• Regularly wearing shoes with poor support, such as very flat, soft or worn-out shoes
• Being pregnant
• Getting older, especially over 40

When to see a doctor

See a doctor urgently if:

• A flat foot that has appeared suddenly in one foot
• Severe foot pain or a foot you cannot put weight on
• A red, hot, swollen foot with a fever
• A new wound, blister or ulcer on the foot if you have diabetes
• New numbness, tingling or coldness in the foot
• Foot pain after an injury that is not improving

Book a routine appointment if:

• Feet that ache or hurt regularly after standing or walking
• Pain in the arch, heel or inner ankle that lasts more than a few weeks
• Shoes that wear out quickly or unevenly
• Feeling unsteady on your feet or having balance problems
• Your feet getting flatter over time, or one foot changing shape
• You are worried about your child's feet — for example if they are stiff, painful, or your child struggles to keep up with other children
• Foot problems that are affecting your work, exercise or sleep

Diagnosis

A doctor or foot specialist can usually tell whether you have flat feet just by looking and examining your feet. They will watch you stand and walk, check whether an arch appears when you lift your foot or stand on tiptoes, feel the tendons and joints, and look at how your shoes have worn. They may also check your knees, hips and the way you walk, because foot shape can affect the whole leg.

Tests that may be done

• A physical exam is usually all that is needed — no tests required
• The 'tip-toe test' — seeing whether an arch forms when you stand on your toes
• Watching you walk to check your gait and balance
• X-rays if there has been an injury, or if arthritis or a bone problem is suspected
• Ultrasound or MRI scans if a tendon problem is suspected
• Blood tests if an inflammatory arthritis is possible
• Rarely, a special scan to look at how you stand and walk (gait analysis)

What to expect at your appointment

The appointment is quick and painless. You may be asked to take off your shoes and socks, stand, walk a few steps and rise onto your toes. Bringing a pair of your everyday shoes can be helpful, because the wear pattern gives useful clues. You should get an answer and advice the same day.

Treatment

Most people with flat feet do not need any treatment — only those with pain or problems walking do. When treatment is needed, it usually starts with simple, non-invasive steps: better footwear, supportive insoles, gentle exercises and rest from activities that hurt. Surgery is only considered in a small number of cases.

Self-care at home

• Choose shoes with a firm heel, a supportive sole and room for your toes — avoid very flat, soft or worn-out shoes
• Try off-the-shelf arch-supporting insoles from a pharmacy or shoe shop
• Build up activity gradually rather than going from little walking to a lot in one go
• Rest painful feet and use an ice pack wrapped in a cloth for 10 to 15 minutes to ease soreness
• Gently stretch your calves and the back of your ankles, which can become tight with flat feet
• Try simple strengthening exercises such as rising onto tiptoes, picking up a towel with your toes, and heel raises
• Avoid standing for long stretches on hard floors where you can, and take breaks
• Keep to a healthy weight to reduce strain on your feet
• Wear supportive shoes or slippers at home if bare floors make your feet ache

Medical treatments

If self-care is not enough, your doctor may suggest physiotherapy to strengthen the foot and ankle muscles and improve how you walk. A podiatrist (a foot specialist) can assess you and may provide custom-made insoles called orthoses that support the arch and take pressure off painful areas. Your doctor may also discuss pain relief options with you — always ask a pharmacist or your doctor about what is suitable for you, as some medicines are not right for everyone. Treating any underlying cause, such as arthritis or diabetes, matters too, and your doctor may refer you to a specialist if needed.

When is surgery considered?

Surgery is rarely needed for flat feet. It may be discussed if there is ongoing severe pain that has not improved with shoes, insoles and physiotherapy, if a tendon is badly damaged, or if the foot is stiff and flat because of a bone or joint problem. A foot and ankle surgeon would explain the risks and benefits and what recovery involves.

Living with this condition

Most people with flat feet simply get on with life. If your feet ache, planning ahead helps: wear supportive shoes for long days, break up long periods of standing, and pace yourself when walking or exercising. It can also help to keep a pair of comfortable shoes at work and to build in short rests when your feet start to feel tired.

Lifestyle tips

• Stay active with low-impact exercise such as walking, swimming or cycling — strong legs and feet support the arch
• Wear well-fitting, supportive shoes for the activity you are doing
• Replace worn-out shoes rather than wearing them until they fall apart
• Include calf stretches and foot-strengthening exercises in your routine a few times a week
• Maintain a healthy weight to reduce load on your feet
• Check your feet regularly, especially if you have diabetes — look for cuts, blisters and changes in shape
• If you have diabetes, attend your regular foot checks with your healthcare team

Diet and exercise

There is no special diet for flat feet, but eating well and staying at a healthy weight helps reduce strain on your feet and joints. Exercise is good for flat feet — strong muscles in the feet, calves and legs help support the arch. Choose activities that suit you and build up slowly. If a particular activity makes your feet sore, try a lower-impact option and speak to a physiotherapist or podiatrist for advice.

Mental health and emotional wellbeing

Ongoing foot pain can be tiring and frustrating, and it can affect your mood, sleep, work and social life. It is okay to talk about how it is affecting you. If you are feeling low, anxious or overwhelmed, tell your doctor — support is available. If you ever feel you cannot cope, contact your local emergency number or a crisis support service in your country straight away.

Prevention

You cannot prevent flat feet caused by genetics or normal childhood development. But you may be able to reduce the chance of adult-acquired flat feet or keep them from getting worse by wearing supportive shoes, keeping to a healthy weight, staying active, treating conditions like diabetes and arthritis, and getting foot or ankle injuries checked properly.

Screening programmes

There is no routine screening programme for flat feet. However, if you have diabetes, regular foot checks with your healthcare team are recommended every year, because foot shape, feeling and circulation can change without you noticing. Children's feet are usually checked as part of routine child health reviews.

Complications

If left untreated

• Pain that becomes more frequent or severe, especially in the arch, heel or inner ankle
• Changes in how you walk, which can put strain on the knee, hip or back
• Damage or tearing of the tendon that supports the arch, making the foot flatter over time
• Arthritis in the foot or ankle in some people
• Corns, calluses and skin problems where the foot rubs
• Poor balance and a higher risk of falls, particularly in older adults
• Difficulty staying active, which can affect your general health and wellbeing

Long-term outlook

The outlook is good for most people. Flat feet are common and usually harmless, and when symptoms do appear, simple measures — supportive shoes, insoles, exercises and weight management — help the great majority of people stay comfortable and active. Surgery is needed only in a small number of cases. If your feet are painful, getting advice early usually makes a real difference.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.