Quick Summary
Flat feet (fallen arches, or pes planus) describe a low or collapsed arch on the inner border of your foot, which may cause aching in the arch, inner ankle or knee during prolonged standing and walking — although many people with flat feet have no symptoms at all. Our physiotherapists focus on reducing pain and improving how your foot and leg work together through hands-on manual therapy and a progressive, targeted exercise programme. Most people with symptomatic flexible flat feet notice meaningful progress within 6–12 sessions over 8–12 weeks, with home exercises central to lasting change.
What Is Flat Feet / Fallen Arches?
The medial longitudinal arch is the spring-like curve along the inner border of your foot. It is supported by the posterior tibial tendon (the main dynamic stabiliser that locks the midfoot as you walk), the spring ligament complex (the principal static support beneath the head of the talus), the plantar fascia, and the small intrinsic muscles of the foot. When these structures are working well, the arch stores and releases energy with every step.
Flexible versus rigid flat foot
In a flexible flat foot the arch flattens when you stand but reappears when your foot is off the ground or when you rise onto tiptoe. In a rigid flat foot the arch stays flat in every position, which points to a structural cause such as a tarsal coalition and warrants further investigation.
Children versus adults
Almost all babies are born with flat feet, and the arch usually develops between the ages of seven and ten, so paediatric flexible flat foot is normally a painless, physiological finding. Flat feet that develop after the arch has formed are described as adult acquired flat foot. In 2020 an international consensus group renamed this condition progressive collapsing foot deformity, because the older terms placed too much emphasis on the posterior tibial tendon alone when the deformity actually involves several ligaments, bony alignment and individual host factors (Myerson et al., Foot & Ankle International, 2020).
Posterior tibial tendon involvement
As the posterior tibial tendon degenerates and stretches it can no longer stabilise the midfoot, and the arch gradually collapses into a heel-out position. A useful clinical test is the single-leg heel raise: as you rise onto your toes the heel should swing inwards, and difficulty performing the movement — or a heel that stays out — suggests the tendon is struggling.
Low arches are not automatically a problem
A stable, flexible, painless flat foot is a normal variation rather than a disease, and treatment is only needed when it causes symptoms. A systematic review of twelve population studies reported an overall flat foot prevalence of around 15.6% in the general population, with higher rates in men and in Asian populations (Michaudet et al., Journal of Foot and Ankle Surgery, 2023).
Effects further up the leg
When the arch collapses the foot rolls inwards, the shin bone rotates inwards with it, and this can increase loading through the kneecap and the inner side of the knee, with knock-on effects at the hip and lower back. Research in a large cohort of military recruits found that rates of intermittent low back pain and anterior knee pain rose as flat foot severity increased (Kosashvili et al., Foot and Ankle International, 2008). In any individual, however, it can be difficult to establish whether the foot posture is the cause or the consequence of problems higher up the chain, which is why we assess the whole leg rather than the foot alone.
Do You Experience These Symptoms?
✓ Aching or fatigue through the arch and inner heel, especially after prolonged standing or walking
✓ Pain and sometimes swelling along the inner ankle, tracking the tendon that runs behind the inner ankle bone
✓ Feet that tire quickly and feel heavy or achy by the end of the day
✓ Uneven shoe wear, with the sole worn down along the inner edge and shoes that appear to roll inwards
✓ Secondary aching at the knee, hip or lower back caused by altered alignment of the leg
✓ Difficulty rising onto the toes on one leg, or a heel that fails to swing inwards as you do so
✓ Calf tightness and reduced ankle bend, which commonly accompanies a collapsing arch
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Flat Feet / Fallen Arches?
• Inherited foot structure and ligament laxity
Flat feet often run in families and reflect the foot shape and joint flexibility you were born with.
People with naturally loose ligaments throughout the body frequently have flexible flat feet that are simply a normal variation rather than an injury.
• Posterior tibial tendon overload and degeneration
Repetitive loading can cause gradual wear and micro-damage in the posterior tibial tendon, the main dynamic support for your arch.
As the tendon stretches it can no longer stabilise the midfoot, and the arch progressively drops.
• Increased body weight and loading
A higher body mass places greater mechanical strain on the tendons and ligaments that hold the arch up.
Raised body weight is one of the strongest associations with flat foot reported in population studies.
• Ageing and gradual soft-tissue stretching
With age the spring ligament, deltoid ligament and posterior tibial tendon slowly weaken and lengthen.
This is why adult acquired flat foot typically appears in middle age or later, and more often in women.
• Health, injury and lifestyle factors
Pregnancy, diabetes, inflammatory arthritis and previous foot injuries such as a navicular or midfoot fracture can all trigger or accelerate arch collapse.
Occupations involving prolonged standing, unsupportive footwear, and — in adolescents — a tarsal coalition causing a rigid flat foot, are further contributing factors.
How We Treat Flat Feet / Fallen Arches at J&J Therapy
Hands-On Manual Therapy
Hands-on treatment tailored to your assessment.
Our physiotherapists use joint mobilisation of the subtalar and midtarsal joints, soft tissue work to the calf complex and posterior tibialis, and techniques to restore restricted ankle bend, which is commonly linked with a collapsing arch.
We combine this with a full gait and lower-limb assessment so that treatment addresses the knee and hip as well as the foot.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS
may complement your manual therapy and exercise programme where assessment identifies a specific coexisting tendon or fascia problem — such as plantar fasciitis or posterior tibial tendinopathy — alongside your flat feet. It targets that painful soft-tissue source rather than the shape of the arch itself.
Non-invasive, evidence-based.
Targeted Exercise Programme
A progressive programme built around strengthening rather than support alone.
This typically includes short foot and intrinsic muscle training, heel raises with controlled lowering to load the posterior tibialis, resisted inversion, calf stretching, single-leg balance work, and hip strengthening to control the whole leg.
We then rebuild your walking and running capacity gradually, and where insoles are helpful we use them alongside your exercises rather than in place of them.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Sudden arch collapse with acute inner-ankle pain and an inability to rise onto your toes on that leg
A rigid, painful flat foot in a child or teenager that does not correct when they stand on tiptoe
Redness, warmth, swelling or numbness in a deformed foot if you have diabetes or poorly controlled blood sugar
New or worsening weakness, numbness, or a foot that drags or drops when you walk
FAQs About Flat Feet / Fallen Arches
Do flat feet always cause pain?
No. Many people have flat feet for their whole lives without any pain or difficulty, and a flexible, painless flat foot is considered a normal variation. Treatment is only needed when flat feet are causing pain, fatigue, or knock-on symptoms elsewhere in the leg.
Do I need insoles, or can exercises help on their own?
Both have a role. Research suggests insoles can reduce pain in symptomatic flat feet, and that they tend to work best alongside a strengthening programme rather than on their own. Our physiotherapists will help you decide, with the aim of building lasting foot and leg strength rather than relying on insoles indefinitely.
Can flat feet be corrected in adults?
In adults the shape of the arch itself usually cannot be permanently restored without surgery, which is rarely necessary. The encouraging news is that pain and function often improve substantially with manual therapy and exercise, so most people return to comfortable activity even though the foot remains flatter.
Should I worry about my child's flat feet?
Usually not. Flat feet are normal in young children and the arch typically develops by around the ages of seven to ten. It is worth seeking assessment, though, if your child has foot pain, a stiff foot, or a flat foot that stays flat when they stand on tiptoe.
Can shockwave therapy fix my flat feet?
No — shockwave therapy is not a treatment for the shape of the arch or for the flat foot itself, and there are currently no randomised trials supporting its use for this condition. It may be considered only where our assessment identifies a specific coexisting tendon or fascia problem, such as plantar fasciitis or posterior tibial tendinopathy, and even then it is never a first-line treatment. Where appropriate we use the Swiss Storz Medical MASTERPULS as an optional addition to your manual therapy and exercise programme.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
Last reviewed: