Flat feet (pes planus) means your foot arch sits lower than usual. This allows more of your sole to contact the ground. Some people have flat feet and feel fine. Others notice arch pain, heel pain, shin splints, ankle ache or knee discomfort, especially after long standing, walking, running or sport.

Flat feet often link with overpronation. That means the foot rolls inward more than usual during standing, walking or running. Over time, this may change how load travels through the foot, ankle, shin and knee. Many painful cases respond well to physiotherapy-led foot care, targeted strengthening, load changes and footwear advice.

A footprint test is not a diagnosis. However, it can help you decide whether an assessment may be useful. A physiotherapist can check whether your symptoms come from the arch, a tendon, the plantar fascia, footwear, ankle control or a recent workload spike.

What Causes Flat Feet?

Flat feet may start in childhood or develop later. The key issue is not always the shape of the foot. Pain usually starts when your arch, ankle and calf cannot manage the load placed on them.

• Flexible flat feet: the arch appears when sitting or standing on tiptoes, then flattens in standing.
• Muscle control changes: the small foot muscles and ankle stabilisers may not share load well.
• Footwear changes: worn, soft or unsupportive shoes may increase arch demand.
• Workload spikes: longer shifts, more walking or a sudden running increase can irritate tissues.
• Weight changes: extra load can increase demand on the arch and ankle.
• Tendon overload: the tibialis posterior tendon can become painful in some adults.

Do Flat Feet Always Cause Pain?

No. Many people have flat feet without pain. Pain tends to appear when your foot posture, strength, footwear or training load no longer matches what your tissues can handle.

For example, a runner may tolerate flat feet for years, then develop symptoms after increasing hill work. Another person may develop arch pain after changing to softer shoes or starting a job with longer standing demands.

Common Symptoms of Flat Feet

Flat feet may cause local foot symptoms or contribute to pain higher up the leg. Symptoms can include:

• arch pain or midfoot ache after activity
• heel pain, especially with long standing or first steps
• tired feet or cramping in the sole
• inner ankle pain or swelling
• shin pain with running, jumping or long walks
• Achilles or calf tightness
• knee pain with stairs, squats or running

Related Problems Linked With Flat Feet

Flat feet do not automatically cause these problems. However, extra pronation and reduced arch control may increase load on nearby tissues in some people.

• Plantar fasciitis
• Tibialis posterior tendinopathy
• Shin splints (MTSS)
• Achilles tendinopathy
• Patellofemoral pain syndrome (PFPS)
• Bunions

How Physiotherapists Assess Flat Feet

A physiotherapy assessment looks beyond arch height. Your physiotherapist may assess how your foot behaves during walking, calf raises, squats, balance tasks and sport-specific movements.

They may also check ankle mobility, calf strength, big toe function, footwear, training history and symptoms around the heel, arch and inner ankle. This helps separate a flexible foot posture from painful tissue overload.

Physiotherapy Treatment for Flat Feet

Treatment depends on your symptoms, age, activity level and goals. A physiotherapist may use a mix of strength work, footwear advice, taping, orthotics guidance and load management.

Arch and Foot Strength Exercises

Targeted foot exercises can improve how the arch muscles support the foot during standing, walking and sport. These exercises often include short-foot work, toe control, calf strengthening and balance drills.

See: Active Foot Posture Correction Exercises.

Calf, Hip and Leg Strength

The foot does not work alone. Calf, hip and leg strength can change how the arch loads during walking, running, stairs and jumping. Your program should match your current capacity and build gradually.

Footwear Advice

Supportive shoes may reduce symptoms during painful phases. The right shoe depends on your foot shape, work demands, training load and comfort. A sudden change to very soft, very stiff or very minimal shoes can irritate symptoms in some people.

Orthotics When They Suit Your Needs

Orthotics may help some people during painful flare-ups, long standing days or higher-load sport. They should not replace strength and load management when those are needed.

Orthotics are most useful when they improve comfort, help you keep moving, and fit well inside your footwear. Children, adults, athletes and workers may need different advice.

Flat Feet Exercise Progression

A staged plan usually works better than one exercise used for every person. Your physiotherapist can adjust the stage to your pain, strength and goals.

Stage	Focus	Examples
Settle	Reduce overload	Footwear changes, taping, short walks, symptom-guided activity
Control	Improve arch awareness	Short-foot drills, toe control, balance work
Strengthen	Build tissue capacity	Calf raises, step work, hip strength, loaded balance
Return	Prepare for work or sport	Longer walks, graded running, jumping, sport-specific drills

Should Children With Flat Feet Be Treated?

Many children have flexible flat feet, and many are painless. Treatment is usually more relevant when a child has pain, fatigue, poor tolerance for sport, shoe problems, or a clear change in function.

If your child has pain, limping, one-sided symptoms, stiffness, or avoids activity, book an assessment. A physiotherapist can check whether the foot is flexible, how the child moves, and whether advice, exercises or orthotic support may help.

Can Adults Improve Flat Feet?

Adults can often improve symptoms and function, even when arch shape does not change much. The goal is usually better load control, strength, comfort and activity tolerance.

Adults with inner ankle pain, swelling or a gradually flattening arch should be assessed, especially if the tibialis posterior tendon may be involved.

What To Do Next

If flat feet are painless, you may not need treatment. If you have ongoing arch, heel, shin, ankle or knee pain, a physiotherapy assessment can help identify the main driver and guide your next step.

Book a PhysioWorks appointment if symptoms limit walking, work, running, sport or footwear choice. Your plan may include exercises, footwear advice, orthotic guidance and a graded return to activity.

References

1. Jaffri AH, Ahmed S, Razak A, et al. Evidence for intrinsic foot muscle training in improving foot function: a systematic review. Sports Med Open. 2023;9(1):87.
2. Jia Y, Wang Y, Zhang Y, et al. Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials. Sci Rep. 2024;14:16498.
3. Molina-García C, Banwell G, Rodríguez-Blanque R, et al. Efficacy of plantar orthoses in paediatric flexible flatfoot: a five-year systematic review. Children (Basel). 2023;10(2):371.
4. Liu C, Huang H, Dong H, et al. The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis. Front Pediatr. 2024;12:1388248.
5. Peters-Dickie JL, Detrembleur C, Guallar-Bouloc M, et al. The effects of foot core exercises and minimalist footwear on foot muscle sizes, foot strength, and biomechanics: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon). 2025;122:106417.

Flat Feet FAQs

Are flat feet a problem?

Flat feet are common and often painless. They may become a problem when your workload, footwear or training demand exceeds your foot and ankle control. Symptoms can include arch, heel, shin, ankle or knee pain.

Can physiotherapy help flat feet?

Physiotherapy may help by improving foot strength, calf capacity, balance, arch control and movement patterns. It can also guide footwear, orthotics and training load so symptoms settle without unnecessary rest.

Do I need orthotics for flat feet?

Not always. Some people benefit from orthotics during painful phases, long standing days or sport. Others improve with exercise, footwear changes and load management. The right choice depends on your symptoms and goals.

What exercises help flat feet?

Common options include short-foot exercises, toe control drills, calf raises, balance work, hip strength and graded walking or running tasks. Your program should match your pain level and current strength.

When should I get flat feet checked?

Book an assessment if you have ongoing arch or heel pain, inner ankle swelling, repeated shin splints, changing foot shape, or pain that limits walking, work, running or sport.

Can children grow out of flat feet?

Many children have flexible flat feet that are painless. Assessment is useful when there is pain, limping, tiredness with activity, one-sided symptoms, stiffness or reduced sport tolerance.