This article to let you konw all about flat feet. Flat feet symptoms, flat feet diagnosis, flat feet treatment and how to exercise.
The relationship of flat feet with Overpronation and Underpronation/Supination.

What is flat feet?

Flat feet, also called pes planus or fallen arches, are a phenomenon in which the inner arch of the foot is collapsed and the sole of the foot is flat against the ground. The picture below shows three feet arches patterns, normal arch, flat arch, high arch.

Three kinds of foot arches
Three kinds of foot arches

Causes of flat feet

Congenital/Genetic cause

Abnormal development of foot bones, ligaments, or muscles.

Acquired developmental causes

  • Tendon strain
  • Paralysis and atrophy of the calf muscles
  • Long-term failure to exercise muscles and ligaments
  • Long-term weight-bearing standing
  • Wear inappropriate shoes for a long time, such as high heel shoes
  • Baby walks too early
  • Caused by polio
  • Overweight

Flexible flat feet and Rigid flat feet

Flexible flat feet refer to the fact that the arch of the foot collapses or disappears when standing, but the arch is normal when non-weight bearing, for example, sitting on a chair. Flexible flat feet mostly is acquired developmental flat feet.

Rigid flat feet refer to the collapse or disappearance of the feet arch in both of weight-bearing and non-weight-bearing conditions. Rigid flat feet is mostly congenital or genetic flat feet.

Symptoms of flat feet


The pain is usually located on the inside of the plantar (pain on the posterior medial side of the hindfoot), and it is aggravated after standing or walking for a long time, and it can often become progressively worse. Occasionally the pain can also be located near the lateral malleolus outside the ankle joint. This is due to the collapse of the arch of the foot causing the hindfoot to valgus, and then the fibula collides with the calcaneus.

The overpronation of flat feet can cause pain and arthritis in knees, hips, back, etc.

The overpronation of flat feet can cause pain and arthritis in knees, hips, back, etc.
The overpronation of flat feet can cause pain and arthritis in knees, hips, back, etc.


Swelling outside of pain joint , especially at the navicular tuberosity.

Abnormal gait

Pain in the affected foot and collapse of the arch can cause a decrease in running or even walking ability, and abnormal gait, such as a splay feet gait.

Diagnosis of flat feet

Self test on home or find the help of doctor. The following method is self-testing on home.

Get your barefoot wet, then find a piece of newspaper or white paper and put your inside foot tightly against the wall and step on paper with normal force. You will get a wet footprint on paper.

There are three degrees of flat feet, the severity level from low to high is 1, 2, 3. Measure the hollow length of the middle footprint and the lengh of non-hollow. Toward the ratio of hollow and non-hollow length we can get how serious flat feet is. Follow the picture below.

Flat feet degree
Flat feet degree

The relationship of flat feet with overpronation and underpronation

Pronation DegreeArchPicture
Underpronation/supinationHigh ArchesHigh Arches
Normal pronationNormal ArchesNormal Arches
OverpronationFallen ArchesFallen Arches
The relationship of flat feet with overpronation and underpronation

The table above is only showing the commom sense of relationship between pronation and feet arches. There are still some other situations, for instance, fallen arches with underpronatioin or supination, etc. But it rarely happens.


Wear shoes with better arch support performance

No matter whatever of the type of flat feet, it is always good to wear shoes with good arch support, and may be able to alleviate foot, leg or back symptoms. Try to buy a pair of comfortable casual shoes or sports shoes. To ensure that the arches are well supported, the toes have space for movement, a firm heel stabilizer and a flexible sole included. Supporting the arch of the foot helps reduce the tightness of the posterior tibial muscle tendons and Achilles tendons.

Do not wear shoes with heels higher than 6 cm, as they will make the Achilles tendon short and tight. Wearing shoes with a flat sole is not good, because the heel must bear too much pressure. It is best to wear shoes with heels about 0.5 or 1 cm high.

Get custom orthopedic appliances

If you have flexible flat feet and need to stand or walk for a long time, consider customizing a pair of orthopedic insoles. This kind of insole is neither too hard nor too soft. It can support the arch of the foot well and improve the mechanical mechanism of standing, walking and running. Orthotic insoles provide cushioning and some shock absorption, and can also reduce the possibility of problems in other joints such as ankles, knees, hips, and lumbar spine.

There are the things you should know.

  • Orthotic insoles and similar orthopedic appliances cannot reverse the deformation of the foot structure, nor rebuilding the foot arch after long-term use.
  • Health professionals who help patients customize orthopedic insoles include podiatrists, osteopaths, doctors, chiropractors and physical therapists.
  • Usually the insoles that come with the shoes must be taken out before they can be replaced with orthopedic insoles.
  • Some health insurance plans with custom orthopedic equipment included. If your insurance does not cover this service, you may wish to consider buying ready-made orthopedic insoles. They are not that expensive, but they can also provide proper arch support. In fact, studies have shown that these finished products have the same effects as customized orthopedic insoles in some cases.

Consider losing weight

If you are overweight (especially obese people), losing weight has many health benefits, including reducing the pressure on the bones, ligaments and tendons of the feet, and making the blood flow more smoothly in the feet. Weight loss cannot reverse rigid flat feet, but it has a certain positive effect on other types of flat feet. Even if most women do only light exercise, as long as they consume no more than 2,000 calories a day, it is enough for them to lose some weight every week. Most men consume no more than 2200 calories a day and can also lose some weight every week.

  • Many obese people have flat feet, and the ankles cannot bear the weight and bend to the inside excessively, causing the knees to turn out。
  • Some women experience a collapsed arch in the late pregnancy, which will return to normal after giving birth.
  • To promote weight loss, the diet should consist of lean meat, poultry and fish, grain, fresh vegetables and fruits, only drink purified water. Do not drink sugary drinks such as soda.

Physical therapy

If the flat feet are mainly caused by tightness or weakness in tendons or ligaments, and the soles of the feet still have some flexibility and not completely rigid, you should consider doing some rehabilitation. The physical therapist can demonstrate some stretching and strengthening exercises for the foot, Achilles tendon and calf muscles according to your specific situation to help rebuild the foot arch and allow it to perform greater functions. Physical therapy is usually performed 2 to 3 times a week for 4 to 8 weeks to improve chronic foot disease.

  • If the Achilles tendon is tight, a common stretching exercise is to press your hands against the wall and stretch one leg back, just like a lunge. The foot that is stretched back must remain flat on the ground, so that there will be a feeling of being stretched above the heel. Hold for 30 seconds and repeat 5 to 10 times a day.
  • A physical therapist can apply a strong tape to the foot to artificially temporarily form the arch to relieve symptoms.
  • Flat feet often cause plantar fasciitis, and the arch of the foot will become inflamed and painful when touched. Physical therapists can use therapeutic ultrasound to relieve this condition.
  • See more exercises.

Consult a podiatrist

They are specialist of foot and are familiar with all foot conditions and diseases, including flat feet. The podiatrist will examine the feet to confirm whether the flat feet are congenital or acquired. They also check whether the bones have been wounded, such as broken or displaced, which may require X-rays. Depending on the severity of the symptoms and the cause of the flat feet, the podiatrist may recommend simple palliative treatment (rest during the onset of symptoms, ice and anti-inflammatory, etc.), corrective treatment, wear a foot model or protective gear, or perform surgery.

  • Women are 4 times more likely to have acquired flat feet than men, and it usually occurs in later life, around 60 years of age.
  • X-ray imaging can help doctors see bone problems, but cannot diagnose soft tissue problems, such as Achilles tendons and ligaments.
  • Podiatrists are trained to perform small foot surgeries, but more complex surgeries are still in the field of orthopedic surgeons。


If flat feet cause many problems, and wearing well-supported shoes, orthotics, weight loss, or intensive physical therapy cannot improve the situation, you may wish to consult your doctor about surgical options that may be helpful. Doctors may use computed tomography, MRI, or diagnostic ultrasound to better understand the condition of the soft tissues of the foot.

If the condition is serious and the flat feet are very rigid, especially flat feet caused by tarsal fusion (two or more bones of the foot are not fused normally), then the doctor is likely to recommend surgery. If the Achilles tendon is tight for a long time or the posterior tibial tendon is too loose, surgery is also recommended. The first condition needs to lengthen the Achilles tendon, and the second one needs to reduce or shorten the tendon. Family doctors are not experts in feet, bones or joints, so if you need surgery, they will refer you to an orthopedic surgeon.

  • Surgeons usually only operate on one foot at a time to prevent the patient from being completely unable to move and unduly affecting their lives.
  • Possible complications of surgery include failure to heal the bones after fusion, infection, reduced range of motion of the ankle or foot, and chronic pain.
  • The postoperative recovery time depends on the surgical procedure, such as whether the bone needs to be broken or fused, whether the tendon is cut, whether the ligament is modified, etc. It usually takes several months to recover.


Short Foot Exercise

Keep the feet flat on the ground, try to control the feet shaping a arch in the sole.

Short Foot Exercise
Short Foot Exercise

Toe Yoga Rock-paper-scissors

The muscles that control the toes are similar to the muscles of the fingers. These muscles are often underused and may lack strength and control. Use your feet to make the “rock”, “scissors” and “paper” movements in the picture below. Each movement lasts for 5 seconds.

Toe Yoga exercises
Toe Yoga exercises

Calf Stretch

Keeping back leg knees straight, gently lean forward while bending the knees forward until you feel a stretch on the back of the calf. General guidelines: Keep your feet straight ahead. Keep your heels in a neutral position for 30 to 60 seconds.

Calf Stretch
Calf Stretch

Heel Raises

Heel Raise
Heel Raise

Grabbing towel with toes

This can train some small muscles and flexor muscles that are less commonly used in the soles to improve the muscles strength of the soles or lack of endurance.

Grabbing towel with toes
Grabbing towel with toes

More exercises to follow the video.

Easy Exercise for Foot, Arch and Leg Pain from Fallen Arches, Flat Feet, Pronation