Introduction

Flat feet
Flat feet
Flat feet, or 'fallen arches', are where your feet press flat on the ground.  They're common and usually nothing to worry about.

Check if you have flat feet

To see if you have flat feet, check the inner sides of your feet while you're standing up.
If you have flat feet, your feet will be flat on the ground.
You don't have flat feet if part of your foot is raised off the ground (this is called the arch).

Flat feet don't usually need to be treated

You don't need to do anything if you or your child have flat feet that aren't causing any problems.

Flat feet:

  • don't usually cause any problems
  • shouldn't stop you doing any activities, including sports
  • are rarely a sign of anything serious

In children, flat feet usually last until they're about 6 years of age.

See a GP if you have flat feet and:

  • your feet are painful, stiff, weak or numb
  • you often get feet or ankle injuries
  • you have problems with walking or balance
  • you didn't have flat feet before
  • it only affects 1 foot

These problems mean you might need treatment.

Treatments for flat feet

If you need treatment, your GP may refer you to a specialist like a podiatrist or physiotherapist.

Referral to a specialist isn't available everywhere and waiting times can be long.

Your GP might be able to give you advice about paying to see a specialist privately.

A foot specialist can offer advice about:

  • what shoes to wear (wide, comfortable shoes with a low heel are usually best)
  • shoe insoles to support your feet
  • foot stretches and exercises
  • painkillers

These won't change the shape of your feet, but can help with things like pain and stiffness.

Surgery for flat feet

Surgery is rarely needed for flat feet.

It might help if there's a problem with the bones, tissues or muscles in your feet and other treatments haven't worked.

Your GP may refer you to a surgeon if they think surgery might help.

Causes of flat feet

Often there's no obvious cause for flat feet.  It might just be the way your feet are.

Sometimes flat feet run in families.

Rarely, they may be caused by:

  • the bones in the feet not growing properly in the womb
  • stretching of the tissues in your feet (possibly as a result of things like an injury, getting older and being overweight
  • conditions affecting the muscles, nerves or joints in the whole body

 

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Symptoms

Flat feet do not usually cause problems, but they can put a strain on your muscles and ligaments (the tissue that links two bones together at a joint). This may cause pain in your legs when you walk.

If you have flat feet you may experience pain in any of the following areas:

  • inside of your ankle
  • arch of your foot
  • the outerside of your foot
  • calf (the back of your lower leg)
  • knee, hip or back

Some people with flat feet find that their weight is distributed unevenly, particularly if their foot over-pronates. If your foot over-pronates, it is likely that your shoes will wear out quickly. Over-pronation can also damage your ankle joint and Achilles tendon (the large tendon at the back of your ankle).

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Causes

Having low or no arches is normal for some people. In these cases, flat feet is usually inherited and the feet are fairly flexible.

Occasionally, flat feet can be caused by an abnormality that develops in the womb, such as a problem with a joint, or where two or more bones are fused together. This is also known as tarsal coalition and leads to the feet being flat and stiff.

Flat feet that develops in later life can be the result of a condition that affects the joints, such as arthritis, or an injury to a muscle, tendon or the joints of the foot.

Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. This is because over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this occurs include cerebral palsy, spina bifida and muscular dystrophy.

Adult-acquired flat feet often affects women who are over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time.

It is not fully understood what causes the tendon to become stretched, but some experts believe that wearing high heels and standing or walking for long periods may play a part. You are more at risk if you are obese, have high blood pressure (hypertension) or diabetes.

Recent research has found a link with changes to this tendon and an increase in a type of protein called protelytic enzyme. These enzymes can break down some areas of the tendon, weakening it and causing the foot arch to fall. Similar changes were also seen in other conditions, such as Achilles tendonitis.

This could have important implications for treating flat feet, as medication that specifically targets these enzymes could provide an alternative to surgery.

However, further research is needed and this type of treatment is thought to be about 10-15 years away.

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Diagnosis

When to see your GP

See your GP if you or your child have flat feet and:

  • they are causing pain, even when wearing supportive shoes that fit well
  • shoes wear out very quickly
  • your feet appear to be getting flatter
  • yours or your child's feet are weak, numb or stiff

Your GP may refer you to a podiatrist (foot specialist).

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Treatment

Treatment is not usually needed for flat feet because they do not usually cause any significant problems.

If your feet ache, the achiness can usually be relieved by wearing supportive shoes that fit properly. You may need to wear shoes that are wider than normal.

If your feet over-pronate, you may need to wear a special insole (orthotic device) inside your shoes to stop your feet rolling inwards when you walk or run. These will usually need to be made and fitted by a podiatrist.

In rare cases, surgery may be needed where a child has flat feet due to a problem they are born with (a congenital abnormality). The foot may need to be straightened, or the bones may need to be separated if they are fused together.

Painkillers and insoles are the first treatment options for flat feet that are caused by a joint problem, such as arthritis, or a torn tendon. If the injury or condition is severely affecting your feet, surgery may be recommended.  

In cases where flat feet are the result of a condition that affects the nervous system, special shoes, insoles, or supportive foot or leg braces may be needed. Again, in severe cases, an operation may be required to straighten your feet.

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Selected links

NHS Direct Wales links

Bunion

Heel pain

External links 

Feet for Life  - The Society of Chiropodists and Podiatrists

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 21/01/2019 14:22:48