Flat Feet/Pes Planus

When you stand, most people have a gap under the arch of their foot.  The arch, the inner part of the foot is slightly raised off the ground. People with flat feet or fallen arches either have no arch, or it is very low. 

A significant number of people with fallen arches (flat feet) experience no pain and have no problems. 

Some, however, may experience pain in their feet and even ankles, knees and hips, especially when the connecting ligaments and muscles are strained. 

Some people have flat feet because of a developmental fault during childhood, while others may find that the problem develops as they age, or after a pregnancy. 

Symptoms may vary and generally depend on the severity of the condition. It can range of ankle pain to heel pain to sometimes knee pain. Some people may have an uneven distribution of bodyweight and find that the heel of their shoes wear out more rapidly and more on one side than the other. 


  • Family history- experts say flat feet can run in families.
  • Weak arch – the arch of the foot may be there when no weight is placed on it, for example, when the person is sitting. But as soon as they stand up the foot flattens (falls) onto the ground.
  • Injury
  • Arthritis
  • Tibialis posterior injury (ruptured tendon)
  • Pregnancy
  • Nervous system or muscle disease
  • Tarsal Coalition – the bones of the foot fuse together in an unusual way, resulting in stiff and flat feet. Most commonly diagnosed during childhood.
  • Age and wear and tear – years of using your feet to walk, run, and jump eventually may take its toll. 

There are 26 different bones in each foot, held together by 33 joints and more than 100 muscles, tendons and ligaments (in each foot). The way they weave and align together determine the formation of our arches. Sometimes these structures need external support to help maintain their proper biomechanical position.

If you experience symptoms with flatfoot, the most common treatments begin with:

  • Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
  • Orthotic devices. Custom orthotic devices for your shoes can provide you with more support to the arches.
  • Immobilization. In some cases, it may be necessary to use a walking cast or to completely avoid weight-bearing.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Shoe modifications. Wearing shoes that support the arches is important for anyone who has flatfoot.