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Flat Foot

(Pes Planus; Pes Planovalgus; Fallen Arches)
  • Definition

    Feet usually have an arch on the inside portion of the foot. A flat foot is a foot that has lost or never developed this arch. It is often associated with the lower part of the legs being angled outwards
    Most flat feet are flexible. This type rarely causes problems and usually do not require treatment. Rigid flat feet can cause problems and are best treated.
    Normal Foot Arch
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  • Causes

    Infants and young children naturally have flat feet. The arch should develop over time. Sometimes, the arch does not develop. It is not always clear why this happens.
    Flat feet may develop because of:
    • Ruptured or damaged tendon that supports the arch
    • Medical conditions that affect muscles or nerves in the foot
    • Degenerative changes in certain foot joints
    • Ligament damage in the foot
  • Risk Factors

    Factors that increase your chance of flat feet include:
    • Family history
    • Diseases that cause muscle or nerve damage, such as peripheral neuropathy, diabetes, cerebral palsy, spina bifida, or muscular dystrophy
    • Foot injuries
    • Conditions of the feet that can injure foot tissue such as osteoarthritis
    • Conditions present at birth, such as excess laxity of joint capsules and ligaments, such as Ehlers-Danlos syndrome
    • Obesity
  • Symptoms

    Flat feet may not cause any symptoms at all. Rigid flat feet may cause:
    • Pain
    • Calluses, blisters, or skin redness on the inner side of the foot
    • A stiff foot
    • Weakness or numbness of the foot
    • Rapid wearing out of shoes—worn shoes lean in toward each other
    • Difficulty or pain with activities like running—in the foot, knee or hip
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.
  • Treatment

    If the flat foot is rigid and causing problems, you will be referred to a foot specialist. Talk with your doctor about the best treatment plan for you. Options include the following:
    Physical Therapy and Exercises
    Physical therapy may relieve discomfort. You may be given a specific stretching and strength program. You may also have treatment to help manage the discomfort.
    Exercises can help with the strength of the surrounding muscles. It may relieve some of the pressure in the foot.
    Orthotics and Support
    Orthotics are shoe inserts that support the foot. These inserts may help to reduce pain and disability in some people. In mild cases, a well-fitting pair of shoes with arch support may be all that is needed.
    Flat feet caused by nerve or muscle disease may need special braces.
    Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.
  • Prevention

    Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches.

    American Academy of Orthopaedic Surgeons

    American College of Foot and Ankle Surgeons


    Canadian Podiatric Medical Association

    Nurses Entrepreneurial Foot Care Association of Canada


    Adult acquired flatfoot. American Academy of Orthopedic Surgeons website. Available at: Updated December 2011. Accessed March 2, 2015.

    Flat foot. UCSF Children’s Hospital website. Available at: Accessed March 2, 2015.

    Pes planus. EBSCO DynaMed website. Available at: Updated June 10, 2014. Accessed March 2, 2015.

    11/19/2010 DynaMed's Systematic Literature Surveillance Rome K, Ashford R, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;(7):CD006311.

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