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Education2026-03-05•6 min read

Flat Feet: Do They Need Fixing? Exercises, Orthotics, and the Truth

The Flat Feet Question

Someone looked at your feet and said they're flat. Maybe a doctor, a shoe salesperson, or a well-meaning family member. Now you're worried.

Here's what you actually need to know about flat feet—and when to do something about them.

What Are Flat Feet?

Normal Anatomy

The foot has three arches:

  • **Medial longitudinal arch:** The main arch (inside of foot)
  • **Lateral longitudinal arch:** Outside of foot
  • **Transverse arch:** Across the midfoot

    • When people say "flat feet," they usually mean the medial arch appears collapsed when standing.

    Types of Flat Feet

    Flexible flat foot:

  • Arch appears when non-weight-bearing
  • Collapses when standing
  • Most common type
  • Often asymptomatic

    • Rigid flat foot:

  • No arch even when non-weight-bearing
  • May indicate structural difference
  • More likely to cause problems

    • How Common?

    Very. About 20-30% of adults have some degree of flat feet. Many have no symptoms at all.

    Do Flat Feet Need Treatment?

    The Short Answer

    Not necessarily. Flat feet without symptoms don't require intervention.

    When Flat Feet Are Fine

  • No pain during activity
  • No significant fatigue
  • Can participate in desired activities
  • No progressive deformity

    • Many elite athletes have flat feet. Your foot structure doesn't determine your destiny.

    When to Address Flat Feet

  • Foot pain during or after activity
  • Ankle, knee, or hip problems potentially related
  • Significant fatigue with standing or walking
  • Progressive worsening
  • Pain affecting daily activities

    • What Causes Flat Feet?

    Congenital

  • Developed in childhood
  • Often runs in families
  • Most people's flat feet fall into this category

    • Acquired

    Posterior tibial tendon dysfunction: The most common cause of adult-acquired flat foot. The tendon that supports the arch weakens.

    Injury: Fractures or dislocations affecting foot structure.

    Arthritis: Inflammatory or degenerative changes.

    Nerve conditions: Affecting muscle control.

    Pregnancy: Hormonal changes plus weight gain can flatten arches.

    The Assessment

    What to Look For

    Standing:

  • Does the arch touch the ground?
  • Does the heel tilt outward (valgus)?
  • Does the forefoot point outward?

    • Single-leg heel raise:

  • Can you rise onto your toes on one foot?
  • Does the arch reform?
  • Is there pain?

    • Walking:

  • Does the arch collapse excessively?
  • Is gait symmetrical?

    • When It Matters

    The assessment helps determine if flat feet are causing problems or just an anatomical variant that's functioning fine.

    Treatment Options

    Exercise and Strengthening

    When it helps: Flexible flat feet, mild symptoms, posterior tibial tendon dysfunction in early stages.

    Key exercises:

    Short foot exercise:

  • Stand with weight evenly distributed
  • Without curling toes, lift the arch by pulling the ball of foot toward heel
  • Hold 5-10 seconds
  • This activates intrinsic foot muscles

    • Towel scrunches:

  • Place foot on towel
  • Scrunch towel toward you using only toes
  • Builds intrinsic foot strength

    • Heel raises:

  • Single-leg when possible
  • Focus on controlling the foot position
  • Progress to adding weight

    • Posterior tibial strengthening:

  • Seated, press inside of foot against resistance
  • Or: band around forefoot, turn foot inward

    • Single-leg balance:

  • Focus on maintaining arch position
  • Progress to unstable surfaces

    • Orthotics

    When they help:

  • Symptoms relieved by arch support
  • Activity demands exceed what exercises can accomplish
  • Posterior tibial tendon dysfunction
  • As adjunct to strengthening (not replacement)

    • Types:

  • Over-the-counter inserts (Superfeet, PowerStep)
  • Custom orthotics from podiatrist
  • Shoe modifications

    • The evidence:

  • Orthotics can reduce pain and improve function
  • But they don't permanently "fix" flat feet
  • Consider them a tool, not a crutch

    • Footwear

    What to look for:

  • Firm heel counter
  • Motion control or stability features
  • Adequate arch support
  • Proper fit (not too wide or narrow)

    • What to avoid:

  • Completely flat shoes
  • Worn-out shoes
  • Flip flops and minimalist shoes (at least initially)

    • Physical Therapy

    A physical therapist can:

  • Assess your specific needs
  • Design an appropriate exercise program
  • Provide manual therapy if helpful
  • Address contributing factors (hip weakness, ankle mobility)
  • Determine if orthotics would help

    • Surgery

    Rarely needed. Reserved for:

  • Severe rigid flat foot
  • Failed conservative treatment
  • Posterior tibial tendon rupture
  • Significant arthritis

    • Types include tendon repairs, bone cuts (osteotomies), and fusions.

    The Minimalist Shoe Debate

    The Argument

    Some claim that supportive shoes weaken feet, and going barefoot or wearing minimal shoes strengthens them.

    The Reality

    There may be something to it, but:

  • Transition must be very gradual (months to years)
  • Not appropriate for everyone
  • People with symptomatic flat feet often do worse
  • Sudden change leads to injury

    • If you want to try it:

  • Start with just a few minutes daily
  • Very gradually increase
  • Do foot strengthening exercises alongside
  • Be prepared to go back to supportive shoes if needed

    • Living With Flat Feet

    Practical Tips

    1. Strengthen your feet even if asymptomatic

    2. Rotate footwear to vary support

    3. Watch for changes (increasing flatness, new pain)

    4. Address the whole chain (hips and core matter too)

    5. Don't catastrophize (flat feet ≠ broken feet)

    Activity Modifications

    If flat feet cause problems during activity:

  • Use supportive shoes/orthotics during high-demand activities
  • Strengthen before adding volume
  • Gradually increase demands
  • Consider low-impact alternatives if high-impact causes issues

    • Children and Flat Feet

    What's Normal

    Most children have flat feet until around age 6. The arch develops with age and activity.

    When to Worry

  • Pain during activity
  • Rigid flat foot (arch never appears)
  • Significant functional limitations
  • Progressive worsening after age 6-8

    • Most children's flat feet require no intervention and resolve on their own.

    The Bottom Line

    Flat feet are extremely common and often require no treatment. If you have flat feet without pain or functional limitations, you're likely fine.

    If flat feet cause symptoms, start with strengthening exercises and appropriate footwear. Orthotics can help but shouldn't replace building foot strength.

    Your foot structure is just one factor. What matters more is whether your feet do what you need them to do. If they do, leave them alone. If they don't, there are effective ways to help.

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