Foot

What It Is

Line drawing of the underside of the foot with the muscles removed, showing the long ligaments running from the heel towards the toes and the tendons that cross beneath the arch from the inner and outer ankle. — Beneath the muscles, ligaments and tendons crossing under the foot help hold the arch up.

Flat foot, sometimes known by the medical term pes planus, is when the arch along the inside of your foot is flattened, so the whole sole of the foot presses on the floor when standing. Flat feet are common and usually nothing to worry about. They don't usually cause any problems and shouldn't stop you doing any activities, including sport (NHS, 2025). But sometimes you may have pain around your ankle or lower leg, the inner side of your foot may ache, or your shoes may wear out quickly (NHS, 2025).

There is often no obvious cause for flat feet; it might just be the way your feet are, and sometimes flat feet run in families (NHS, 2025). Most children have flat feet when they are young and develop arches between 3 and 10 years of age (NHS, 2025). Some people never develop arches, and this is a normal variation of the foot (American Academy of Orthopaedic Surgeons, n.d.a).

Sometimes flat foot develops in adulthood. This is called adult acquired flat foot. It is most commonly caused by a problem with the posterior tibial tendon, which runs along the inside of the ankle and helps support the arch. If this tendon becomes strained, inflamed, overstretched or torn, the arch can drop (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.; American Academy of Orthopaedic Surgeons, n.d.b). This type of flat foot is progressive and should be treated as early as possible (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

If you don't have pain or other problems, you don't need to do anything about flat feet (NHS, 2025).

Flat Foot Anatomy

Flat foot is common in toddlers and infants because the arch in the foot hasn't developed yet. Most of the time, the arches develop throughout childhood, but some people never develop arches. This is a normal variation in foot type, and people without arches may not have any problems (American Academy of Orthopaedic Surgeons, n.d.a).

Over time, arches can fall. Overuse, being overweight, age-related changes in the tendon, a previous injury such as an ankle sprain, and conditions such as rheumatoid arthritis can all weaken the tendon running along the inside of the ankle that supports the arch (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). This is more common in women and in people over 40 (American Academy of Orthopaedic Surgeons, n.d.b).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Flat Foot

Treatment is only needed if your flat feet are causing problems. A family doctor or nurse practitioner may refer you to a specialist such as a podiatrist or physiotherapist, and in some areas you can refer yourself to a podiatrist. A foot specialist can advise you about shoes, insoles, foot stretches and exercises, and painkillers. These will not change the shape of your feet, but can help with pain or stiffness (NHS, 2025). An acquired flat foot is usually treated to rest and support the tendon and to strengthen it (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

Exercises to stretch a tight calf or Achilles tendon can help (American Academy of Orthopaedic Surgeons, n.d.a; American Academy of Orthopaedic Surgeons, n.d.b), and for adult acquired flat foot, specific exercises to strengthen the tendon are extremely important and, if done properly, may prevent the need for surgery (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.). I can guide you through these stretching and strengthening exercises, with hands-on work for your calf and foot. See the My Approach tab for how I work.

1. Arch Supports

Shoe insoles and arch supports can help to relieve pain (NHS, 2025). In children, custom-moulded arch supports usually offer little benefit over over-the-counter ones (American Academy of Orthopaedic Surgeons, n.d.a). For adults with a mild change in foot shape, an over-the-counter insert may be enough (American Academy of Orthopaedic Surgeons, n.d.b). I can help you work out whether one might help and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic. Arch supports may not change the shape of the foot, but they can help to reduce symptoms.

2. Proper Footwear

Wide, comfortable shoes with a low heel are usually best (NHS, 2025). Wearing non-supportive footwear such as sandals over a long time can add to tendon problems (American Academy of Orthopaedic Surgeons, n.d.b).

3. Pain Relief

The NHS (2025) says a foot specialist can give advice about painkillers. The American Academy of Orthopaedic Surgeons (n.d.b) says anti-inflammatory medicines, such as ibuprofen or naproxen, can reduce pain and inflammation in adult acquired flat foot, but they do not treat the underlying condition or change the shape of the foot; talk to your doctor about side effects first, especially if you have heart, kidney or stomach problems. (This medicine information comes from the NHS and the American Academy of Orthopaedic Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Brace or boot: a brace, or a boot or cast worn for a short time, may be used to rest the tendon in adult acquired flat foot (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
Surgery: surgery is rarely needed for flat feet. It may help if there is a problem with the bones, tissues or muscles in the feet and other treatments haven't worked (NHS, 2025). For adult acquired flat foot, it may involve repairing or transferring the tendon, lengthening the calf, or reshaping the bones (American Academy of Orthopaedic Surgeons, n.d.b).

How I can help (see the My Approach tab)

Hands-on work for the calf, lower leg and foot
Stretching and strengthening exercises for the arch and its tendon
Advice on footwear and arch supports

Tips

Avoid activities that aggravate the condition and make it worse. Try low-impact activities, such as cycling, swimming or an elliptical (cross-trainer) machine, instead of running and jumping (American Academy of Orthopaedic Surgeons, n.d.b).
For those who are overweight, losing weight is a very effective way to reduce the stress on the arch and the tendon that supports it (American Academy of Orthopaedic Surgeons, n.d.b; The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
As you get older, the tendon that supports the arch tends to lose its elasticity, which can lead to adult acquired flat foot (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
A previous injury to the ankle or foot, such as a sprain, can damage this tendon and lead to flat foot (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).
If a child's flat feet cause pain that doesn't go away, see a doctor (American Academy of Orthopaedic Surgeons, n.d.a).

Treatment

My Approach

Flat feet are often just the way your feet are, and massage doesn't change the shape of the foot. What I can help with are the aches, tight or tired muscles and stiffness that can come with it in your feet, ankles and lower legs. If your arch has dropped in adulthood, the focus shifts to resting and strengthening the tendon on the inside of the ankle that supports it.

I start by assessing how your feet and arches behave when you stand and walk, how your ankles and calves move, and the strength of the muscles that hold up your arch, and I look at your shoes.

Hands-On Treatment

Warmth first, then myofascial, kneading and trigger point work through the calf and the muscles down the outside of the lower leg, which can tighten and pull the foot inward
Brisk, stimulating work for the muscles along the front and inside of the shin and in the sole of the foot, which help hold the arch up
Calf stretches using the heel as the lever, so the arch isn't pushed down further
I avoid mobilising the already-loose joints along the inside of the arch

Exercise and Home Care

Band exercises for the muscles that lift the inner foot, and simple toe exercises
Pressing the base of the big toe down while lifting the arch, building from sitting to standing to heel raises with the arch held up
For a strained tendon, strengthening that builds gradually, with cycling, swimming or a cross-trainer instead of running and jumping in the meantime
Daily calf stretches, and a contrast foot bath after long days on your feet

Footwear and Arch Supports

Supportive shoes usually feel better than going barefoot or wearing flat sandals
I'll help you work out whether an arch support would help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic; build up wearing time gradually and stop if it's uncomfortable

For children, parents are welcome to sit in, with their child's agreement, and learn the exercises too.

If the inside of your ankle becomes painful and swollen, your foot gets flatter, or you can't rise up on tiptoe, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Usually visits start once a week, or twice if it's sore, then space out as you manage more on your own, with a reassessment at about 4 to 6 weeks. Most people notice their aches easing within about 6 to 12 weeks of regular exercise, while a strained tendon on the inside of the ankle can take several months of steady work.

What I Focus On

Assessment

Calf & Lower-Leg Release

Arch Strength

Footwear & Arch Support Advice

Low-Impact Activity

Please read

When to See a Doctor First

When to see your family doctor or nurse practitioner

See your family doctor or nurse practitioner if you have flat feet and

your feet are painful, stiff, weak or numb
you often get foot or ankle injuries
you have problems with walking or balance
you did not have flat feet before, or it only affects one foot

(NHS, 2025)

Signs of adult acquired flat foot include pain and swelling along the inside of the ankle, the foot becoming flatter, and being unable to rise up on to tiptoe (The Royal Orthopaedic Hospital NHS Foundation Trust, n.d.).

Sources

References

NHS (2025) Flat feet. Available at: https://www.nhs.uk/conditions/flat-feet/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.a) Flexible flatfoot in children. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/flexible-flatfoot-in-children/ (Accessed: 7 October 2026).
The Royal Orthopaedic Hospital NHS Foundation Trust (n.d.) Adult acquired flat foot (posterior tibial tendon dysfunction). Available at: https://roh.nhs.uk/services-information/foot-and-ankle/adult-acquired-flat-foot-posterior-tibial-tendon-dysfunction (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.b) Progressive collapsing foot deformity (flatfoot). OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/posterior-tibial-tendon-dysfunction/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooFlat Foot (Pes Planus)

What It Is

Flat Foot Anatomy

Self-Care & Treatment

How to Treat Flat Foot

1. Arch Supports

2. Proper Footwear

3. Pain Relief

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Home Care

Footwear and Arch Supports

Typical Course

When to See a Doctor First

When to see your family doctor or nurse practitioner

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooFlat Foot (Pes Planus)

What It Is

Flat Foot Anatomy

Self-Care & Treatment

How to Treat Flat Foot

1. Arch Supports

2. Proper Footwear

3. Pain Relief

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise and Home Care

Footwear and Arch Supports

Typical Course

When to See a Doctor First

When to see your family doctor or nurse practitioner

References

Related Conditions

Plantar Fasciitis

Morton's Neuroma

Shin Splints

Patellofemoral Pain Syndrome

Flexible Flatfoot in Children

Book a session