Flat Feet: Causes, Effects and How to Address Them
Your feet feel fine when you leave home, but by mid-afternoon, your arches ache, your calves feel tight, and standing becomes uncomfortable. You blame the long working day, yet the same discomfort returns after your weekend run. Could flat feet be contributing to the problem?
At ATLAS, clients rarely come in complaining about their arches. They describe tired legs, persistent calf tightness, or knee and lower back discomfort they have never connected to their feet.
Flat feet are not automatically a problem. Some people live comfortably with low arches, while others develop symptoms that affect everyday movement. The important question is whether your arches have always been low or whether your feet have recently started changing.
What Are Flat Feet, and What Causes Them?
Flat feet occur when the arches along the inside of your feet are unusually low or flatten when you stand. Your arch helps distribute weight, adapt to uneven surfaces, and manage forces as you walk.
The (Hong Kong College of Orthopaedic Surgeons) estimates that approximately 15% of adults have low arches or flat feet. Many experience no discomfort and need no treatment. To understand why, it helps to distinguish between naturally low arches and changes that develop later in life.
Flexible Flat Feet and Naturally Low Arches
Some people inherit naturally low arches or have more flexible ligaments connecting the bones in their feet. Their arches flatten when standing but reappear when sitting or rising onto their toes.
This is known as flexible flat feet. If your feet have looked this way since childhood and you can walk, stand, and exercise comfortably, there may be nothing to correct.
Rigid flat feet are different. The arch stays low even without weight on the foot, and movement through some foot joints may be restricted. These changes may warrant further assessment, particularly when accompanied by pain.
Why Foot Arches Can Fall in Adulthood
An arch that becomes flatter later in life deserves closer attention. The posterior tibial tendon runs behind your inner ankle and helps support your arch. When it becomes damaged or weakened, the foot may gradually lose support. Ligaments and joints can also contribute to this progressive change.
Someone might initially notice soreness behind the inner ankle, followed by increasing difficulty rising onto the toes or maintaining the arch while standing. Recognizing these changes early matters because progressive arch collapse may require more specific treatment. A persistent change affecting one foot, especially when accompanied by swelling or weakness along the inner ankle, deserves professional assessment.
Aging, injuries, increased body weight, and certain medical conditions may increase the risk. Long hours standing or sudden increases in training can aggravate symptoms, although they do not necessarily cause structural arch collapse.
At ATLAS, we distinguish between a foot that has always been flat and one that has recently changed. A flat foot is a shape, not a diagnosis.
Common Flat Feet Symptoms and Changes to Watch For
Flat feet symptoms can include aching arches, inner-ankle discomfort, tight calves, and tired legs after prolonged standing. However, many people with low arches experience no symptoms. What matters is whether the discomfort keeps returning, changes how you move, or begins interfering with your normal routine.
Foot Pain, Ankle Discomfort, and Tired Legs
One common complaint is feet that feel heavy by mid-afternoon. You may also notice aching along the arch, tenderness around the inner ankle, or calves that remain tight despite stretching.
Some people notice their shoes wearing faster along the inner edge. Although this can suggest a particular loading pattern, shoe wear alone cannot diagnose flat feet. These symptoms can also have other causes, so persistent discomfort needs more than a quick look at your arch.
Changes in Walking, Balance, and Everyday Movement
Sometimes the first noticeable change is what you can comfortably do. Perhaps you could previously spend an entire day walking around Central without trouble. Now your feet start aching after a few hours, or your usual weekend run leaves your calves unusually sore.
Other clients report knee, hip, or lower back discomfort alongside their foot symptoms. These complaints do not necessarily share the same cause, but they raise questions about how the feet and legs move together.
Signs That Your Foot Function Is Changing
Pay attention when one foot becomes noticeably flatter, rising onto your toes becomes difficult, or an arch that was previously comfortable starts hurting. Discomfort that once disappeared after resting but now persists into the following day also deserves attention.
Difficulty performing a heel raise may indicate pain or weakness involving the calf or posterior tibial tendon. A newly flattening arch may also suggest changes in the structures supporting the foot. Neither finding confirms a particular condition, but both deserve a closer look.
How Flat Feet Can Affect Your Knees, Hips, and Back
A change in how your foot bears weight can affect the movement of your ankle, knee, and hip. That connection becomes particularly relevant when you develop discomfort while walking or running. Think of the arch as a spring. It helps your foot adapt to the ground and manage forces with each step.
How Fallen Arches Influence Lower-Body Movement
When an arch lowers under weight, the foot may roll farther inward. This movement is called overpronation. Depending on the person, increased inward rolling may accompany changes in lower-leg rotation, knee tracking, and hip movement.
However, foot posture and foot movement are different. Having a low arch does not automatically mean your foot rolls excessively inward when walking. Likewise, someone may overpronate without having persistently flat arches.
The (Framingham Foot Study) examined whether foot posture was associated with knee pain. The association with knee pain overall was no longer statistically significant after accounting for age, sex, and body mass index, although a separate analysis found an association with knee pain occurring without pain at other lower-extremity joints. These findings suggest that the relationship is complex and do not establish that flat feet cause knee pain.
Why Symptoms May Increase With Standing or Exercise
Activity places repeated demands on your feet and legs. If their strength or capacity cannot comfortably manage those demands, discomfort may become more noticeable.
This is familiar among professionals who spend weekdays at desks in Central or Admiralty, then move into running, gym sessions, or HYROX training over the weekend. A sudden increase in training intensity can aggravate existing discomfort. At ATLAS, we consider how your feet, ankles, knees, and hips work together, rather than assuming the painful area is the only one involved.
How to Manage Flat Feet and Support Better Movement
Foot exercises, suitable shoes, and adjustments to daily activity can help manage mild discomfort associated with flat feet. These approaches aim to make walking, standing, and exercise more comfortable. However, significant pain, worsening weakness, or a newly collapsing arch deserves assessment before starting a generic exercise programme.
Exercises That Strengthen and Support Your Feet
Two exercises from our clinical approach can help you work on foot muscle control and balance. Both are simple enough to practise at home, provided you can perform them comfortably. Short-foot exercises activate muscles that support the arch, while single-leg balance helps you practise controlling your weight and maintaining stability.
- Short-foot exercise: Start seated with your foot flat on the floor. Keep your heel and toes touching the ground, then gently draw the base of your big toe towards your heel without curling your toes or gripping the floor. Hold for a few seconds and repeat 10–15 times as tolerated. Once you can perform the movement comfortably, try progressing to standing.
- Single-leg balance: Stand on one foot for approximately 30 seconds, then change sides. Hold a stable surface if necessary, particularly if your balance feels uncertain.
A (2023 systematic review in the Journal of Athletic Training) examined 13 studies and found that intrinsic foot muscle training improved measures of foot strength, balance, and posture. However, the pooled evidence did not show superior pain reduction. These exercises can support foot function, but they are not a guaranteed solution for discomfort.
Stretching Tight Calves and Relieving Arch Discomfort
Tight calves can make walking and standing uncomfortable, particularly after long periods on your feet. Try standing facing a wall with one leg behind you. Keep your back heel on the floor and gently bend your front knee until you feel a comfortable stretch through the rear calf.
You should feel gentle tension through the calf rather than (pain around your ankle or arch). Avoid forcing the movement farther than feels comfortable.
You can also roll the underside of your foot over a small ball for one or two minutes. This may temporarily ease discomfort around the plantar fascia, the strong band of tissue running along your sole. Keep the pressure gentle and stop if stretching or rolling makes your symptoms worse.
Choosing Supportive Footwear and Considering Orthotics
Shoes that fit properly and provide comfortable support can make prolonged standing easier. Replace trainers when they become excessively worn rather than relying on the same pair indefinitely.
Foot orthotics, or shoe inserts, may help some people experiencing pain from flat feet. Their benefits vary according to the individual and the condition being treated.
A (systematic review published in 2023) examined nine studies, including five involving 268 adults. Its analysis suggested that orthoses might reduce pain in adults with flexible flat feet, although differences between studies limited firm conclusions.
Orthotics provide support, but they do not necessarily rebuild the arch. Not everyone with flat feet needs them, so your symptoms and the demands of your daily activities should guide the decision.
Managing Training Load and Prolonged Standing
Even supportive shoes may not prevent discomfort if you increase your running distance too quickly or stand for hours without moving. If you are beginning a running programme or increasing your gym sessions, build gradually rather than suddenly doubling your training demands. Pay attention to discomfort that persists after exercise.
For example, if you are returning to running after several inactive weeks, begin with shorter, manageable sessions instead of immediately attempting your previous distance. Increase your workload according to how comfortably you move and recover between sessions.
On long workdays, change positions and walk around periodically instead of standing still for hours. Even brief movement breaks can make prolonged standing more manageable.
When Should You Seek Professional Help for Flat Feet?
Not every low arch needs attention. The decision depends on whether your feet are changing, causing discomfort, or limiting what you can do.
If your flat feet have remained stable since childhood and you experience no symptoms, treatment is generally unnecessary. Arrange a professional assessment if you notice (persistent foot pain), a newly flattening arch, swelling along the inner ankle, increasing weakness, or difficulty walking and exercising.
A foot and ankle specialist may need to investigate progressive changes or suspected tendon problems. Progressive neurological weakness or foot drop requires prompt medical evaluation. New saddle numbness or loss of bladder or bowel control, particularly with back or neurological symptoms, requires emergency medical attention.
How ATLAS Assesses Flat Feet and Whole-Body Function
At ATLAS, we assess; we don't guess. Rather than judging your feet solely by their appearance, we examine how they behave when you stand, walk, and move. We also ask when your discomfort starts, whether it improves with rest, and whether your arch or walking tolerance has changed.
Checking Arch Flexibility, Ankle Mobility, and Tendon Function
We begin by looking at your arch while sitting and standing. We may also ask you to rise onto your toes to see how the arch responds when your calf muscles work.
Heel-rise testing helps us examine calf function and the performance of structures supporting the arch, including the posterior tibial tendon. We also check ankle and big-toe movement, tenderness, and differences between your feet. Pain or weakness during these tests may indicate that further medical investigation is appropriate.
Assessing Walking Patterns, Balance, and Joint Movement
Foot discomfort may involve more than the arch, particularly when your symptoms appear during walking or exercise. We observe how you walk, where your feet bear weight, and how steadily you balance on one leg. When your symptoms suggest wider involvement, we also examine knee movement, hip control, pelvic position, and lower back mobility.
How Assessment Findings Shape Your Care Plan
Your symptoms and assessment findings help us decide what care or further investigation may be appropriate. For example, a client with painless flexible flat feet, good strength, and comfortable movement may not need active treatment. Someone with progressive arch collapse, inner-ankle pain, and difficulty performing a heel raise may need further assessment by a foot and ankle specialist.
Where relevant, ATLAS may also use CLA Insight measurements as part of its broader chiropractic assessment. These measurements do not diagnose flat feet, posterior tibial tendon problems, or neurological conditions, and they are not necessary for every client.
Chiropractic adjustments do not have established evidence for permanently rebuilding fallen arches. Follow-up focuses on meaningful changes, such as whether discomfort has eased, walking has become easier, or you can manage daily activities more comfortably. We examine how you move, recommend suitable next steps, and refer you for medical care when your findings call for it.
Can Flat Feet Be Corrected in Adults?
Adults with flat feet may improve their comfort and foot function through exercises, orthotics, or condition-specific treatment. However, these approaches do not necessarily change the arch permanently.
Progressive arch collapse may require specialist care, depending on the underlying cause and severity. Treatment focuses on managing symptoms and addressing the structures involved.
Can Flat Feet Get Worse With Age?
Yes, some people develop flatter arches as they get older. Changes affecting tendons, ligaments, and joints can gradually reduce the support beneath the foot. However, aging does not mean everyone with flat feet will develop pain or deformity.
A noticeable change in one arch, especially with inner-ankle pain, swelling, or weakness, deserves assessment. Progressive adult-acquired flat feet may require different management from the flexible, painless flat feet someone has had since childhood.
Is Walking Barefoot Good or Bad for Flat Feet?
Walking barefoot is not automatically harmful if you have flat feet. Whether it feels comfortable depends on your symptoms, strength, the surface, and how much activity you undertake.
Some people with flexible flat feet walk barefoot without difficulty. Others experience arch or ankle discomfort on hard surfaces and feel better in supportive footwear. If barefoot walking feels comfortable, you can begin with short periods on safe surfaces and increase gradually. If it repeatedly causes pain, avoid forcing yourself through it and consider assessment if the problem continues.
Sources
- Cleveland Clinic — Flat Feet (Pes Planus): Types, Symptoms & Treatment — https://my.clevelandclinic.org/health/diseases/flat-feet-pes-planus
- Hong Kong College of Orthopaedic Surgeons — Flexible Flat Feet — https://www.orthoinfo-hkcos.org/?c=8&i=31&lang=1&route=injuries-detail&t=115
- Journal of Athletic Training — Evidence for Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-Analysis — https://pmc.ncbi.nlm.nih.gov/articles/PMC10784881/
- BMC Musculoskeletal Disorders — Foot Orthoses for Flexible Flatfeet in Children and Adults: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes — https://pmc.ncbi.nlm.nih.gov/articles/PMC9825043/
- Mayo Clinic — Flatfeet: Symptoms and Causes — https://www.mayoclinic.org/diseases-conditions/flatfeet/symptoms-causes/syc-20372604
- Mayo Clinic — Flatfeet: Diagnosis and Treatment — https://www.mayoclinic.org/diseases-conditions/flatfeet/diagnosis-treatment/drc-20372609
- Arthritis Care & Research — Associations of Foot Posture and Function to Lower Extremity Pain: The Framingham Foot Study — https://pmc.ncbi.nlm.nih.gov/articles/PMC4039193/
Final Thoughts
Flat feet are not automatically something you need to fix. What matters is how comfortably your feet support your daily activities and whether that has started to change.
Exercises, supportive footwear, and sensible activity adjustments may help manage mild discomfort. Persistent pain, progressive arch changes, or weakness deserve closer assessment.
If your feet or legs are making everyday movement difficult, (contact ATLAS). We can assess your symptoms, examine how you move, and help you understand the most appropriate next steps.
