Flat Feet and Treatment Options

“Human feet are a masterpiece of engineering and a work of art.” (Leonardo da Vinci)

Our feet consist of 26 bones, 33 joints, and 19 muscles, totaling a length of approximately 5.7 meters. They are also made up of 107 ligaments, arteries, veins, and nerves, which stretch over 1.6 kilometers, not including hundreds of thousands of sweat glands and pores. The foot is one of the most heavily loaded parts of the body, and the functions it performs are proportional to its complex structure. In order for our feet to serve us at their full potential, well-shaped arches are crucial for their function.

Longitudinal and Transverse Arches Support the Body and Protect the Joints from Overload

Our feet have two longitudinal arches and one transverse arch, which absorb shocks when we land on hard surfaces. The longitudinal arch of the foot runs between the heel and the big toe (inner longitudinal arch) and also between the heel and the little toe (outer longitudinal arch). The transverse arch extends from the big toe joint to the little toe joint. The structure of the arch determines how we walk. Arches must be firm yet flexible to adapt to loads and different surfaces. Their role is to relieve pressure on the joints and protect the spine from large shocks. Arches also provide flexibility and mobility in the center of the foot, aiding in even weight distribution and overall body balance. If body weight distribution is asymmetrical, we might notice that shoes wear unevenly or more quickly, especially on one side.

What is Flat Foot?

People with flat feet have either a very low arch or no arch at all, meaning one or both feet may make full contact with the ground. Flat feet are the most common foot diagnosis in both adults and children. When the foot is flat, the rest of the body must compensate for this deficiency. Changes occur in the load and movement axes of all the joints above the foot, leading to increased stress on the ankles, knees, and back. Flat feet then affect the body’s alignment while standing, walking, or running.

Flat Feet in Children

Children are not born with arches; they develop gradually based on not only genetic factors but also the muscular coordination of the entire lower extremities and body. Many factors contribute to the development of the arch.

From birth to 2-3 years, children’s feet have a fat pad on the inner side, which makes babies’ footprints flatter. This fat pad gradually disappears, and the stiffness of the ligaments changes. Arch formation can only be assessed when the gross motor skills and foot development are mature (around 4 years old). However, physiotherapists primarily assess function, not structure. If you feel that development is not proceeding correctly, do not wait. An experienced physiotherapist can evaluate muscle activity and foot function at a very early age. How muscles function ultimately shapes bones, arches, and the overall structure. Early childhood is a crucial period for this development. Often, only a small stimulus is needed to support natural growth, and the results will show soon after.

Flat Feet in Adults

In adulthood, flat feet often develop due to excessive looseness of the ligaments combined with muscle weakness. Other common risk factors include being overweight, pregnancy, joint diseases (such as rheumatoid arthritis), or genetic factors.

Stages of Flat Feet Based on Severity

• Stage 1 (Mild): The condition only manifests under static loading, with mild widening in the middle part of the foot. The arches reappear during movement, standing on tiptoes, or squatting. The condition is almost always bilateral. Movement is pain-free, but shoes may wear faster on the inner side due to increased load.
• Stage 2 (Moderate): The deformity is visible even during movement. Walking puts stress on the inner part of the foot, where the longitudinal arch should prevent contact with the ground. Walking can become tiring and painful after a while, with swelling in the feet and ankles. Physiotherapy can still influence the condition at this stage, returning the feet to a pain-free state.
• Stage 3 (Severe): A clear deformity is present in the shape of the foot. Arches can no longer be actively formed, as the tissues have adapted to poor habits. The footprint shows no arch, and there is noticeable widening on the inner side. The deformity is structural and is accompanied by pain when walking and after exertion.

How Does Flat Foot Pain Feel?

Many people with flat feet may not experience any discomfort. The most common symptom is pain due to overstrained muscles or ligaments. In more severe cases, swelling or stiffness can occur. If the condition continues to be aggravated by ill-fitting shoes, obesity, or excessive physical activity, further complications may develop. These conditions are usually quite bothersome and have a high risk of becoming chronic.

Common Complications Associated with Flat Feet

• Metatarsalgia: Pain in the forefoot, often caused by the collapse of the transverse arch. Initially, it feels like walking with a pebble in the shoe, which progresses to a sharp, burning pain, with numbness or tingling in the toes. Pain worsens when standing, running, or walking barefoot.
• Fatigue Fracture of the Metatarsus: This type of fracture occurs due to excessive physical stress rather than an injury. Microfractures form in the bones under strain. If the foot is overloaded before the cracks can heal, they deepen into a fracture. Runners, for example, often suffer from fractures of the second metatarsal. Initially, it causes pain only during activity but later during rest, eventually leading to an inability to move, with swelling at the site.
• Plantar Fasciitis: Pain in the bottom of the heel, typically a stabbing pain in the foot arch. It is most noticeable when taking the first steps in the morning or after a period of rest. This is caused by inflammation of the foot fascia, which has been exposed to excessive strain. Micro-tears, irritation, and degenerative changes lead to inflammation over time.

Other common complications include Achilles tendonitis, bunions (hallux valgus), hammer toes, and heel spurs.

How Can Physiotherapy Help?

In most cases, physiotherapy can be effective in treating flat feet. The main benefit of physiotherapy is alleviating problems associated with flat feet. At Fyzio svět, we teach you how to care for your feet and move naturally with them. You will learn techniques and exercises to improve arch function and enhance posture. If you are experiencing pain, physiotherapists can relieve it through joint mobilization, muscle, and fascia release. In some cases, we use shockwave therapy or high-performance lasers in treatment. Properly conducted physiotherapy accelerates healing, eases pain, and reduces swelling in acute conditions. Other effective techniques include taping or working with floss bands.

We will also advise you on suitable footwear and insoles to improve foot positioning. A tailored program will improve walking quality, stability, and coordination, reducing pain and the risk of future health issues.

For information on the use of orthopedic insoles or barefoot shoes, see the next article.

When to See a Specialist?

• Flat feet have developed suddenly and recently.
• Pain is present in the feet, ankles, or lower legs.
• Symptoms do not improve even with well-fitting supportive shoes.
• Persistent feelings of stiff, heavy, or clumsy feet.

7 Exercises for Arch Training at Home

1. Sit on a chair with your feet touching the ground. Place a golf ball under your foot and gently press it while rolling it back and forth under the arch for 2 minutes to stretch the fascia and ligaments.
2. Sitting, clench your right fist and massage your left foot with your knuckles for at least 30 seconds. Repeat with the other foot.
3. With relaxed feet, slowly lift your big toe while keeping the other toes on the ground. Reverse the movement by lifting the other toes and keeping the big toe on the floor. Repeat for 2 sets of 10.
4. Stand with your feet shoulder-width apart and use a wall for support. Step one foot forward and the other backward, keeping the toes facing forward. The front leg should be bent, and the back leg straight. Lean forward gently until you feel a stretch in the back calf. Hold for 30 seconds, repeating twice.
5. Place a small ball between the big toes of both feet while standing. Try to maintain the ball in place by using both big toes. Practice for 2 minutes.
6. Stretch the foot fascia by getting on all fours. Keep your knees under your hips and hands under your shoulders. Push your toes into the ground while lifting your knees by about 10 cm, holding for a few seconds, then lower them. Repeat 5 times with a 10-second hold.
7. Stay in the same position as in exercise 6, but instead of lifting the knees, move your pelvis backward toward your heels. Keep the spine straight and feet parallel throughout the movement. Try to maintain the center of the heels aligned with the second or third toe. Repeat 10 times.

At Fyzio svět, we specialize in treating flat feet and would be happy to help you.