Painful Flat Feet: Causes, Exercises, Orthotics and What a Podiatrist Can Do

Introduction

Flat feet are common. Some people have flat feet all their lives and never have pain, difficulty walking or any need for treatment. For others, flat feet can become painful, especially when the arch, ankle or supporting tendons are overloaded.

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This article explains what flat feet are, why they can sometimes hurt, what can make them worse, and how a podiatrist may approach treatment. It also covers exercises such as heel-ball raises, toe scrunches, calf stretching and the use of orthotics.

The aim is not to frighten people about flat feet. The aim is to help you understand when flat feet are harmless, when they may need support, and when professional assessment is sensible.

What are flat feet?

Flat feet, sometimes called fallen arches or pes planus, occur when the inside arch of the foot sits lower than usual when standing. In some people, the whole sole of the foot appears to contact the ground.

There are different types of flat feet. Some are flexible, meaning the arch may appear when the person is sitting or standing on tiptoe but flatten when standing. Others are more rigid, meaning the arch remains low even when non-weight-bearing.

Flat feet can be present from childhood, run in families, or develop later in adulthood. Adult-onset flatfoot deserves more attention, especially if one foot becomes flatter, painful, swollen or weaker over time.

Do flat feet always cause pain?

No. Flat feet do not always cause pain.

Many people with flat feet walk, work and play sports without any problem. Having a low arch by itself does not automatically mean something is wrong.

Flat feet are more likely to become a problem when there is pain, fatigue, stiffness, swelling, difficulty walking, repeated ankle injuries or a noticeable change in foot shape. Pain may occur because the foot and ankle are having difficulty managing load.

In simple terms, the issue is not always the shape of the foot. The issue is whether the foot is coping well with the demands placed on it.

Where can painful flat feet hurt?

Painful flat feet can cause symptoms in different areas, including:

• the inside arch
• the inside of the ankle
• the heel
• the lower leg
• the outside of the ankle
• the ball of the foot
• the knees or hips in some people

One important structure often discussed with adult flatfoot is the posterior tibial tendon. This tendon runs behind the inside ankle and helps support the arch. If it becomes irritated, weak or dysfunctional, a person may feel pain along the inside of the ankle or arch.

The spring ligament is also important. This ligament helps support the head of the talus and contributes to the stability of the inside arch of the foot. In some adult flatfoot problems, the issue is not only the posterior tibial tendon, but also the supporting ligaments, including the spring ligament.

However, not every person with flat feet has posterior tibial tendon dysfunction or spring ligament injury. That is why assessment matters. The goal is to understand which structures are overloaded, painful or failing to support the foot properly.

What worsens flat feet?

Flat feet may feel worse when the foot is placed under more stress than it can tolerate. Common aggravating factors include:

• long periods of standing
• sudden increases in walking, running or exercise
• unsupportive shoes
• very flat sandals or slippers
• walking barefoot on hard floors when already painful
• tight calf muscles
• weak foot and ankle muscles
• weight gain or increased load
• previous injury
• tendon irritation
• arthritis or joint stiffness

This does not mean everyone with flat feet must avoid all these things. It means these factors should be considered when flat feet become painful.

Can flat feet be cured?

This is one of the most common questions people ask.

In many adults, treatment does not “cure” flat feet by permanently rebuilding the arch. Instead, treatment usually aims to reduce pain, improve function, support the foot, strengthen key muscles and reduce overload.

That is still valuable. The goal is not always to create a perfect-looking arch. The goal is to help the person walk, stand, work and exercise more comfortably.

Children are different. Many young children have flat feet as part of normal development, and the arch may develop naturally as they grow. Painful, stiff or one-sided flat feet in children should be assessed.

Can flat feet be reversed?

Sometimes the appearance of the arch may improve with strength, mobility and better control, especially in flexible flat feet. However, in many adults, especially where the flatfoot is long-standing, rigid or linked with tendon and ligament changes, the foot shape may not fully reverse.

This is why it is better to think in terms of function rather than perfection.

A more realistic question is:

Can painful flat feet become less painful and more functional?

In many cases, yes.

How do I stop my flat feet from hurting?

A good approach depends on why the flat feet hurt. A podiatrist would usually consider footwear, activity levels, tendon function, calf flexibility, foot strength, joint movement and whether the foot is flexible or rigid.

A practical treatment plan may include:

• supportive footwear
• orthotics or insoles
• calf stretching
• strengthening exercises
• activity modification
• reducing barefoot walking on hard floors if painful
• gradual return to walking, running or sport
• referral if symptoms suggest a more serious problem

Painful flat feet are rarely solved by one thing alone. In practice, the best results often come from combining support, strengthening and load management.

My podiatry approach to painful flat feet

When treating painful flat feet, I do not focus only on the arch. I look at the whole picture: pain location, walking pattern, footwear, activity level, calf flexibility, tendon load, foot strength and how long the problem has been present.

A common approach may include four key areas:

1. heel-ball raises
2. toe scrunches
3. calf stretching
4. arch taping
5. orthotics or supportive insoles

These are not used randomly. They are selected depending on the person’s symptoms, foot type, tolerance and goals.

Heel-ball raises for flat feet

Heel-ball raises are a useful strengthening exercise in some people with painful flat feet.

The aim is to build better control through the foot and ankle while strengthening the calf and the muscles that help support the arch. A common version involves rising slowly onto the balls of the feet while keeping the movement controlled, then lowering slowly until they touch the floor.

Some clinicians use a small ball between the heels or ankles during the movement to encourage better alignment and control. The exercise should feel controlled, not forced.

A simple version may look like this:

1. Stand near a wall or chair for balance.
2. Keep the feet hip-width apart.
3. Slowly rise onto the balls of the feet.
4. Control the movement at the top.
5. Slowly lower back down.
6. Stop if the exercise causes sharp pain.

This exercise may be progressed gradually, but it should not be rushed. If someone has strong pain along the inside ankle or arch, they may need assessment before loading the tendon aggressively. This exercise helps to strengthen the tibialis posterior muscle and tendon.

Toe scrunches for intrinsic foot muscle strength

Toe scrunches are often used to help activate and strengthen the small muscles inside the foot, known as the intrinsic foot muscles.

These muscles help with foot control and stability. They do not work alone, and they are not a magic cure for flat feet, but they can be a useful part of a wider programme.

A simple toe scrunch exercise may involve placing a towel under the foot and gently drawing it toward you using the toes. It should be done for approximately 3 minutes.

The key word is gently. The toes should not cramp, claw painfully or grip aggressively. If toe scrunches cause toe pain, arch cramping or discomfort under the ball of the foot, the exercise may need to be modified.

Toe scrunches are best seen as one part of foot strengthening, not the whole treatment plan.

Calf stretching for flat feet

Calf tightness can affect how the foot works. If the calf or Achilles tendon is tight, the foot may compensate during walking, sometimes increasing strain through the arch or inside ankle.

Calf stretching may help when tightness is contributing to symptoms.

A basic calf stretch can be done against a wall:

1. Place one foot behind the other.
2. Keep the back heel on the ground.
3. Keep the back knee straight.
4. Lean forward until a stretch is felt in the calf.
5. Hold the stretch comfortably.
6. Repeat on both sides.

A bent-knee version may also be used to target the deeper calf muscle.

Stretching should feel like a comfortable pull, not sharp pain. Stretching alone usually does not fix painful flat feet, but it can help when combined with strengthening, footwear changes and orthotic support.

Arch taping

Arch taping may also be used as a short-term support strategy for painful flat feet. The aim is to help support the inside arch, reduce strain on irritated tissues and make walking or standing more comfortable while the foot settles.

Taping is not usually a permanent solution, but it can be useful as part of a wider treatment plan that includes strengthening exercises, calf stretching, footwear advice and orthotics where needed.

It may also help indicate whether extra arch support could be beneficial before considering insoles or orthotics.

Arch taping should feel comfortable. It should not cause numbness, increased pain, skin irritation, tingling or restricted circulation.

Orthotics for flat feet

Orthotics, also called insoles or foot orthoses, can be very helpful for painful flat feet when the foot needs support.

The purpose of an orthotic is not simply to “push up the arch.” A good orthotic may help improve foot position, reduce strain on irritated tissues, support the inside arch, improve comfort and help the person tolerate daily activity better.

Some people do well with prefabricated insoles. Others may need custom orthotics, especially if symptoms are more persistent, one foot is more affected, the foot shape is more complex, or there are associated tendon problems.

Orthotics work best when they are part of a wider plan. They should usually be combined with suitable footwear, strengthening, stretching and advice on activity.

What shoes are best for flat feet?

Shoes matter. A good shoe can make orthotics work better and reduce strain on the foot.

For painful flat feet, useful shoe features may include:

• a firm heel counter
• good midfoot support
• enough width in the toe box
• a stable sole
• a low to moderate heel height
• enough depth for an orthotic if needed
• a sole that bends at the toes, not excessively through the middle

Very flat, flimsy or unsupportive shoes may make symptoms worse in some people, especially if they are already experiencing arch, heel or ankle pain.

This does not mean everyone with flat feet needs heavy shoes. It means the shoe should match the person’s symptoms, foot shape and activity level.

Is walking barefoot good for flat feet?

It depends.

Some people with flat feet can walk barefoot comfortably. Others find that barefoot walking on hard floors makes their arch, heel or ankle pain worse.

If flat feet are painful, reducing barefoot walking for a period may help calm symptoms. Supportive slippers, sandals or indoor shoes may be useful for people who get pain walking around the house.

Barefoot strengthening may have a role in some people, but it should be introduced gradually and not used as a blanket recommendation for everyone.

Can stretching help flat feet?

Stretching can help if tight calves or limited ankle movement are contributing to symptoms. However, stretching alone is unlikely to “fix” flat feet.

A better approach is usually:

• stretch what is tight
• strengthen what is weak
• support what is overloaded
• improve footwear
• manage activity levels

This combination is more realistic than relying on one exercise.

What muscle is weak with flat feet?

There is not always one single weak muscle.

In painful flat feet, several structures may be involved, including:

• posterior tibial tendon and muscle
• intrinsic foot muscles
• calf muscles
• peroneal muscles
• muscles controlling the hip and leg during walking

The posterior tibial tendon is often discussed because it helps support the arch and control the foot during walking. But painful flat feet are usually not just a single-muscle problem. They are usually a load, strength, support and movement problem.

Are calf raises good for flat feet?

Calf raises can be useful, especially when they are controlled and introduced gradually. Heel-ball raises are one way to make the movement more focused and controlled.

However, calf raises are not right for everyone at every stage. If a person has strong pain, swelling or suspected posterior tibial tendon dysfunction, they may need a modified programme. In some cases, starting with double-leg raises, seated raises, isometric work or professional guidance may be safer.

The rule is simple: strengthening should build capacity, not flare the problem.

What do podiatrists do for flat feet?

A podiatrist may assess:

• where the pain is
• when the pain started
• whether one or both feet are affected
• whether the flatfoot is flexible or rigid
• footwear
• walking pattern
• calf flexibility
• foot and ankle strength
• tendon pain
• swelling
• skin and nail issues
• medical history, including diabetes or inflammatory conditions

Treatment may include footwear advice, orthotics, stretching, strengthening, taping, activity modification or referral for imaging or specialist opinion when needed.

The treatment depends on the person, not just the foot shape.

What is Stage 3 flatfoot?

Stage 3 flatfoot usually refers to a more advanced, rigid flatfoot deformity. At this stage, the foot may be less flexible, and there may be joint involvement or arthritis.

This is different from a flexible flat foot that simply lowers when standing.

If someone has been told they have Stage 3 flatfoot, they should not rely only on online exercises. They need proper assessment and management.

What is Stage 4 flatfoot?

Stage 4 flatfoot usually means the deformity has progressed enough to involve the ankle joint as well as the foot.

This is a more serious stage and may require specialist assessment. Treatment may involve bracing, custom orthoses or surgical discussion depending on pain, function, deformity and general health.

Stage 4 flatfoot is not something to self-treat with generic exercises.

How long do flat feet take to fix?

This depends on the meaning of “fix.”

If the aim is to reduce pain, improvement may happen over weeks to months with the right combination of footwear, orthotics, stretching, strengthening and load management.

If the aim is to permanently change the shape of an adult flat foot, that is much less predictable. Many adult flat feet do not fully reverse without surgery, and surgery is only considered in selected cases.

A realistic goal is usually better comfort, better function and less strain.

Is it ever too late to correct flat feet?

It is rarely too late to improve comfort and function, but the type of treatment changes depending on the stage of the problem.

A flexible painful flat foot may respond well to exercises, footwear changes and orthotics. A rigid, arthritic or severe flatfoot may need bracing or specialist opinion.

The earlier a painful adult flatfoot is assessed, the easier it may be to manage conservatively.

When should you see a podiatrist?

You should consider seeing a podiatrist if:

• your flat feet are painful
• one foot has become flatter than the other
• you have swelling along the inside ankle
• you have pain when walking or standing
• you keep getting ankle injuries
• your feet feel weak, stiff or numb
• your shoes are wearing unevenly
• pain is not improving with basic care
• you have diabetes, circulation problems or reduced sensation
• the problem started suddenly
• you are finding it harder to walk or balance

Flat feet are usually not an emergency, but painful or changing flat feet should be assessed.

Final thoughts

Flat feet are not automatically a problem. Many people have flat feet and never need treatment.

But when flat feet become painful, the answer is not simply to “build an arch” or buy any insole online. The better approach is to understand why the foot is hurting.

In my approach, painful flat feet are managed by looking at support, strength, flexibility, footwear and load. Heel-ball raises, toe scrunches, calf stretching and orthotics can all play a role when used appropriately.

The goal is simple: reduce pain, improve walking, support the foot and help the person return to daily activity with more confidence. Good Luck!

References

• Ghorbani, M., Yaali, R., Sadeghi, H. and Koumantakis, G.A. (2025) ‘The impact of flatfeet on the correlation between functional movement scores, balance, agility, and core muscle strength in young females: a cross-sectional study’, Scientific Reports, 15, article number 5077. doi: 10.1038/s41598-025-89364-8.
• Kolhe, P.D., Sharath, H.V., Rathi, S.G. and Patil, D.S. (2024) ‘Effect of foot rehabilitation exercises for painful flat foot in a 20-year-old female: A case study analysis’, Cureus, 16(4).
• Moore, J. and Tafti, D. (2026) ‘Pes Planus’, in StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.