Flat Feet & Fallen Arches: Causes, When to Worry and Treatment

Flexible vs Rigid Flat Feet

The most important distinction your podiatrist will make is whether your flat foot is flexible or rigid. A simple way to tell: stand on tiptoes — if an arch forms, your flat foot is flexible.

Flexible flat feet

The arch is visible when you're sitting or on tiptoes and disappears when you stand. This is by far the most common type, and most flexible flat feet are painless and need no treatment. Supportive footwear, strengthening exercises and occasional insoles are usually all that's needed — if anything.

Rigid flat feet

The arch is flat whether sitting, standing or on tiptoes. Rigid flat feet are more likely to be painful and are often caused by an underlying problem with the bones, joints or tendons. These feet always warrant a proper podiatric assessment, and sometimes imaging, to identify the cause and prevent long-term joint wear.

Flat Feet in Children: What's Normal and When to Get Them Checked

Flat feet are the norm in babies and toddlers — nearly all young children have flexible flat feet, and a padding of baby fat makes the foot look even flatter. Arches develop gradually as the bones strengthen and the ligaments tighten, usually forming by around age 6–8. Most children outgrow flat feet completely, and a flexible flat foot that causes no pain needs no treatment.

It's worth getting your child checked if:

• Pain: they complain of foot, ankle or leg pain, or point to their arches or heels after activity
• Stiffness: the foot seems stiff rather than supple, or they struggle with movements other children find easy
• One foot only: one foot is flatter than the other, or the shape has changed suddenly
• Tripping: they trip or fall frequently, or walk awkwardly
• Tiring quickly: they fatigue fast on walks, want to be carried, or start avoiding running and play because of their feet
• Stays flat on tiptoe: the arch doesn't reform when they stand on tiptoes — a sign the flat foot may be rigid

We see children of all ages at our Sydenham, Covent Garden and Croydon clinics. A simple gait and foot-posture check gives parents reassurance and, where needed, early advice on footwear and exercises to support healthy development.

Adult Acquired Flat Foot (Fallen Arches)

When an adult's arch gradually lowers — a "fallen arch" — it's usually because the supporting tendons and ligaments are straining or weakening. Common triggers include age, weight gain, pregnancy, injury, inflammatory arthritis, and years of unsupportive footwear.

The most common cause of a progressive adult flat foot is posterior tibial tendon dysfunction (PTTD), where the main arch-supporting tendon on the inside of the ankle becomes overloaded and starts to fail. Early treatment protects the tendon and can prevent permanent arch collapse.

Read our dedicated page on posterior tibial tendon dysfunction (PTTD) for the stages, symptoms and treatment of this specific condition.

Symptoms That Mean You Should See a Podiatrist

Flat feet themselves aren't a diagnosis — get assessed if you notice any of the following:

• Pain or aching on the inside of the foot or ankle, especially after activity
• Swelling along the inside of the ankle
• Feet that tire quickly, or calf and leg fatigue with everyday walking
• Heel pain, arch pain or pain on the outside of the ankle
• A visibly lowering arch, or feet that roll inwards (overpronation) when you walk
• One foot becoming flatter than the other, or a rigid arch that won't reform on tiptoes
• Knee, hip or lower back pain linked to the way your feet roll — see our guides on feet, orthotics and knee pain and can foot problems be causing your back pain?

At Flawless Feet, your gait analysis & biomechanical assessment (£170) includes gait analysis, foot posture and joint range of motion testing, muscle strength checks, and diagnostic ultrasound if we need to look at tendon health directly — giving you a clear diagnosis and treatment plan.

Treatment for Flat Feet: From Footwear to Surgery

Treatment follows a clear ladder — we always start with the simplest options that will work for your foot type and lifestyle:

1. Footwear

For many people with painless flat feet, well-fitting supportive shoes with good arch support and a firm heel counter are all that's needed. We provide tailored footwear advice — especially important for active individuals or physically demanding jobs.

2. Off-the-Shelf Insoles

Ready-made supportive insoles are an affordable first step for mild aching or fatigue. They suit many people and are often the only intervention required.

3. Custom Orthotics

Custom-made foot orthotics are prescribed when off-the-shelf support isn't enough. Made in-house to fit your foot and shoe type — daily wear, sports, or formal — they redistribute pressure, control overpronation and support the arch. Custom orthotics start from £350 (an additional pair costs £290).

4. Exercises

Targeted strengthening (particularly of the tibialis posterior and foot muscles) and stretching programmes improve foot biomechanics and prevent further arch collapse.

5. Therapies (Laser & Shockwave)

Where tendons are strained or inflamed, we may add Low-Level Laser Therapy or Shockwave Therapy as an adjunct — to stimulate healing, reduce inflammation and relieve tendon pain without surgery. They are used alongside, never instead of, the mechanical support above (footwear, insoles or orthotics and exercises), and only where tendon pain — not the flat foot itself — is the problem.

6. Surgery Referral

Surgery is only considered when symptoms are severe, the arch deformity is rigid and progressive, or conservative treatment has failed. If appropriate, we refer you to a trusted foot and ankle surgeon and co-ordinate your care before and after.

Why Choose Flawless Feet Podiatry & Laser Clinic?

• Highly experienced podiatrists and chiropodists in London with expertise in foot posture, gait and arch problems
• Access to state-of-the-art treatments including shockwave and laser therapy
• Customised orthotic solutions made in-house
• Multiple clinics across London – Sydenham, Covent Garden, and Croydon
• Friendly, professional, and holistic approach — with honest advice about when no treatment is needed