Flat Feet and Orthotic Insole

Flat foot is the fall or low foot arch. The rise of the arch causes a gap between the inner part of the foot sole and the ground when standing. Flat arches cause discomfort and pain in the feet and other parts of the body, such as the back, and may cause other disorders.

There are exercises that help to prevent and relieve pain caused by flat feet.

In the continue of this article, you can get good information about the causes, symptoms and how to treat flat feet.

What is flat foot?

Flat foot means low arch height. It is also known as fallen arch and flat foot. The entire foot sole comes into complete or near contact with the ground in this condition. People with flat feet notice that their arch height is low compared to other people.

flat feet

The foot is a complex mechanical structure of the human body. It is the last part of the lower limb and functions mostly to support weight and help with movement. The 26 bones in the foot include the tarsal, metatarsal, and phalange bones. The muscles, ligaments, and tendons that support the foot’s bones and give them their longitudinal and transverse arches allow for flexibility as well as dynamic and static support. Three main arches and several ligaments are necessary for the structure of the foot.

The structure of the arch shows how people walk. They are crucial for distributing weight and allowing the ability to adapt to uneven terrain when standing, walking, and running. Also, both the rigidity and flexibility of the arches are important in order for the foot to be able to perform well with the forces applied to it when moving on different types of surfaces.

People’s feet with fallen arches may collapse excessively downward or inward when walking and standing. This condition is called overpronation.

When the foot rolls too far inward toward the arch, overpronation happens. Overpronation is a condition in which the arches of your feet eventually flatten down more than they normally would as a result of your gait (the way you walk or run). That puts strain on the muscles, tendons, and ligaments that support your arches. People who overpronate may have a higher risk of certain injuries than people with normal pronation.

Over-pronation is generally caused by either flat or very flexible feet, which people are often born with or for other reasons such as being pregnant, being overweight or obese, etc.

Most people with this condition don’t experience any symptoms. However, others have a variety of symptoms that generally depend on how much the foot sole is flat. Activity may make the pain worse.

What are the symptoms of flat feet?

Many individuals with flat feet don’t have any pain or other problems. However, some flatfoot types can cause pain. Common symptom in people with flat feet is leg pain. It is the result of fatigue in the muscles and ligaments that connect them to each other.

Abnormal pressure on the knee and hip may be the cause of foot pain in the joints. This pressure is probably due to the rotation of the ankle inward.

The following areas of the body are most affected by pain, and sometimes swelling or stiffness:

  • ankle
  • arch of the foot
  • calf
  • knee
  • hip
  • lower back
  • lower legs

  It is also possible to feel stiffness in both legs or just one leg.

Uneven weight distribution that cussed by flat foot may cause wear on the sole of the shoe, especially on one side, which leads to further injuries to the foot in the long run.

What is the cause of flat feet?

Flat foot, or pes planus, occurs when the entire sole of your foot is in contact with the ground when standing.

Both environmental and genetic factors can cause flat feet. In most cases, genetic factors cause this condition throughout a person’s life. However, environmental factors usually cause flat feet after a long period of time.

These reasons are:

Genetic factors

Flat feet occur when your foot arch is not well-formed during childhood. All babies have flat feet. Our arch is formed during the normal period of growth in childhood. Sometimes our plantar muscles, bones, and ligaments don’t develop enough to create a stable arch. Flat feet can pass from parent to child through the genes.

Tendon injuries 

Your bones aren’t the only thing that connects you. The posterior tibial tendon, which joins your ankle to the inside of your foot and the network of plantar fascia ligaments, is connected to your Achilles tendon in the ankle. Your arches may fall if these tendons are injured by tears, inflammation, or other injuries.

Broken bones

Your arches may fall if you break or dislocate any of the bones in your foot, which can also affect the posterior tibial tendon. Your feet’s bones and connective tissue work together to form a complex network that supports and helps you move. Flat feet and other issues could result from an injury to any part of your foot or ankle.  

Rheumatoid arthritis

Rheumatoid arthritis can change the shape of your feet and lead to flat feet.


Obesity and being overweight put pressure on your arches, raising your risk of flat feet. This pressure affects the anatomy of the foot in addition to the posterior tibial tendon.


In addition to weight gain, pregnancy is accompanied by hormonal changes. Both factors of weight gain and hormonal changes can cause flat foot.

Due to the weight gain and increased production of elastin, a protein that enhances the flexibility of skin and connective tissues, pregnancy might result in temporary or permanent flat-footedness.

Stress fracture

A past injury, such as a stress fracture, may also lead to a fallen arch. A stress fracture is a very small crack in the bone. It is most common in the weight-bearing bones of the legs and feet and can occur in the hip, lower back, foot, heel, shin bone, and heel. Stress fractures are more likely to occur during certain activities, such as:

  • Basketball
  • Gymnastics
  • Tennis
  • Long-distance running


Diabetes weakens the tendons and provides inadequate support for the foot arch by weakening the plantar nerves, in addition to the serious risks it causes for diabetic feet.

People with diabetes often have less feeling in their feet or neuropathy, so they do not initially notice as their foot collapses.

High blood pressure

High blood pressure causing weak ligaments and tendons, resulting in flat feet.

Age increasing

People’s foot arches slowly break down and flatten as they grow older. This causes their shoe size to increase as their feet flatten out.

What are the disadvantages of flat feet?

Whether you have a natural flat foot or your arch has fallen due to an injury or other conditions, in both cases, many problems such as foot and back pain, lack of stability, ankle swelling, and excessive pronation will cause you. Also, people with flat feet consume more energy than others.

The orthopedic insole for flat feet can easily fix many of the problems associated with flat feet or fallen arches. Experts scan the feet in two different methods to create the best orthopedic insoles for flat feet; that includes a 3D scan and a pressure scan of the foot. Custom orthopedic insoles are created using milling machines after being built in insole design software, taking into account the needs of each patient.

The relationship between foot fatigue and flat feet

One of the identifiable characteristics and symptoms of flat feet is fatigue along your arches and the inner side of your feet. In particular, this complication is more visible at the end of a working day.

Foot pain and flat feet

Another common complication related to flat feet is foot pain. Pain may occur throughout the entire foot or in a specific area of the foot, such as ankle pain, heel pain, arch pain, etc. The pain typically happens on the inside of the ankle, on the outer edges of the foot, in the heel (known as plantar fasciitis), or in the foot arch.

Ankles and flat feet

Ankles or foot swelling is another problem that may happen for people with this complication. Ankle swelling can cause foot discomfort in shoes and usually causes people to complain about their shoes.

Changing the gait pattern

Pain in the calf, knees, thighs, hips, pelvis, and back is caused by flat feet. Naturally, changes in gait are related to changes in the body’s structure in order to reduce this pain while walking. Over time, these changes lead to basic issues with the person’s walking gait and worsen the pain.

Excessive pronation and flat feet

Another complication is pronation, or excessive inward rotation of the foot. It is a condition in which the arches of your feet gradually flatten more than they typically would as a result of your gait (the way you walk or run).

Flat feet is one of the causes of bunions

People with other foot, ankle, or lower leg problems may find that flat feet make symptoms worse.


The following are examples of complications:

  • Achilles tendonitis
  • Arthritis in the ankle
  • Joint swelling in one or both legs
  • thumb deviation (bunion)
  • hammer finger
  • fallen arch, inflammation of the ligaments in plantar
  • Inflammation of the posterior tibia
  • calf pain

Flat feet can affect body alignment when standing, walking, or running. As a result, they can increase the possibility of pain in the hips, knees, and ankles.

Flat feet in children

Flat feet are normal in babies and toddlers at the age of arch development. The foot arches develop throughout childhood for most individuals. The extra fat on the plantar also hides the arch. As a result, having flat feet in childhood does not indicate having flat feet throughout a person’s life.

child flat feet

But if a child has flat feet due to improper bone growth or another condition such as spina bifida (a birth defect that occurs when the spine and spinal cord don’t form properly), a doctor is needed for treatment.

Diagnosis of flat feet

If you don’t know if you have flat feet or not, be sure to scan your feet at least once.
Foot pressure scan while walking is the best type of scan to determine the flatness of the foot.

However, people who have the following symptoms should definitely visit a doctor:

  • If the flat feet have developed recently or their feet become flatter.
  • Pain in the foot, ankle or lower limb.
  • Symptoms that do not improve with right arch support.
  • Feeling of stiffness, tightness, heaviness and discomfort in the leg

Best exercises to flat feet

Doctors or physiotherapists recommend specific exercises to control symptoms or prevent flat feet. The American Academy of Orthopedic Surgeons (AAOS) recommends the following exercises to improve strength and flexibility in the foot and ankle, which may help relieve symptoms.

Strengthening and stretching exercises for the foot, calf and ankle can help reduce pain. For long-term pain relief, add arch support insoles to your shoes.

You can start by taking the time and doing some of the following exercises:

Strengthen the foot and practice stretching foot muscles to reduce the effects of flat feet

Weakness in the plantar muscles can lead to instability and injury. While we often focus on the extrinsic foot muscles in the foot that support the ankle and foot, there are 11 small intrinsic muscles that lie entirely within the foot and are overlooked. These muscles keep your foot balanced when it contacts the ground and when it leaves the ground. These muscles absorb the force on the leg and store energy in the mid-stance phase. The most important thing is, these muscles support the foot arch. Strengthening these muscles allows them to support the arch.

Here are two quick exercises to strengthen the inner leg muscles:

Foot Dip – Place your foot on the floor in a neutral, flat position. Then, bend your foot by contracting the inner muscles of the foot. Be sure to keep your toes on the ground. Start sitting. As you do the movement, try standing on two legs, then standing on one leg, and then jumping.

Heel Raises: Stand in the middle of the room and press all your toes firmly into the floor. Lift both heels so that your weight is on your toes. Hold for two seconds and repeat. Try two sets of 15.

Strengthening and stretching calf and ankle muscles for flat feet

Dry and inflexible calf muscles and Achilles tendons cause pressure on the ankle, resulting in pronation of the foot, or inward rotation. As a result, the foot arch is straightened. Stretching the calf and heel muscles is so important to prevent the arch of the foot from flattening.

Here we will explain two simple exercises:

Achilles tendon stretch: stand at the very top of one step so only your toes are on the step. Stretch the calf muscle completely and then flip your toes up. Repeat 3×10-12 times

Calf Stretch: While holding on to a chair, keep one leg back with your knee straight and your heel flat on the floor. Slowly bend your elbows and front knee and move your hips forward until you feel a stretch in your calf. Hold this position for 30 to 60 seconds. Switch leg positions and repeat with your other leg.

Stretching and strengthening the foot arch and calf muscles helps relieve the pain associated with flat feet. But finding supportive insoles for flat feet will provide the long-term arch support you really need.

Types of flat feet

Rigid: This type of plantar is flat in both sitting position (no weight) and standing position (full weight). It is present since birth, but if it develops in adults, it is called Adult acquired flatfoot or posterior tibial tendon dysfunction. Adult acquired flatfoot can develop in one or both feet.

Flexible: It is a sole that is flat when standing and has an arch when sitting. If you put your foot on the opposite knee, the foot arch is clear in this position. People with flexible flat feet prefer insoles with medium arch support.

It is important to distinguish between flexible and rigid types because the appropriate arch height is different for each arch.

 Treatments for flat foot

As said before, there is no need to be concerned about having flat feet if there is no pain. However, it’s crucial to remember that, because of alignment issues, having flat feet can contribute to problems with the ankles and knees. Some people may feel pain during physical activity or having ankle swelling. In these cases, you must consult with a doctor or specialist.

Orthopedic shoe insoles for flat feet

Custom-made insoles, orthotics, or arch supports may relieve pressure on the arch and reduce pain if the feet roll too inward.

flat foot insole

Braces and flat foot

People who suffer from posterior tibial tendonitis will feel less pain by placing wedge insoles in their shoes. This will reduce some of the pressure the body puts on the tendon and help relieve the tissue.

Another therapeutic aid is an ankle brace. This brace is useful until the inflammation heals. It is also possible that the doctor may prescribe absolute rest instead of using a brace to reduce the inflammation.

The use of orthopedic insoles is very useful for person with flat foot due to torn tendons or fallen arch, but surgery is needed for severe complications.

Childhood and flat feet

As mentioned above, some bones do not develop properly in childhood, which can lead to flat feet from birth to adulthood. In these rare cases, surgical intervention may be necessary to separate the bones fused together. And as all of us know, obesity also causes flat feet, and weight loss improves its symptoms.

What are the characteristics of orthopedic insoles for flat-footed people?

In this section, we describe the features of flat soles.

Low and supporting arch:

An orthopedic insole with a low arch that provides good foot arch support is necessary for people with flat feet. When wearing shoes, flat-footed individuals will experience pain due to the excessive arch height of the shoes. Long-term pain relief is not achieved even by compressing a very soft insole under the foot. Each person should therefore have an insole that is the right arch and material for their needs.

Heel Stabilizer:

Orthopedic shoe insoles can help flat feet by providing the exact support your feet need, especially in the heel region. They are designed to be deeper than the insole surface. This reduces excessive pronation and increases shock absorption caused by the contact of the heel on the ground.

Remember that if you have flat feet, wearing the right shoes makes a big difference. Shoes that do not support your arch will cause you to feel tired and achy at the end of the day. High-heeled shoes, sandals, and flip-flops increase foot pain.

The best thing you can do for your flat feet is to visit a podiatrist or other related specialist who will scan your feet with high-tech foot scanners and design orthopedic insoles with the appropriate arch height for you. Supporting the arch of the foot with a suitable orthopedic insole can eliminate the pain in your foot and make you feel good walking forever.

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Fascinating insights on flat feet and the intricacies of orthotic insole solutions! The interconnectedness of our musculoskeletal system is truly remarkable. For those delving deeper into rehabilitation techniques and the significance of patient education, it’s crucial to understand the parallels and differences between Chiropractic and Physiotherapy protocols. To illuminate this further, consider exploring “Comparing Chiropractic and Physiotherapy Protocols with a Focus on Patient Education for Empowered Rehabilitation“. The juxtaposition of the methodologies and educational approaches in both fields provides a comprehensive perspective on holistic rehabilitation strategies, especially for conditions intertwined with flat feet. Keep up the enlightening work on these vital topics!