Flat Foot Pain-Explained!

Flat Foot Pain

Have you ever wondered exactly why the human foot is arched at the sole? This arch is mostly responsible for maintaining body balance when walking, standing, or running.

But not every individual is born with a foot arch – those without it presumably suffer from flat feet.

Statistics show that 60 million Americans suffer from flat feet, about 25% of the country’s population!

For this reason, we’ll discuss everything you need to know about a flat foot, covering flat foot pain, types, causes, symptoms, treatment options, and much more.

But first things first, let’s define a flat foot!

What is a flat foot?

Also known as pes planus, a flat foot is a condition that results in the loss of the medial longitudinal arch of the foot such that the entire sole flattens out when standing. This condition can affect one foot or both feet due to an injury, aging, or childhood progressive heel valgus deformity. It’s a common condition for infants but typically disappears after two or three years.

There are two common types of flat feet, namely:

Congenital Flat Foot

Congenital is a hereditary condition common in children between the age of two to five. Infants with flat feet develop a fat pad under the foot arch complex, which usually disappears as they grow older. However, some children fail to develop a proper longitudinal arch of the foot by adulthood due to the following reasons:

  • Genetics
  • Ligament’s laxity
  • Tight Achilles tendon

Most flat foot problems in children are not a cause for concern because they develop proper arch as they grow. However, suppose the flat foot deformity continues after their early years (between age three to five). In that case, you can have them examined by a podiatrist.

The good thing is that most advanced flat foot deformities in children are treatable with non-surgical options. However, the doctor can recommend surgery to prevent developmental complications in the long run.

Adult Flat Foot

Adults who have Posterior Tibial Tendon Dysfunction (PTTD) commonly experience flat feet. PTTD is a common foot and ankle problem caused by the inflammation or tearing of the tibial tendon. As a result, the posterior tibial tendon fails to provide stability and support, causing flat foot problems.

Adult or acquired flat foot is common among athletes participating in high-intensity sports such as tennis, soccer, or long-distance running due to the overuse of the tendon tissue.

Additionally, an acute injury on the foot can cause inflammation of the tendon, leading to the gradual collapse of the medial longitudinal arch.

What Causes Flat Foot?

The medial longitudinal arch of the foot provides a support base for the entire body. When the arch complex develops a dysfunction, it may lack neuromuscular control, which causes pain or discomfort when walking.

Common causes of flat foot in adults include:

  • Foot injury
  • Wearing unsupportive footwear
  • Tight Achilles tendon
  • Abnormal joint formation
  • Diabetes
  • Obesity or sudden weight gain
  • Long-term strain on the foot due to excessive standing or walking
  • Rheumatoid arthritis
  • Stroke
  • Pregnancy
  • Aging
  • Marfan syndrome

General Symptoms of Flat Foot

Most people with flat feet experience pain at the inner side of their feet when standing or carrying heavy items. Additional symptoms to watch out for include:

  • Having an inflamed foot
  • Constant foot or leg pain after high-intensity activities such as running or walking for a long time
  • Foot or ankle pain
  • Swelling of the posterior tibial tendon
  • Abnormal walking patterns because the heel bone has shifted to an outward position

Flat Foot Treatment

Most people don’t seek flat foot treatment unless they experience unbearable pain. So when you visit an ankle or foot doctor, they’ll first analyze your medical history and check for flat foot symptoms.

Alternatively, they may conduct a foot and ankle examination that often involves the ‘single-limb heel rise’ test.

This test requires you to perform a single-limb heel-rise on either of your legs. If you fail to stand and raise your heel on one leg, it could be due to PTTD.

Depending on how severe your pain is, doctors usually recommend two forms of treatment:

  • Non-surgical treatment
  • Surgical treatment

Here’s what to expect from these two flat foot treatment alternatives.

Non-Surgical Treatment

Your foot doctor can recommend the following non-surgical treatment options:

  • Wearing orthotic shoe devices and lace-up ankle braces.
  • Wearing heel cups
  • Wearing supportive footwear such as shoes with arch support.
  • Physical therapy
  • Body exercises such as calf stretch that help stretch out tight calf muscles
  • Resting and stopping high impact activities
  • Weight loss program
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen and Naproxen
  • Foot massage
  • Cortisone steroid injection around the posterior tibial tendon area.
  • Applying cold packs on the affected area three to four times a day.
  • Immobilization or a walking boot if no other forms of non-surgical treatment work.

Most non-surgical procedures mentioned above relieve aches and pain, although doctors may recommend surgical treatment if you experience no change after several months.

But before suggesting surgical treatment, your doctor might first conduct imaging tests and a complete foot examination to determine the root cause of the problem. Imaging tests help the doctor determine the type of surgery best suited for you and provide detailed images of your posterior tibial tendon and bone structure.

Surgical Treatment

Surgical treatment involves the removal of an inflamed posterior tibial tendon tissue or repairing a torn tissue. It often includes the following procedures:


Your doctor may conduct a tenosynovectomy if there’s mild swelling over the tendon area. It involves removing the inflamed tendon tissue, performed with other procedures for treating flat feet.

Transfer of the Tendon

This surgical procedure recreates a damaged posterior tibial tendon by removing it and replacing it with a healthy tendon. It helps patients with ‘too many toes sign’ or those having difficulties walking.

Lengthening of the Achilles Tendon

Doctors recommend this procedure for patients who cannot move their ankle up because it has low complication rates. However, the side effects may include nerve damage and weakness in conducting activities such as climbing stairs.

The Bottom Line

Flat foot pain is a condition that usually results from the rupture of the posterior tibial tendon.

You might be suffering from this condition if you’re experiencing pain and swelling on the medial ankle or tenderness along the tendon.

However, prompt treatment can help prevent permanent deformity and further complications deriving from flat feet.

Want to learn some interesting facts about the human foot? Click here!