# Flat feet > Flat foot means the arch on the inside of the foot is low or missing. It's often painless and needs no treatment, and most young children grow out of it. If it's sore, supportive shoes, insoles and exercise can help, and new or changing flat feet should be checked. Guide in [Heel and arch pain](https://footanklelowerlimb.com.au/learn/topics/heel-and-arch-pain), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/flat-foot Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **Flat feet are common and often harmless:** the arch on the inside of the foot is low or missing, and many people have no pain. - **Most young children grow out of it:** a flat foot is a normal stage of childhood development. - **No problems, no treatment:** flat feet that don't cause trouble don't need treating. - **If it's sore, simple steps come first:** supportive shoes, insoles, exercise and weight management. - **New, painful or changing flat feet need checking.** ## What is flat foot, and how common is it? Flat foot (pes planus) means the arch on the inside of your foot is low or missing, so the sole comes into contact with the ground [1]. It can be flexible, where an arch forms when you stand on tiptoe, or rigid, where it doesn't [2]. In children it's usually a normal stage of development, not a disease [3]. Flexible flat feet are present in 90% of 1 year olds and up to 20% of adults [4]. Reported rates vary widely with age and how flat foot is measured, so figures from different sources can't be compared directly [5]. ## What causes flat foot, and who gets it? In young children, flat feet are usually part of normal development: their joints and ligaments are more flexible, and they have a soft fat pad under the arch [4][6]. Other things linked with flat feet include family history, tight muscles or tendons, obesity, and conditions such as Ehlers-Danlos syndrome, cerebral palsy, juvenile arthritis and muscular dystrophy [6]. In children, flat feet are found more often in boys and in younger children [3]. Obesity is linked with flat foot that lasts [7], though it isn't clear that weight itself is the cause [8]. ## What does it feel like, and how is it diagnosed? Flat feet don't always cause symptoms [6]. When they do, you might notice foot pain, pain in your shins or calves, pain or swelling on the inside of your ankle, or uneven wear on your shoes [9]. Aching or tiredness tends to show up during or after activity [6]. A podiatrist or doctor diagnoses flat foot from your history and an examination of your feet, including the tiptoe test to tell flexible from rigid [2]. For children, gait analysis (looking at how they walk) or imaging is added only where needed [7], and X-rays aren't routinely used [5]. ## What helps first? If flat feet aren't causing any problems, you don't need to do anything, whether you're an adult or a child [10]. Flexible flat feet in children are normal and don't routinely need treatment [4]. If they're sore, options include more supportive shoes, insoles or orthotics (shoe inserts), physiotherapy and weight management [6]. Insoles can improve foot shape and the way pressure moves through the foot in people with flexible flat foot, though how much they ease pain isn't clear yet [11]. Exercise may also help, but results are mixed; programmes longer than 6 weeks seem more likely to improve arch measurements [12]. Use arch supports if a podiatrist advises them [9]. ## What helps if that isn't enough? If symptoms aren't settling, a podiatrist or GP can advise on seeing a foot and ankle (orthopaedic) team. In children, a rigid flat foot, significant pain, or ongoing symptoms despite arch supports are reasons for orthopaedic assessment [4]. In adults, assessment is suggested for a very painful or rigid flat foot, pain at rest or at night, trouble with daily activities, or a mildly sore, flexible flat foot that hasn't improved after more than 6 months of non-surgical care [13]. Exact referral steps vary, so ask your podiatrist or GP. Which treatment, including surgery, suits which person isn't clear yet. Ask about the benefits and risks before you decide. ## How long does it take, and can I stop it coming back? The outlook in children is generally good. Over 95 percent of children aged 1–5 years grow out of flat feet and develop a normal arch [14]. Only a minority have flat foot that lasts, and fewer than 2% develop pain [7]. In adults, flat foot that develops later from a tendon problem on the inside of the ankle (tibialis posterior tendon dysfunction) tends to get worse over time. If it isn't managed, it can cause pain, weakness and a change in foot shape, so early assessment matters [15]. There's no sure way to stop flat feet developing or returning. It's sensible to check your feet often for changes or increased pain, use arch supports only if a podiatrist advises them, and wear supportive shoes if you're pregnant [9]. > [!tip] Try this > Once a month, stand in front of a mirror and look at the inside of each foot and ankle. Note any new pain, swelling or change in shape, and mention it to a podiatrist. ## When to see a podiatrist See your GP or a podiatrist the same day if: - your foot is red, hot or swollen, especially if you have diabetes or have had an injury, so that Charcot foot can be ruled out [13][16]; - you have diabetes and notice a wound, sore, blister or colour change on your foot; - a flat foot appears suddenly after an injury [13]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. See your GP soon if your foot shape is changing or getting worse [13], your flat feet are new, only one foot is flat, or you have new pain on the inside of your ankle [10][16]. Also see your GP soon if you have night sweats, fever, weight loss, numbness, limb weakness or a burning feeling [2]. See a podiatrist or your GP if your flat feet are painful or stiff, you get frequent injuries, or you have trouble walking or balancing [10]. For a child, see a podiatrist or your GP if they have painful or stiff flat feet, walk oddly or clumsily, complain of calf or muscle pain, or developed flat feet after having normal arches [14][9]. A child under 8 who keeps falling, has trouble walking or has a limp should also be seen [6]. ## Common questions ### Can flat feet cause knee or back pain? They can in some people. Flat feet can cause foot, ankle, knee and low back pain, although many people with flat feet have no symptoms at all. If you have aching in these areas, a podiatrist can check how your feet are working and talk through options such as supportive shoes or insoles. ### At what age do arches develop? Most children have flat feet when they're young, and arches usually develop on the inner sides of the feet between 3 and 10 years of age. It's a gradual process, so a flat-looking foot in a small child is usually part of normal growing rather than a sign that something is wrong. ## Further reading - [Flat feet on Clindice](https://clindice.com/flat-foot) - [Flat feet](https://111.wales.nhs.uk/encyclopaedia/f/article/flatfeet/), NHS - [Flat feet (fallen arches)](https://www.healthdirect.gov.au/flat-feet), healthdirect - [Royal Orthopaedic Hospital - Adult Acquired Flat Foot (Posterior Tibial Tendon Dysfunction)](https://roh.nhs.uk/services-information/foot-and-ankle/adult-acquired-flat-foot-posterior-tibial-tendon-dysfunction), NHS - [A Patient's guide to Adult Acquired Flatfoot Deformity Tibialis Posterior Tendon Dysfunction :: Royal National Orthopaedic Hospital](https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/adult-acquired-flatfoot-deformity-tibialis-posterior-tendon-dysfunction), NHS - [Flatfeet – Advice for Referrers | NHSGGC](https://www.clinicalguidelines.scot.nhs.uk/rhc-for-health-professionals/guidelines/primary-care-referral-guidelines/orthopaedic-pre-referral-guidance/flatfeet-advice-for-referrers), NHS ## Sources 1. Flat foot · NHS. https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Trauma%20and%20Neuro%20services/Trauma%20and%20Orthopaedics/Flat%20foot.pdf 2. Foot and ankle history and clinical examination: A guide to everyday practice · Alazzawi S, Sukeik M, King D et al. · World Journal of Orthopedics · 2017. https://doi.org/10.5312/wjo.v8.i1.21 3. Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis · Xu L, Gu H, Zhang Y et al. · International Journal of Environmental Research and Public Health · 2022. https://doi.org/10.3390/ijerph19148247 4. Flatfoot in children · NHS. https://www.nuh.nhs.uk/flatfoot-in-children/ 5. Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review · Banwell HA, Paris ME, Mackintosh S et al. · Journal of Foot and Ankle Research · 2018. https://doi.org/10.1186/s13047-018-0264-3 6. Flat feet (fallen arches) · Healthdirect Australia. https://www.healthdirect.gov.au/conditions/joint-and-muscle-diseases/flat-feet 7. S2-Guideline: Pediatric Flat Foot · Hell AK, Döderlein L, Eberhardt O et al. · Zeitschrift Fur Orthopadie und Unfallchirurgie · 2018. https://doi.org/10.1055/s-0044-101066 8. Pes planus and paediatric obesity: a systematic review of the literature · Stolzman S, Irby MB, Callahan AB et al. · Clinical Obesity · 2015. https://doi.org/10.1111/cob.12091 9. Flat feet · Health New Zealand | Te Whatu Ora. https://www.healthnz.govt.nz/health-topics/conditions-treatments/feet-and-ankles/flat-feet 10. Flat feet · NHS · 2025. https://111.wales.nhs.uk/encyclopaedia/f/article/flatfeet/ 11. Optimizing Flatfoot Management With Foot Orthoses: A Systemic Review and Meta-analysis · Shim SR, Kim JY, Shin J et al. · American Journal of Physical Medicine & Rehabilitation · 2026. https://doi.org/10.1097/phm.0000000000002833 12. Effects of short foot training on foot posture in patients with flatfeet: A systematic review and meta-analysis · Cheng J, Han D, Qu J et al. · Journal of Back and Musculoskeletal Rehabilitation · 2024. https://doi.org/10.3233/bmr-230226 13. Pes Planus Flat Foot · NHS. https://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/orthopaedics/primary_care_clinical_referral_criteria/primary_care_clinical_referral_criteria/orthopaedics/foot_and_ankle_referral/pes_planus_flat_foot 14. Flat foot - Paediatric Orthopaedics - Oxford University Hospitals · NHS. https://www.ouh.nhs.uk/paediatricorthopaedics/information/conditions/flat-foot/ 15. MSK Tibialis Posterior tendon dysfunction (adult acquired flat foot) | Right Decisions · NHS. https://www.rightdecisions.scot.nhs.uk/borders-ref-help-toolkit/podiatry/msk-tibialis-posterior-tendon-dysfunction-adult-acquired-flat-foot/ 16. East Sussex MSK Community Partnership · NHS. https://eastsussexmsk.nhs.uk/wp-content/uploads/2025/10/Foot-Ankle-Triage-Guidance-2025.pdf --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.