Flatfoot Pain: Tips and Exercises to Get Relief, According to Physical Therapists

If you’ve been told you have flat feet (also called flatfoot) or can simply tell just by looking, you might be wondering what effect this has on your body and how it may impact your everyday life. After all, you know how important your feet are to keeping you upright, from sitting to standing to walking to running. 

“Flat feet are just feet that don’t have an arch,” says Sarah Kellen, PT, DPT, a physical therapist at Hinge Health. Many people have them, and it just means that when you stand, the middle of your foot touches the ground.

Flatfoot is often painless, but it can sometimes lead to discomfort, ranging from occasional foot aches and pains to tight calf muscles. The good news: Any flatfoot pain you’re experiencing can usually be addressed with some simple at-home strengthening and stretching exercises and tweaks to footwear.

Read on to learn more about flat feet: what causes them and why targeted foot exercises recommended by our Hinge Health physical therapists can help. 

A Word About Foot Anatomy

Your feet are one of the most complex parts of your body — they have 26 bones, 33 joints, and more than 100 muscles, tendons, and ligaments. 

When you have flat feet, your feet have little to no arch. “When you stand, the arch of your foot lowers to the ground,” explains Dr. Kellen. Most of the time, this isn’t a big deal. But it can put more strain on the connective tissue, tendons, and ligaments in your feet, increasing the risk of irritation or inflammation. This, in turn, may contribute to developing conditions such as plantar fasciitis (inflammation of the plantar fascia, the band of tissue on the bottom of your foot), Achilles tendinitis (irritation of the Achilles tendon), and metatarsalgia (inflammation in the ball of your foot).

Flat Feet: A Hinge Health Perspective

If you have flat feet, it’s important to know that there’s nothing “wrong” with you. In fact, a group of doctors published an editorial in the British Journal of Sports Medicine in 2023 pointing out that about a third of all people have flat feet, and it should be considered a “healthy anatomical variant.” Here, at Hinge Health, we agree.

Most of the time, flat feet cause no symptoms whatsoever, says Dr. Kellen. But sometimes, especially if you ramp up activity before your body is completely ready for it, you can experience some foot pain with flat feet. “It’s best to view this pain not as a reason to stop exercising, but as a sign that you may need to tweak your routine,” says Dr. Kellen.

With flat feet, you may find relief by making changes to your footwear that provide more arch support. Over-the-counter or custom orthotics are another option to help cushion your fallen arches. Physical therapy can also be beneficial to help you strengthen and stretch strained foot muscles. “Movement is medicine, and that’s especially true for flat feet,” says Dr. Kellen. “There’s no reason you won’t be able to continue doing whatever activities you want, whether it’s playing basketball or running a half marathon.”

What Causes Flat Feet?

There are many different contributors to flat feet. Some of the more common causes include:

• Genetics. Some people are just genetically prone to flat feet, just like others have a family history of high arches. “Sometimes you’re just born that way, and that’s okay,” reassures Dr. Kellen.

• Posterior tibial tendonitis. Your posterior tibial tendon attaches one of your calf muscles to the bones on the inside arch of your foot. As this tendon is crucial for holding up your arch, it can sometimes become inflamed as a result of flat feet. 

• Pregnancy. When you’re pregnant, the extra weight from your belly can put pressure on lower extremities, including your feet, which, in turn, can cause arches to flatten. Research suggests that this may be most pronounced during your first pregnancy.  Pregnancy also causes ligaments to relax which might also be a contributor to flat feet.

• Loose ligaments. People who naturally have looser ligaments may simply be more susceptible to flat feet, says Dr. Kellen.

Flat Feet Symptoms

It’s important to remember that flat feet can be a normal part of your anatomy. Many people have flat feet, and don’t have any symptoms. But if you do have flat feet pain, here are some of the most common symptoms you might experience:

• Pain the arch, or along the inside of your foot and ankle, where your posterior tibial tendon is located. You may also notice swelling if you have a slight tear in the tendon.

• Pain with activity. You may find it uncomfortable to walk or stand for long periods and the pain may worsen with high-impact activity like running.

• Weakness when you “push off” or stand on your toes.

• Pain on the outside of your ankle.

• Heel pain.

Flat feet can also cause issues higher up in the body, notes Dr. Kellen. Knee pain, for example, may be related to — or made worse by — flat feet. That’s why it can be helpful to get evaluated by a physical therapist for any musculoskeletal pain so they can help you get to the root cause of your discomfort.

Treatment for Flat Feet

If your flat feet don’t cause any symptoms, you don’t need to worry about them. “You usually learn that you have flat feet after a physical assessment, in which a healthcare provider, physical therapist, or orthopedic specialist examines your feet,” says Dr. Kellen. “If you are diagnosed with flat feet, most of the time your foot pain can be treated conservatively without the need for medical intervention.”

While flat feet can’t be corrected, “there’s really no need to ‘fix’ them — they’re a natural part of your foot anatomy,” says Dr. Kellen. “But there are things you can do to manage any associated discomfort.” These recommendations from Hinge Health physical therapists can help you keep your flat feet as healthy and happy as possible. 

• Exercise therapy. Foot strengthening and stretching exercises can help take pressure off the arches of your feet, says Dr. Kellen. You can start with some of our recommendations below. 

• Bracing. Ankle braces are usually recommended in situations in which flat feet have led to another injury, such as plantar fasciitis or Achilles tendinitis. In these cases, an over-the-counter lace-up ankle brace will support your ankle joints and the back of your foot in order to take tension off the sore tendon. But they’re not recommended for more than a week or two, since they can reduce range of motion over time, says Dr. Kellen.

• Orthotics. These are shoe inserts that support your feet when you walk. Most of the time, an over-the-counter orthotic will work, says Dr. Kellen. But if your flat feet have caused you so much pain that it makes it hard to engage in regular activities, you may need a custom orthotic that’s specially molded to your foot. A March 2024 review in the Journal of Orthopaedic Reports found that foot orthotics reduce pain, improve balance, and enhance the gait and range of motion in people with flat feet. Since there are many different kinds on the market, you can ask a physical therapist or healthcare provider to recommend a specific one for you. 

• Activity modifications. If you have flat feet and develop pain from a particular activity — for example, marathon training — that doesn’t mean you have to put the kibosh on your workouts entirely. But you may need to switch up your exercise for a bit while you work to stretch and strengthen your feet through physical therapy, says Dr. Kellen. That may mean adding some cross training. For example, if you run most days, substitute a few days of biking and swimming instead. “This will help keep up your cardiovascular conditioning while your foot pain subsides,” explains Dr. Kellen. 

• Strive for a healthy weight. If you have flat feet, it’s harder for them to properly distribute weight throughout all the structures in each foot. This can put stress on specific areas of your feet, which, over time, can cause inflammation and pain. Research suggests that people who aren’t at a healthy weight are more likely to develop flat feet over time, and to report pain. Talk to your doctor about what weight range is best for you.

Flat Feet and Running

If you have flat feet, you may wonder if it’s okay to keep running. The answer is a resounding yes. In fact, a University of Tampa study analyzed the effects of flat feet on sports performance and found no impact at all. “If you have flat feet but don’t have any pain while running or playing other sports, then there’s no need to change anything,” stresses Dr. Kellen. 

But if you do develop pain, it’s a good idea to seek help from a physical therapist. “It’s possible that flat feet can cause some gait variations due to overpronation when running,” points out Dr. Kellen. This can also lead to some aches and pains further up the body, like in your ankles, knees or hips, she notes. Rest assured, you won’t need to give up running. “A physical therapist can work with you on activities, such as gait modification, that put less pressure on your feet,” says Dr. Kellen.

The Importance of Physical Therapy for Flat Feet

Physical therapy can help treat any issues that crop up with flat feet. “A physical therapist can help you strengthen your arches as well as surrounding areas,” says Dr. Kellen. “Your feet have four different layers of muscle strength in them, and when each of those layers is stronger, it can help to provide better support to your arches.” 

A physical therapist can also work with you to stretch your calf muscles and your Achilles tendon, both of which can tighten up with flat feet, points out Dr. Kellen. A 2023 study in the Journal of Physiotherapy found that people with flat feet who did physical therapy that included foot and lower body stretching and strengthening exercises three times a week for six weeks improved their foot alignment. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Foot and lower leg exercises are important when you have flat feet, even if you don’t experience any pain. “These moves help to keep muscles strong, which takes stress off the arches of your feet,” explains Dr. Kellen. In fact, research shows that foot exercises, when done roughly three times a week, can help raise arches and ease future foot discomfort. These five moves are commonly recommended by Hinge Health physical therapists.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Lift Your Arches

When you’re doing basic lower body exercises like squats or lunges, pay attention to your foot arches, too, advises Dr. Kellen. “Try pulling the ball of your foot towards your heel when doing some of your exercises. This will automatically lift the arch, and help to strengthen it.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Raj, M. A., DeCastro, A., Seaman, T. J., & Kiel, J. (2020). Pes Planus. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430802/ 

2. Manganaro, D., Dollinger, B., Nezwek, T. A., & Sadiq, N. M. (2021). Anatomy, Bony Pelvis and Lower Limb, Foot Joints. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536941/ 

3. Moisan, G., Griffiths, I., & Chicoine, D. (2023). Flat feet: deformities or healthy anatomical variants? British Journal of Sports Medicine, 57(24), 1536–1537. doi:10.1136/bjsports-2023-107183

4. Segal, N. A., Boyer, E. R., Teran-Yengle, P., Glass, N. A., Hillstrom, H. J., & Yack, H. J. (2013). Pregnancy Leads to Lasting Changes in Foot Structure. American Journal of Physical Medicine & Rehabilitation, 92(3), 232–240. doi:10.1097/phm.0b013e31827443a9

5. Bednarczyk, E., Sikora, S., Aneta Kossobudzka-Górska, Jankowski, K., & Yunuhen Hernandez-Rodriguez. (2024). Understanding flat feet: An in-depth analysis of orthotic solutions. Journal of Orthopaedic Reports, 3(1), 100250–100250. doi:10.1016/j.jorep.2023.100250

6. Brijwasi, T., & Borkar, P. (2023). A comprehensive exercise program improves foot alignment in people with flexible flat foot: a randomised trial. Journal of Physiotherapy, 69(1), 42–46. doi:10.1016/j.jphys.2022.11.011

7. Kim, E.-K., & Kim, J. S. (2016). The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients. Journal of Physical Therapy Science, 28(11), 3136–3139. doi:10.1589/jpts.28.3136