Flat foot correction

When do flat feet need treatment? 

Flat feet are common. An estimated one in five adults in the UK has some degree of flat feet, and for most people this causes no problems at all. 

Treatment may be needed when flat feet are causing: 

• Pain in the heel, arch, ankle, or along the outer edge of the foot 
• Rolled-in ankles (over-pronation, where the foot rolls too far inward with each step) 
• Pain along the shin bone (shin splints) 
• Aching or tiredness in the feet or legs 
• Pain in the knees, hips, or lower back, which can occur when weight is distributed unevenly through the legs with each step 
• Difficulty with balance or walking 
• Frequent foot or ankle injuries 
• Shoes wearing out unusually quickly.

It is worth seeking advice even if the pain feels mild. Seeing a specialist at an early stage gives more treatment options and is more likely to prevent long-term difficulties. 

What causes problematic flat feet? 

Flat feet sometimes run in families and can have no obvious cause. In other cases, they develop as a result of: 

• Weakening or tearing of the tibialis posterior tendon (the main tendon that supports the inner arch of the foot), which is the most common reason flat feet develop in adulthood, typically in your forties and fifties 
• Stretching or damage to the ligaments and tendons in the foot, related to injury, ageing, or being overweight 
• Excessive laxity (looseness) in the joints, sometimes linked to weight gain 
• An abnormal joining of two foot bones (called a coalition), which can lead to a rigid flat foot 
• Arthritis in the foot or ankle joints 
• A birth defect affecting the shape of the bones 
• Conditions that affect the muscles, nerves, or joints more broadly, such as cerebral palsy or spina bifida.

Children often have flat feet. Most develop the arch of the foot naturally during childhood, between the ages of 3 and 10. 

What are the benefits of treatment? 

The main goals of flat foot treatment are to reduce pain, improve stability, and restore a more normal foot position so that weight is loaded more evenly with each step. 

Non-surgical treatment will not change the shape of your feet but can significantly reduce pain and stiffness.

When surgery is needed, the aim is to realign the foot and relieve pain. The best surgical results are seen in children with flexible flat feet. Adults with more advanced flat feet, particularly where arthritis has developed, can generally expect a reduction in pain and a more stable foot, though the foot is likely to be stiffer after the operation. 

Types of flat foot treatment 

Non-surgical treatment 

Non-surgical approaches are always tried first, unless the flat foot has been caused by an acute injury such as a sudden tendon rupture or fracture. 

Options include: 

• Supportive footwear: Shoes should be fairly stiff and secured firmly to the foot with laces; wide, low-heeled shoes are generally recommended 
• Orthoses (shoe insoles): Custom or standard insoles that support the arch and hold the foot in a more neutral position; these are most effective in laced training shoes 
• Ankle braces: To provide additional support and reduce unwanted movement 
• Calf stretching: Tight calf muscles make the foot more likely to roll inward. Standing on an adjustable slant board for 2 to 3 minutes twice a day can help improve flexibility over time 
• Physiotherapy: A tailored exercise programme targeting the core, thigh, and buttock muscles, which play a role in overall foot and leg alignment 
• Anti-inflammatory tablets and painkillers: Such as ibuprofen, to manage pain and swelling 
• Steroid injections: Injecting a steroid (a strong anti-inflammatory medicine) directly into the painful area may provide relief 
• Activity modification: Reducing activities that cause pain and limiting prolonged standing or walking 
• Immobilisation: In some cases a walking cast may be used temporarily to allow the tendons and tissues to settle.

Surgical treatment 

Surgery is considered only when non-surgical treatment has not given enough relief. The approach depends on whether your flat foot is flexible or rigid, whether arthritis is present, and your age and activity level. 

• Flexible flat foot means the arch disappears when you stand but returns when you sit and take weight off the foot.
• Rigid flat foot means the foot stays in a flat position regardless of whether you are standing or sitting, and is typically caused by arthritis, a coalition (abnormal joining of two bones), or a birth defect. 

Your surgeon will recommend one procedure or a combination, based on X-ray findings and your individual circumstances. Techniques may include: 

• Calcaneal osteotomy (heel shift): The heel bone, which has shifted out of its correct position, is moved back into alignment and held in place with screws. This can sometimes be done using a minimally invasive approach. 
• Tendon transfer: When the tibialis posterior tendon is severely damaged or has torn, a healthy tendon from one of the lesser toes is repositioned to take over its role. This does not affect the function of the toes, and a full recovery is expected. 
• Calf tendon lengthening: Used when the calf muscle is too tight and has not responded to stretching exercises. The tendon is surgically lengthened to allow the foot to function more normally. The calf may be weaker and slightly smaller on the treated side after surgery. 
• Kidner procedure: If an extra bone (called an accessory navicular) at the attachment point of the tibialis posterior tendon is causing pain, this is removed and the tendon is shortened. The cut (incision) runs from around the ankle to the midfoot. 
• Evans procedure: A lateral column procedure frequently used in children with flexible flat feet. It has well-established results in the published literature.
• Arthroereisis: A small implant is inserted into the foot to help maintain the corrected position. 
• Joint fusion: For more advanced cases where arthritis has developed, fusing one or more joints may be needed to reliably reduce pain. A fused joint will be stiffer but more stable. 

Before your treatment 

Your GP may refer you to a specialist such as a podiatrist, physiotherapist, or foot and ankle surgeon.  

At your specialist appointment, the type of flat foot, its severity, and any underlying cause will be assessed. This typically involves: 

• A physical examination of your foot, including observation of how it looks when you stand and how you walk 
• X-rays to establish the degree and nature of the deformity 
• An ultrasound or MRI scan in some cases, particularly to assess the condition of the tibialis posterior tendon. 

Your diagnosis, treatment options, and the likely outcomes will be discussed with you before any decisions are made. 

What happens during surgery? 

The specific operation, or combination of operations, will be confirmed following your consultation and will depend on your diagnosis. 

In general, flat foot surgery aims to restore the correct alignment between the foot and the lower leg. Depending on what is needed, this can involve: 

• Cutting bones (osteotomies) to reposition them, then securing them in the corrected position 
• Fusing joints to provide stability, particularly in rigid or arthritic flat feet 
• Repairing, lengthening, or transferring tendons 
• Inserting an implant to help maintain correction 

Your surgeon will explain exactly what is planned for your case, including where the incisions (cuts) will be made. 

Recovery from flat foot surgery 

Recovery time varies depending on which procedures were performed. Your surgical team will give you specific guidance after the operation. 

Risks and complications 

Your surgeon will discuss the specific risks of your planned operation before you consent to go ahead. 

Known outcomes and risks based on the available sources include: 

• Adults with flat feet that have progressed to arthritis should expect some degree of stiffness in the foot after surgery, alongside the expected reduction in pain 
• Some degree of asymmetry or contour irregularity is a predictable result of flat foot surgery and may not require further treatment 
• After calf tendon lengthening, the calf muscle on the treated side is often weaker and slightly smaller than the other 
• Rarely, the sural nerve (a nerve that runs close to the outer side of the lower leg) can be irritated during calf tendon lengthening, leaving numbness or sensitivity in the lower leg 

Frequently asked questions

Do flat feet always need treatment?

No. Flat feet are very common and are usually harmless. Most people with flat feet have no pain or difficulty and need no treatment at all. Treatment is only needed when flat feet are causing pain, stiffness, problems with balance, or frequent injuries.

What is the difference between a flexible and a rigid flat foot?

With a flexible flat foot, the arch disappears when you stand but comes back when you sit and lift the foot. With a rigid flat foot, the foot stays flat whether you are standing or not. Rigid flat feet are usually caused by arthritis, an abnormal joining of two bones, or a birth defect, and typically require more complex surgery.

Will surgery cure flat feet?

Surgery aims to reduce pain, improve stability, and restore better foot alignment. The best outcomes are in children with flexible flat feet. In adults, particularly where arthritis has developed, surgery typically brings a meaningful reduction in pain and a more stable foot, but the foot is likely to be stiffer than before.

Is surgery always a last resort for flat feet?

Yes, with one exception. Surgery is only considered after non-surgical approaches such as orthotics, physiotherapy, supportive footwear, and pain relief have not provided enough improvement. The only exception is an acute injury, such as a sudden tendon rupture or fracture, where surgery may need to happen sooner.

Can flat feet cause pain in other parts of the body?

Yes. Because flat feet alter the way weight travels up through the legs with each step, they can contribute to pain in the shins, knees, hips, and lower back. If you have flat feet and are experiencing pain in any of these areas, it is worth discussing with a specialist whether your foot structure may be a contributing factor.