Flat feet, also called pes planus or fallen arches, is a foot posture in which the arch collapses so that most of the sole contacts the ground when standing. Many people have no symptoms, but others develop arch, heel, knee or hip pain. Physical therapy can improve strength and mechanics at SportsMed locations in New Jersey and Connecticut.
What Are Flat Feet?
Flat feet describe a lowered or absent medial longitudinal arch, the curve on the inside of the foot formed by the calcaneus, navicular, cuneiforms and metatarsals and held up by the plantar fascia, the spring ligament and the posterior tibial tendon. When those structures lose support, the arch drops and the heel often tilts outward, a pattern called overpronation.
Clinicians distinguish flexible flat feet, where an arch appears when you rise onto your toes or sit, from rigid flat feet, where no arch appears in any position. Adult acquired flatfoot, most often from posterior tibial tendon dysfunction, develops later in life and tends to be progressive.
Flat feet are common, present in roughly 20 to 25 percent of adults. All infants appear flat-footed, and the arch typically develops between ages 3 and 10. Flat feet are only a medical problem when they cause pain, fatigue or difficulty with activity, not simply because a footprint looks wide.
What Causes Flat Feet?
Some people simply inherit a flexible foot structure and never have trouble. Problems more often arise when the tissues that support the arch are overloaded or weakened. The posterior tibial tendon, which runs behind the inner ankle bone and lifts the arch with each step, is the usual failure point in adults. Years of high load, extra body weight, or a foot that has always pronated heavily can wear it down. Pregnancy hormones loosen ligaments and can permanently lower the arch, and some people develop flat feet after an ankle fracture or a tarsal coalition.
Load history is often the deciding factor. A nurse, teacher or warehouse worker who spends 10 hours a day on concrete places far more strain on the arch than someone at a desk, and the supporting tendons gradually stretch. Weight gain, a sudden increase in walking or running, and unsupportive footwear each add to that total load.
Common causes and risk factors include:
- Family history and inherited foot structure
- Posterior tibial tendon dysfunction, most often after age 40
- Obesity or rapid weight gain, which increases arch load
- Pregnancy and hormone-driven ligament laxity
- Prolonged standing or walking on hard surfaces at work
- Prior ankle or midfoot fracture, or tarsal coalition
- Diabetes, rheumatoid arthritis or other inflammatory conditions
What Are the Symptoms of Flat Feet?
Many people with flat feet feel nothing at all. When symptoms do appear, they typically show up as aching along the inner arch or inner ankle after long standing, walking or running. Because the foot is the base of the chain, strain often travels upward, producing shin, knee, hip or low back complaints. Shoes commonly wear down on the inner edge. Symptoms usually build gradually over months rather than starting on a single day, and they often first appear after a change in job, shoes or training volume.
Typical symptoms include:
- Aching or fatigue in the arch, inner ankle or heel after activity
- Swelling along the inside of the ankle
- Difficulty standing on tiptoes or performing a single-leg heel raise
- Shin splints, knee pain or low back discomfort after walking
- Uneven shoe wear on the inner side
- A heel that visibly tilts outward when viewed from behind
Seek prompt medical attention if the arch collapses suddenly, the foot becomes hot, red and swollen, you cannot bear weight, or numbness develops, since these suggest tendon rupture, infection or fracture.
How Are Flat Feet Diagnosed?
Assessment is hands-on. A therapist watches you stand, walk and rise onto your toes, checks whether an arch reappears with a heel raise or a big toe extension test, and grades the heel position from behind. Strength testing focuses on the posterior tibialis, calf and hip abductors, and ankle dorsiflexion range is measured, since a tight calf drives the arch down. Footwear and callus patterns provide useful clues.
Weight-bearing X-rays help when the foot is rigid, painful or deformed, and MRI or ultrasound is used when posterior tibial tendon tearing is suspected or symptoms do not settle with conservative care.
How Physical Therapy Treats Flat Feet
Treatment targets symptoms and function, not the shape of the arch on its own. A flat foot that is strong, mobile and pain-free needs no correction. SportsMed physical therapy begins with identifying what is actually generating pain, then reducing load through activity modification, temporary supportive footwear or an over-the-counter orthotic while tissues calm.
The active phase focuses on strength. Posterior tibialis strengthening with resistance bands, short foot and toe control exercises, calf raises progressing to single leg, and hip abductor work all reduce the collapsing forces at the arch. Calf flexibility is addressed because limited ankle dorsiflexion forces the midfoot to flatten. Gait and balance training refines how you load the foot during walking and stair climbing. Runners and court athletes progress through a return to sport plan with gradual mileage rebuilding. Because flat feet often coexist with plantar fasciitis, Achilles tendinitis and other overuse injuries, these are managed together.
Footwear and daily habits get equal attention. Therapists review your work shoes as well as your athletic ones, discuss standing mats and shift rotations for people on their feet all day, and phase out temporary supports as foot and hip strength improve. The measure of success is comfortable walking and standing tolerance, not a particular arch height on an imprint.
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How Long Does Recovery Take?
Most people with painful flexible flat feet feel noticeably better in 6 to 12 weeks of consistent strengthening, and foot muscle strength continues improving for several months. Adult acquired flatfoot from posterior tibial tendon dysfunction is slower, often needing 3 to 6 months plus bracing or orthotics. Progress is faster with daily exercises, supportive footwear and gradual activity increases. It slows with continued long standing shifts on hard floors, unsupportive shoes, higher body weight and advanced tendon degeneration. Rigid deformities and painful arthritic changes sometimes require an orthopedic consultation alongside therapy.
Flat Feet Treatment Near You in New Jersey and Connecticut
SportsMed maintains clinics across New Jersey and Connecticut, so foot and gait care stays close to home for people who cannot comfortably travel far on sore feet. Bergen County patients are seen at physical therapy in Fair Lawn, NJ, our Glen Rock clinic, Ho-Ho-Kus, Paramus and Ridgewood. We also treat patients from Franklin Lakes, Emerson, Hackensack, Fairview, Garfield, Englewood, Bergenfield, Fort Lee and Lyndhurst, plus Newark and Stamford, Connecticut. Our caseload ranges from high school athletes and adult runners to retail and hospital staff who stand through long shifts.
Our clinics cover Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Ocean, Passaic and Union Counties in New Jersey, together with Fairfield and New Haven Counties in Connecticut. Browse clinics in New Jersey and clinics in Connecticut, open the location directory, or book a foot and gait assessment.
Frequently Asked Questions About Flat Feet
Q: Do flat feet always need treatment?
A: No. Many people with flat feet walk, run and work for decades without symptoms, and a painless flat foot needs no intervention. Treatment is warranted when the foot aches, fatigues quickly, swells at the inner ankle, or contributes to knee, hip or back pain during normal daily activity.
Q: Can exercises rebuild a fallen arch?
A: Exercises rarely change the visible arch height much, but they reliably improve how well the foot supports itself under load. Strengthening the posterior tibialis, intrinsic foot muscles, calf and hip muscles reduces pain and improves function for most people, which matters more than the appearance of the arch.
Q: Are orthotics or arch supports necessary for flat feet?
A: Not always. Orthotics can relieve symptoms quickly and are especially helpful for adult acquired flatfoot or for people who stand all day. Most patients do best using them alongside strengthening rather than instead of it, so the foot builds its own support while the insert reduces strain.
Q: Should my child with flat feet see a therapist?
A: Usually only if there is pain, frequent tripping, unusual fatigue, or a rigid foot that has no arch even when sitting or on tiptoes. Flexible flat feet are normal in young children, since the arch typically develops between ages 3 and 10 without any treatment.
Q: Can I still run with flat feet?
A: Yes. Many distance runners have flat feet and race without problems. What matters is gradual mileage progression, adequate calf and hip strength, and shoes that feel stable to you. If arch or inner ankle pain appears, reduce volume and get assessed before it becomes a tendon injury.
Q: Is there a SportsMed location near me for foot care?
A: Yes. SportsMed has clinics across New Jersey and Connecticut, including Bergen County sites in Fair Lawn, Glen Rock, Paramus, Ridgewood, Ho-Ho-Kus, Franklin Lakes, Hackensack, Emerson, Fort Lee, Englewood, Bergenfield, Fairview, Garfield and Lyndhurst. Use the location directory to find the closest clinic and available times.
Arch pain that returns every time you increase your walking or running is a signal worth acting on. A SportsMed therapist can assess your foot posture, strength and gait, then build a plan that keeps you active.
Book an appointment at a New Jersey or Connecticut clinic near you.Reviewed by the SportsMed Physical Therapy clinical team. Last updated: August 2026.