Flat Feet & Overpronation

Overview

Flat feet (pes planus) means the arch on the inside of the foot is low or absent when you stand, so more of the sole touches the ground. Overpronation describes the related movement pattern: the foot rolls inward and the arch collapses more than usual with each step. Many people have flat feet and no symptoms at all — it is only a problem when it causes pain or contributes to injuries elsewhere.

Most adult flat feet are "flexible": the arch appears when you stand on tiptoe or sit, and flattens under load. This is often lifelong and runs in families. A smaller number of people develop a flat foot in adulthood when the tendon that supports the arch (the tibialis posterior) weakens over time — this "adult-acquired" flat foot tends to be one-sided, progressive and painful on the inner ankle, and it needs earlier attention.

The reason flat feet matter in a pain clinic is the knock-on effect. When the arch collapses, the shin bone rotates inward and the knee drifts toward the midline. This changes loading at the heel, Achilles, shin, knee and even the hip and lower back, and is a common thread in plantar fasciitis, shin splints, runner's knee and recurring ankle sprains.

Causes and risk factors

• Family history — foot shape is largely inherited
• Weak muscles in the foot and lower leg
• Joint hypermobility (very flexible ligaments)
• Weight gain, pregnancy or age-related tendon changes
• Previous ankle or foot injury
• Wearing flat, unsupportive footwear for years
• Diabetes or inflammatory arthritis, which can affect the foot structure

How we may be able to help

Assessment comes first. We examine how your arch behaves when standing, on tiptoe and walking; test the strength of the arch-supporting muscles; check ankle and big-toe mobility; and look at the alignment of your knees and hips. Importantly, we distinguish a flexible flat foot from an adult-acquired one, because the latter may need a medical opinion and we can arrange an online private GP consultation if so.

Our 3D foot scan captures the shape and loading of your feet in detail, including arch height, heel alignment and pressure distribution. Where the scan and assessment indicate that your foot posture is contributing to pain, fully custom orthotics are made in the UK from your scan data. They are designed to support the arch, reduce inward rolling and improve the alignment of the whole lower limb. Many people with flat-foot-related pain notice a difference in all-day comfort.

Physiotherapy works alongside orthotics rather than instead of them. Rehabilitation exercise strengthens the small muscles of the foot, the tibialis posterior and the calf, and improves hip control so the knee stays better aligned. Manual therapy may help with stiff ankle or foot joints. Kinesiology taping can support the arch temporarily while strength builds. Where knee, hip or back symptoms are part of the picture, a 3D posture scan can show how your foot posture is affecting alignment further up.

What you can do at home

• Choose shoes with a firm heel counter, some arch support and a stiff sole — avoid soft, flat shoes and flip-flops for long walks
• Practise "short foot" exercises: gently draw the ball of the foot toward the heel without curling the toes
• Do calf raises with a focus on keeping weight over the big toe
• Walk barefoot on sand or grass occasionally to work the foot muscles, if it is comfortable
• Watch for pain on the inner ankle — if it is new and one-sided, get it assessed
• If you are carrying extra weight, reducing it lessens the load on the arches