Disclaimer: This article is for general educational purposes only and does not constitute medical advice. Always consult a qualified health professional for advice specific to your condition. © 2026 Better Physiotherapy Bundoora.
Many people are told they have flat feet and immediately prescribed orthotics. But research increasingly shows that strengthening the muscles that support the arch can be just as effective — and more durable — than passive support alone.
Understanding Flat Feet
The medial longitudinal arch is maintained by a combination of bony architecture, ligaments, the plantar fascia, and — crucially — active muscular support from the tibialis posterior, fibularis longus, flexor digitorum longus, and intrinsic foot muscles. When these dynamic supports are insufficient, the arch drops under load.
Flat feet are extremely common — studies find them in approximately 26% of adults. The key point: the majority of people with flat feet have no pain or functional limitation. Flat feet are a problem only when they cause symptoms.
When Flat Feet Cause Pain
Symptomatic flat feet cause problems through increased loading on:
- The plantar fascia — increased arch-flattening tension causes plantar fasciitis
- The tibialis posterior tendon — the primary arch-maintaining muscle is overloaded, leading to medial ankle pain and tendinopathy
- The medial knee — excessive foot pronation increases tibial internal rotation, stressing the medial knee structures
- The hip and lower back — altered gait mechanics from over-pronation propagate up the kinetic chain
The Short Foot Exercise
The short foot exercise (or “foot doming”) is the most evidence-based intrinsic foot muscle exercise for flat feet. It involves shortening the foot by drawing the ball of the foot toward the heel, creating a dome shape, without curling the toes. Starting with seated practice and progressing to standing, single-leg balance, and functional tasks builds the active muscular support the arch needs.
Tibialis Posterior Tendinopathy and Flat Feet
In severe or progressive flat feet in adults, tibialis posterior tendinopathy should be ruled out. This tendon is the primary dynamic arch support, and its degeneration causes the arch to progressively collapse. Early physiotherapy intervention — with eccentric calf raises, tibialis posterior loading, and orthotic support — can halt progression and prevent surgical intervention.
Frequently Asked Questions
What are flat feet?
Flat feet (pes planus) refers to reduced or absent medial longitudinal arch — the arch on the inner side of the foot. It can be flexible (the arch disappears with weight bearing but returns when non-weight bearing) or rigid (arch is absent in all positions). Flexible flat feet are extremely common and often asymptomatic. Rigid flat feet are less common and more associated with pain.
What problems can flat feet cause?
When painful, flat feet are associated with: plantar fasciitis (from increased fascial tension), posterior tibial tendinopathy (the tendon responsible for maintaining the arch), medial knee pain (from increased inward rotation of the tibia), and hip and lower back pain from altered gait biomechanics. However, many people with flat feet have no problems at all.
How does physiotherapy treat flat feet?
Physiotherapy addresses flat feet through: intrinsic foot strengthening (short foot exercise, toe curls, single leg stance progressions), tibialis posterior strengthening, calf strengthening, and proximal chain strengthening (hip abductors and external rotators) to reduce excessive inward knee rotation. Footwear advice and, where appropriate, orthotics complement the exercise program.
Are orthotics better than exercises for flat feet?
Orthotics and exercises address different aspects of flat feet. Orthotics provide passive structural support; exercises build active muscular support. Current evidence suggests exercises produce more durable improvements in foot function — particularly for children, where arch development is still occurring. For adults, a combination is often most effective.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora