Why Flat Feet Are More Than Just a Foot Problem
Key insights: 60-second read
- My clinical perspective: In my physiotherapy practice, I often find that a collapsed or poorly controlled arch is not something I should assess in isolation. I look at how the ankle, knee, hip and lower back are contributing to the way the leg moves.
- The leg works as a system: Ankle stiffness, reduced hip mobility, and poor control of hip and lower-limb rotation can all influence how the foot behaves during movement.
- Three areas I commonly assess: Ankle mobility, hip rotational control and hip range of motion.
- Three exercises: The accompanying video demonstrates simple exercises targeting ankle mobility, hip rotational control and hip mobility.
A physiotherapist's clinical perspective
One of the things I have found repeatedly in clinical practice is that when someone presents with a flat or collapsing arch, it's crucial to look beyond the foot itself. I assess the movement of the whole lower limb and look for restrictions or weaknesses that may be influencing how the foot is being loaded and controlled.
Are flat feet really just a foot problem?
In my clinical experience, a flat or collapsing foot can sometimes be the end result of a broader movement problem rather than an isolated foot problem.
It's important to consider the ankle, knee, hip and lower back, and particularly how the leg rotates and controls movement when the person walks, squats, runs or performs other relevant activities.
In my experience, some of the most common findings associated with a poorly controlled or collapsing arch are reduced ankle mobility, reduced hip range of motion and insufficient control of hip and lower-limb rotation.
These findings do not mean that every person with flat feet has the same underlying problem, but it's a common theme clinically nonetheless. Yes, flat feet can be a normal anatomical variation, and people can have flat feet without pain or functional limitation - but it's hard to know what's what if we aren't taking the whole leg into account.
I want to understand why the foot is moving the way it is and whether improving the function of the ankle, hip, and lower limb changes the person's movement or symptoms.
So, have a watch of the video below, and let's dive into it.
On this page
The Broader Perspective on Flat Feet
A flat foot is usually described in terms of the position of the foot and its inner arch. But foot posture is only one part of how the lower limb functions.
From a physiotherapy perspective, I am interested in what happens above the foot as well. Does the ankle have enough movement? Can the hip move adequately? Can the muscles around the hip and lower limb control rotation during weight-bearing?
These questions can be particularly useful when someone has pain or a functional problem alongside their flat foot.
What Does an Internally Rotating Leg Have to Do With Flat Feet?
Clinically, a flat or collapsing arch is commonly associated with excessive inward rotation of the lower limb during weight-bearing.
As you may see in the video above, as we allow the entire leg to rotate inward, the inner arch tends to flatten as a consequence. Similarly, external rotation tends to pull the arch up from above.
Again, this doesn't automatically mean that an internally rotating leg is abnormal, but if improving this mechanism alters a person's pain and symptoms, then it becomes highly important.
In my clinical experience, restrictions or weaknesses at the ankle, hip and sometimes the lower back can influence this overall movement pattern.
This is why I prefer to assess the whole movement system rather than treating the appearance of the arch in isolation.
Three Common Areas I Assess
In my experience, three areas are particularly worth assessing when someone presents with a collapsing or poorly controlled arch:
- 1. Ankle mobility - Limited ankle dorsiflexion can force the leg to internally rotate as a way of "going around" the restriction. Improving available range may allow the leg and foot to move more efficiently.
- 2. Hip rotational control - The muscles around the hip help control the position and rotation of the femur. Improving strength and neuromuscular control may help some people better manage inward movement of the leg.
- 3. Hip range of motion - Similarly to a lack of ankle dorsiflexion, a lack of hip external rotation or hip extension may ask the leg to dump inwards as a workaround.
Can Arch Supports Fix Flat Feet?
Arch supports and supportive footwear can be useful tools, but I do not view them as the only answer.
Orthoses can alter foot loading and lower-limb mechanics, with good clinical outcomes. They can be useful for some people with flat feet or related conditions. However, they don't intuitively stop the arch from "wanting" to collapse.
As soon as you take your shoes off to walk on the beach or around the house, those arches will still function poorly.
Interestingly, in architecture, arches are the weight-bearing surface, not the other way around.
So while arch supports clearly have their place in pain and symptom management, we also need to be working hard on any potential reasons for why those arches collapsed in the first place so we can eventually wean you back off those supports once again.
Three Exercises to Improve Arch Function
The above video demonstrates three exercises I use clinically to address the broader mechanics of the lower limb.
The aim is not simply to force the arch into a particular position. The aim is to improve the capacity and movement of the areas that may be contributing to how the leg and foot are functioning.
- Exercise 1: Ankle Mobility - Using a power band or lacrosse ball to work on ankle movement and mobility.
- Exercise 2: Hip Rotational Control - Strengthening and improving control of the muscles involved in controlling hip and lower-limb rotation.
- Exercise 3: Hip Range of Motion - Mobility work designed to improve available hip movement and give the lower limb more options during movement.
One important point: I would not assume that everyone needs these exercises in the same way. The appropriate exercise depends on what is actually limited or poorly controlled in that individual.
This is also why an assessment can be useful. If improving ankle mobility changes a person's squat, walking pattern or symptoms, that provides useful clinical information. The same principle applies when testing hip mobility or rotational control.
Helpful Equipment for This Video
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The key clinical takeaway
A flat foot does not automatically mean something is wrong with the foot. When symptoms or functional problems are present, it can be useful to look at the ankle, hip and whole lower-limb movement system rather than focusing exclusively on the arch.
I genuinely hope this article offers a different way of looking at flat feet, or at least one useful takeaway. My aim as a physiotherapist is not to tell everyone with a flat foot that they need to change it, but to look for the factors that may actually matter for that individual.
If you have a different issue, or simply want to learn more about how your body moves, head over to the Your Wellness Nerd YouTube channel. Subscribe if you feel inclined, and let me know in the comments what you'd like me to cover next.
- Grant
Frequently Asked Questions
What is the root cause of flat feet?
There is not one universal root cause of flat feet. Clinically, I often assess ankle mobility, hip mobility and hip and lower-limb rotational control because these factors can influence how the foot behaves during weight-bearing and movement.
Can flat feet be corrected with exercise?
Exercise can improve strength, movement capacity and function in people with flexible flat feet, and research suggests that combinations of foot, hip and lower-limb exercise can influence arch-related measures. Whether exercise changes the appearance of an individual's foot depends on the underlying problem and the person.
Can arch supports fix flat feet permanently?
Arch supports can change foot loading and may help reduce symptoms for some people, but they should not be viewed as a guaranteed permanent correction of foot posture. The evidence for orthoses in adult flat feet is mixed, so treatment should be based on the individual's symptoms, function and clinical findings.
What exercises help flat feet?
Exercises commonly used in rehabilitation include foot and ankle strengthening, ankle mobility work, hip strengthening and exercises that improve lower-limb control. In this article, the three exercises demonstrated target ankle mobility, hip rotational control and hip range of motion.
Should everyone with flat feet see a physiotherapist?
Not necessarily. Many people have flat feet without pain or functional problems and do not require treatment. An assessment may be useful when flat feet are associated with persistent pain, weakness, reduced function, a noticeable change in foot shape or difficulty with activities such as walking, running or sport.
Living With Persistent Pain?
If your pain has lasted longer than expected, feels disproportionate to injury, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our sports injury physiotherapy services in Port Macquarie.
Want personalised guidance?
If you'd like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
