A flat foot is not always a problem
A painful or progressively changing foot needs assessment.
Many people naturally have a relatively low arch and have no symptoms at all.
The situation is different when the arch progressively collapses, the heel moves outward, the foot becomes painful or the shape of the foot starts interfering with walking and footwear.
This condition has traditionally been called adult-acquired flatfoot or posterior tibial tendon dysfunction. The term progressive collapsing foot deformity (PCFD) better reflects the fact that several structures—including tendons, ligaments and joints—may contribute to the deformity.
What does progressive collapsing foot deformity look like?
The changes can develop gradually. You may notice:
- Flattening of the arch
- The heel appearing to move outward
- Increasing difficulty standing on the toes
- Pain or swelling along the inside of the ankle
- Increasing difficulty with prolonged walking
- The forefoot appearing to move outward
- Pain shifting towards the outside of the ankle in more advanced deformity
- Difficulty finding comfortable footwear
Why does it happen?
The posterior tibial tendon plays an important role in supporting the arch and controlling the foot during walking.
However, PCFD is not simply a “tendon problem.”
The supporting ligaments, bones, joints and calf-Achilles complex can also contribute to the developing deformity.
How do I assess a flat foot?
A proper assessment involves more than looking at the arch while sitting.
I assess:
- Standing alignment
- Hindfoot position
- Arch shape
- Forefoot alignment
- Ability to perform a single-leg heel rise
- Posterior tibial tendon function
- Achilles/calf tightness
- Flexibility of the hindfoot
- Ankle alignment
- Walking pattern
- Associated pain
Does every flat foot require surgery?
No. Many patients can be managed without surgery, particularly when the deformity is flexible and symptoms are relatively early.
The treatment is tailored according to symptoms, deformity, flexibility and functional requirements.
Treatment may include
- Activity modification
- Appropriate footwear
- Physiotherapy
- Calf stretching
- Strengthening
- Orthoses
- Bracing
- Temporary immobilisation in selected cases
When is surgery considered?
Surgery may be considered when pain and functional limitation persist despite appropriate non-operative treatment, or when the deformity is significant or progressive.
There is no single operation for flat foot. Depending on the deformity, surgery may involve a combination of procedures addressing:
- Tendon dysfunction
- Hindfoot alignment
- Medial column instability
- Forefoot deformity
- Calf/Achilles tightness
- Arthritic joints
In more advanced or rigid deformities, fusion procedures may be necessary. The choice depends on the individual pattern of deformity rather than simply the degree of arch flattening.
Why early assessment matters
Progressive deformity can change the mechanics of the entire foot and ankle.
Frequently Asked Questions
Is having flat feet abnormal?
Not necessarily. Many people have flat feet without pain or functional problems.
Can flat feet be corrected with exercises?
Exercises may improve strength and symptoms, particularly in earlier stages, but they cannot necessarily reverse a fixed structural deformity.
Do I need custom insoles?
Not everyone does. Orthoses can be useful in selected patients, depending on the foot shape, symptoms and mechanical requirements.
Will my flat foot get worse?
Some deformities progress while others remain relatively stable. It is difficult to predict progression in every individual patient.
Is flat-foot surgery cosmetic?
The primary goals of surgery are usually pain relief, functional improvement and restoration of appropriate alignment—not cosmetic correction.
If your arch is changing or your foot is becoming painful
A clinical assessment can determine whether you have a simple flexible flat foot or a progressive deformity requiring more detailed evaluation.
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