Pain guide · Foot pain
Flat feet, or fallen arches, are when the inner arch touches the ground as you stand. They are common, usually cause no problems, shouldn't stop you doing sport, and are rarely serious. Most children develop arches between the ages of 3 and 10, and you don't need to do anything if flat feet aren't causing problems.
A flat foot that is painful, new, or on one side only is different: in adults it is often a problem with the tibialis posterior tendon, which supports the arch. This guide says when to get checked, and gives a 12-week strengthening plan built on the trials for that tendon.
Exercise is for pain that has been checked or is clearly mild and settling.
The NHS says flat feet are common, usually cause no problems, and need no treatment unless they do. In children, trials of insoles were too few to draw conclusions (3 trials, 305 children).
See a GP if flat feet are painful, stiff, weak or numb, you often get foot or ankle injuries, you have balance problems, you didn't have flat feet before, or only one foot is affected.
The tibialis posterior muscle runs from deep in the calf, behind the bony bump on the inside of the ankle, into the arch. When its tendon is irritated, there is pain, warmth and swelling along that line, the arch drops, and standing for long or rising onto tiptoe becomes hard. Surgeons now call the whole spectrum progressive collapsing foot deformity, and the shape can get worse over time. The tibialis posterior muscle guide explains what the muscle does.
A review of 21 cohorts (6,228 people) found a pronated (flat) foot was a small risk factor for shin splints, with very limited evidence for kneecap pain, and was not linked to foot and ankle injuries or bone stress. In 927 novice runners in neutral shoes, those with pronated feet were not at higher risk, and had slightly fewer injuries per 1,000 km. A painless flat foot doesn't need correcting.
Wide shoes with a low heel, insoles, foot stretches and exercises, and painkillers. The NHS is clear that these will not change the shape of your feet, but can help with pain or stiffness. Surgery is rarely needed.
Source 1
In a trial of 36 adults with early tendon dysfunction, everyone wore orthoses and stretched for 12 weeks. Adding resisted exercise helped, and the group with a slow, lowering (eccentric) phase improved most in pain and function. Their exercise swept the forefoot inwards against resistance with the foot slightly pointed: 3 sets of 15 at a load they could only just manage, twice a day.
In another trial of 39 adults, a home programme of band work and heel raises added little over orthoses and stretching, as both groups improved. A review of the 3 trials (93 people) found moderate effects for eccentric strengthening but called the research thin.
In 4 trials (186 people, mostly at high risk of bias), orthoses reduced pain early on, more so with exercise, and arch-supporting orthoses beat flat insoles.
Source 10
Foot muscle training builds strength and may reduce arch drop by a couple of millimetres after about 8 weeks, at low certainty. In 15 people with tendon dysfunction, 4 weeks of the short foot exercise changed muscle activity in walking but not the foot's shape.
Calf stretches were part of every trial (3 to 10 holds of 30 seconds, 2 to 4 times a day), but the review authors note that holding the ankle fully bent squeezes the tendon behind the ankle bone and may work against pain relief. Keep calf stretches gentle and optional while the tendon is sore.
Source 9
Some discomfort during exercise is fine. Aim for pain you would call mild to moderate, no more than about 5 out of 10, that settles within an hour, with no more swelling or stiffness the next morning. If it's worse the next day, do a little less (a smaller range, fewer reps, a lighter band), not nothing.
For tendon pain on the inner ankle, the 5 out of 10 figure borrows the pain-monitoring rule from an Achilles trial, in which carrying on with activity under the rule did no harm. It hasn't been tested in this tendon.
The exceptions: pain in one spot on a bone should be pain-free, because it could be a stress fracture; burning, tingling or numbness means stop that movement; and if your feet are numb, pain won't warn you, so check your skin after exercise.
If pain climbs day after day, or you notice a warning sign, stop and get it checked. The 5 out of 10 figure is an editorial starting point that matches this site's other pain guides, not a tested rule.
Start at the first stage. Each move opens a full guide with a 3D demo.
Weeks 0 to 2. Wear the insoles or supportive shoes you've been advised to use. Doses come from the Kulig 2009 trial where named; the rest are editorial starting points.
3D demoBand ankle inversionBeginner · A band + A bench or box3 sets of 15, once or twice a day · A light band; the trial's format, with the light start editorial
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box3 sets of 15
Harder: Slow calf raise
Short foot + toe splayBeginner · No equipment10 holds of 5 s · Arch lift, then toe spread; a trial in tendon dysfunction used 5 sets of 15 a day, 3 days a week
Easier: Towel toe curl · Harder: Peroneals Stretch
3D demoSeated calf stretch with a towelBeginner · Other / check instructions3 holds of 30 s · Optional; gentle, never forced at the end of the range
Move on when: Three sets of 15 with a light band stay within the tendon pain rule and have settled by the next morning.
Weeks 2 to 6.
3D demoBand ankle inversionBeginner · A band + A bench or box3 sets of 15, twice a day · A band you can only just manage; take 2 to 3 s to let the foot back, as in the trial's best group
3D demoSlow calf raiseBeginner · A wall2 sets of 10, building to 3 sets of 30 · The Houck 2015 trial's heel-raise progression
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoTowel toe curlBeginner · Other / check instructions + A bench or box3 sets of 15
Harder: Short foot + toe splay
3D demoSingle-leg standBeginner · A wall3 holds of 30 s each leg
Easier: Tandem stance and heel-to-toe walk · Harder: Single Leg Reach Matrix
3D demoClamshellBeginner · No equipment2 to 3 sets of 12 each side · Hip muscles; the review suggests looking at hip function
Harder: Lateral band walk
Move on when: Twenty or more calf raises on both feet are comfortable and within the pain rule.
Weeks 6 to 12, and on. The trials ran for 12 weeks.
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall2 to 3 sets of 10 each leg, building · Start on flat ground; single-leg heel raises were part of the Houck programme
Easier: Slow calf raise · Harder: Single-leg pogo hops
3D demoStanding dumbbell calf raiseIntermediate · A dumbbell3 sets of 8 to 12
Easier: Slow calf raise · Harder: Single-leg pogo hops
3D demoSingle Leg Reach MatrixIntermediate · No equipment3 rounds of 5 each direction
Easier: Standing crossed-leg side reach
3D demoTreadmill walkingBeginner · Cardio machineBuild your walking time · Within the tendon pain rule
Harder: Treadmill jogging
Move on when: Single-leg heel raises are comfortable. Keep strength work going twice a week after the 12 weeks (editorial).
| Habit or position | Why it matters | Instead |
|---|---|---|
| Ignoring a foot that is flattening on one side | The NHS says new or one-sided flat feet need a GP, and the deformity can get worse. | Get it assessed, and ask about insoles. |
| Hard end-of-range calf or inner ankle stretches | Holding the ankle fully bent may squeeze the irritated tendon. | Gentle, short holds; strengthen the tendon instead. |
| Long spells on your feet, running and jumping during a flare | Arthritis UK says the pain gets worse with activity, particularly running and jumping. | Cycling, swimming and shorter walks. |
| Unsupportive flat shoes or flip-flops | An editorial swap: the NHS says wide, comfortable shoes with a low heel are usually best. | Supportive shoes and insoles. |
Not the shape, as a rule. The NHS says exercises, insoles and shoes help pain and stiffness but won't change the shape of your feet. Foot strengthening may reduce how far the arch drops by a couple of millimetres.
Only if your flat feet hurt or cause problems, the NHS says. For early tibialis posterior tendon pain, arch-supporting orthoses may ease pain, especially with exercise.
No trial of them in flat feet was found. Walking in minimalist shoes strengthened foot muscles in one trial, but runners who switched to them had more injuries. If you try them, change slowly.
Usually. Most children develop arches between 3 and 10, and the evidence for insoles in children is too limited to recommend them. See a GP if a child's flat feet hurt, are stiff, or affect only one foot.
The best-tested exercise sweeps the forefoot inwards against a band with a slow return: 3 sets of 15, twice a day, alongside insoles. The trials ran for 12 weeks; no source gives a typical recovery time.
Not as a rule. A review of 21 cohorts found a flat foot was a small risk factor for shin splints and, on very limited evidence, kneecap pain. No source behind this guide links flat feet to back pain.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.