How flat feet in adults destroy knees and back
Pain in the heel after getting up in the morning, tired legs after a short walk, or the feeling that you are standing with your full weight on the inner side of your foot – these are signals that many people ignore or attribute to poor footwear. Yet behind these complaints may lie a collapse of the foot arch, a condition in which the natural curve of the foot decreases or disappears entirely. Flat feet in adults is far more widespread than it might seem – according to estimates by orthopaedic specialists, approximately one in four to five adults struggles with some degree of this problem.
Interestingly, most of those affected are unaware of their condition for a long time. Arch collapse does not necessarily cause pain at first. The body gradually adapts to the changed position of the foot, compensating elsewhere – in the ankle, knee, hip, or even the back – and only when these compensations are no longer sufficient do problems begin to appear. By that point, the condition is usually already well developed and more difficult to address.
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How to recognise that the arch is collapsing
The simplest way to check the condition of your arch yourself is the so-called wet test. Simply wet your foot, step onto a piece of paper or a tile, and walk away. The imprint left behind will reveal a great deal. A healthy arch leaves an imprint with a distinct curve on the inner side – approximately one third of the width of the foot should leave no trace at all. If the imprint is almost complete, with no clear curve, or conversely very narrow (which indicates a high arch), it is worth paying closer attention to your feet.
Another clue is the wear pattern on your shoes. Look at the soles of your favourite trainers or everyday footwear. Excessive wear on the inner side of the heel and the front part of the shoe suggests that the foot is rolling inward during walking – a phenomenon technically known as pronation. Mild pronation is entirely natural and part of the normal gait cycle, but when it is excessive it is one of the typical signs of flat feet.
Symptoms that should definitely not be overlooked include pain in the area of the inner ankle or along the inner side of the foot, swelling around the ankle, a feeling of stiffness or cramping in the arch of the foot particularly after prolonged standing, as well as knee and lower back pain that may not seem related to the feet at all. People with a collapsed arch also frequently report that their feet tire more quickly than before, even during activities that previously caused them no difficulty. If these symptoms recur or persist, it is appropriate to visit an orthopaedic specialist or podiatrist – a specialist in feet and their biomechanics.
It is important to distinguish between two basic types of flat feet. Flexible flat feet refers to a condition in which the arch is partially or fully restored when the foot is unloaded (for example, when standing on tiptoe). This is the more favourable variant, which responds well to exercise and appropriate footwear. Rigid flat feet, by contrast, is a condition in which the arch is absent even without load – the bone is permanently deformed. This type tends to be associated with greater pain and requires a more complex approach.
There are many reasons why arch collapse occurs in adults. Genetic predisposition plays a role – if parents suffered from flat feet, the risk in their children increases. Excess weight and obesity place enormous demands on the arch and gradually overload it. Pregnancy, during which hormones relax the ligaments and increasing body weight shifts the centre of gravity, can lead to temporary or permanent arch collapse. Similarly, prolonged standing on hard floors – for example at a checkout, in a production facility, or in a kitchen – has the same effect. Tendon injuries, particularly what is known as posterior tibial tendon dysfunction, are among the most common causes of flat feet developing in middle age. And finally, inappropriate footwear – too rigid, too soft, or lacking any arch support – contributes to the weakening of the muscles and ligaments that naturally maintain the arch.
What to do about a collapsed arch
Once the problem has been identified, the question arises of what to do about it. The good news is that in the vast majority of cases, flat feet in adults can be managed using conservative methods – that is, without surgery. The key lies in a combination of appropriate footwear, orthopaedic insoles, and targeted exercise.
Orthopaedic insoles, or orthoses, are today available both custom-made from an orthopaedic technician and as prefabricated options in pharmacies and specialist shops. Their purpose is to support the arch from the outside, distribute the load correctly across the entire foot, and reduce excessive pronation. A scientific review published in the Journal of Foot and Ankle Research confirms that regular use of orthopaedic insoles significantly reduces pain and improves foot function in patients with a collapsed arch. Insoles alone, however, do not treat the underlying problem – they are more of a supportive tool, while the real work is done through movement and strengthening.
Exercise focused on strengthening the muscles of the foot and calf is an indispensable part of treatment. Physiotherapists most commonly recommend exercises such as picking up objects with the toes (for example marbles or a towel from the floor), the "short foot exercise", in which the big toe is drawn towards the heel without lifting the toes, or walking barefoot on uneven surfaces – grass, sand, or specialised balance pads. Walking barefoot in particular is currently the subject of growing interest among researchers. Studies show that people who grew up or live in environments where walking barefoot is the norm have significantly stronger arches and a lower incidence of arch disorders.
Imagine Martina, a forty-year-old teacher who two years ago began complaining of heel and knee pain. An orthopaedic specialist diagnosed her with flexible flat feet caused by a combination of genetic predisposition and prolonged standing in the classroom. She was recommended orthopaedic insoles, began exercising regularly under the guidance of a physiotherapist, and replaced her favourite ballet flats with footwear offering adequate arch support. After six months, the pain had subsided to the point where she no longer needed the anti-inflammatory medication she had previously taken almost every day.
Choosing the right footwear is a topic that deserves a chapter of its own. As a general rule, shoes for people with a collapsed arch should have a firm heel counter, sufficient room for the toes, a stable mid-section (known as torsional rigidity), and mild inner arch support. Conversely, completely flat shoes with no structure whatsoever, such as flip-flops or minimalist ballet flats, provide no arch support and can worsen the condition when worn every day. Equally problematic are shoes with excessively high heels, which distribute the load unevenly and shorten the Achilles tendon.
Alongside exercise and footwear, there are other supportive methods. Physiotherapy focused on mobilisation of the joints of the foot and ankle, taping the arch with sports tape for temporary support, or hydrotherapy and massage can all contribute significantly to pain relief and improved function. For those seeking natural supplements to foot care, there are also special foot baths with mineral salts or massage rollers that can be used in the comfort of home.
When is surgery necessary? This is a question many patients ask. Surgical intervention is only considered when conservative treatment has failed over a sufficiently long period – usually at least one to two years – and the complaints are significantly reducing quality of life. Surgery is performed using various techniques depending on the cause and extent of the problem: from tendon transfer and osteotomy (reshaping of the bone) to joint fusion. Recovery tends to be lengthy and outcomes depend on the patient's age, overall health, and the thoroughness of rehabilitation.
It is important to mention the preventive dimension of the subject as well. Maintaining a healthy body weight, regular physical activity, alternating footwear, and conscious care of the feet are factors that can significantly prevent the development of flat feet or at least slow its progression. As orthopaedic physiotherapist Clare Frank puts it: "The feet are the foundation of the entire musculoskeletal system. If we neglect them, sooner or later we pay for it throughout the whole body." These words are doubly true in an era when most of us spend long hours sitting or wearing inappropriate footwear.
Arch collapse in adults is therefore neither merely an aesthetic matter nor an inevitable fate. It is a condition that, when recognised early and approached correctly, can be managed effectively and in many cases significantly improved. What is decisive is not to underestimate the signals that the feet send, and not to regard chronic fatigue or pain as a normal part of everyday life. Feet carry a person throughout their entire life – and they deserve attention accordingly.
