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The Painful Flat Foot 🦶

Flat Feet, also known as fallen arches or Pes Planus, is a common condition in which the arch of the foot collapses, causing the entire sole of the foot to come into complete or near-complete contact with the ground. Most people with flat feet do not experience any pain or discomfort, some individuals do feel pain in feet, ankles, or lower legs as a result of this condition. In this blog post by ACTIVATE, we will discuss the causes, symptoms, diagnostics and treatment options for painful flat feet.

What are the causes of Painful Flat Feet?

There are several possible causes of painful flat feet. One common cause is structural abnormalities present at birth, such as a low arch or loose ligaments that prevent the feet from forming a normal arch. Another potential cause is trauma or injury to the ankle or foot, such as a sprain or a break, which can damage the structures that support the arch of the foot.

Obesity can also contribute to the development of painful flat feet. Being overweight or obese puts added strain on the feet and can cause the arches to flatten over time. Similarly, conditions that cause inflammation or stiffness in the feet, such as arthritis, can lead to the development of painful flat feet.

Overuse or overtraining can also cause the feet to become painful and flattened. This can happen when the feet are subjected to repeated stress and strain, such as from running or jumping, without sufficient rest, recovery time or appropriate foot wear. Wearing poorly fitting or unsupportive shoes can cause the feet to over-pronate and become painful.

Are there any other symptoms associated with Painful Flat Feet?

In addition to pain, other symptoms of painful flat feet (pes planus) may include:

  • Swelling in the feet or ankles

  • Heel pain or tenderness

  • Pain or discomfort in the arch of the foot

  • Difficulty standing on tiptoe

  • Knee pain or discomfort

  • Pain in the legs or lower back

  • Foot fatigue or stiffness

  • Difficulty walking or difficulty participating in physical activities

How can we diagnose painful flat feet?

Flat feet can be diagnosed by a physical examination, during which the doctor will check the shape and function of your feet. You will be asked to walk or stand on your toes to see how your feet move. Imaging tests, such as x-rays, ultrasound or MRI scan, can also be used to diagnose flat feet and rule out other potential causes of foot pain. In some cases. If you are experiencing foot pain, it is important to see a doctor to determine the cause and get appropriate treatment.

What is the role of Ultrasound and MRI in the diagnosis and treatment of Painful Flat Feet?

Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves to produce images of the inside of the body. In the case of pes planus (flat feet), ultrasound may be used to assess the condition of the tendons, ligaments, and other structures in the feet and ankles.

Ultrasound is a non-invasive, painless, and relatively inexpensive imaging modality that is often used in the evaluation of musculoskeletal disorders, including pes planus. It can provide detailed images of the soft tissues of the feet and ankles, including the tendons, ligaments, and muscles, which can help doctors to diagnose and treat flat feet.

For example, ultrasound can be used to assess the integrity and function of the tendons and ligaments that support the arch of the foot, such as the posterior tibial tendon and the peroneal tendons. It can also be used to evaluate the muscles of the feet and ankles, including the calf muscles, to assess their strength and function.

In addition to its diagnostic capabilities, ultrasound can also be used to guide certain treatment procedures for flat feet, such as injections of medication or other therapeutic agents. Watch this video from ACTIVATE to learn more about Ultrasound scans

Magnetic resonance imaging (MRI) is a type of imaging test that can be used to diagnose painful flat feet. MRI uses a powerful magnetic field and radio waves to create detailed images of the inside of the body. This test can help doctors to see the structures of the feet in greater detail and identify any abnormalities or injuries that may be causing pain. MRI can also be used to rule out other potential causes of foot pain, such as a stress fracture or a tear in a ligament or tendon. If MRI scan is required, this can be arranged via our partners at a convenient time and place.

Overall, ultrasound and MRI scans plays a valuable role in the evaluation and treatment of pes planus by providing detailed images of the structures of the feet and ankles and helping doctors to diagnose and treat the condition effectively.

What are the treatment options in Painful Flat Feet?

Treatment for painful flat feet will depend on the underlying cause of the condition and the severity of the symptoms. In many cases, simple self-care measures, such as rest, ice, and over-the-counter pain medication, may be enough to relieve pain and discomfort. In other cases, other forms of treatment may be necessary. Some possible treatment options for painful flat feet include:

  • Physiotherapy to improve strength and flexibility in the feet and ankles

  • Orthotic inserts to support the arch of the foot (custom or ready made)

  • Stretching and strengthening exercises

  • Weight loss to reduce pressure on the feet

  • Injections for pain relief, combined with physiotherapy and orthotics

  • Surgery to correct underlying structural abnormalities

How can orthotics help in Painful Flat Feet?

Orthotics are custom-made shoe inserts that can be used to treat painful flat feet. These inserts are designed to support the feet and improve their function. Orthotics can help to distribute weight evenly across the feet and reduce strain on the joints, muscles, tendons and ligaments. They can also provide cushioning and shock absorption to protect the feet from the impact of walking, running and jumping. Orthotics are typically prescribed by a doctor, orthotist or physiotherapist and are made based on a mould or impression of the feet. They can be made from a variety of materials and can be customized to meet the specific needs of the individual. Some orthotics can be purchased over the counter.

What types of injections are there in treating Painful Flat Feet?

There are several types of injections that may be used in the treatment of Painful Flat Feet, depending on the underlying cause of the condition and the symptoms being experienced. Some possible injections that may be used in the treatment of flat feet include:

  • Corticosteroid injections: These injections can be used to reduce inflammation and pain in the feet and ankles. Corticosteroid medications are anti-inflammatory agents that can help to alleviate swelling and discomfort in the feet and ankles.

  • Platelet-rich plasma (PRP) injections: PRP injections involve injecting a concentration of platelets from the patient's own blood into the affected area. Platelets are rich in growth factors and other substances that can promote healing and tissue repair. PRP injections may be used to promote the healing of tendons and ligaments in the feet and ankles.


The management of painful flat feet typically involves a combination of treatments. Non-surgical options may include the use of orthotic inserts, physiotherapy, medications or injections to reduce pain and inflammation. In some cases. If non-surgical treatments are not effective, surgery may be recommended to repair structural abnormalities in the feet or to release tight tendons that are contributing to the pain. If you are experiencing foot and ankle pain, contact us or book an appointment for diagnosis and treatment.

About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.


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