What Are Fallen Arches In Feet? Causes And Treatment

Fallen arches, also called flat feet, happen when the arch on the inside of the foot flattens and the entire sole comes close to or touches the ground. This is common and often painless. Some people are born with flat feet and never have a problem. Others develop fallen arches later in life, and that is when pain or discomfort tends to show up. The causes range from genetics to injury to the natural wear that comes with age. Treatment depends on whether the condition causes symptoms and what is driving it.

What Are Fallen Arches In Feet Causes And Treatment?

Fallen arches means the medial longitudinal arch — the curve along the inside of your foot — has dropped or never formed properly. Your foot may roll inward when you stand or walk, a pattern called overpronation.

There are two broad types. Flexible flatfoot means the arch is visible when you sit or stand on tiptoes but disappears when you stand flat. Rigid flatfoot means the arch is gone no matter what position your foot is in. Rigid flatfoot is less common and more likely to signal an underlying problem.

The arch itself is not a bone. It is a structure formed by the bones of the foot, supported by tendons and ligaments. The most important of these is the posterior tibial tendon, which runs along the inside of the ankle and attaches to bones in the midfoot. When that tendon stretches, tears, or becomes inflamed, the arch can collapse.

Treatment ranges from doing nothing at all — if there is no pain — to custom orthotics, physical therapy, and in serious cases surgery. Most people with flat feet do not need treatment.

What Causes Fallen Arches?

The causes fall into two groups: those present from birth and those that develop later.

Congenital causes

Many people are simply born with flat feet. The arch may never fully develop during childhood, or the foot structure is naturally low. This is often inherited. In most cases, congenital flat feet are flexible and painless.

In rare cases, flat feet in children can be linked to conditions like tarsal coalition, where bones in the foot fuse abnormally. A doctor can usually tell the difference during an exam.

Acquired causes

Fallen arches that develop in adulthood usually have a specific trigger. The most common is dysfunction of the posterior tibial tendon. This tendon works like a cable that holds up the arch. Over time — from overuse, injury, or inflammation — it can weaken or tear. When it does, the arch drops.

Other causes include:

• Injury to the foot or ankle, including fractures
• Rheumatoid arthritis, which can damage the joints and ligaments in the foot
• Diabetes, which can affect nerve function and connective tissue in the foot
• Obesity, which puts added stress on the arch over time
• Pregnancy, due to hormonal changes that loosen ligaments and added weight
• Neurological conditions such as cerebral palsy or muscular dystrophy
• Normal aging, which weakens tendons and ligaments

Posterior tibial tendon dysfunction is more common in women than men and typically appears after age 40. But it can happen at any age.

What Are the Symptoms of Fallen Arches?

Many people with flat feet have no symptoms at all. When symptoms do appear, they usually include:

• Pain along the inside of the ankle or in the arch
• Swelling on the inner side of the ankle
• Pain that worsens with activity and improves with rest
• Difficulty standing on tiptoes
• Foot fatigue after walking or standing for long periods
• Pain in the heel, knee, hip, or lower back — because the changed foot position alters how you walk
• One foot flattening while the other stays normal (a sign of posterior tibial tendon problems)

A key sign of posterior tibial tendon dysfunction is that the arch flattens on one side only. If both feet have always been flat, that is usually a structural trait, not a progressive problem.

If you notice your arch dropping on one side, or if pain is getting worse over weeks or months, see a doctor. Early treatment for tendon problems tends to work better than waiting.

How Are Fallen Arches Diagnosed?

Diagnosis usually starts with a physical exam. A doctor will look at your feet from the front and back, ask you to stand on your toes, and check how your foot moves. They may ask you to walk so they can see your gait.

The “too many toes” sign is a common clinical observation. When viewed from behind, more toes are visible on the affected side because the foot has rolled outward.

Imaging may be used if the cause is unclear or if surgery is being considered:

• X-rays show bone alignment and any arthritis or fractures
• Ultrasound or MRI can show tears or inflammation in the posterior tibial tendon
• CT scans may be used to check for tarsal coalition or other bone abnormalities

Not everyone with flat feet needs imaging. If the condition is painless and flexible, a physical exam is often enough.

What Treatment Options Exist for Fallen Arches?

Treatment depends on whether you have symptoms and what is causing the problem. If there is no pain, no treatment is needed.

When symptoms are present, treatment usually starts with conservative approaches:

• Rest and activity modification. Reducing activities that aggravate the foot can help calm inflammation in the posterior tibial tendon.
• Orthotic inserts. Over-the-counter arch supports may help some people. Custom orthotics made from a mold of your foot are often recommended for posterior tibial tendon dysfunction. Evidence for their effectiveness is mixed — some studies show benefit for pain and function, others show limited difference compared to over-the-counter options.
• Physical therapy. Strengthening the posterior tibial tendon and surrounding muscles may help slow progression. This is commonly recommended, though high-quality trials are limited.
• Bracing. An ankle-foot orthosis or a stirrup brace can support the foot and reduce tendon strain.
• Weight management. If excess weight is contributing to strain on the arch, losing weight may reduce symptoms.
• Pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce pain and swelling. These are available over the counter but should be used according to label directions.

Surgery is considered when conservative treatment fails and symptoms are significantly affecting daily life. Procedures may involve tendon repair, tendon transfer, or fusion of affected joints. Recovery can take months, and outcomes vary depending on the severity of the tendon damage and other health factors.

No medication or supplement has been shown to rebuild a fallen arch. Once the posterior tibial tendon is significantly torn, it does not heal on its own without intervention.

Can Fallen Arches Be Prevented?

You cannot prevent flat feet you were born with. But you may be able to reduce the risk of acquired fallen arches or slow their progression.

Maintaining a healthy weight reduces the load on your feet. Wearing supportive shoes — especially during activities that stress the feet — can help. If you have diabetes or rheumatoid arthritis, managing those conditions well may lower the risk of foot complications.

Stretching and strengthening the muscles around the ankle and foot may help maintain support. This is often recommended by physical therapists, though direct evidence that it prevents fallen arches is limited.

If you notice early signs — pain on the inside of the ankle, swelling, or a change in how your foot looks — see a doctor. Early treatment for posterior tibial tendon problems is more likely to be effective than waiting until the tendon is severely damaged.

When Should You See a Doctor?

See a doctor if you have foot pain that does not improve with rest, if your arch is dropping on one side only, or if you have trouble standing on your toes. These can be signs of posterior tibial tendon dysfunction, which tends to get worse without treatment.

Also see a doctor if you have diabetes and notice any change in your feet. Foot problems in people with diabetes can become serious quickly.

If you have flat feet but no pain and no changes over time, you likely do not need medical care. Routine checkups are enough.