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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Feet Ask The Expert, Ask The Expert Feet Ask The Expert, Ask The Expert

What exactly are “flat feet” and “fallen arches?” Are they the same thing? What causes them and how should they be treated?

March 11, 2013


“Flat feet” and “fallen arches” refer to the same thing. It’s a downward sagging of the inside edge of the foot during standing or walking. The term “pes planus” is another name for flat feet. Sometimes flat feet can explain pain symptoms in the feet and legs. Arch supports or shoes with good support may help.

The front-to-back arches (called the “longitudinal arches”) of the feet are natural curves along the bottom of both feet that are supported by muscles and ligaments. When these muscles and ligaments give way, the arches sag with each step. When the arches sag, your weight is shifted towards your big toes.

“This can create some sore spots. Sagging arches also change the angle of each heel bone. When this happens, the heel tendons (Achilles tendons) and the muscles in your legs and back can become tight due to a lack of natural stretching. Symptoms from fallen arches can include:

  • Pain in the feet
  • Pain under the heels (“plantar fasciitis”)
  • Sore calf muscles
  • Lower back or leg muscle fatigue after walking short distances

Because the toes spread out more widely with each step when the arches are lost, it is also common for fallen arches to lead to painful red corns on the toes.

When fallen arches cause symptoms, stretches of the heel tendons are the most important part of treatment. Stretching can be continued at night. You wear a brace or splint (“plantar fasciitis splint”) around your ankle. Supportive footwear (with good cushion and good arch support) can redirect where your feet carry your weight.

Many people with true fallen arches will notice that the heels of their shoes wear down over time on the sides of the big toes, instead of wearing down first on the outer edges of the heels. Wedge-shaped shoe inserts that lift the heel (“Thomas heels”) or a “plantar fasciitis strap” that lifts your arch can be helpful. Sometimes arch supports (a firm cushion or molded plastic that props up the arch) can be added to your shoes as well. Any time an arch support is tried, it should be used for both feet at the same time. This helps avoid new balance problems.

Fallen arches can be a family tendency. They can also be brought on by:

  • A foot injury
  • Tendinitis
  • Obesity
  • Too little cushioning of the foot from below, especially if you work on a concrete floor.

Do not jump to conclusions that your arches are the cause of symptoms! Although most people develop a front-to-back arch in their feet during infancy, flat arches can be normal in some people. This is especially true for blacks and Native Americans. And flat arches usually do not cause symptoms.

Your doctor or a podiatrist can be helpful in deciding whether your arches are the source of symptoms.

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