Flat Feet Exercises: A Physio Program for Painful Arches

What are flat feet?

Flat feet, also called fallen arches (pes planus), means the inner arch of your foot sits low or presses flat on the ground when you stand. The NHS describes them as common and usually nothing to worry about. Most children have flat feet when they are young, and the arch usually develops between the ages of 3 and 10. If your flat feet do not hurt, the NHS advice is that you do not need to do anything, and they should not stop you doing any activities, including sports.

Some people do get symptoms. The NHS lists an ache along the inner arch, pain around the ankle or lower leg, and shoes that wear out quickly. A flat foot that still shows an arch when you sit or rise onto tiptoe is called a flexible flat foot, and the review of insoles for adults further down looked at this type.

Painful flat feet and a collapsing arch

The foot that needs more attention is one that was not flat before and is now changing. OrthoInfo, from the American Academy of Orthopaedic Surgeons, calls this progressive collapsing foot deformity, and older names for it are adult acquired flatfoot and posterior tibial tendon dysfunction. It often starts with the tendon of the tibialis posterior, a muscle whose tendon runs behind the bony bump on the inside of your ankle and helps hold up the arch. When that tendon weakens, the arch can slowly sag and put extra strain on the ligaments and joints around it.

It is more common in women and in people over 40, and OrthoInfo lists obesity, diabetes and high blood pressure as risk factors. Typical signs are pain along the inside of the foot and ankle, pain and weakness with activity, and trouble standing for long. As the arch drops, pain can appear on the outside of the ankle too. It may start mild. OrthoInfo notes it can progress to a very painful flat foot that does not work well, so if your foot is newly flattening, get it checked rather than waiting.

A simple sign is whether you can rise onto tiptoe on that leg alone. OrthoInfo explains that this needs a healthy tibialis posterior tendon, which is why doctors and physios use it as a test.

Why does exercise help painful flat feet?

Most of the research is on the tendon problem, not on flat feet in general. In a trial of 36 adults with early tibialis posterior tendon problems, every group wore orthoses and stretched for 12 weeks (Kulig and colleagues, 2009). Those who also did resistance exercise for the tendon improved more than those who only had orthoses and stretching, and the group doing slow lowering (eccentric) exercise improved the most. A later trial found that a moderate home strengthening program added little to orthoses and stretching over 12 weeks, although both groups improved (Houck and colleagues, 2015).

A 2018 systematic review found only 3 trials, with 93 people in total (Ross and colleagues, 2018). It found moderate effects on pain and disability when eccentric strengthening was added to stretching and orthoses. It also concluded that high-quality research is scarce and that the trials reported their exercise doses poorly. So strengthening has some support and is a reasonable thing to try, but the evidence is thin.

For painful flexible flat feet without a tendon problem, there is even less trial evidence. The NHS includes foot stretches and exercises among the treatments that can help with pain or stiffness, and it is clear that they will not change the shape of your feet. The aim of this program is a foot and ankle that are stronger and less sore, not a higher arch.

Insoles, orthoses and shoes: what the evidence says

The evidence for insoles and orthoses is weaker than many people expect. A systematic review of 13 studies in adults with flexible flat feet found no high-level evidence for orthoses (Banwell and colleagues, 2014). It found good to moderate evidence that they improve some measures of function, such as steadiness in standing and the energy it takes to walk, but only low-level evidence that they reduce pain. In the tendon trials above, every group wore orthoses and every group improved, but without a group that had no orthoses, those trials cannot show how much came from the insoles.

For shoes, the NHS suggests wide, comfortable shoes with a low heel. A podiatrist or physio can advise whether ready-made insoles are enough or custom orthoses are worth trying for you.

With a painful tibialis posterior tendon, OrthoInfo lists cutting back on the activities that make it worse, ice on the sorest area, anti-inflammatory painkillers and an ankle brace. In some cases a walking boot or short cast is used for 6 to 8 weeks to rest the tendon. Ask a pharmacist if you are not sure a medicine is safe for you. If you are overweight, OrthoInfo advises losing weight, and swapping some walking or standing for cycling or swimming lowers the load while the tendon settles.

How to use this program

If your flat feet do not hurt, you do not need this program. If your pain is mainly under the heel, the plantar fasciitis program may suit you better. If your flat feet ache, pick the stage that matches your foot today. If you are unsure, start at stage 1, and move up when the current stage feels easy and your foot is no worse the next morning.

Stage 1 exercises should be pain free. From stage 2, mild discomfort during the exercises is usually acceptable if it settles soon after and your foot is no worse the next morning. If the arch or inner ankle is clearly worse the next day, the load was too much, so drop back a step rather than stopping altogether.

In the two main tendon trials, people did their strengthening exercises twice a day for 12 weeks, with 2 to 3 sets of 10 to 30 repetitions in one trial and 3 sets of 15 in the other (Ross and colleagues, 2018). Many home programs start lower, at 2 to 3 sets of 10 to 15 once a day, and each exercise page gives a typical starting dose. Calf stretches are usually held for about 30 seconds, 2 to 3 times on each leg. Your physio will adjust this to your foot and to what you need to get back to. Tendon pain settles slowly, and OrthoInfo notes it can last more than 3 months even with early treatment, so judge progress over weeks and months.

Keep a hand on a counter or wall for the standing and balance exercises if you feel unsteady. If you have diabetes or numb feet, check the skin of both feet after each session, and ask your doctor, podiatrist or physio before doing exercises that press or roll on the sole.

The exercise program

Stage 1: Settle a sore arch and start gently

For an arch or inner ankle that aches with everyday walking or standing, and for the first weeks of any program. Keep these exercises pain free. The isometric inversion and the towel sweeps start working the deep muscle that holds up the arch (tibialis posterior) while the foot is supported. Towel scrunches work the small muscles under the foot. Both main trials on this tendon included calf stretches: do one with the back knee straight, then one with it bent. Stop each stretch short of any pain along the inside of the ankle, as a full stretch also squeezes that tendon. Use the strap version if standing stretches are hard to balance in.

Stage 2: Build strength in the arch muscles and calf

When everyday walking is comfortable and the stage 1 exercises no longer bring on pain. The band exercise loads the tibialis posterior against resistance. Take the slow return seriously: in a small trial, the group doing slow lowering (eccentric) work improved most. Calf raises on both feet come next. Once plain calf raises feel easy, try the version with the toes turned in, which is just a small change of position. The foam pad teaches the foot and ankle the small corrections you need on uneven ground.

Stage 3: Heavier single leg work and balance

When 2 to 3 sets of calf raises on both feet feel easy and your foot is no worse the next morning. Rising onto tiptoe on one leg needs a healthy tibialis posterior tendon, so single leg heel raises are a good goal to work toward, with your fingertips on a counter for balance. The eccentric calf raise is the step in between: up on both feet, down slowly on the sore one. Single leg balance, then balance while passing a ball, prepares the foot for longer walks and uneven ground.

When to see a physio or doctor

The NHS advises seeing a doctor if your feet are painful, stiff, weak or numb, if you often get foot or ankle injuries, or if you have problems with walking or balance. It also advises getting checked if you did not have flat feet before, or if only one foot is affected. A physio or podiatrist can assess the arch and the tendon, set your starting stage and advise on insoles. If you have diabetes, some foot changes need checking the same day, and the warning signs below explain which ones.

OrthoInfo advises considering surgery if the pain does not get better after several months of appropriate treatment, so if your foot is not improving, ask to see a specialist. If you have had surgery on your foot or ankle, follow your surgeon's program rather than this page. This page is for adults. If your child has flat feet that hurt, feel stiff or affect only one foot, get them checked by a doctor or physio.

For physiotherapists

This page gives patients a starting program for painful flexible flat foot and early progressive collapsing foot deformity (PCFD), which OrthoInfo also calls adult acquired flatfoot or posterior tibial tendon dysfunction. Screen with the single limb heel rise and the "too many toes" sign from behind, compare sides, and check whether the deformity corrects when the foot is unloaded. A rigid deformity, or one that keeps progressing, needs an orthopedic opinion rather than a loading program alone.

In people with diabetes or neuropathy, rule out active Charcot neuroarthropathy before loading. NICE NG19 advises suspecting it with redness, warmth, swelling or deformity, even without pain, and referring within 1 working day to the multidisciplinary foot care service, with non-weight-bearing treatment until then. The patient warning signs on this page ask for advice the same day.

The trial evidence is small. Kulig and colleagues (2009) randomized 36 adults with stage I or II PTTD to 12 weeks of orthoses and stretching, with or without concentric or eccentric resisted foot adduction in plantarflexion at a 15 repetition maximum load. The Foot Function Index improved in all groups, most with eccentric work and least with orthoses and stretching alone. Houck and colleagues (2015) gave 39 people with stage II TPTD a prefabricated orthosis and stretching, with or without home strengthening, and found the strengthening minimally effective as an add-on at 12 weeks.

Ross and colleagues (2018) included 3 RCTs (n=93) and found moderate effects (SMD 0.6 to 1.2) for eccentric strengthening added to stretching and orthoses. They found load, tempo and progression poorly reported, so no firm dosing recommendation is possible. They also note that calf stretching into full dorsiflexion compresses the tendon behind the medial malleolus, so keep stretches short of medial ankle pain. For flexible pes planus in general, Banwell and colleagues (2014) found no high-level evidence for orthoses, good to moderate evidence for improved physical function and low-level evidence for pain relief. Base progression on the 24-hour response rather than a fixed sheet, and use the single limb heel rise as a practical marker over time.

See a doctor promptly if

You have diabetes or numb feet, and one foot becomes hot, swollen or red, or changes color or shape, with or without pain. Take your weight off that foot straight away and get advice the same day from your doctor or your diabetes foot team. This can be Charcot foot, where the bones and joints of the foot are damaged and the foot can collapse. Do not exercise that foot until it has been checked. If you also have a fever or feel very unwell, or redness is spreading up your foot or leg, go to an emergency department.
The foot is hot, red and swollen, or you have a fever or feel unwell. Get medical help the same day, and go to an emergency department if you feel very unwell. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
You have diabetes or numb feet and find a new blister, cut or sore on your foot, especially one you did not feel, a wound that smells or is leaking, or new pain in your foot that you cannot explain. Get it seen by your doctor or foot team the same day. If you also have a fever or feel very unwell, redness is spreading up your foot or leg, or part of your foot or a toe turns black, go to an emergency department.
Part of your foot or a toe turns cold, pale, blue or black. Call emergency services or go to an emergency department straight away, and do not drive yourself, as the blood supply to the foot may be blocked.
The pain started with a fall, a twist or a sudden pop on the inside of the ankle, and there is swelling or bruising, or you cannot put weight on the foot. Get it checked the same day.
A calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
The arch on one foot has dropped, suddenly or over weeks or months, or you can no longer rise onto tiptoe standing on that leg alone, especially with pain or swelling along the inside of the ankle. See a doctor within a few days. This can be a sign that the tendon that holds up the arch (tibialis posterior) is failing, and it can keep getting worse without treatment. If you have diabetes or numb feet, a change in the shape of your foot is a same-day sign, as described above.
The pain is there at night or at rest as well as when you stand and walk, and it is getting worse. See your doctor within a few days. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse. If you are being treated for cancer now, contact your cancer team the same day.
You have new numbness, tingling, burning or loss of feeling in the foot or toes. Book an assessment with a doctor or physio in the next week or two.

Common questions

Can exercise fix flat feet?

Do not expect exercise to give you a permanent new arch. The NHS says treatments for flat feet will not change the shape of your feet, but can help with things like pain or stiffness. Where exercise does help is with a painful foot, and most of all with a sore tibialis posterior tendon. In a small trial, people who added strengthening to orthoses and stretching improved more than those who had orthoses and stretching alone (Kulig and colleagues, 2009), although a second trial found a home strengthening program added little (Houck and colleagues, 2015). Your physio will adjust the exercises to your foot.

Are flat feet a problem?

Usually not. The NHS describes flat feet as common and usually nothing to worry about, and says they should not stop you doing any activities, including sports. They are worth checking if they hurt, feel stiff, weak or numb, if you did not have flat feet before, or if only one foot is affected.

Do insoles help flat feet?

They can help some people, but the evidence is weaker than many expect. A systematic review in adults with flexible flat feet found good to moderate evidence that orthoses improve some measures of function, such as steadiness in standing and the energy it takes to walk, but only low-level evidence that they reduce pain (Banwell and colleagues, 2014). If your flat feet do not hurt, you do not need them. A podiatrist or physio can tell you whether ready-made insoles are enough or custom orthoses are worth trying.

What shoes are best for flat feet?

The NHS suggests wide, comfortable shoes with a low heel. There is no single best shoe, so go by comfort and by how your feet feel in the evening. If the inside of your foot or ankle aches, ask a podiatrist or physio whether an insole in those shoes is worth adding.

Can adults get flat feet later in life?

Yes. The NHS lists stretching of the tissues in the feet from injury, aging or extra body weight as one of the less common causes. OrthoInfo describes a form that gets worse over time, progressive collapsing foot deformity, which often starts with the tibialis posterior tendon and is more common in women and in people over 40. A foot that was not flat before and is now flattening, especially on one side, should be checked by a doctor.

References

NHS. Flat feet. Page last reviewed 24 June 2025. https://www.nhs.uk/conditions/flat-feet/
American Academy of Orthopaedic Surgeons. Progressive Collapsing Foot Deformity (Flatfoot). OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/posterior-tibial-tendon-dysfunction/
Kulig K, Reischl SF, Pomrantz AB, Burnfield JM, Mais-Requejo S, Thordarson DB, Smith RW. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Physical Therapy. 2009;89(1):26-37. https://doi.org/10.2522/ptj.20070242
Houck J, Neville C, Tome J, Flemister A. Randomized controlled trial comparing orthosis augmented by either stretching or stretching and strengthening for stage II tibialis posterior tendon dysfunction. Foot and Ankle International. 2015;36(9):1006-1016. https://doi.org/10.1177/1071100715579906
Ross MH, Smith MD, Mellor R, Vicenzino B. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport and Exercise Medicine. 2018;4(1):e000430. https://doi.org/10.1136/bmjsem-2018-000430
Banwell HA, Mackintosh S, Thewlis D. Foot orthoses for adults with flexible pes planus: a systematic review. Journal of Foot and Ankle Research. 2014;7:23. https://doi.org/10.1186/1757-1146-7-23
Diabetes UK. Charcot foot and diabetes. Last reviewed 8 November 2024. https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/feet/charcot-foot
Diabetes UK. Serious foot problems and diabetes. Last reviewed 24 December 2024. https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/feet/serious-foot-problem
National Institute for Health and Care Excellence. Diabetic foot problems: prevention and management. NICE guideline NG19. Published 26 August 2015, last updated 11 October 2019. https://www.nice.org.uk/guidance/ng19
NHS. Sepsis. Page last reviewed 14 May 2026. https://www.nhs.uk/conditions/sepsis/
NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/

Written and checked by the PocketPhysio editorial team. Last updated 2026-09-28.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.

Flat feet exercises and physiotherapy