The foot arch is formed by bones, ligaments, and tendons that support the body’s weight. Its primary function is to act as a spring, absorbing shock and distributing forces during movement like walking or running. When this architecture is compromised, resulting in fallen arches (Pes Planus), the body’s alignment can be affected, leading to pain or instability.
Identifying Arch Issues and Common Causes
A simple way to check for a fallen arch at home is the wet footprint test. Wet your feet and step onto a flat surface; if the imprint shows your entire sole touching the ground with little to no inward curve, you likely have a low or flat arch. It is helpful to distinguish between flexible flatfoot, where the arch appears when sitting or on tiptoes but disappears when standing, and rigid flatfoot, where the arch remains flat regardless of foot position.
The most common cause of a newly acquired flat arch in adults is Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon is the main structure that supports the arch, and inflammation or injury to it can cause the arch to collapse over time. Other contributing factors include aging and mechanical stresses such as obesity or poor gait mechanics that place excessive strain on the foot structures. Conditions like diabetes, hypertension, and certain forms of arthritis can also compromise tendon health and increase the risk of arch collapse.
Passive Support Strategies (Footwear and Devices)
Immediate relief and external support can be provided through careful selection of footwear and the use of supportive devices. For supportive shoes, look for a firm heel counter, which is the rigid material cupping the back of the heel, to minimize the inward rolling motion of the ankle known as overpronation. The shoe’s midsection should also resist twisting, and the sole should bend only at the ball of the foot, not in the middle of the arch. Footwear with built-in arch support and a structured midsole is preferable to overly flexible or minimalist styles that lack necessary stability.
For more targeted support, orthotics are an effective intervention, and they fall into two categories. Over-the-counter (OTC) insoles provide general cushioning and basic arch support, making them a cost-effective choice for mild discomfort. In contrast, custom-made orthotics are prescription medical devices tailored to the exact contours of your foot, based on a detailed assessment of your biomechanics. These professionally fitted devices provide targeted pressure redistribution and superior, long-term support for more severe or persistent arch issues.
In cases where the posterior tibial tendon is inflamed or injured, temporary external stabilization may be necessary. This can involve specialized ankle-foot orthoses, such as a PTTD brace, which provides a lift to the arch and medial support. Athletic taping techniques can also be used to create a temporary supportive sling underneath the arch, reducing strain on the tendon during activity. Both bracing and taping serve to passively support the compromised structure, allowing the tendon to rest and begin healing.
Active Correction Through Exercise and Movement
Addressing the underlying arch issue requires actively strengthening the intrinsic muscles within the foot that provide dynamic support. The Short Foot Exercise (SFE) is a fundamental movement for this purpose, aiming to activate the muscles that naturally pull the arch upward, such as the abductor hallucis. To perform the SFE, sit or stand with your foot flat and attempt to draw the ball of your foot toward your heel without curling your toes, subtly lifting the arch while maintaining the tripod contact points of your foot. This action shortens the foot and strengthens the medial longitudinal arch from within.
Other exercises focus on improving toe dexterity and strength, which are interconnected with arch function. The Towel Scrunch, or towel curl, is performed by sitting with a small towel placed under your foot and using your toes to grip and pull the towel toward you. Similarly, Marble Pickups involve using the toes to grasp small objects, which enhances the fine motor control and strength of the small muscles on the bottom of the foot. These movements are effective for strengthening the flexor muscles that control the toes and contribute to overall foot stability.
Because the posterior tibial tendon connects muscles in the calf to the foot, tight calf muscles can increase strain on the arch. Incorporating regular calf stretches is therefore an important part of an active correction plan. Perform stretches with the back knee straight to target the larger calf muscle, the gastrocnemius, and then repeat the stretch with the back knee slightly bent to focus on the deeper soleus muscle. Consistent practice of these exercises is necessary to build the strength and endurance required for the foot’s muscles to support the arch effectively.
Consulting a Specialist and Surgical Considerations
If at-home treatments like supportive footwear and strengthening exercises do not improve persistent pain, or if you notice a sudden, painful arch collapse, it is time to consult a medical professional. Other warning signs include numbness or tingling in the foot, which may indicate nerve involvement, or difficulty standing on your tiptoes. Podiatrists, who specialize in the foot and ankle, can diagnose the specific cause of the arch problem and are equipped to prescribe custom orthotics and manage conservative care.
A physical therapist (PT) specializes in movement and will provide a tailored exercise program to strengthen the foot and ankle, often focusing on gait correction. For complex or severe structural issues, particularly rigid flatfoot, an orthopedic surgeon specializing in the foot and ankle can assess the need for surgical intervention. Surgery is generally reserved as a last resort when non-invasive treatments have failed, especially in cases of advanced posterior tibial tendon damage or fixed joint deformities.
Surgical options aim to restore the foot’s proper alignment and may involve procedures such as a tendon transfer, often using the flexor digitorum longus tendon to replace the function of a damaged posterior tibial tendon. For fixed deformities or cases with severe arthritis, bone procedures like a calcaneal osteotomy or joint fusion (arthrodesis) may be performed to structurally stabilize the arch. The choice of procedure depends on the flexibility and stage of the deformity, with the goal of providing a stable, pain-free platform for walking.