Flat feet: do they always need orthotics

Flat feet are very common and are often noticed when the arch of the foot appears low or absent when standing. For some people, flat feet cause no symptoms at all. For others, they may be associated with foot fatigue, discomfort, or pain elsewhere in the lower limb.

Because flat feet are frequently discussed in relation to orthotics, many people assume that a low arch automatically requires treatment. In reality, the picture is more nuanced. Understanding what flat feet are, why they develop, and when intervention is helpful can prevent unnecessary concern and support better decision-making.

What are flat feet?

Flat feet describe a foot posture where the arch appears lower when a person stands. This may be present in one or both feet and can vary in degree. In some cases, an arch is visible when sitting or standing on tiptoes, but flattens when standing normally.

Flat feet can be flexible or more rigid. Flexible flat feet are very common and often function well, while more rigid or painful presentations may require closer assessment.

Why do flat feet develop?

Flat feet can develop for a variety of reasons. In many people, foot posture is largely determined by genetics and natural variation rather than a problem or abnormality.

Other contributing factors can include ligament laxity, muscle strength, changes in body weight, prolonged standing, or injury. Flat feet are also common in toddlers and often change naturally as the foot matures.

Importantly, foot posture alone does not determine whether pain or problems will develop. Many people with flat feet remain symptom-free throughout life.

What usually helps?

Whether flat feet require intervention depends on symptoms and how flat the feet are. Feet that are a little flat can be quite normal and are not necessarily bad,  while very flat feet usually require management to help long term function.

This may include:

• Monitoring symptoms rather than treating foot posture alone
• Addressing load, activity levels, or footwear factors
• Supporting comfort and function where symptoms are present
• Considering orthotics only when there is ongoing discomfort or functional limitation

Orthotics can be helpful in some cases, but they are not necessary for everyone with flat feet. The goal is usually to support comfort and movement rather than “correct” foot shape.

When should further advice be considered?

Further assessment with a podiatrist is usually recommended if feet are very flat or if they are associated with persistent pain, fatigue, or difficulty with walking or standing. Symptoms that worsen over time or interfere with daily activities should also be reviewed.

Children with pain, reduced activity, or asymmetry between feet may also benefit from assessment to ensure normal development.

Key points to remember

• Flat feet are common and often pain-free
• Foot posture alone does not determine the need for treatment
• Many people with flat feet function well without intervention
• Orthotics are helpful in some cases but not always required

This article is for general information only and is not intended as a substitute for individual assessment or medical advice.

Rob Hanley, Clinic Director