Flat foot

Do you suffer from knee or hip pain? Do you often feel pain in your head or cervical spine? It can be caused by flat feet! Does it seem impossible and hardly comprehensible? Maybe you ask yourself whether it is possible? Truth is, flat feet can affect also more distant parts of the body. They can even be the cause of muscle spasms in the calves, for which is usually blamed insufficient amount of magnesium in the body. Therefore it is good to not underestimate the flat feet, because it can cause a whole lot of problems.


The leg is very important part of the body. It has to enable us to walk and run and hold our whole body in a standing position. 26 bones, 33 joints,12 tendons an 18 smaller muscles which together create a precise mechanism with complicated construction. Human foot i composed of 4 functional “units”: heel, instep, the space behind the instep and single toes.

This difficult system, consisted of two footarches, is secured statically as well as actively. The statics of the feet is secured by the tendons and activity by the muscles. The foot arch is formed by two types of muscles, long and short. Among the long muscles, which start in the area of the calves, are also tibialis anterior muscle and tibialis posterior muscle as well as flexor pollicis longus muscle.

The foot has longitudinal and transverse arches. There are two longitudinal arches of the foot. The first arch is stretching across the inner side of the foot from the big toe towards the inner side of the heel. The second arch runs in parallel from the pinky toe to the towards the outer side of the heel.

The foot has three transverse foot arches. Most people know the transverse foot arch that stretches between the big toe and pinky toe and the metatarsal bones. But there are two additional foot arches located around the metatarsal bones. Their function is to protect the soft parts of the foot and secure flexibility of the foot. At the same time they determine the the size and shape of the foot mark.


The foot is under normal circumstances continually touching the ground only with the surface of the sole and toes on the outer side of the foot. But if the muscles in the foot and ligaments get weaker the foot gets affected by slight deflections. One type of deflection is increased surface of the foot mark, as a result of lowered inner edge of the foot. More serious deflections are connected to lowered inner heel below its original level. That causes also changed position of the vertical axis of the heel bone.


There are three degrees of flat foot. The first degree is a slightly flat foot, which is flattened, only when stepping on the foot. There is a visible but only slight widening of the foot mark in the center part of the foot.

More serious is the second degree. During walking the weight is being transferred to the inner side of the foot, which is directly visible also on the shoes, where the soles are worn off much more on the inner side of the shoes. In the second degree it is still possible to affect the flat foot and return to the ideal condition of the foot.

And basically irreversible changes occur in case of significantly flat foot, that is when the soft tissues are already adjusted to the incorrect habits and condition of the foot. In this stage, people step only on the inner side of the foot, which carries most of the body weight.


Exactly the opposite problem is too high instep. The foot is leaning against the toes and metatarsal bones, the center of the outer edge is not burdened at all and the foot mark continues with the contact in the heel. But the reality that the foot is not touching the ground with the outer edge, causes enormous burden on the joints on the front side of the foot (toes and metatarsal bones). Less serious degree is increased foot arch, when the foot mark gets narrower.


The most common cause is chronic overloading of the feet. Another, just as important factor which we can hardly affect is congenital disorder or inclination to relaxed ligaments, e.g. during general hypermobility of the body, which affects women more than men (it is given by the presence of estrogen which binds molecules of water). Children also tend to have more elastic ligaments (due to higher ratio of water in the body). The effect of formation flat foot can also have pregnancy, it can be also one of the physiological changes during gravidity.

Factor which we can affect is weight or insufficient stimulation of the foot, caused by the fact, that our feet are constantly “imprisoned” in our shoes, where they don’t have enough free space for natural movement. One of the main causes of flat feet by children is when they are forced to wear some sort of footwear too early, wearing some kind of slippers whole day, or putting on shoes when they can’t even walk yet, or incorrectly chosen shoes in the period when the bones of the feet grow.


Possible prevention against formation of flat feet are various exercises, with which we will gladly help you. Especially in cases of 2nd and 3rd degree of flat feet it becomes important to use quality insoles in your shoes, especially shoes which you use for sport. It is important to note that your feet will have to get used to it at first because in the beginning the medical insoles won’t be comfortable at all. But that it completely normal. However the most simple and most natural thing you can do for yourself and your feet is to walk barefoot on various terrain (soft, warm, cold, rough…).


How to find out whether this problem is concerning your feet? The most simple method, which can test on yourself, it when you stand on a wet floor, for example in the bathroom. Subsequently you can check out your foot prints and see what type of foot mark does your foot resemble. However, this is not professional evaluation of the foot. Doctor would tell you exact diagnostic and he would also offer you examination on a device called podoscope.
CLPodoskop fill 224x150

Among other physiotherapeutic techniques is for example Dr. Véle test, which will check the condition of the toe flexors. And how can you do this test yourself? Stand with your bare feet on a mat, and bend with your trunk forward. Did your toes stay without any significant activity as they were, or do you feel your toes want to “hold onto” the floor? If you slightly bent your toes when you bowed forward, then the muscles in your feet function correctly. On the other hand, if your toes did not bend, it can be assumed that the foot muscles are weakened, including those which support the foot arches.


In treatment and prevention against flat feet can help these simple exercises:

„Small foot”

The principle of this exercise is the effort to “downsize” the foot (half up to whole one size), without bending your toes. It is therefore only about lifting the instep and longitudinal foot arches. Imagine that between your big toe joint and heel is a straight line and between the pinky toe and heel is the second line. Try to adduct the big toe and pinky joints along these lines towards the heel. But your toes cannot bend at all - we do not work with the flexor muscles, but with the muscles which support the longitudinal foot arch.

Transverse and Longitudinal foot arch

„Big toe in”

In this exercise we try to pull the big toe as much as possible to the side away from other toes. Our ancestors who climbed on the trees or held a banana in one foot,were able to stretch the big toe apart from the other toes just a thumb on the hand. The muscles had remained in our foot since the time of the apes, we are just not used to activating it anymore. Therefore try to push your big toe on the ground away from the other toes. If you would gently massage the area between your big toe and heel on the inner edge of the foot, you will at the same time stimulate the muscles to bigger activity.

Foot Supportive points

Exercise with a towel

For a correct execution of the exercise you can help yourself with a towel or just imagine it. Place the towel on the ground and stand straight on both of your feet. Try to stretch the (imaginary) towel with both hands from the center to the sides. Keep your feet one the same spot, you should just feel as if your feet was widening, just as you can do it with your hand. You might feel that your longitudinal arches are lifted up. During the exercise your may also feel that you involve the hips and thigh muscles.

Big foot

Walking on the toes

If you want to improve the foot arch by very small children, who do not yet understand movements of the of the foot joints. It will be enough if you would walk with the child on the toes. Muscles in the feet will get exercise, and you can help the children by slightly lifting them up against the gravity.

You should keep in mind that problems with flat feet should be treated as soon as possible. In most severe cases can flat feet significantly affect the natural position of the pelvis and lumbar spine. Problems of the flat feet are not even closely innocent as it may seem, and given the great effect on the more distant parts of the body, you should pay more attention to it.

Related articles:

Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic
Source: Clinical experience from a private practice in physiotherapeutic field, FYZIOklinika

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