Flatfoot – is it normal and when should we treat it?


The feet are the foundation of our beautiful bodies.

If we calculate the surface of our whole body – on average around 1.73m2 – we can notice that when we’re standing up only around 2.5% of its surface is supporting us. When we start feeling discomfort in the feet this impacts our whole rhythm of life, it becomes difficult to be active, to work, to exercise and forces us to spend more time sitting or lying and less time wearing our favourite shoes.

Плоското стъпало – нормално ли е и кога да го лекуваме | ОРТОТЕХ Блог 2
What is flatfoot?

Flatfoot is a drop in the transverse and/or longitudinal arch of the foot, which may or may not cause discomfort, pain, tingling and increased fatigue when walking or practicing physical activities. Normally, the foot acts as a shock absorber for the whole body. When walking or running the feet take up to 5 times our weight at every step. Without this shock-absorbing function, our bones would not be able to bear the weight we put on them and would shift or even break.

There is also the so-called asymptomatic flatfoot, i.e. medical examination reveals the presence of the condition, but the patient doesn’t feel it. In such cases, individual orthopaedic insoles could be used, optionally, to prevent future complaints.

Плоскостъпие – как се причинява | ОРТОТЕХ Блог

The most common consequence of flatfoot is overpronation (inward rolling of the foot) which is also the one that causes the most medical issues. How to check if your feet have this issue:

  1. When standing upright on a flat surface, look towards the feet from their backside.
  2. With a normal foot, the Achilles tendon should be perpendicular to the ground surface while flatfoot causes the tendon to run outwards while the foot contacts the ground along its inner edge.

If this condition is left untreated it leads to other painful conditions – plantar fasciitis, bone spurs in the heel, frequent ankle traumas, acute pain in the feet.

What should we do if we have flatfoot?

First, visit a specialist to determine the condition of your feet. When diagnosing flatfoot, the specialist observes the position of the feet while standing and while sitting, from the front and the back. An analysis is usually also performed by observing the volume of foot movement while walking. Because the condition of the foot is often associated with changes in the hip joints and knees, they can often also be examined. X-rays are sometimes needed to assess the extent of changes in the bone structure of the foot. Nowadays, the method of computer diagnostics of the load-bearing points is also used in order to record the patient’s data and create a digital file through which the changes in the foot can be subsequently tracked.

Flatfoot in children

Modern orthopaedics assumes that flatfoot is normal until the second year after the birth of the child. Flatfoot is not prevented or treated with shoes. In the period from 3 to 7 years, the real complaints from flatfoot appear. This is an important time, during which it is good for the parents to encourage a healthy attitude towards sports and physical activity in general. Many of the orthopaedic problems in the following periods of childhood are due to muscle weakness and lack of activity in children accustomed to sitting in front of the TV or computer more often than exercising. Complaints of flatfoot at this age may increase and it may be necessary to consult an orthopaedist and buy custom or standard orthopaedic insoles.


Some of the symptoms of flatfoot in children include:

  • Pain or cramps in the foot, calf or leg
  • Curvature of the heel to the side
  • Odd gait or change in gait
  • Complaining about discomfort when wearing shoes
  • Reduced energy during physical activities
  • Voluntarily quitting physical activities


The following complex treatment is recommended when such symptoms are present:

  • Change of the physical activity – the child has to limit activities, such as walking or standing for long periods, which cause pain and discomfort.
  • An appropriate insole should be procured in order to ease the complaints.
  • Appropriate shoes should be procured – which are the correct size and width, according to the foot, with soft soles, made of natural materials in order to prevent moisture, which are easy to take care of and provide enough space to put insoles into.

If the child has asymptomatic flatfoot, it is recommended to strengthen his/her muscles and create healthy habits such as being physically active, walking barefoot on sand and grass, playing sports.

A diagnosis of flatfoot rarely results in operative treatment. Flatfoot can be innate and if it is discovered early in the childhood is can easily be corrected without leading to any of the complaints typically present at an adult age.

Flatfoot in adults

Flatfoot can occur in adults when wearing inappropriate shoes – especially wearing heels over 4cm or shoes with a narrow front – or in professions which require long hours of standing. It can be diagnosed through an examination by a medical specialist – orthopaedist – who can determine the condition of the feet by examining their position when standing, sitting and walking.


The treatment includes:

  • Choosing the appropriate corrective product – a custom orthopaedic insole or insert.
  • Choosing appropriate shoes – wide enough at the front, without heels over 4cm, with a soft sole and in the correct size.
  • Exercises for strengthening the foot muscles and creating healthy habits for alternating activity and rest in everyday life.


Effective activities include:

  • Running barefoot on grass, shallow water, small gravel or sand
  • Walking across uneven terrain with elastic soft shoes with thin soles
  • Walking barefoot with raised heels
  • Grabbing a small ball with the toes
  • Reducing body weight
  • Alternating activities and rest for the feet when walking or standing up for long periods – around 1-2 minutes per hour.
What is a custom insole?

How is it made?

Orthopaedic insoles can generally be classified as two types – standard (pre-made) and custom. The standard insoles are factory made according to shoe sizes and offer moderate correction of the transverse and longitudinal arches.

Custom insoles are produced after taking a 3D imprint of the foot using either orthopaedic foam or a 3D scanner. In the former case, the imprint is made using a gypsum cast of the patient’s foot which is then placed into a vacuum moulding machine.

One production technology is thermoforming. The materials used for the insole are heated up to a specific temperature, placed onto the positive of the gypsum imprint and moulded according to the individual contours of the foot. The specialists make the necessary corrections to the transverse arch and, if necessary, additional elements are added to stabilise the longitudinal arch and/or raise the heels; openings may also be made in order to accommodate for calluses or heel bone spurs. A final top layer is then added in order to ensure a good design, comfort and hygiene. The insoles are placed in the patient’s shoes and cut at the front, following the line of the shoe, for maximum comfort. Care for the insoles is the same as for the shoes – it is recommended to take them out to air after each use, they can be wiped with a moist towel and kept far from heat sources and running water in order to protect them from deformation. The insoles can be placed in different shoes as long as their shape at the front end is similar.

If the patient is wearing insoles for the first time, it may take about a week to get used to them. On the first day they should be worn for around 1 – 1.5 hours and this time can be increased by 1 hour per day. It is possible to feel some discomfort in the first few days which should quickly disappear when following these advices. Flatfoot cannot be cured by insoles. Insoles help relieve issues and pain. If the arch is already low, it is not possible to permanently raise it through the use of insoles, shoes and other products. The purpose of the treatment is to correct the position of the foot relative to the surface, to improve the posture and exercise habits and to reduce or remove issues.

To conclude, we can offer the following advice:
  • Take care of the comfort of your feet, do not squeeze them into narrow shoes or 8-12 cm high heels for 10-12 hours per day on a daily basis because over the years complaints of pain in the toes and arches will become inevitable.
  • Choose your shoes carefully, always buy the right size and correct shape for your foot, do not buy only according to fashion trends.
  • It is good to avoid shoes with a narrow front, regardless of how much you like this style. If you can’t fully give them up at least try to limit wearing them to 1-2 hours at a time and only on special occasions, while wearing comfortable shoes the rest of the time.
  • Walk barefoot at every opportunity – at home, on grass, on the beach. People who live in areas where you traditionally walk barefoot do not suffer from flatfoot and their feet have stronger and better trained muscles.
  • Maintain your body weight. If it is excessive aim to reduce it as this will relieve the load both on the feet and on many other joints – hips, knees.
  • Keep the skin of your feet in perfect condition – moisturize with foot cosmetics, regularly clean rough skin, do not allow painful calluses to develop, daily hygiene with soap and water is mandatory for the prevention of fungus and odour.
  • Take care of your shoes, air them, wear at least 2 pairs per season and alternate them.
  • Exercise – running, especially on the toes (5-10 minutes per day), hiking, team games such volleyball, basketball, jogging, cycling. Your whole body will be grateful for these activities.
  • Alternate exercise and rest, going too much toward either extreme is not healthy.
  • If you are feeling pain or have any other complaints visit a specialist quickly in order to make sure your feet are healthy and able to serve you well in order to stay active and happy.