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Flat Feet (Pes Planus)

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Flat foot (pes planus) is a condition where the arch of the foot collapses. It is common in children whose arches are still developing, and can also develop in adults due to tendon weakening. Not all flat feet are problematic.

Causes

• Injury to the foot or ankle
• Rheumatoid arthritis
• Genetics and hypermobility
• Obesity
• Failure of arch-supporting tendons
• Tight calf muscles

Symptoms

Flat feet can cause pain in the feet, ankles, legs, knees, hips, and back. An assessment with a specialist is important to develop an appropriate treatment plan.

Non-Surgical Treatment

• Physiotherapy and stretching exercises to strengthen the arch
• Custom orthotics following gait analysis to support the arch
• Heel raises to reduce calf strain
• Bracing in more severe cases
• Weight management
• Single heel raise exercises and toe curl exercises to strengthen the arch

Surgical Treatment

Flatfoot reconstruction involves correcting the deformity through a combination of techniques, which may include:

• Extra-articular implants to stabilise the foot
• Calcaneal osteotomy — cutting and resetting the heel bone to realign the hindfoot
• Midfoot joint fusion to reduce arch collapse
• Tendon transfer to improve arch strength and foot function

Minimally invasive flatfoot surgery uses specialised instruments to cut and reset the hindfoot joints through small incisions, secured with screws.

Recovery

Timeframe	What to Expect
0–6 weeks	Immobilisation. Non-weight-bearing or protected weight-bearing.
6–12 weeks	Gradual return to walking with physiotherapy support.
3–6 months	Return to most daily activities. Orthotics may be required long-term.
6–12 months	Return to sport and full activity for significant reconstructive surgery.