Condition · Foot and ankle
Flatfoot — pes planus
Flatfoot may be a longstanding flexible shape or a progressively acquired adult deformity. When the posterior tibial tendon, ligaments and joints no longer support the arch, the heel shifts and the forefoot turns outwards.
Clinical context
What you should know
The flexibility of the deformity is crucial: a correctable foot may benefit from joint-preserving procedures, whereas osteoarthritis and rigidity change the strategy.
Obesity, diabetes, inflammatory disease and trauma may affect progression and treatment risk, but each case must be assessed in context.
First step
Consultation and assessment
The examination is performed while standing and walking and assesses heel alignment, flexibility, the posterior tibial tendon and the joints. Weight-bearing radiographs show the true deformity under load.
MRI or CT is used selectively to assess tendons, osteoarthritis or complex surgical planning. Neurological or inflammatory causes are also considered when the clinical picture is atypical.
Stepwise treatment
Options are chosen according to the diagnosis and treatment goal
Conservative treatment
- supportive footwear, insoles or an orthosis tailored to the stage
- exercises for the posterior tibial tendon, calf and control of the entire limb
- pacing walking and reducing load during painful phases
- weight management and control of associated medical conditions where relevant
Medication, injections and devices each have their own indications and contraindications. They are not recommended automatically and do not replace a diagnosis or monitoring of the response.
When surgery is considered
Reconstruction may combine calf-lengthening, tendon and ligament procedures, and osteotomies. Rigid deformities with osteoarthritis may require fusion. The plan is individualised rather than one standard operation.
Do not delay
Signs that require prompt assessment
- rapidly progressive deformity with inability to bear weight
- a red, warm and swollen foot in a person with neuropathy or diabetes
- a wound, discharge or change in foot colour
In an emergency or if symptoms are severe, call 112 or go to the nearest emergency department.
Frequently asked questions
Concise answers, without blanket promises
Does an orthosis permanently correct flatfoot?
It can support the foot and reduce symptoms but does not always reverse the structural deformity. Its role depends on flexibility and stage.
Why are standing radiographs required?
The deformity and the relationship between the bones change under body weight. Non-weight-bearing images may underestimate the problem relevant to walking.
Editorial responsibility
Medically reviewed content
Dr. Răzvan Anițaș
Consultant orthopaedic and trauma surgeon; PhD in medical sciences
Last editorial update: 22 August 2026
First step
Consultation, diagnosis and a clearly explained plan
This content is educational and does not replace medical assessment. Similar symptoms can have different causes and require different treatments.