Flat feet

Hollow foot (Pes Cavus)
November 19, 2015
How the foot moves
November 19, 2015

The foot has still not fully adapted to the role of walking on two legs that it has been forced into by evolution. It cannot bear constant use and both its longitudinal and transverse arches fall so the inner side of the foot touches the ground. If you step on concrete with wet feet, an impression of the sole becomes visible. Naturally, a more professional way of checking this is to use the computer examination equipment.

The image on the right shows a clear illustration of a fallen transverse arch (1), the yellow area showing strong pressure. The body’s weight line has shifted towards the centre (2). The inner ankle protrudes as the ankle leans inwards.

The signs of the disorder can be recognised by the man-in-the-street and is called flat feet in everyday language. Due to the disappearance of the arch, the inner ankle stands out noticeably. The foot loses its graceful shape together with the ability to walk flexibly. Flat feet can develop in early childhood when the child starts walking. (But don’t confuse a toddler’s soft archless sole full of fatty tissue with flat feet!) Later it can develop in the periods of rapid growth between the ages of 7-10 and 16-20 years. In adult life women are prone to develop flat feet around the menopause, probably due to the hormonal changes, but this can often happen during pregnancy as well.

  • Symptoms
    • At first an insignificant, vague, burning sensation in the sole and later a definite pain, which can be excruciating after standing or walking for a long time. Pain spreads to the whole foot and even radiates into the calf, knee, thigh or even the hip and waist. The pain lessens when resting.
    • Other typical symptoms are that the foot and the entire lower leg becomes tired quickly, and rigidity in the ankle and foot joints. It is often accompanied by strong perspiration of the foot and being prone to skin diseases. People with flat feet are a little awkward in their movement.
  • Prevention
    Most disorders can be prevented, including flat feet. In early childhood it is the parents’ responsibility to avoid encouraging standing too early and long tiring walks. The main rule for children with healthy bones and muscles is to let them follow their natural inclination to move and not to intervene in any way in their normal development.
    Correct footwear is crucial. Sandals, shoes with a soft sole and no heel are not recommended. Laced shoes shaped to the foot with a leather sole, possibly supporting the ankles should be worn.
    It is worth remembering that flat feet often develop in the teenage years, for instance when a child used to sitting at a school desk starts working as an apprentice, standing next to the workbench all day long.
  • Treatment
    • Orthotic insole
      When symptoms of flat feet appear in adulthood, the arches need to be supported by orthotic insoles. Good orthotics ensure that the weight of the body rests on the orthotics, thus relieving the tired ligaments. The permanent use of orthotic insoles usually eradicates the complaint.
    • Other methods
      Apart from wearing orthotic insoles there are a number of tried and tested methods to alleviate unpleasant symptoms and prevent the condition getting worse, i.e. stopping the arch falling further.
      First of all, you have to learn to walk correctly, with parallel feet which are not turned outwards. Attention should be paid to ensure that the sole rolls from the heel to the big toe. When standing, the foot should always rest on its outer edge and don’t let the inner ankle drop in.
      Secondly, there are special foot exercises which aim to stretch contracted ligaments and strengthen the muscles.

Exercises for flat feet – 1

The following exercises encourage the foot to bear weight on the right three points of the sole:

  • In a standing position place your feet next to each other in parallel, and lift both heels at the same time (on tiptoes).
  • Alternately raise your right and left heel to the tiptoes position
  • In a standing position place your feet next to each other in parallel, and at the same time stand on your heels with both feet
  • Stand on each heel alternately
  • In a standing position roll on both feet at the same time from the tiptoes position onto your heels, and back
  • With parallel feet, stand on the outer edges of the soles at the same time and tightly curl up then stretch out your toes
  • Stand on the toes of both feet at the same time, move your heels apart and, keeping them apart, bring your feet back to the ground. With heels apart, again stand on your toes and bring your heels together in the air, then with your feet in parallel, bring them back to the ground
  • Start in a sitting position with parallel feet. With the toes of the right foot stroke the left foot from the outside ankle to the toes. Then repeat with the opposite foot
  • Also do this exercise standing up.

Walking exercises:

  • With heels lifted high walk with tiny steps on tiptoe
  • Bear gait: placing your weight on the outer edges of your soles, walk with toes curled up tightly and small steps, rocking from one side to the other.


  • Sitting on the ground, hold a ball between your soles. Throw it up a little and try to catch it between your soles
  • Put a sock on the ground. Sit down and get a firm grip on the two ends of the sock with your toes, lift it up and pull it apart
  • Sitting on the ground, pick up a pencil with the toes of one foot, lift it up in the air and try to take it with the toes of the other foot. Repeat starting with the other foot
  • Standing, grasp a marble with the toes of each foot, then holding the marbles, take a few steps on your soles
  • Pick up with the toes of each foot tiny torn pieces of paper scattered on the ground.

The exercises build on each other, so it is very important to keep to the order and complete the whole series of exercises!

Exercises for flat feet – 2

The muscles of the foot must always be loosened and the orthotics worn before the exercises. A tennis ball can be used to loosen and massage the soles of the foot by rolling it with a to and fro movement from the heel towards each toe in turn. You can cool your feet with an ice bag or ice jelly.

Stand barefoot and lift both your heels a few millimetres off the ground. Keep your body straight with your weight evenly spread on both feet. Try to take a small step forward without wobbling. Each day alternate starting with the left or right leg. This should be done gradually and slowly in small steps. It may even take 2 to 3 weeks to get it right.Then you must walk 1 to 1.5 m without wobbling. (1 month)

The exercise can be made harder by slowing down the pace, by increasing the length of the step, by stepping backwards and finally by walking on pebbles.

Stand on the outer edge of the foot. Try standing on one leg by lifting your knee. This may even take a year. Try it every day until you can do it without wobbling.

Walking on the inner edge of the foot with your feet a little astride, knees held together and rigid ankles. Gradually increase the distance between your feet.

The hardest level is walking on pebbles. Fill a cardboard box with pebbles, alternating small and big ones. Step in with one foot, then step next to it with your other foot. Repeat several times, always stepping in from a different side of the box.