Flat feet, or flatfoot, is a condition in Singapore characterised by little to no arch in both or one of the feet.
It is a common condition affecting roughly 20% to 37% of the global population – making it one of the most common foot-related problems that warrants clinical visits.
A flat foot has a reduced or absent arch, causing more of the sole to come into contact with the ground during standing and walking.
At a glance:
Condition
Flat feet (pes planus) occur when the arch of the foot is absent or collapses.
Common symptoms
Heel pain, arch pain, ankle pain, foot fatigue and swelling.
Common causes
Genetics, ageing, tendon injuries, obesity and underlying medical conditions.
Diagnosis
Physical examination with imaging when required.
Treatment
Physiotherapy, orthotics, supportive footwear and surgery for selected patients.
Flat feet, also known as pes planus or fallen arches, refer to a condition in which the arch on the inside of the foot is lower than usual or absent. The condition may affect one foot or both feet and can occur in both children and adults. While some individuals are born with flat feet because their arches do not fully develop, others develop the condition later in life due to ageing, tendon dysfunction, injury or certain underlying medical conditions.
The arch of the foot plays an important role in supporting body weight, absorbing shock and maintaining balance during standing, walking and running. When the arch collapses or fails to develop, the foot makes greater contact with the ground, which may alter the alignment of the feet and lower limbs. Although many people with flat feet do not experience symptoms, others may develop pain, swelling, fatigue or difficulty with prolonged walking or standing.
Types of flat feet
The four main types of flat feet and how they differ in their causes, foot structure and clinical presentation.
Flat feet can generally be classified into several types:
Flexible flat feet
The arch is visible when the foot is not bearing weight, such as when sitting or standing on tiptoe, but flattens when standing normally. This is the most common type and often develops during childhood or adolescence. While many people remain symptom-free, some may experience discomfort as the supporting muscles, ligaments and tendons gradually weaken over time.
Rigid flat feet
The arch is absent regardless of whether the foot is bearing weight or at rest. This less common type is often associated with stiffness, reduced foot mobility and a greater likelihood of pain.
Adult-acquired flatfoot (fallen arches)
This occurs when a previously normal arch gradually collapses during adulthood, most commonly due to dysfunction or injury of the posterior tibial tendon, which helps support the arch. It may cause pain along the inside of the foot and ankle, particularly during walking or prolonged standing.
Congenital vertical talus
A rare condition present at birth in which the talus bone develops in an abnormal position, preventing the normal formation of the foot arch. The foot typically has a rigid "rocker-bottom" appearance and usually requires specialist assessment and treatment.
What does a normal foot arch do?
The arch of the foot plays an important role in supporting movement and maintaining proper alignment of the lower limbs.
It helps: Absorb shockDistribute body weight evenlyProvide stability during standing and walkingImprove walking efficiencyMaintain alignment of the feet, ankles, knees and hips
What causes flat feet?
Flat feet can be present from birth or develop later in life. Common causes of flat feet include:
Incomplete arch development
Some children are born with flat feet because the arches do not fully develop as they grow. While arches develop naturally in most children, some continue to have flat feet into adulthood.
Genetic factors
Flat feet can run in families, making individuals with a family history of the condition more likely to develop it.
Age-related changes
Over time, the tendons and ligaments supporting the arch may gradually weaken or lose elasticity, increasing the likelihood of the arch collapsing.
Posterior tibial tendon dysfunction
Damage, inflammation or tearing of the posterior tibial tendon, which helps support the arch, is one of the most common causes of adult-acquired flat feet.
Foot or ankle injuries
Trauma such as fractures, ligament injuries or tendon damage can alter the structure of the foot and lead to flattening of the arch.
Underlying medical conditions
Conditions such as diabetes and rheumatoid arthritis may affect the muscles, joints and tendons that help maintain the foot's normal structure.
Pregnancy
Hormonal changes during pregnancy, particularly increased levels of relaxin, can temporarily loosen ligaments throughout the body, including those supporting the arches of the feet.
Excess body weight
Carrying additional body weight places greater stress on the feet and may contribute to the gradual collapse of the arches over time.
What are the symptoms of flat feet?
Many people with flat feet experience few or no symptoms, particularly if the condition is mild. However, when the altered foot mechanics place excessive strain on the muscles, tendons and joints, symptoms may gradually develop and affect everyday activities such as walking, standing or exercising.
Common symptoms of flat feet include:
Pain in the arch, heel or ankle
Discomfort may occur during or after prolonged standing, walking or physical activity.
Foot fatigue
The feet may feel tired or achy more quickly, particularly after long periods of weight-bearing activities.
Swelling along the inside of the ankle
This may occur when the posterior tibial tendon becomes inflamed or weakened.
Stiffness or reduced flexibility
Some individuals, particularly those with rigid flat feet, may find it difficult to move or flex the foot normally.
Changes in walking pattern (gait)
Flattening of the arch may alter the way you walk, leading to instability or poor balance.
Pain extending to the knees, hips or lower back
Changes in foot alignment may place additional stress on other joints in the lower limbs.
Uneven shoe wear
Shoes may wear down unevenly due to changes in weight distribution across the feet.
Frequent tripping or poor balance
Children and adults with significant flat feet may be more prone to losing balance or tripping.
Outward turning of the toes (toe drift)
The front of the foot may gradually point outward due to altered foot alignment.
Can flat feet cause pain?
Yes. Not everyone with flat feet experiences symptoms. However, when the altered mechanics of the foot place excessive strain on the muscles, ligaments, tendons and joints that support movement, pain and discomfort may develop. The severity of symptoms varies depending on the underlying cause and the degree of arch collapse.
Pain most commonly develops in the arch, heel or along the inside of the ankle, particularly during or after prolonged standing, walking or exercise. In adults with acquired flat feet, pain may occur when the posterior tibial tendon, which supports the arch, becomes inflamed, weakened or torn.
When should you see an Orthopaedic Specialist?
Most people with flat feet don’t require treatment. However, it is advisable to seek a specialist if you experience:
Persistent pain in the arch, heel or ankle that does not improve with rest or supportive footwear.
A noticeable collapse of the arch, particularly if it develops suddenly during adulthood.
Swelling or tenderness along the inside of the ankle, which may indicate injury or dysfunction of the posterior tibial tendon.
Difficulty walking or standing for prolonged periods due to pain, stiffness or fatigue.
Changes in your walking pattern or balance, including frequent tripping or instability.
Pain that extends to the knees, hips or lower back, which may result from altered foot alignment.
Symptoms that interfere with daily activities, work or sports, despite conservative measures such as rest or over-the-counter pain relief.
How are flat feet diagnosed?
An orthopaedic assessment for flat feet typically includes evaluating the foot arch, alignment, gait and range of motion to determine the underlying cause of symptoms.
Diagnosing flat feet typically begins with a comprehensive clinical assessment. An orthopaedic specialist will evaluate the structure, alignment and function of your feet to determine the type of flat foot, identify the underlying cause and assess whether treatment is necessary.
Diagnosis may involve:
Medical history
Your specialist will ask about your symptoms, when they began, any previous foot or ankle injuries, your activity level, medical conditions and family history of flat feet.
Physical examination
The feet will be examined while sitting, standing and walking to assess the height of the arch, foot alignment, range of motion and overall gait. Your specialist may also assess muscle strength and identify areas of tenderness or swelling.
Gait assessment
Observing how you walk helps evaluate how flat feet affect your foot mechanics, balance and weight distribution.
Common imaging tests include:
X-rays
Used to evaluate the alignment of the bones and joints, assess the severity of the deformity and identify conditions such as arthritis or fractures.
Ultrasound
Helps assess the condition of tendons and other soft tissues, particularly the posterior tibial tendon.
Magnetic Resonance Imaging (MRI)
Provides detailed images of both bones and soft tissues, allowing tendon injuries, ligament damage and inflammation to be evaluated.
Computed Tomography (CT) scan
Produces detailed cross-sectional images of the bones and joints and may be recommended when complex structural abnormalities are suspected.
Not everyone with flat feet requires imaging. In many cases, a thorough clinical examination is sufficient to establish the diagnosis, with imaging reserved for individuals with persistent pain, suspected tendon injuries or more complex foot deformities.
How are flat feet treated in Singapore?
Treatment for flat feet depends on the underlying cause, severity of the condition and whether symptoms are present. Many people with flat feet do not experience pain and therefore do not require medical treatment. However, if flat feet cause persistent discomfort, reduced mobility or interfere with daily activities, an orthopaedic specialist may recommend a personalised treatment plan to relieve symptoms, improve foot function and prevent further progression.
Treatment options may include:
Activity modification
Reducing or modifying activities that worsen symptoms may help relieve pain while allowing inflamed tissues to recover.
Medications
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to help reduce pain and inflammation when appropriate.
Physiotherapy
Stretching and strengthening exercises can improve the flexibility and strength of the muscles and tendons that support the foot, helping to improve stability and function.
Custom orthotics
Prescription arch supports or customised shoe inserts may help improve foot alignment, redistribute pressure and reduce strain on the feet during walking and standing.
Supportive footwear
Wearing well-fitted shoes with adequate arch support and cushioning can help improve comfort and reduce stress on the feet.
Surgery
Surgery is generally reserved for patients with severe pain, rigid flat feet, tendon injuries or structural deformities that do not improve with conservative treatment. Depending on the underlying cause, surgery may involve repairing damaged tendons, correcting bone alignment or addressing associated foot abnormalities.
What happens if flat feet are left untreated?
When symptomatic flat feet are left untreated, it could potentially lead to complications, such as:
Persistent foot pain
Ongoing pain in the arch, heel or ankle may gradually worsen, particularly during prolonged standing, walking or physical activity.
Changes in foot alignment may increase the likelihood of developing forefoot deformities.
Arthritis
Abnormal loading of the foot and ankle joints over time may contribute to degenerative changes and joint pain.
Altered walking pattern (gait)
Changes in foot mechanics may affect the way you walk, reducing stability and increasing fatigue.
Pain in other joints
Poor foot alignment may place additional stress on the ankles, knees, hips and lower back, leading to discomfort beyond the feet.
Reduced mobility and physical activity
Persistent pain may make everyday activities and exercise more difficult, which can affect overall health and quality of life.
Flat feet treatment in Singapore
Flat feet are a common condition that may be present from birth or develop later in life due to ageing, tendon dysfunction, injury or underlying medical conditions. While many people remain symptom-free, others may experience pain, changes in walking pattern or reduced mobility that can affect their quality of life. Early assessment is important to identify the underlying cause and determine whether treatment is necessary.
At Cove Orthopaedic Clinic, our orthopaedic specialist, Dr. Sean Ng, provides comprehensive assessment and personalised treatment for flat feet, ranging from conservative management to surgical intervention when indicated. If you are experiencing persistent foot pain, a collapsing arch or difficulty walking, schedule a consultation to discuss the most appropriate treatment options for your condition.
Frequently Asked Questions (FAQ)
Can flat feet be corrected without surgery?
Many people with flat feet do not require surgery. Conservative treatments such as supportive footwear, custom orthotics, physiotherapy and activity modification are often effective in relieving pain and improving foot function. Surgery is generally considered only when symptoms are severe or do not respond to non-surgical treatment.
Are flat feet always painful?
No. Many people with flat feet have no symptoms and are able to carry out their daily activities without discomfort. Pain usually develops when the altered mechanics of the foot place excessive strain on the muscles, tendons or joints, or when an underlying tendon injury is present.
Can adults develop flat feet?
Yes. Although some people are born with flat feet, others develop the condition later in life. Adult-acquired flat feet are commonly associated with ageing, posterior tibial tendon dysfunction, injury, obesity or inflammatory conditions such as rheumatoid arthritis.
Are flat feet hereditary?
Yes, genetics can play a role. Individuals with a family history of flat feet may be more likely to develop the condition, particularly if the arches do not fully develop during childhood.
Do children with flat feet need treatment?
Not always. Flat feet are common in infants and young children because the arches may not have fully developed. Many children naturally develop arches as they grow. Treatment is generally only recommended if flat feet cause pain, affect mobility or are associated with an underlying structural abnormality.
What type of shoes are best for flat feet?
Supportive shoes with good arch support, cushioning and a stable heel are generally recommended for people with symptomatic flat feet. Shoes should fit comfortably and provide adequate support during walking and other daily activities. Your orthopaedic specialist may also recommend custom orthotics if appropriate.
Can exercise improve flat feet?
Exercises cannot usually restore a structural arch in adults, but they can strengthen the muscles that support the foot, improve flexibility and reduce symptoms.
Can flat feet affect sports or exercise?
Many people with flat feet can continue participating in sports and exercise without difficulty. However, if flat feet cause pain during physical activity, an orthopaedic specialist may recommend supportive footwear, custom orthotics or activity modification to reduce symptoms and prevent further injury.
Will flat feet get worse with age?
Not necessarily. Many people have stable, symptom-free flat feet throughout their lives. However, in some individuals, particularly those with tendon dysfunction or progressive arch collapse, the condition may worsen over time if left untreated.
When is surgery recommended for flat feet?
Surgery is typically reserved for patients with persistent pain, significant deformity, tendon injuries or rigid flat feet that do not improve with conservative treatment. The type of surgery depends on the underlying cause and severity of the condition.
At Cove Orthopaedic Clinic, our utmost importance is in helping our patients maintain or regain the mobility that they deserve, all through excellent patient care right from the start.
Happy and satisfied patients are what keeps us going!
Consult Us Today
If you have further enquiries or would like to make an appointment at Cove Orthopaedic Clinic, simply fill in the form below or call us at +65 9631 7637.
