Fallen arches, also called flat feet, means the arch along the inside of your foot has partially or fully collapsed so that the entire sole touches the ground when you stand. About 20% of adults have flat feet, though most never experience pain from them. When arches do cause problems, the issue is almost always a weakened or damaged tendon on the inner side of the ankle that can no longer hold the arch up.
What Holds Your Arch Up
Your foot’s arch isn’t just bone. It’s an active structure held in place by a combination of tendons, ligaments, and muscles working together. The most important of these is the posterior tibial tendon, a thick cord that runs from your calf muscle, behind the inner ankle bone, and attaches to bones in the middle of your foot. When this tendon contracts, it pulls the arch upward and keeps your foot stable as you walk.
Backing up that tendon is a ligament called the spring ligament (connecting the heel bone to the navicular bone in the midfoot), which acts as a kind of hammock under the arch. The plantar fascia, a tough band of tissue along the sole, also provides support. When the posterior tibial tendon weakens or tears, the spring ligament stretches under the new load, and the arch gradually flattens. Without a functioning tendon pulling inward, the muscles on the outer side of the ankle pull unopposed, forcing the foot outward and accelerating the collapse.
Why Arches Fall
Some people are simply born with low or flat arches, and the trait often runs in families. Children almost universally have flat feet (prevalence around 28%), and most develop a visible arch by age six or seven. In adults, arches that were once normal can fall for several reasons.
The most common cause is gradual wear on the posterior tibial tendon over years of use. Being overweight places extra load on this tendon with every step. Aging naturally reduces the tendon’s elasticity and blood supply. Injuries to the foot, including fractures of the heel bone, navicular bone, or the midfoot joints, can also trigger arch collapse. Less commonly, conditions that affect muscles, nerves, or joints throughout the body, such as cerebral palsy or spina bifida, lead to flat feet.
Diabetes and high blood pressure are additional risk factors because they impair blood flow to tendons, making them more vulnerable to damage. Pregnancy can temporarily flatten arches due to hormonal changes that loosen ligaments combined with increased body weight.
What Fallen Arches Feel Like
Many people with flat feet feel nothing at all. When symptoms do appear, pain typically concentrates along the inner ankle and the inner edge of the midfoot, right where the posterior tibial tendon runs. You might notice swelling behind the inner ankle bone, and the area can feel tender to the touch.
As the arch drops further, the heel tilts outward. This shift changes how force travels up your leg, which can produce aching in the outer ankle, the shin, the knee, or even the lower back. You may find that your feet tire quickly during walks, or that standing for long periods becomes uncomfortable. Some people notice their shoes wear unevenly, with the inner heel edge grinding down faster than the rest.
A quick way to check at home: stand normally and have someone look at your feet from behind. If the heel angles outward and several toes are visible poking out on the outer side of the ankle (sometimes called the “too many toes” sign), the arch has likely collapsed. You can also wet your feet and step onto a paper bag or dark surface. A complete footprint with no inward curve suggests a flat arch.
How It Gets Worse Over Time
Fallen arches progress through a predictable pattern when left unmanaged. Early on, the tendon is inflamed but still intact, and pain comes and goes. At this stage, the foot is still flexible: if you sit down and point your toes, the arch reappears. Over time, the tendon stretches permanently and the supporting ligaments follow. The arch stays flat even when you’re not bearing weight, and the joints in the midfoot and hindfoot stiffen into that collapsed position.
In advanced stages, arthritis develops in the joints of the hindfoot because they’ve been forced into unnatural alignment for months or years. The ankle joint itself can eventually tilt, creating pain that extends well above the foot. Each stage is harder to treat than the last, which is why early intervention matters.
Exercises That Help
Strengthening the small muscles inside the foot can provide meaningful support to a sagging arch, especially in earlier stages. Aim to do these exercises at least three times a week.
- Towel curls: Sit in a chair with a towel flat under your bare feet. Keep your heels planted on the floor and use your toes to scrunch the towel toward you. Hold a few seconds, release, and repeat. This targets the muscles that run along the arch.
- Ball rolls: Sit with a tennis ball or golf ball under one foot. Roll it slowly along the arch for two to three minutes per foot. This loosens the plantar fascia and improves circulation in the sole.
- Heel stretches: Stand facing a wall with one foot forward and one back, both heels flat on the ground. Bend the front knee and lean into the wall until you feel a stretch in the back leg’s calf and Achilles tendon. Hold 30 seconds, four times per side. A tight Achilles tendon pulls the heel into a position that flattens the arch, so keeping it flexible is important.
- Short foot exercise: While standing or sitting, try to shorten your foot by drawing the ball of your foot toward your heel without curling your toes. You should see the arch lift slightly. Hold five seconds and repeat ten times. This trains the intrinsic foot muscles that act as the arch’s internal scaffolding.
Shoes and Orthotics
The right footwear won’t rebuild a fallen arch, but it can significantly reduce pain and slow further collapse. Look for shoes with a firm midsole that doesn’t twist easily when you wring it, built-in arch support, a wide toe box that doesn’t crowd your toes, and a sturdy heel counter (the rigid cup around the back of the shoe that keeps your heel from rolling inward). Cushioning in the sole helps absorb shock that would otherwise travel up through misaligned joints.
Over-the-counter arch support insoles work well for mild cases. They redistribute pressure across the sole and nudge the foot into better alignment. For more significant collapse, a podiatrist or orthopedic specialist can create custom-molded orthotics shaped to your foot’s exact contours. These are more expensive but provide targeted correction. Ankle braces are sometimes used alongside orthotics when the tendon is significantly weakened, giving external stability that the tendon can no longer provide on its own.
When Surgery Becomes an Option
Surgery is only considered after months of conservative treatment (orthotics, physical therapy, bracing) have failed to relieve pain. The specific procedure depends on how far the arch has collapsed and whether the joints are still flexible.
In earlier, flexible stages, surgeons can transfer a nearby tendon to take over the job of the damaged posterior tibial tendon, often combined with reshaping the heel bone to shift it back under the leg. This combination relieves pain effectively, though tendon transfers alone don’t fully restore the arch’s height. Additional bone cuts or grafts in the midfoot may be needed to bring the arch closer to its original position.
When the foot has stiffened into a flat position and arthritis has set in, the only reliable option is joint fusion, where the damaged joints are permanently locked together with screws or plates. This eliminates the arthritic pain but reduces some foot flexibility. Recovery from fusion surgery typically takes several months of limited weight-bearing.
For most people with fallen arches, surgery is never necessary. The combination of supportive shoes, orthotics, and targeted exercises keeps the condition manageable and comfortable for years.