Flat Feet / Tibialis Posterior Tendinopathy
Flat feet can cause aching, tiredness or pain through the arch, ankle or lower leg.
For many people, flat feet are simply part of their natural foot shape and do not cause a problem. For others, a low arch or a change in arch height can affect walking, running or footwear.
Expert assessment helps to clarify whether your symptoms are linked to flat feet, tibialis posterior tendinopathy, footwear, lower-limb mechanics or another cause of foot arch pain.
What are flat feet?
Flat feet describe feet where the arches sit low or the foot presses flatter against the ground. The medical term is pes planus.
Some people have always had a flat foot shape. Others notice their arches lowering over time, which is sometimes described as fallen arches.
Flat feet are not always painful. They only usually need assessment if they are causing symptoms, changing, affecting activity or making footwear difficult.
Pain may be felt through the arch, inside of the ankle, heel, lower leg or forefoot. The position of the arch is only one part of the picture. How the foot moves, loads and responds to activity is often just as important.
What is tibialis posterior tendinopathy?
The tibialis posterior is a tendon that runs down the inside of the ankle and helps support the arch of the foot.
Tibialis posterior tendinopathy can develop when this tendon becomes irritated, overloaded or less able to support the arch comfortably. It may cause pain on the inside of the ankle, swelling, weakness or a feeling that the arch is lowering.
This is not the same as simply having flat feet. Some people have low arches without pain. Others develop symptoms because the tendon, foot posture and loading patterns are no longer working well together.
Assessment helps identify whether the tibialis posterior tendon is involved and whether your arch pain is linked to tendon irritation, foot mechanics, footwear or activity demands.
Common symptoms of flat feet and tibialis posterior tendinopathy
Symptoms can vary. Some people notice mild aching, while others find that walking, running or standing becomes increasingly uncomfortable.
You may notice:
- Low or flattened arches
- Pain in the foot arch
- Aching or fatigue through the foot
- Pain on the inside of the ankle
- Swelling around the inside of the ankle
- Foot or ankle pain when walking
- Shoes wearing unevenly
- A feeling that the arch is dropping
- Discomfort during longer walks
- Running-related arch or ankle pain
- Reduced confidence on uneven ground
You do not need to know whether your symptoms are coming from flat feet, fallen arches or tibialis posterior tendinopathy before booking. A podiatry assessment with Stuart can help make this clearer.
What can contribute to flat feet or fallen arches?
Flat feet may be linked to natural foot shape, inherited tendency or how the foot has developed over time.
In some people, symptoms appear when the foot and lower limb are being asked to manage more load than they can comfortably tolerate.
Possible contributing factors include:
- Natural foot shape
- Family tendency
- Age-related tissue changes
- Injury
- Increased body weight
- Sudden activity changes
- Footwear
- Tendon overload
- Foot posture
- Lower-limb mechanics
- Previous foot, ankle or lower-limb injury
Fallen arches can sometimes develop gradually. If one foot appears to be changing more than the other, or the arch is lowering alongside pain or swelling, it is sensible to arrange an assessment.
Foot arch pain
Foot arch pain can come from several structures, including muscles, tendons, ligaments, joints or the plantar fascia.
With flat feet or tibialis posterior tendinopathy, pain is often felt along the inside of the foot or ankle. It may become more noticeable during walking, running, standing for long periods or wearing unsupportive shoes.
The painful area is important, but it is not always the full story. Assessment may look at how your arch behaves when standing, how your ankle moves, how your foot loads and whether the tibialis posterior tendon is being placed under strain.
When should you get flat feet assessed?
It is sensible to arrange an assessment if flat feet, arch pain or inside ankle pain are affecting movement, footwear or activity.
Assessment may be helpful if:
- Foot arch pain is affecting walking or standing
- Symptoms keep returning
- One arch appears to be lowering
- Pain is felt on the inside of the ankle
- There is swelling around the inside of the ankle
- Running or sport is bringing on pain
- Shoes are wearing unevenly
- You are struggling to find comfortable shoes
- You are considering insoles or orthoses
- Pain has not improved with sensible self-care
- You have diabetes and foot pain
- You have tingling, numbness or altered sensation
Please seek urgent medical advice if you have severe pain after an injury, cannot walk, notice sudden deformity, have spreading redness, fever, pus, a deep wound or signs of infection.
How Stuart assesses flat feet and tibialis posterior tendinopathy
Your appointment is designed to understand your symptoms, foot posture, arch function and how your lower limb is managing load.
Stuart may assess:
- Foot posture and arch height
- Whether the arch changes when standing or moving
- Pain along the tibialis posterior tendon
- Swelling or tenderness around the inside of the ankle
- Foot and ankle movement
- Strength and flexibility
- Walking or running gait where appropriate
- Footwear and shoe wear patterns
- Activity, work or training demands
- Whether orthoses may be suitable
- Whether referral or imaging may be needed
A biomechanical assessment may be useful if symptoms are linked to foot posture, loading or recurring arch pain. Gait analysis may also help if walking or running appears relevant to your symptoms.
Stuart will explain the findings clearly, so you understand whether flat feet, tibialis posterior tendon irritation or another factor may be contributing to your pain.
Flat feet treatment options
Treatment depends on your symptoms, foot function, activity level and assessment findings.
A plan may include:
- Reassurance and monitoring where no treatment is needed
- Footwear advice
- Load management
- Activity modification
- Strengthening guidance
- Mobility or flexibility work
- Gait or movement advice
- Foot orthoses where appropriate
- Referral for imaging or onward care if needed
Not everyone with flat feet needs treatment. If your feet are comfortable and not affecting activity, reassurance may be enough.
If symptoms are linked to tibialis posterior tendinopathy, treatment often focuses on reducing avoidable strain, improving support where appropriate and helping the tendon tolerate load more comfortably over time.
Shoes for flat feet
Shoes for flat feet should be chosen around your symptoms, foot shape, activity and comfort.
There is no single “best” shoe for everyone with flat feet. Some people feel better in shoes with more structure. Others need a wider fit, more cushioning or room for orthoses.
Useful features may include:
- A comfortable fit through the midfoot and forefoot
- Enough depth if orthoses are being used
- A stable sole
- Support that feels comfortable, not restrictive
- A fastening that helps secure the foot
- Cushioning suited to your walking, work or sport demands
A footwear review can help Stuart identify whether your current shoes are supporting your needs or adding to irritation.
Best running shoes for flat feet
Running shoes for flat feet should be chosen carefully, especially if you have arch pain, inside ankle pain or tibialis posterior symptoms.
The best running shoes for flat feet will vary from person to person. Your running style, training load, foot strength, ankle mobility, shoe history and symptoms all matter.
Stuart is a runner himself, so he understands how frustrating it can be when arch or ankle pain interrupts training. Your assessment may look at your running shoes, gait, training changes, recovery and how your foot is managing load.
The aim is not simply to put every runner with flat feet into the same type of shoe. It is to understand what your foot needs and whether footwear, gait advice, strengthening or orthoses may be useful.
Podiatry clinics in London and Surrey
Evolution Podiatry provides specialist foot, ankle and lower-limb care across London and Surrey. Choose the clinic that is most convenient for you, then book an appointment or speak to the clinic if you are unsure which location or appointment type is most suitable.
Notting Hill, W10
Specialist Podiatry care in Notting Hill for patients across West London.Wimbledon, SW19
Foot and lower-limb assessment in Wimbledon for patients across South West London.Woking, GU21
Podiatry appointments in Woking for patients across Surrey.
Meet Stuart Hodder
Stuart Hodder is a Specialist Podiatrist and the clinical lead at Evolution Podiatry. He works with patients experiencing foot, ankle and lower-limb pain, helping them understand what may be contributing to their symptoms and what the most suitable next step is.
His approach is calm, practical and personal. Patients see Stuart for clear explanations, careful assessment and treatment planning that is shaped around their symptoms, movement, footwear, activity level and goals.
Stuart has a particular interest in lower-limb function, biomechanics, gait analysis, sports and exercise injuries, child development and alignment concerns. This means he often looks beyond the painful area itself. His work involves assessing concerns such as heel pain, Achilles pain, shin splints, flat feet, sports injuries, gait problems, children’s foot concerns and orthotic needs.
- Specialist Podiatrist and a member of the Royal College of Podiatrists
- HCPC registered (CH14453)
- Experienced in NHS and private practice
- Strong interest in biomechanics and gait analysis
- Runner and cyclist with personal experience of injury and rehabilitation
- Registered and works with insurance medical providers
Flat feet FAQs
- Are flat feet always a problem?
No. Flat feet are often harmless, especially if they do not cause pain or limit activity. Assessment is usually most helpful when symptoms are present, the foot shape is changing or activity is affected.
- What is pes planus?
Pes planus is the medical term for flat feet. It describes a foot posture where the arch sits low or the foot presses flatter against the ground.
- What is tibialis posterior tendinopathy?
Tibialis posterior tendinopathy affects a tendon on the inside of the ankle that helps support the arch. It can cause inside ankle pain, swelling or a feeling that the arch is lowering.
- What causes pain in the foot arch?
Pain in the foot arch may be linked to tendon irritation, plantar fascia strain, foot posture, footwear, activity changes, muscle fatigue or lower-limb loading patterns. Assessment can help identify what may be involved.
- Are fallen arches the same as flat feet?
They are closely related terms. Flat feet may describe a natural foot shape, while fallen arches often refers to arches that appear to have lowered over time.
- When should flat feet be assessed?
Flat feet should be assessed if they are painful, worsening, linked to fatigue or affecting walking, running, sport or footwear.
- What shoes are best for flat feet?
There is no single best shoe for flat feet. The right choice depends on your foot shape, symptoms, activity and whether orthoses are needed. A footwear review can help guide this.
- Will I need orthoses for flat feet?
Not everyone with flat feet needs orthoses. They may be discussed if your assessment suggests they could help support foot function, manage loading or improve comfort.
Insights
Helpful, plain English articles about foot pain, sports injuries, gait, children’s foot health and treatment options.
How your footwear can affect foot and lower-limb pain
Why does my foot hurt when I walk?
When should you see a Podiatrist for foot pain?
Book a flat feet assessment
If flat feet, fallen arches or pain in the foot arch are affecting how you walk, run or choose shoes, an assessment can help identify what may be contributing to your symptoms.
Book an assessment with Stuart to understand what may be driving your arch or ankle pain and what the most suitable next steps may be.