Adult flat feet: if you have ended up here, you have probably been told you have low arches, or you noticed it from the wet footprint left on the floor. Before the list of exercises, I need to tell you the thing that almost no article on this topic says: that exercises make the pain of flat feet go away is not proven. What the evidence shows is more modest, and it is still enough to make sense.
In this guide you will find the warning signs to check first, what really changes with foot training according to randomised studies, the exercises that have been tested, and the cases where the problem is not "flat feet" but something more specific that needs a different approach.
⚠ Important: read this before continuing
The exercises and advice in this article are general indications and may not suit your situation. Everyone has a unique clinical history: what works for others could be counterproductive for you.
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First things first: the signs that should not be handled alone
An arch that has been low since always, the same in both feet and without symptoms, is a normal variant. An arch that is lowering now is a different story, and someone should see it before you start doing exercises.
The arch has flattened over time, and in photos or shoes from a few years ago the foot was different. A progressive flattening in adulthood is the typical way that a failing posterior tibial tendon presents; reviews on the subject identify this as the most important contributor to acquired flat foot in adults.
One foot is different from the other. A collapse on one side only, especially if recent, deserves an assessment and not a programme copied from the internet.
Pain or swelling on the inner edge of the ankle, along the route that goes behind the inner ankle bone towards the arch. This is the territory of the posterior tibial tendon.
You cannot rise onto the toes of one foot, or when you try, the heel does not turn inwards as it should. It is one of the first tests a physiotherapist uses to get a picture of that tendon, and it takes two seconds.
The foot is stiff: the arch does not reappear even when you lift the foot off the ground or rise onto your toes. A rigid arch has different causes and treatments from a flexible one, and exercises matter little there.
You have diabetes with reduced sensation in the feet, or a warm, swollen, red foot without an obvious trauma. This picture needs urgent medical assessment: there are joint collapses of the foot in which there is no pain precisely because sensation is impaired.
Pain in both feet in a young person, with prolonged morning stiffness, or pain in other joints: this needs a rheumatological assessment first.
If you recognise yourself in any of these points, skip the practical part and get assessed. The rest of this article assumes a flexible foot that is stable over time and has no warning signs.
What it is and how to tell it apart
During pregnancy the foot changes on its own, and it does not always go back to how it was: we discuss this in the foot in pregnancy.
In flat feet, the medial longitudinal arch drops towards the ground: the footprint shows almost the whole sole in contact with the floor, the heel tends to tilt outwards and the forefoot to splay.
The distinction that really matters is between flexible and rigid. In a flexible foot the arch reappears when the foot is not loaded, when you rise onto your toes or when you extend the big toe: this means the joints move and there is room to work on them. In a rigid foot the arch stays absent in any position, and there the problem is structural.
There is also a difference in history. Childhood flat foot in children is considered in paediatrics, in the great majority of cases, a developmental phase that resolves on its own. The acquired flat foot of adults, which appears or worsens after the skeleton has finished growing, is instead a condition in its own right: an orthopaedic review from 2017 estimates a prevalence above 3% and identifies the loss of function of the posterior tibial tendon as the most important contributor. The two share the same name but are not the same thing, which is why "it sorted itself out as a child" is not a good argument in either direction.
What the research really says about exercises
This is the part that sets us apart, and I ask you to read it before you start.
Exercises do change something measurable about foot posture. The most robust systematic review with meta-analysis on training the intrinsic foot muscles included 13 randomised studies and found effects in favour of exercise on the navicular drop (the lowering of the navicular bone when the foot is loaded) and on the Foot Posture Index, as well as on balance, strength and disability reported by patients. A necessary clarification: that review does not concern only flat feet, but intrinsic muscle training in general, so it includes different populations. A 2024 network meta-analysis, specific to adults with flexible flat feet, with 11 studies and 335 participants in total, mostly young adults, reaches the same conclusion: the different forms of exercise improve arch shape and function.
But not on pain. In the same meta-analysis on intrinsic muscles, exercise was not superior to control groups for reducing pain. This is the most important finding in this whole article, and it is exactly the opposite of what is usually read. It holds with the limit just mentioned, since that finding comes from studies not all conducted on people with low arches, but it remains the best we have, and none of the specific reviews on flat feet contradicts it.
The effects on shape are real but small. In a randomised single-blind study of 20 people with flat feet, eight weeks of short foot three times a week significantly improved the inversion/eversion component of the heel on the Foot Posture Index and shortened the time the navicular takes to reach its lowest point during the step, a sign of better functioning of the windlass mechanism of the sole. The control group did nothing, and the sample was small: it is a signal, not proof of transformation. We are talking about millimetres and points on a score, not a reconstructed arch.
Working on the foot alone probably is not enough. The 2024 network meta-analysis places at the top of its ranking not isolated foot exercises, but combinations that include the hip and lower limb: strengthening the posterior tibial muscle combined with iliopsoas stretching and towel curling, and intrinsic muscle training combined with gluteal strengthening. The short foot on its own showed a more modest effect on the navicular drop than those combinations.
It should be said how that ranking is built, because it is less solid than it sounds: the authors built three separate networks for the navicular drop, so the positions are not all comparable with one another, and the hip-centred neuromuscular exercise, although first in its network, had a confidence interval against control that included zero. The more direct and more useful comparison is another one: in one of the included studies, gluteal strengthening added to intrinsic foot muscle work was compared with foot work alone, and the combination did better. This is why the hip deserves a place in the programme, not evidence that the foot matters little.
And the link "flat foot leads to pain elsewhere" is weaker than it is made out to be. A systematic review of foot posture and lower limb kinematics during walking found a relationship between flat feet and greater rearfoot movement in the frontal plane, but with small effects and inconclusive results. And in a cross-sectional study of 784 older people, most of the foot abnormalities examined were not associated with pain or functional limitation: the only ones associated with worse function scores were plantar fasciitis and, to a lesser extent, cavus foot, while low arch did not appear. The authors conclude that many of these conditions, when asymptomatic, may not require clinical attention.
In short: if your flat foot does not hurt, it is not a problem to be solved. If it does hurt, exercises are a reasonable attempt; they cost little, do no harm and improve strength and balance, but they are not a guarantee on pain.
The causes
The most frequent cause of acquired flat foot in adulthood is failure of the posterior tibial tendon. It is the tendon that runs behind the inner ankle bone and attaches under the arch: when it degenerates or stretches, the arch loses its main active support and the heel slides outwards. If the picture looks like this, the right article is the one on posterior tibial tendinitis, because the treatment changes.
Age, trauma and fractures of the ankle and midfoot, inflammatory arthritis, some neurological conditions and generalised ligament laxity also contribute.
On weight, it is worth being precise, because this is where the most exaggeration happens. A systematic review of 25 studies found a strong association between high body mass index and non-specific foot pain in the general population, and with chronic heel pain in non-athletes; but the relationship between BMI and flat feet specifically was inconclusive, and the evidence that losing weight reduces foot pain is limited. So: weight does put load on the feet, and this is documented for pain; that it is what flattens the arch is another claim, and that one is not proven.
Footwear is often cited as a cause. It is plausible, but it remains a hypothesis: I have not found studies showing that years of the wrong shoes produce an adult flat foot.
The symptoms
When it does produce symptoms, flat feet make themselves felt with pain in the arch, the inner edge of the foot and the inner ankle, typically worse when standing for long periods or walking and improving with rest.
Early tiredness of the feet, swelling around the inner ankle bone, difficulty rising onto the toes and asymmetric wear of the shoes, more marked on the inner edge, are often added. Some people also report discomfort in the knee, hip and back: it is a plausible association, but as we have seen, the chain "low arch, therefore pain higher up" has more fragile evidence than is believed, and it is never a good idea to attribute back pain to the foot without ruling out everything else. If the pain is concentrated under the heel or at the forefoot, it is better to start from the overview of foot pain, because the diagnoses involved there are different.
An important point: before trying these exercises, make sure you have received a correct diagnosis. People often assume they have one problem, but the real cause of the pain is something else. Doing the wrong exercises can make the situation worse rather than better.
Short foot: the most studied exercise
It is the exercise around which almost all the research on intrinsic muscles revolves, and the first one to learn.
Seated, with your foot resting on the floor and the knee at 90 degrees, try to shorten the foot by drawing the base of the toes towards the heel. The toes stay extended and relaxed: if they curl, you are using the long flexors and have lost the target. Heel and forefoot stay on the floor; under the arch you should feel a deep contraction, not a cramp.
It is difficult, and at first almost everyone does it badly. In the study mentioned above, a progressive protocol was used, three times a week for eight weeks, with measurable improvements in alignment. In practice: hold the contraction for a few seconds, repeat until the execution stays clean, and when you manage it seated, move to standing on two feet, then on one foot. Progression comes from the load, not the number of repetitions.
Strengthening the posterior tibial muscle
It is the muscle that actively supports the arch. In the network meta-analysis its strengthening appears at the top of two rankings: the one on the navicular drop in the first network (in combination with iliopsoas stretching) and the one on the Foot Functional Index (in combination with insoles, stretching and eccentric work), while in two other networks programmes centred on the hip and glutes come first. In short, it is a recurring ingredient of the best programmes, but not the only one.
Heel raises. Standing, lightly holding a support, rise onto your toes and lower slowly. The key point is not how high you rise: it is that the ankle does not collapse inwards and the weight stays towards the big toe. If the heel does not turn slightly inwards as you rise, there is something to look at.
Inversion against resistance. Seated, with a band wrapped around the forefoot and anchored on the outer side, move the foot inwards and upwards while keeping the leg still. The movement is of the foot, not the thigh.
Start with both feet on the ground and move to one leg when the execution is clean and the foot is not worse the next day. In the most robust study on posterior tibial tendon dysfunction, resistance work was progressive, meaning the load increased over time: that is the ingredient, not the number of repetitions.
Finger muscles: towel and small objects
Towel curl. A towel laid flat on the floor, with the foot resting on it: curl it towards you using only the toes, without lifting the heel. When it becomes easy, place a weight on the far end of the towel.
Picking up small objects. Marbles, bottle caps, balls: pick them up with your toes and place them in a container. It helps you regain dexterity and fine control, and it is the simplest way to see how little your foot can currently do.
These exercises belong to the family of intrinsic muscle training, the one for which the meta-analysis showed gains in foot posture, strength and balance. Two limits to keep in mind. First: gains on those indices, not a proven advantage on pain. Second: in the network meta-analysis, the towel curl on its own ranked behind the short foot in the ranking for the navicular drop. Treat them as a complement, not as the main exercise.
Hip and glutes: the part that is usually missing
It is the most interesting result of the 2024 network meta-analysis, and it is absent from most programmes for adult flat feet: the combinations that included gluteal strengthening or hip-centred neuromuscular exercises ranked at the top of the effectiveness ranking for the navicular drop, ahead of exercises for the foot alone.
The logic is this: if the thigh rotates inwards and the knee drops inwards, the foot flattens as a consequence, however much you train the sole. In practice this means adding hip abduction and external rotation work: single-leg bridges, lateral steps with a band above the knees, lunges while checking that the knee stays in line with the foot, and above all looking at yourself in a mirror during single-leg standing exercises.
Single-leg balance exercises complete the picture: in the meta-analysis on intrinsic muscles, balance is among the outcomes in which exercise beat control groups.
Stretching: where it makes sense
A short calf limits ankle dorsiflexion and, when the ankle does not bend, the foot compensates by splaying. It is a solid mechanical argument, but it remains an argument: I have not found studies showing that stretching the calf corrects an adult flat foot.
It is worth doing anyway, because it costs nothing. Gastrocnemius: hands on the wall, back leg straight, heel on the floor, foot pointing forward. Soleus: same position, back knee bent, heel always on the floor; this is the variant almost everyone skips. If the ankle moves little, the specific work is ankle dorsiflexion.
Rolling the sole over a ball is a self-massage: it gives short-term relief and should be treated as such, not as a way of remodelling the arch.
Footwear and insoles: what the evidence says
Here we need to be honest, because the insole is the first thing that is usually prescribed.
A systematic review from 2021 searched for all the evidence on insoles in adults with flat feet: of 110 studies identified, 12 were included, with samples between 8 and 80 people and mostly low methodological quality. The authors' conclusion is clear: there is a lack of evidence on the effect of insoles in adult flat feet, and the frequency with which they are prescribed is, in their own words, surprising.
A direct comparison adds a nuance. In a randomised study from 2024 on flexible flat feet, 45 people were divided into three groups (exercises, custom insoles, exercises plus insoles) and 40 completed the six-week pathway: foot posture improved in all groups, but insoles alone were less effective than exercises and the combination. Static balance improved everywhere, while stability limits improved only in the two groups doing exercise.
This does not mean discarding insoles: it means they do not replace active work, and that they make sense above all when they serve to take load off a painful structure, not as a "correction" of the arch. For shoes: look for a sole that is not too yielding and a good heel grip, and avoid spending the whole day in completely flat, soft shoes if your feet hurt. These are comfort guidelines, not proven corrections.
For children the picture is the same, in an even clearer form: in the absence of pain, custom insoles for flexible flat feet have no supporting evidence, and what remains to be checked is the length and width of the shoe. The practical side, size by size, is in how to choose a child's trainers.
When the problem is the tendon, not the shape
There is one case where the picture changes, and it is the one where the evidence for exercise is strongest: flat foot that arises from an early-stage posterior tibial tendinopathy.
In a randomised study of 36 adults with stage I or II posterior tibial tendinopathy, three groups followed a programme of insoles and stretching for 12 weeks, either alone or with progressive concentric or eccentric resistance exercise added. Foot Functional Index scores improved in all three groups, and pain straight after the 5-minute walking test decreased in all of them; the group that added eccentric work achieved the greatest improvement in every subcategory, while the group with insoles and stretching alone achieved the least. A later systematic review found moderate effects for eccentric strengthening, but noted that only three studies were available, with 93 participants in total.
Two necessary clarifications. First: in that study all the groups wore insoles, so the strengthening was not tested on its own. Second: we are talking about early stages. When the deformity is advanced or the foot has become rigid, the discussion moves onto different ground and needs to be handled with an orthopaedic surgeon.
What to expect, and how long it takes
You will not find here a table with "4 weeks, 8 weeks, 3 months": in adult flat feet those numbers circulate everywhere, but I have not found them supported by studies.
What can be said honestly is that in the studies cited in this guide, the protocols lasted between six and twelve weeks, with sessions spread over three days a week, and that over that time changes in foot posture, strength and balance were measured. On pain, there is no promise: the meta-analysis found no significant advantage.
The practical criterion to use is different: the next day, the foot should not be worse. If after a few weeks of consistent work the pain is where it was, this is not a lack of commitment on your part: it is the moment to have the diagnosis reviewed.
Online physiotherapy: what it is for here
Remote rehabilitation does not add a magic ingredient. For adult flat feet it serves three concrete purposes, which are exactly the areas where self-management tends to fail.
The first is distinguishing the cases: flexible or rigid foot, low arch since always or recently flattened, tendon involved or not. These differences determine everything else, and they are recognised through a few guided tests, not by reading an article. The second is correcting the execution: a short foot done by curling the toes does not train what it should, and on a video call it can be fixed in two minutes. The third is setting the progression, including the hip and glute work that almost everyone leaves out.
Ri-Hub online physiotherapy sessions cost 29,90€ and give you a programme built around your situation, not a list that is the same for everyone.
In summary
Adult flat feet are not, in themselves, a sentence or a disease: when they do not hurt and do not limit anything, population studies suggest they may require no attention at all. When they do produce symptoms, exercises are a sensible starting point: they improve strength, balance, self-reported function and, slightly, the foot's loading indices.
What they have not shown is that they reduce pain better than a control, and it is right that you know this before starting, not after three months. In adult flat feet, the best programme is not the one with the most exercises for the sole, but the one that starts from a correct diagnosis, includes the hip and lower limb, progresses the load and changes course when it is not working.
Sources
- Evidence for Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-Analysis, Journal of Athletic Training, 2023
- Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials, Scientific Reports, 2024
- Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics: A pilot randomized controlled single-blind trial in individuals with pes planus, Gait & Posture, 2020
- Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: A randomized controlled trial, Gait & Posture, 2024
- Evidence for foot orthoses for adults with flatfoot: a systematic review, Journal of Foot and Ankle Research, 2021
- Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial, Physical Therapy, 2009
- Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines, BMJ Open Sport & Exercise Medicine, 2018
- The relationship between foot posture and lower limb kinematics during walking: A systematic review, Gait & Posture, 2013
- Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons, Journal of the American Geriatrics Society, 2005
- The association between body mass index and musculoskeletal foot disorders: a systematic review, Obesity Reviews, 2012
- Adult-acquired flatfoot deformity, European Journal of Orthopaedic Surgery & Traumatology, 2017
Last source check: August 2026.
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