Fallen Arches: Causes, Symptoms, and Treatment Options

Medically reviewed by Dr. Tom Biernacki, DPM

Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026

Quick answer: Fallen arches in adults — known clinically as adult-acquired flatfoot or posterior tibial tendon dysfunction (PTTD) — develop gradually when the posterior tibial tendon weakens and can no longer maintain the medial arch under load. Early stages (pain and mild flattening) respond well to custom orthotics and physical therapy in 70-80% of cases. Progressive stages require surgical reconstruction. The key warning signs of advancing PTTD are inability to perform a single-leg heel raise, the too-many-toes sign (excessive forefoot abduction visible from behind), and increasing lateral ankle pain from the fibula impinging the calcaneus.

Quick answer: Treatment for fallen arches treatment follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

Related Conditions

Plantar Fasciitis

Most common foot condition we treat

Bunions

Progressive deformity — early care prevents surgery

Flat Feet

Root cause of many downstream foot conditions

Morton’s Neuroma

Forefoot burning and electric pain between toes

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Fellow of the American College of Foot and Ankle Surgeons. Updated April 2026.

What Are Fallen Arches?

Fallen arches—also called adult-acquired flatfoot or pes planus—refers to a progressive loss of the medial longitudinal arch (the inner arch of the foot) that develops in adulthood, typically after years of normal arch height. This is distinct from congenital flatfoot, which is present from birth or childhood. The most common cause of adult-acquired flatfoot is posterior tibial tendon dysfunction (PTTD)—a condition in which the tendon that supports the arch weakens, stretches, or tears, causing progressive arch collapse.

Fallen arches affect an estimated 8–10% of adults, with a significant increase in prevalence after age 40. Risk factors include obesity, diabetes, hypertension, prolonged weight-bearing activities, previous ankle sprains, and female sex. The condition is progressive if untreated—early intervention with arch support can halt or slow collapse, while untreated PTTD progresses through predictable stages to irreversible deformity.

Posterior Tibial Tendon Dysfunction: The Most Common Cause

The posterior tibial tendon runs along the inside of the ankle and attaches to the navicular bone in the midfoot—its primary function is to invert the foot and support the arch during the push-off phase of walking. When this tendon degenerates and fails (PTTD), the arch collapses medially and the heel rolls outward (hindfoot valgus). The classic presentation: a middle-aged woman with pain and swelling along the inner ankle and arch, noting that her arch has gotten progressively flatter and she can no longer stand on tiptoe on the affected side (the single-heel-rise test).

PTTD is staged I through IV. Stage I involves tendinitis without deformity—the tendon is painful but the arch is maintained. Stage II shows flexible flatfoot deformity—the arch collapses on standing but can be passively corrected. Stage III shows rigid deformity—the hindfoot is fixed in valgus and cannot be corrected passively. Stage IV involves ankle joint involvement from chronic hindfoot valgus. Treatment options depend critically on stage.

Treatment Options

Conservative Treatment (Stages I–II)

Early PTTD (Stage I) responds well to anti-inflammatory treatment (NSAIDs, ice), activity modification, and custom orthotics with medial arch support and heel posting. A rigid custom orthotic or an Arizona brace (a custom ankle-foot orthosis) provides more substantial support for Stage II flexible deformity. Physical therapy for posterior tibial tendon strengthening and eccentric calf exercises is an important component of conservative management. Many patients with Stage I–II PTTD can maintain adequate function and prevent progression with long-term orthotic use. If conservative treatment fails after 3–6 months, surgical options are considered.

Surgical Reconstruction (Stages II–III)

Surgical treatment of fallen arches combines multiple procedures tailored to the deformity. For Stage II flexible flatfoot, common procedures include: medializing calcaneal osteotomy (shifting the heel bone inward to realign the foot), flexor digitorum longus (FDL) tendon transfer (replacing the dysfunctional posterior tibial tendon with an adjacent tendon), and lateral column lengthening for forefoot abduction correction. For Stage III rigid deformity, subtalar and talonavicular joint fusions are required to correct and stabilize the rigid deformity. Recovery from flatfoot reconstruction is prolonged—non-weight-bearing for 6–8 weeks followed by gradual progressive weight-bearing in a boot, with return to normal shoes at 3–4 months and full recovery at 9–12 months.

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When to See a Podiatrist

If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.

Call Balance Foot & Ankle: (810) 206-1402  ·  Book online  ·  Offices in Howell & Bloomfield Hills

Frequently Asked Questions

Medical References & Sources

• American Orthopaedic Foot & Ankle Society — Adult Flatfoot
• PubMed Research — PTTD Conservative Treatment
• PubMed Research — Flatfoot Reconstruction Outcomes

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He treats adult flatfoot and posterior tibial tendon dysfunction with custom orthotics, bracing, and surgical reconstruction including calcaneal osteotomy and tendon transfer procedures.

Podiatrist-Recommended Products for Fallen Arches

• PowerStep Maxx — maximum medial arch support is the #1 non-surgical treatment for fallen arches
• Doctor Hoy’s Natural Pain Relief Gel — topical pain relief for the arch, heel, and ankle soreness caused by flat foot collapse
• DASS Medical Compression Socks — graduated compression reduces the ankle swelling common in patients with severe flat feet

These are the same products Dr. Biernacki recommends in clinic. Available through our partner Foundation Wellness.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your flat feet, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.

What is the difference between a podiatrist and an orthopedic surgeon?

Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.

How do I know if my foot pain is serious?

Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.

Can foot problems cause back and knee pain?

Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.

Are orthotics worth it?

For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.

How do I choose the right running shoes?

Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.

What is the difference between a sprain and a fracture?

A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.

How do I prevent foot and ankle injuries?

The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.