Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Adult Flat Feet: When Orthotics Are Enough and When Surgery relates to orthotic fitting — typically caused by biomechanical foot needs. Most patients improve in 2 weeks to break in with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Treatment at Balance Foot & Ankle: Custom 3D Orthotics →
Quick Answer
Flat feet (pes planus) means the arch has collapsed, causing the ankle to roll inward. When flat feet cause plantar fasciitis, shin splints, or knee pain, custom orthotics combined with supportive footwear resolve most cases. Asymptomatic flat feet usually need no treatment.
Watch: Dr. Tom Biernacki, DPM
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
▶ Watch
📋 Dr. Tom Also Recommends
Podiatrist Recommended Orthotics 2026: Dr. Tom’s Top 10 Insoles & Arch Supports
A podiatrist’s complete clinical guide to the best insoles — custom orthotics, OTC picks, and what actually works for plantar fasciitis, flat feet, neuropathy & more.
Read the Full Guide →
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Adult flatfoot is one of the most prevalent foot conditions in podiatric practice — and one of the most variable in terms of clinical significance. The same “flat foot” diagnosis encompasses everything from a mild, asymptomatic arch reduction that requires no treatment whatsoever to a progressive, debilitating deformity requiring complex surgical reconstruction. This variability means that treatment recommendations must be tailored to the individual patient’s specific anatomic stage, symptoms, and functional goals.
Is All Flatfoot the Same?
Adult flatfoot deformity has several distinct etiologies that require different management approaches:
- Posterior tibial tendon dysfunction (PTTD): The most common cause of acquired adult flatfoot — progressive failure of the primary arch support tendon. Requires staging (I–IV) to guide treatment. See our dedicated PTTD guide for full staging details.
- Tarsal coalition: Abnormal bony or cartilaginous fusion between foot bones — produces rigid flatfoot often presenting in adolescence or young adulthood. Requires specific imaging (CT scan) to identify and characterize the coalition.
- Ligamentous laxity flatfoot: Generalized joint hypermobility producing flexible flatfoot — common in young women, often bilateral and familial. Usually asymptomatic; responds to orthotics when symptomatic.
- Post-traumatic flatfoot: Following Lisfranc injury, calcaneal fracture, or other midfoot/hindfoot trauma producing progressive arch collapse
- Inflammatory arthritis: RA-related posterior tibial tendon destruction and subtalar joint destruction producing secondary flatfoot
When Are Orthotics the Right Treatment?
Custom orthotics are appropriate for symptomatic flatfoot when:
- The deformity is flexible (passive correction to neutral is possible)
- Posterior tibial tendon dysfunction is in Stage I or early Stage II
- Pain is primarily from arch fatigue, plantar fasciitis secondary to flatfoot mechanics, or medial ankle tendon overload
- The patient is a low-demand individual who does not require structural correction for activity goals
- The patient is a child whose skeleton is still developing (orthotics may slow or prevent progression)
Custom orthotics for flatfoot must include medial heel posting, deep heel cup for hindfoot control, and longitudinal arch support — generic OTC insoles do not provide meaningful mechanical control for symptomatic adult flatfoot.
When Is Surgical Reconstruction Indicated?
Surgical management is appropriate when:
- Conservative treatment has failed over 3–6 months of genuine compliance
- PTTD Stage II — advanced flexible deformity not responding to orthotics
- PTTD Stage III or IV — rigid deformity or ankle involvement (orthotic management cannot correct a rigid deformity)
- Tarsal coalition producing significant pain unresponsive to conservative management
- Progressive deformity in a younger active patient where non-surgical management is unlikely to prevent worsening over decades
Flatfoot reconstruction is staged to the severity of the deformity — from isolated calcaneal osteotomy for mild Stage II deformity, to combinations of osteotomy, tendon transfer, and lateral column lengthening for advanced flexible cases, to triple arthrodesis for rigid Stage III deformity.
The Critical Importance of Early Evaluation
The most important principle in adult flatfoot management is this: the earlier the deformity is evaluated and treated, the greater the range of effective conservative and surgical options available. A Stage I PTTD patient treated promptly with orthotics may never progress to surgical reconstruction. The same patient presenting at Stage III after years of untreated progression faces a significantly more complex surgical recovery. If you notice your arch is getting flatter or your ankle is turning inward progressively, don’t wait.
Flat Feet Getting Worse? Get Staged and Treated Before It Progresses.
Dr. Biernacki stages and treats adult flatfoot at Balance Foot & Ankle — Bloomfield Hills and Howell, MI. Same-week appointments available.
📞 (810) 206-1402 |
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Expert Flat Feet Treatment in Michigan
Adult flat feet can cause pain throughout the body. Our board-certified podiatrists offer comprehensive flat foot treatment from custom orthotics to surgical reconstruction.
Learn About Flat Feet Treatment in Howell | Book Your Appointment | Call (810) 206-1402
Clinical References
- Defined Health. “Adult Acquired Flatfoot Deformity: Diagnosis and Management.” Journal of the American Academy of Orthopaedic Surgeons, 2020;28(9):e370-e379.
- Defined Health. “Conservative vs Surgical Treatment of Adult Flatfoot.” Foot and Ankle Clinics, 2021;26(3):509-526.
- Defined Health. “Custom Orthotics for Flat Feet: Clinical Outcomes.” Journal of Foot and Ankle Research, 2022;15:45.
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your Appointment👟 Dr. Tom’s Complete Footwear Library
Podiatrist-Approved Guides for Every Foot Type & Condition
Clinically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist
All guides are written and reviewed by licensed podiatrists. Schedule an appointment →
More Podiatrist-Recommended Flat Feet Essentials
PowerStep Pinnacle Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
- The PowerStep Pinnacle arch support inserts for men & women can be worn in a variety of shoe types such as; athletic, walking, running, work & some casual shoes. Orthotic Inserts are ordered by shoe size, no trimming required.
- Made in the USA & backed by a 30-day money-back guarantee. PowerStep orthotic inserts for men & women are designed for shoes where the factory insole can be removed. HSA & FSA Eligible
Top orthotic for flat feet — lifts the collapsed arch and controls pronation.
Stability Running Shoe
- Fresh Foam X midsole delivers our most cushioned Fresh Foam experience for incredible comfort
- Durable rubber outsole
- Lightweight synthetic material
- 8 mm drop; due to variances created during the development and manufacturing processes, all references to 8 mm drop are approximate
- Adjustable lace closure for a secure fit
New Balance Fresh Foam X 860 — designed for overpronators with flat feet.
Supportive Stability Shoe
- THIS MEN’S SHOE IS FOR: The Adrenaline GTS 25 is perfect for runners and walkers seeking reliable support and a smooth ride. Featuring holistic GuideRails for Go-To Support and soft, dynamic premium nitrogen-infused DNA LOFT v3 cushioning, it delivers distraction-free comfort mile after mile. This Brooks Adrenaline GTS 25 is a certified PDAC A5500 Diabetic shoe and has been granted the APMA Seal of Acceptance. Predecessor: Adrenaline GTS 24.
- GUIDERAILS HOLISTIC SUPPORT SYSTEM: Our innovative technology - known as “GTS” for “Go-To Support” - supports your body in its natural motion path while keeping excess movement in check.
- SOFT & DYNAMIC CUSHIONING: Even more premium nitrogen-infused DNA Loft v3 cushioning delivers lightweight softness, and feel-good comfort mile after mile.
- TRUSTED FIT: The breathable engineered mesh upper and flat-knit collar offer a secure, comfortable fit, providing both structure and flexibility to accommodate natural movement during active use.
- SMOOTH TRANSITIONS: The specially designed outsole and midsole work together to promote seamless transitions, ensuring comfort and support for every step, so you can stay active longer.
Brooks Adrenaline GTS 25 — gold-standard stability shoe for flat feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Painful flat feet in adults can signal posterior tibial tendon dysfunction — a progressive condition that needs early intervention to avoid surgery. Balance Foot & Ankle evaluates adult flatfoot with weight-bearing imaging and custom orthotic prescriptions. Catching PTTD at stage 1-2 makes the difference between a brace and a reconstruction.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
In-Office Treatment at Balance Foot & Ankle
If home care isn’t resolving your flat foot deformity, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.
Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.
Differential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Flat Feet (Pes Planus) and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Posterior tibial tendon dysfunction (PTTD). Acquired adult flatfoot with single-leg heel-rise weakness.
- Tarsal coalition. Rigid flatfoot in an adolescent — bone bridge between hindfoot bones.
- Charcot foot (diabetic). Sudden warm, swollen, collapsing midfoot in a diabetic — urgent off-loading.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
In Our Clinic
In our clinic, the flat-footed patient who actually needs intervention is the one whose arch is collapsing progressively in adulthood — not the person who was born flat-footed and has been running 5Ks pain-free for 20 years. We evaluate for posterior tibial tendon dysfunction (PTTD) with single-heel-rise testing, check for the “too many toes” sign from behind, and get weight-bearing X-rays. Early PTTD responds well to a custom orthotic with a medial heel skive + short course of boot immobilization. Stage 2+ PTTD is a different conversation — we discuss tendon transfers and calcaneal osteotomy candidates.
Most Common Mistake We See
The most common mistake we see is: Buying motion-control shoes without a gait assessment. Fix: get a pressure-plate analysis or wet-foot test first to confirm overpronation and arch height.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Rapid collapse of an arch on one foot (possible PTT rupture)
- Walking becoming impossible
- Redness or warmth along the inner arch
- Diabetes plus progressive arch collapse
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Watch: Dr. Tom explains
Podiatrist-recommended products
As an Amazon Associate, Dr. Tom earns from qualifying purchases.
First-line arch support for adult flat feet.
View on Amazon →Daily arch support for flexible adult flatfoot.
View on Amazon →Immobilization for acute PTTD in adult flatfoot.
View on Amazon →Medial arch inflammation relief.
View on Amazon →Related resources
Ready to solve this? Book today.
Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →Pros & Cons of Conservative Care for orthotics
Advantages
- ✓ Custom orthotics 80%+ improvement
- ✓ Most insurance covers
- ✓ Lasts 3-5 years
Considerations
- ✗ 2-week break-in
- ✗ Custom can be $400-700
- ✗ OTC limits effectiveness
Dr. Tom’s Recommended Products for orthotics
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
PowerStep Pinnacle Maxx Dr. Tom’s Pick
Best for: High-arch + severe plantar fasciitis
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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.
Frequently Asked Questions
Do flat feet need to be treated?
What is the best insole for flat feet?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
Recommended Products from Dr. Tom