Flat Feet
Flat feet — fallen arches — means the entire sole touches the ground when you stand. Some people have flat feet their whole lives without problems. Others develop pain in the feet, ankles, knees, or even the lower back as the lack of arch support creates a chain reaction up the body.
Symptoms
- Foot pain, especially in the arch or heel area
- Ankle pain or swelling on the inner side
- Knee or hip pain with no obvious cause
- Shoes wearing unevenly on the inner edge
- Feet that tire easily during standing or walking
- Difficulty with balance or standing on tiptoe
Who Gets It
Flat feet are normal in children up to about age 5-6, when arches typically develop. In adults, flat feet are either structural (lifelong) or acquired — the arch collapses due to posterior tibial tendon dysfunction, injury, obesity, or arthritis. Adults with flat feet who spend long hours standing, or who take up running, often develop symptoms that weren't present before.
Flat feet become a problem when demands on the foot increase — and Austin offers plenty of that. Trail running at Brushy Creek, hill climbing in the Hill Country, or even long shifts at a standing-desk job can push a flat-footed patient into pain they hadn't experienced before. Dr. Wokasien evaluates how flat feet affect your gait and where problems are developing.
Treatment
Dr. Wokasien evaluates how flat feet affect your gait and where problems are developing:
- Custom orthotics — the primary treatment. Precisely fitted inserts restore the support arches aren't providing. Off-the-shelf insoles rarely match.
- Targeted exercises to strengthen the muscles that support the arch
- Footwear guidance — the right shoes make a measurable difference
- Activity modification for acute pain periods
In severe cases with tendon damage (posterior tibial tendon dysfunction), surgical reconstruction may be necessary.
When to Call
Most children have flat feet until age 5-6. If your child complains of foot pain, tires quickly during play, or walks unusually, an evaluation can determine whether treatment will help. For adults, if flat feet are causing pain that limits your daily activity or exercise, call (512) 250-0444.
Frequently Asked Questions
Do flat feet always need treatment?
No. Flexible flat feet with no pain or functional limitation are common and often require no treatment. The decision to intervene is driven by symptoms — pain, excessive wear on shoes, problems up the kinetic chain — not by appearance alone. Dr. Wokasien evaluates function, not just anatomy.
Will orthotics fix flat feet?
Custom orthotics don't change foot structure — they provide support that the arch isn't generating naturally. Most patients experience significant pain reduction and functional improvement. Think of it as glasses for your feet: they correct the functional problem without changing the underlying anatomy.
Are custom orthotics really better than store-bought insoles?
For many flat-footed patients, yes. OTC insoles are made for general arch shapes. Custom orthotics are cast from your specific foot in a specific functional position and address your particular gait mechanics. Patients who've tried OTC insoles without success often notice an immediate difference with custom devices.
What is posterior tibial tendon dysfunction?
The posterior tibial tendon is the main tendon supporting the arch on the inside of the ankle. When it's damaged or overstretched — common in adults with flat feet who've been physically active for years — the arch can collapse further and the foot rolls inward. Caught early, treatment prevents severe deformity. Advanced cases may need surgery.
My child has flat feet. Should I be concerned?
Not unless they're having symptoms. Flat feet are normal in toddlers and early-grade-school children as arches are still developing. By age 6, most children have visible arches. If your child complains of foot pain, fatigues easily, or you notice unusual gait, an evaluation makes sense — not to intervene unnecessarily, but to know where things stand.
Can flat feet cause knee or back pain?
Yes. When feet overpronate (roll inward), it cascades up the kinetic chain — the ankle, knee, hip, and lower back all compensate. Patients with unexplained knee pain or chronic lower back discomfort sometimes find significant improvement after addressing their flat feet. Dr. Wokasien evaluates the whole picture.
What's the best exercise for flat feet?
Calf raises, towel scrunches, and arch-strengthening exercises can build the intrinsic foot muscles that support the arch. Dr. Wokasien prescribes specific exercises based on your situation. Stronger foot muscles complement orthotics — they don't replace them for structural flat feet.