The Best Flat Foot Exercises to Reduce Pain and Support Your Arch Are PTTD Exercises. Here’s Why.
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Flat foot (also called flatfoot or fallen arches) can be hereditary without any negative symptoms, but it can cause pain, if it’s caused by an overuse injury, or due to weak muscles in your foot, ankle, or calf. If you have pain from flat foot, physical therapy exercises to treat a condition called PTTD are perfect for reducing flat foot pain and maintaining the healthy shape of the arch of your foot. Read on!
PTTD (Posterior Tibial Tendon Dysfunction, also called Posterior Tibial Tendonitis) is a painful condition that affects a tendon in the ankle. The tendon, called posterior tibial tendon, connects your calf muscles to the bones on the inside of your foot. Its main function is to maintain the healthy shape and shock-absorbing spring of the arch of your foot. In other words, this tendon prevents flat foot formation.
When the repetitive load and stress of walking, running, or standing exceeds the tendon’s capacity to support the arch, the tendon can develop tiny tears and inflammation. This causes inner ankle pain, arch pain, and ankle swelling, and can significantly limit your mobility.
Flat foot is one manifestation of PTTD. The tiny tears from PTTD weaken the posterior tibial tendon. Swelling associated with the condition causes tightness in the ankle, which often interferes with the tendon’s smooth up and down movement to adjust to the impact of your steps. Both of these reduce the tendon’s ability to maintain the convex shape of the foot, leading to flat foot.
(A side note: people refer to PTTD with a lot of different names , including flatfoot. You may also see “Adult-Acquired Flatfoot Deformity” or flat foot, flat feet, and flatfeet in this context. Confusing, but they more or less all refer to the same thing!)
Absolutely. Many people with flat foot are just born that way. Others develop flat foot slowly over time, as the wear and tear of everyday activities accumulate on the muscles and tendons that work together to maintain the arch.
If you notice that your foot is becoming flatter (or your arch is falling in), though, it’s likely that there’s a fundamental mismatch between how much stress you’re putting your arch through, and how strong all the muscles and tendons that support your arch are:
Have you gained weight without a corresponding increase in your strength? This includes pregnancies, too.
Have you lost some muscle strength due to lower activity levels or aging?
So, if you want to correct flat foot, the key is to build - or rebuild - strength in the muscles and tendons that maintain the spring of the arch. This is the same principle as the gold standard of physical therapy for PTTD, because the mechanisms are the same.
If it’s not causing you any pain or limiting your activities, you don’t need treatment. However, in other cases, active treatment for flat foot is a good idea:
If your flatfoot is causing you foot pain, especially in the arch
If it’s accompanied by ankle pain or swelling: this is a sign that you have PTTD that can get worse if left untreated.
If it’s negatively affecting other parts of your kinetic chain: knee pain is especially common among people flatfoot, but you may feel it elsewhere.
There are several supportive devices to reduce pain and discomfort from flatfoot, mostly of the insoles/orthotics variety. They can be effective at symptom relief, but they don’t permanently correct flat foot or strengthen your arch. Just adding insoles to your shoes means the pain will return when you stop using them; for a permanent fix, you’ll need to address the root cause.
Our Loft 2 Brace, while effective at lifting your arch and relieving pain, also can't fix flat foot on its own. For a permanent, root-cause solution, you need strengthening exercises.
The gold standard of flatfoot treatment is physical therapy. Whether it’s from PTTD specifically or not, physical therapists address the root cause of flat foot by 1) massaging the problematic tissue, 2) reducing, then gradually increasing the load, and 3) building strength with targeted exercises.
We’ve seen that flat foot often has the root cause in the mismatch between a tissue’s capacity to tolerate stress and the amount of stress (load) that is placed on the tissue. With physical therapy exercises that systematically build strength in the muscles and tendons, including the posterior tibial tendon, you can increase your overall ability to maintain the healthy shape and function of the arch.
Exercises are key to reducing pain now, but that's not all - by building strength, you can prevent it from getting worse or coming back in the future. Insoles and orthotics can reduce pain temporarily, but they can't prevent recurrences!
There isn’t a single “best exercise” to correct flat feet. Instead, a good physical therapist would build you a structured program of exercises that get more challenging, as you get stronger. Individual exercises are ingredients; the structure is the recipe that puts everything together. The structure makes the exercises more efficient, and reduces the risk of aggravation.
Our PTTD Guided Recovery Program replicates this structured approach of in-person PT work. The six-level program gradually moves you from easy exercises that isolate one part of your kinetic chain - like Single Leg Stand - to more challenging exercises that work multiple muscles and tendons at the same time (similar to how you move naturally) - like Tree Pose and Forefoot Stability. With progress assessment after each session, you can be sure that you’re doing just the right exercises at the right time on your recovery journey.
Consistency is the name of the game when it comes to building strength and treating chronic pain. Ideally, physical therapy exercises should be done every day, and that’s what you’ll do in the PTTD Guided Recovery Program as well.
Does that sound like a lot? It can be, if you had to go to a physical therapist’s office! But the exercises themselves are never more than 15 minutes (closer to 10 minutes in most levels), so with the at-home program, it’s easy to fit it into your regular routine.
When you’re following a structured program that properly targets the key muscles and tendons, you should feel pain reduction within the first couple of days, if not on the first day. On average, Alleviate users experience a 40% decrease in their initial pain within the first 2 weeks of the program. Your recovery time will depend on the severity of your symptoms when you get started, but many of our users “graduate” from the Guided Recovery Program in 6-10 weeks.
Use PTTD exercises to fix flat foot: if you have pain from flat foot, physical therapy exercises for PTTD can be very effective for pain relief and arch support. Make sure to use a structured program like our PTTD Guided Recovery Program to maximize the "bang for the buck" of your effort.
Target the root cause for long-term solution: a key root cause of flat foot pain is weakness in your foot, ankle, or calf. Work on the root cause with targeted exercises, and you'll go, and stay, pain-free.
Don't rely on insoles alone: Flat foot insoles and braces can be effective at symptom relief, but they can't fix flat foot by themselves. Incorporate strengthening exercises for a permanent solution.
Alleviate was founded by a patient-and-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With our PTTD Guided Recovery Program, you can reduce pain and discomfort from flat foot, and prevent it from getting worse or returning - all without leaving the comfort of your own home.
Luke Ferdinands, Physical Therapist & Co-Founder
A New Zealand-trained physical therapist with over 20 years of experience, Luke developed the Alleviate Method to bring the gold standard of physical therapy care to everyone's home. Luke leads the development of physical tools and digital physical therapy content, focusing on driving clinical outcomes for people with chronic musculoskeletal pain conditions like Tennis Elbow, Plantar Fasciitis, Runner's Knee, and more.
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