- are common and don't always cause problems
- Pain, swelling, or difficulty walking are signs you need treatment
- Adult-acquired is different from lifelong and can worsen
- Treatment ranges from orthotics and physical therapy to surgery for severe cases
What Are ?
—also called or —occur when the arches of your feet collapse, allowing the entire sole to touch the ground when you stand.
Some people have their whole lives without any issues. Others develop as adults, which can cause significant pain and mobility problems. Understanding the difference is key to knowing when you need help.
Types of in Adults
Flexible
With flexible , you have an arch when sitting or on your tiptoes, but the arch disappears when you stand. This is the most common type and often doesn't cause pain.
Rigid
Rigid show no arch whether you're standing, sitting, or on tiptoes. This type is more likely to cause pain and may indicate structural problems in the foot.
Adult-Acquired (AAFD)
This is the most concerning type. Adult-acquired develops when the posterior tibial tendon—the main tendon supporting your arch—becomes weakened or torn. Without treatment, this condition progressively worsens.
What Causes in Adults?
You Were Born With Them
Some people never develop arches. If you've had since childhood without pain, they're probably not a concern.
Posterior Tibial Tendon Dysfunction (PTTD)
This is the most common cause of adult-acquired . The posterior tibial tendon runs along the inside of your ankle and supports your arch. When this tendon becomes inflamed, overstretched, or torn, the arch collapses.
Injury
Fractures, dislocations, or severe sprains can damage the structures that support your arch.
Arthritis
Rheumatoid arthritis and osteoarthritis can destroy the joints that maintain foot shape and stability.
Diabetes
Diabetes can damage nerves and joints in the foot (Charcot foot), leading to arch collapse.
Aging
Tendons lose elasticity with age. Years of wear and tear take their toll.
Obesity
Excess weight places tremendous stress on foot structures, accelerating tendon damage.
Pregnancy
Hormonal changes cause ligaments to relax, and increased weight stresses the feet. Some women's arches flatten permanently during pregnancy.
Symptoms: When Become a Problem
don't always hurt. Many people with low or no arches live active, pain-free lives. But become a medical concern when they cause:
Pain
- Arch pain, especially during activity
- Pain along the inside of the ankle (following the posterior tibial tendon)
- Pain in the knees, hips, or lower back from altered gait
Swelling
- Swelling along the inside of the ankle
- Puffy appearance of the inner foot
Fatigue
- Tired feet after standing or walking
- Inability to walk or stand as long as you used to
Changes in Foot Shape
- Arch that's getting flatter over time
- Toes pointing outward ("too many toes" sign when viewed from behind)
- Heel tilting outward
Difficulty with Activities
- Trouble standing on tiptoes
- Pain when walking on uneven surfaces
- Decreased athletic performance
When to See a Podiatrist
Don't wait until severely impact your life. See a foot specialist if:
- You have foot or ankle pain that doesn't improve with rest
- You notice your arch getting flatter
- One foot is flatter than the other (especially concerning)
- You can no longer stand on your tiptoes on one foot
- Swelling persists along the inside of your ankle
- are limiting your activities
- You need new arch support recommendations
Early treatment for adult-acquired can prevent the condition from worsening and may help you avoid surgery.
How We Diagnose
At Central Florida Foot & Ankle Institute, we'll perform a thorough evaluation:
Physical Examination
We'll observe your feet while standing and sitting, check your range of motion, and assess tendon strength. The "single heel raise test"—standing on one foot and rising to your toes—helps us evaluate posterior tibial tendon function.
Gait Analysis
Watching you walk reveals how your affect your overall movement patterns.
Imaging
X-rays show bone structure and alignment. For suspected tendon problems, we may recommend an MRI to visualize soft tissue damage.
Treatment Options
Treatment depends on the cause and severity of your .
Conservative Treatments
Orthotics and Arch Supports Custom orthotics are often the first line of treatment. These devices support your arch, control abnormal motion, and reduce stress on damaged structures. Over-the-counter arch supports may help mild cases. Physical Therapy Exercises to strengthen the posterior tibial tendon and supporting muscles can stabilize your arch and reduce pain. Proper Footwear Supportive shoes with good arch support and motion control make a significant difference. Our team can recommend appropriate shoe choices for your foot type. Activity Modification Reducing high-impact activities while increasing low-impact exercise (swimming, cycling) takes stress off the feet while maintaining fitness. Weight Management Losing excess weight significantly reduces stress on foot structures. Bracing For moderate to severe cases, an ankle-foot orthosis (AFO) or similar brace provides additional support and stability.Surgical Options
Surgery may be recommended if conservative treatment fails or if the condition is severe:
- Tendon repair or transfer to restore arch support
- Osteotomy (bone cuts) to realign the foot
- Fusion to stabilize severely arthritic or deformed joints
We always exhaust conservative options before recommending surgery, but when surgery is needed, early intervention typically produces better outcomes than waiting until deformity becomes severe.
Living with in Central Florida
Florida's active lifestyle—from theme parks to beaches to golf courses—demands a lot from your feet. If are holding you back, don't accept it as normal.
Whether you need custom orthotics, physical therapy guidance, or surgical consultation, our team at Central Florida Foot & Ankle Institute has the expertise to help. We treat at every stage, from early intervention to complex reconstruction.
📞 Schedule your evaluation today and take the first step toward comfortable, functional feet.