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Flat Feet (Pes Planus)

Arch height is a major characteristic of a wide range of foot shape variants. Low arch height results in flat feet, or pes planus. A flat foot is not usually abnormal in itself, but it can predispose an individual to many musculoskeletal conditions and injuries. Therefore, it is used by non-specialists as an umbrella term to describe any foot problem which features a low arch. This is why just using a generic arch support often does not resolve an individual’s foot pain, even if he/she has flat feet. “Flat feet” is not a medical diagnosis by itself.


As lower limb specialists, podiatrists conduct a full biomechanical examination in order to make a comprehensive diagnosis of a patient’s present and future foot conditions. Addressing the low arch height is only a part of the treatment.

Flat Foot

Flat foot is a very common condition in Singapore. This is due to the genetic demographics of the region where this type of foot may be hereditary, acquired or due to ligamentous laxity. The artificial surfaces we walk upon every day expose our foot to greater wear and tear or degeneration.


The foot is the foundation of the whole body. When the foot is out of alignment (fallen arches), greater stress is placed on other joints in the body to help compensate. This is often the cause of soft tissue pathology and the two most common ones are Achilles tendonitis (tendon overuse injury) or Plantar fasciitis (inflammation of the ligament).


There are 2 kinds of flat feet:


  1. Congenital flat foot is hereditary and can be observed in children as young as 2 years old. Flat footed children may appear to have arches while they are seated or standing on tip toes. The medial arch only collapses when the child stands up. Flat footed individuals may also be diagnosed with hypermobility, a condition related to the laxity of muscles, especially in the feet. This laxity can cause problems elsewhere in the lower limb also, not just in the arches with unstable knee and hips.
  2. Adult-acquired flat foot can be caused by posterior tibial tendon dysfunction (PTTD) , arthritis, injury or diabetes. If untreated, the affected foot may deform and collapse more and more over time. This can result in loss of mobility, postural changes, and pain all the way up to the spine.

Flat feet can be corrected using flat feet insoles that are podiatrist-prescribed customised foot orthoses  and wearing footwear designed for flat feet.

Patient with stage III posterior tibial tendon dysfunction

Flat footed patients may experience a few symptoms such as:

  • Pain on the inside of the foot and ankle near the navicular bone
  • Pain after activity or with high intensity sports
  • Pain on the outside of the ankle at the fibula bone. This is due to the valgus position of the heel
  • Pain along the arch of the foot

Flat feet can be corrected by podiatrist-prescribed customised foot orthoses (flat foot insoles) and footwear designed for flat feet.

Foot Orthotics

Customised foot orthoses are a prescription-only medical devices customised for individual patient needs to address specific foot pathology. The podiatrist will decide on the materials, densities and designs of the orthotics depending on the medical requirements and lifestyle choices of the patient. Due to advancements in technology and manufacturing, specific custom foot orthoses can also be fitted into pumps, court shoes, and even specialised footwear like soccer boots or hockey shoes.


For diabetic patients, total contact orthoses are tailored with the aim of offloading pressure and provide cushioning movement to minimise any abrasion or irritation against the skin of the foot. This serves to prevent foot ulceration that often develops in areas of high pressure.

Scanning machines

At East Coast Podiatry Singapore, we utilise advanced computer-aided design and manufacturing (CAD/CAM) processes that provide an accuracy of up to +/- 0.4mm. To ensure that the 3D image of the foot is captured perfectly, the patient will undergo 3 different types of 3D scans. These scans are heavily reliant on the clinician’s skill and training to capture the foot at maximum precision.


The results of your scans will be combined with the information derived from the musculoskeletal/biomechanical assessment done by the podiatrist. This is necessary for the prescription and precise manufacturing of orthotic devices that are designed specifically to correct flat foot condition.

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