Can Fallen Arches Cause Knee or Back Pain?

Fallen arches (flat feet) or foot pronation has been associated with everything from ankle pain, foot & knee conditions to low back pain. This would appear logical given that the foot is the first point of contact with the ground and forms the foundation upon which the rest of the body moves.


Can My Flat Feet Be the Cause of my Leg Pain?

There is a widespread belief that flat feet & differences in leg length are major causes of knee, ankle & back pain. Many people, in my experience, are of the belief that these factors are the primary cause of the their pain. 

Conventional wisdom suggests that over-pronation (where the foot rolls in as we step) is one of the major drivers of injury, especially in runners. When the scientific evidence is analysed, however, any such link between foot posture & leg length differences & injury is shown to be largely absent.

For example, a prospective study (where a group is followed over time) found leg length discrepancy was not associated with injury in runners (Hespanhol Junior et al. 2016).


Is it Normal for Infants to Have Flat Feet?

Flat feet in infants is a common parental concern; however, all infants will have flat feet up until approximately 2 years of age. The arches should begin forming in a child by the age of 2 or 3 & will be evident in standing by around the age of six.

Around one in five children will never develop an arch. Flat feet in older children generally does not cause significant issues & frequently is genetic, with one or more parents also having flat feet. In some cases, a strengthening programme is warranted to help develop foot strength. 

Causes of fallen arches with treatment at Naas Physio Clinic

Fallen Arches. Ross Allen is Ireland’s only dual qualified Chartered Physiotherapist & Chiropractor.



Do Fallen Arches Increase My Risk of Injury from Running?

Neilsen et al. (2014) performed a one year study of over 900 novice runners. They concluded that foot pronation (where feet roll inwards) was not associated with an increased injury risk. In fact, those classified as having pronated feet sustained significantly fewer injuries per 1000km than those with ‘neutral’ feet.

The study points out though, as a limitation, that few runners with ‘highly-pronated’ feet were included in the study. This research suggests that supposedly ‘abnormal’ degrees of pronation may in reality be considered normal and do not contribute to injury.

We must also apply caution with this conclusion though as the lack of runners with ‘highly-pronated’ feet means that there may be a small category of individuals in the extreme range of pronation that are indeed more prone to injury. This has not been proven, however.


What are the best Running Shoes for fallen arches?

There is too much emphasis placed on specialised running shoes in order to prevent injury and support ‘fallen arches’. Research does not support a link between the use of such shoes and a decrease in injury risk.

Some research suggests that modern running shoes may predispose to injury because the heavily cushioned soles encourage heel striking while running. This causes a greater transfer of load from the ground into the lower limb joints.

People often ask me what running shoes I recommend but, in reality, there is no one type of shoe that is superior to others. As I always say: people tend to look externally for the source of their injury when, in fact, the source invariably lies internally i.e. running technique, strength, degree of conditioning etc.


Are My Flat Feet the Cause of My Shin Splints or Knee Pain?

An excellent systematic review (review of all the available literature on a topic) by Neal et al. (2014) did identify evidence that pronated foot posture may be a risk factor for two types of knee pain (Medial Tibial Stress Syndrome and Patellofemoral (kneecap) Pain).

This included 21 studies with varied populations including runners and non-runners.  Another review of dynamic foot function (how the foot moves during gait), however, found very limited evidence that it was a risk factor for patellofemoral pain (pain under the kneecap), achilles tendinopathy and non-specific lower limb overuse injuries.

In conclusion, there is a lack of clarity as to whether flat feet play a role in knee or shin pain

Physiotherapy Treatment for Fallen Arches/Foot Pain

Foot pain such as that associated with plantar fasciitis (the tissue under the sole of the foot) or achilles tendonopathy can be improved by improving strength, mobility & power.

It is important to analyse running technique to evaluate whether there are obvious technique issues that may be predisposing to pain. If this is not resolved then the pain may return, much to the frustration of the athlete. 

Another important consideration is the overall training volume. If this is ramped up too quickly then this will create a massively increased risk of injury. The training schedule may need to be altered to include adequate rest, graduated increases in training volume & variability in the type of exercise performed



  1. Luiz Carlos Hespanhol Junior, Aline Carla Araújo De Carvalho, Leonardo Oliveira Pena Costa & Alexandre Dias Lopes. Lower limb alignment characteristics are not associated with running injuries in runners: Prospective cohort study. European Journal of Sport Science, 2016.
  2. Neilsen et al. (2014). Incidence of Running-Related Injuries Per 1000 h of running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine, 2015; 45(7): 1017-1026.
  3. Neal et al. (2014). Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. Journal of Foot and Ankle Research; 7:55.

    4.  Dowling et al. (2014). Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. Journal of Foot and Ankle Research.

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