11 Best Treatment Exercises For Flat Feet Causing Knee Pain

Flat feet can be very frustrated because they can cause a variety of issues including pain and mobility problems. Flat feet is a common condition that approximately 26% of people experience. This article will provide the 11 best physical therapy exercises for flat feet.

Can Flat Feet Cause Knee Pain?

The answer is absolutely yes! Flat feet can place additional stress on the knees when standing, walking and performing your daily activities. This additional stress can cause chronic knee pain.

When someone has a higher body weight they put more stress on the knee joint. Over time this can cause cartilage damage in the knee joint and eventually lead to knee osteoarthritis. Knee osteoarthritis or knee OA is defined as degenerative changes to the inside of the knee.

Overweight individuals are at higher risk for knee osteoarthritis, however, it can occur in any patient population. It is usually caused by years of wear and compensations developed over the years. This causes knee joint pain.

Physical Therapy: Flat Feet Knee Pain Exercises

There are many exercise programs out there that promise to fix flat feet by performing only foot/ankle exercises. Although this is one way to treat flat feet, it is not the best way to fix flat feet long term. The 11 best flat feet knee pain exercises are 1. Heel Raises 2. Arch Lifts 3. Towel Curls 4. Toe Raises 5. Hip Abduction 6. Clamshells 7. Bridge 8. Single Leg Squat 10. Calf stretch 11. Posterior Pelvic Tilt 12. Hip Flexor Stretch.

Research such as in this article shows that treating the entire body, rather than just the feet helps to fix flat feet.

Lower body strengthening is a big part of treatment, however, it is not all of the treatment. Now, moving on to the exercises for flat feet that target the entire body to fix flat feet for good. 

Ankle/Foot Exercises

Strengthening and stretching the muscles in your feet and ankles can help alleviate some of the symptoms associated with flat feet. Strengthening the muscles in the arch of the foot, promotes better foot stability and support of the entire body including the foot, knee and hip. These ankle foot/ exercises include 1. Heel Raises 2. Arch Lifts 3. Towel Curls 4. Toe Raises.

1. Heel Raises

• Heel raises are a great exercise to strengthen the calves.
• To perform this exercise hold onto a wall for balance and push up on both toes so that the heels are fully off the ground.
• Now slowly lower the heels back down to the floor.
• To make this more difficult you can perform a single leg heel raise or perform the regular heel raise but pause for 1-2 seconds while standing at the highest point on your toes.
• If this is too difficult don’t rise up so high or perform a seated heel raise.

2. Arch Lifts

• Arch lifts strengthen the intrinsic muscles of the feet, which assists in rebuilding the arch of the foot.
• While standing raise the arch of your feet while the rest of your foot stays flat on the floor.
• If you are having difficulty performing this exercise think about shifting your weight to the outside of your foot.
• Your heels and toes should remain flat on the ground for the entire exercise.
• If this is too easy perform the exercise while balancing on one leg.
• If this is too difficult you can start by performing this exercise while seated.

3. Towel Curls

• This exercise strengthens the intrinsic muscles of the foot, which assists in rebuilding the arch of the foot.
• Although similar muscles can be targeted by performing an exercise such as marble pick up, in which you pick up marbles with your toes, I have found this exercise to be more beneficial.
• While sitting barefoot or in socks with a towel under your foot, attempt to scrunch up the towel beneath your toes.
• Think of it like you are trying to pick the towel up with your toes. 
• If this is too easy stand on one leg and perform towel curl on the opposite leg.
• If this is too hard scrunch the towel up to start instead of having the towel flat on the ground.
• This makes it easier to pick the towel up with your toes. 

4. Toe Raises

• This exercise targets the muscles in the front of your foot and ankle and effectively strengthens the front of the shins and stretches the bottom of the foot.
• Start by sitting in a chair with both feet flat on the floor. Slowly raise your toes up towards the ceiling as high as you can.
• Hold this position for 1 second and then slowly bring your toes down to the ground.
• If this is too easy perform this exercise in standing.
• Be sure to hold onto a sturdy surface as this exercise is about strengthening and not balance.
• If this is too difficult do not lift your toes up as high.

Hip And Knee Strengthening Exercises

Strengthening the muscles around the hips and knees can help support the arches of the feet indirectly by promoting proper movement mechanics and reducing compensatory movements. Strengthening the hips improves overall stability, which can help prevent excessive pronation and strain on the feet and arches while also reducing the risk of injuries. These hip and knee strengthening exercises include 5. Hip Abduction 6. Clamshells 7. Bridge 8. Single Leg Squat.

5. Hip Abduction

• This exercise strengthens the hip abductors and external rotators, which are the muscles that are typically weak in people with flat feet.
• These muscles are also responsible for stabilizing the pelvis.
• Start by lying down on your side with your bottom knee bent and your top knee straight.
• Keep your hips stacked on top of each other and lift your top leg while keeping it straight.
• Try not to let your hips roll or rotate while performing this exercise
• If this is too easy you can stand and balance on one leg while kicking the other left leg out to the side.
• Another option to make the exercise harder is to add a resistance band around the ankles when performing this exercise in either side lying or standing.
  • If this is too hard you can lie on your back and slide one leg out to the side at a time.

6. Clamshells

• This exercise targets your hip joint and external rotators which are weak in people with flat feet.
• This also helps to reverse the excessive internal rotation of the hip.
• Start by lying on your side with both knees bent and hips and feet stacked on top of each other.
• While maintaining your feet stacked on top of each other slowly lift top leg up and then slowly lower it back down to your other knee. 
• If this is too easy you can add a resistance band above your knees when performing the exercise. 
• If this is too hard you can lie down on your back and slowly let your legs fall to opposite sides and then slowly bring them back to starting position.

7. Bridge

• This exercise targets the glutes which strengthen the hip extensors.
• This muscle group is typically very weak in people with flat feet. 
• Begin by lying on back with both knees bent.
• Squeeze butt and abs and lift butt/hips off the ground.
• Pause at the top once hips are fully extended and then slowly bring hips and butt back to the floor. 
• If this is too easy hold the bridge in the top position for increased time or perform a single leg bridge.
• If this is too hard perform bridge to decreased height. 

8. Single Leg Squat

• The quads are typically weak in people with flat feet.
• This exercise strengthens the upper leg or quads and the stability in the hip and works on single leg balance.
• Start by standing on one leg with your opposite leg straight out in front of you and squat down.
• Don’t let your knee cave in. 
• If this is too easy perform a deeper squat.
• If this is too difficult rest your back on a wall and slide back down the wall while performing a single-leg squat.

Stretching/ Mobility Exercises

Stretching and mobility exercises can help improve flexibility, alleviate pain, and enhance the overall function of the feet and ankles in individuals with flat feet. These exercises include 9. Calf Stretch 10. Posterior Pelvic Tilt 12. Hip Flexor Stretch.

9. Calf Stretch

• The muscles in the calves are typically tight in people with flat feet which is why stretching these muscles helps to decrease the tension in the calves. 
• Start by standing facing the wall with your front knee bent and back knee straight. Push your back heel down into the ground.
• You should feel a stretch in the back of the calf.
• If this is too easy lean further forward, increase the distance of feet from each other, and push the heel down further.
• If this is too hard or painful bring the feet closer distance together and don’t put as much pressure through heel.
• The exercise should feel like a good stretch but not painful.

10. Posterior Pelvic Tilt

• In order to counteract an anterior pelvic tilt, which is a common posture in people with flat feet, a posterior pelvic tilt must be done.
• This exercise helps to bring the pelvis closer to its neutral position. 
• Lie on your back with both knees bent and feet flat on the floor.
• Perform this by slowly drawing your belly button in towards your spine as you contract your abdominal muscles.
• Another way to think about this exercise is to flatten back onto the floor beneath you.
• If this is too easy hold for increased time.
• It is important to note that this exercise should not be difficult.
• The purpose of the exercise is to better align your pelvis posture.
• If this is too hard move in a smaller range of motion.

11. Hip Flexor Stretch

• Tight hip flexors can force the pelvis to rotate resulting in an anterior pelvic tilt.
• This exercise helps to bring the pelvis back to neutral by relieving the tightness in the hip flexors.
• Start by kneeling on the floor with the leg that you want to stretch in the back.
• If you want to stretch your right leg for example, the right knee will be on the ground in the back and the left thigh will be parallel to the floor.
• Lean forward in order to get a deeper stretch
  • If this is too easy lean further into the stretch or perform while side-lying and grab the top leg with your hand and gently pull backward until you feel a stretch.
  • If this is too hard or painful lie on your back with the leg that you wish to stretch hanging off the table.
    • Allow the leg to hang off the table to your tolerance. You should feel a good stretch but not pain.

Are you having groin and hip pain? It may be due to a labral tear rather than flat feet. If you are interested in more exercises for a hip labral tear you can read Hip Labral Tear Symptoms Physical Therapy Treatment For Hip and Lower Back Pain here.

Symptoms of Flat Feet

The symptoms of foot overpronation are painful feet, unstable feet, weak feet, foot imbalance, knee pain, ankle pain, hip pain, and compensations due to poor foot posture. It is important to address these compensations in order to fix flat feet long term. If your flat feet are causing you instability you can find 11 Creative Dynamic Balance Exercises For Stability in Seniors here.

Rheumatoid arthritis is one of the risk factors for flat feet. It is the progressive flattening of the arch which can occur in older adults. It is important to get an accurate diagnosis for flat feet prior to starting an exercise program. An accurate diagnosis will allow you to receive the proper treatment for your injury.

What Problems Can Flat Feet Cause?

The technical term for a flat foot is overpronation, also known as pes planus. This is also known as excessive pronation of the foot.

Overpronation can cause overpronation knee pain. This is because typically flat feet are also associated with knee valgus, internally rotated hips and anterior pelvic tilt. This alters the body’s kinetic chain and can cause chronic pain.

In addition to these issues, a common complaint from people with flat feet is that it is associated with

• Plantar Fascitis
  • This common foot problem occurs due to the collapsed arch found in flat feet. This causes pain and instability in the plantar fascia of the foot.
• Shin Splints
  • Flat feet places additional stress on the ankle stabilizing muscles which can result in pain in the front of the shins, or shin splints.
• Tight Achilles Tendon
  • Flat feet or overpronation places additional stress on the achilles tendon. Every time you walk, stand or run, your achilles tendon is working overtime. As a result, this can cause a tight achilles tendon.
• Foot Problems
• Knee Problems

This post will explain these terms and provide the best exercises for flat feet along with providing pain relief for the feet, knees, hips, and back.

Can Flat Feet Be Corrected?

Flat feet can be corrected with a combination of physical therapy exercises, lifestyle modifications and the use of orthotics. The goal of physical therapy is to strengthen the muscles of the arch of the foot in order to decrease symptoms. The best way to do this is to treat the entire body, not just the feet.

Why Are My Feet Flat And Can Flat Feet Cause Knee Pain?

The anatomical definition for overpronation is subtalar eversion, ankle dorsiflexion and forefoot abduction. So what does this mean? It means the soft tissues such as the intrinsic and extrinsic foot muscles are weak and the calves are tight.

This can negatively affect your foot function. Although this may sound complicated, it is fairly easy to fix with the correct exercises. So how do we fix flat feet? Strengthen the intrinsic and extrinsic muscles and stretch the calves!

Most people with flat feet have poor posture that affects multiple body parts. This includes the hips, knees, back and ankles.

Knee Valgus

Knee valgus is when the knees appears to cave in towards each other. This is due to weak muscles in the lower leg such as the quads and tight adductors (the muscles in the inside of your thighs.)

This can cause chronic knee pain. So, how do we fix knee valgus? Strengthen the quads and stretch the adductors. You can find 9 Forgotten Knee Exercises For Pain here.

Anterior Pelvic Tilt

In an anterior pelvic tilt, the pelvis is rotated forward, with tight hip flexors and back extensors and weak glutes and abdominal muscles. How do we fix this? Stretch the hip flexors and back extensors and strengthen the abdominal and glute muscles.

People with an anterior pelvic tilt also commonly have lower back pain. You can find more exercises for lower back pain at 7 Miraculous Exercises For Lower Back And Hamstring Pain.

Rigid Flat Feet vs. Flexible Flat Feet

Rigid flat feet are flat when weighted and unweighted. This means that when you are standing on hard surfaces your feet are flat and rigid. They are also flat when your foot is not on the ground

Flexible flat feet are flat when weighted but less flat when unweighted. A flexible flatfoot will be flat when you are standing but have a small arch when not standing. Essentially they have extra motion when not bearing weight on the ground.

Orthotic Devices

The treatment options for flat feet, knee pain and back pain are exercises and orthotic insoles. These insoles help place the flat feet into a neutral position. This will help to prevent other compensations and pain that are associated with flat feet. The best orthotic shoe insert will have a firm midsole.

Arch Supports

The type of arch support you use will depend on the type of flat foot you have. For example the best shoe inserts for a rigid flat foot is a low but supportive arch. Someone with flexible flat feet will do better with a medium arch shoe insert.

Shoe inserts that are too rigid for your foot will be painful. Shoe inserts that are too soft will waste your money and not help long term.

Custom Orthotics

The goal of an orthotic is to correct overpronation. The proper footwear should assist in shock absorption. Every flat foot is slightly different and you cannot treat every flat foot the same.

Custom orthotics are the best orthotics to use to treat flat feet due to them being customized to your specific foot. These do an excellent jobs at supporting the arches of your feet. It is best to wear these custom orthotics during all physical activity regardless of your activity level.

A good custom orthotic can even help to reduce the need for anti-inflammatory medication. It is important to wear supportive shoes with your foot orthotics. The appropriate footwear can make a huge difference in your pain and function level. Make sure that you are wearing stable shoes.

Summary: Can Flat Feet Cause Knee Pain?

In conclusion, as is true for most things in life, if you want to fix a problem, you must look at the big picture. Although treating only the feet will fix the problem in the short term it won’t fix flat feet long term or improve your daily life in a meaningful way. It is important to address the root cause associated with flat feet, including the hips and knees.

If you suspect your knee pain may be due to an ACL tear you should read 15 Fantastic ACL Physical Therapy Exercises To Rehab ACL Injury.

These specific exercises should be incorporated into daily activities. It is always a good idea to combine this specific exercises, orthotic insoles and proper shoes in treating flat feet.

I hope by the end of this article you can confidently answer yes to the question “can flat feet cause knee pain.” Most importantly you now know how to fix this knee pain!

These exercises for flat feet are a great starting point to fix flat feet. However, going to physical therapy and having a physical therapist or health care provider evaluate you and develop a specific physical therapy exercise for flat feet for you is an even better alternative.