What Is Pes Planus (Flat Foot)?
Pes planus, more commonly known as flat foot, describes a foot where the medial longitudinal arch is markedly reduced or entirely absent, so the sole makes near-full contact with the ground. Beyond the visual change, this alters load distribution through the foot and can affect alignment further up the kinetic chain, into the lower leg.
Not every case of pes planus needs treatment. Many people go through life with flat feet and no symptoms at all. It’s persistent pain, swelling, or a growing struggle with everyday activity that typically signals the need for conservative care, or, when that’s not enough, surgical reconstruction.
In Singapore, we commonly see symptomatic flat feet in patients whose work or training keeps them on their feet for extended periods on hard, unforgiving surfaces, warehouse and logistics staff, security personnel doing long standing shifts, and recreational runners who notice arch fatigue setting in as weekly mileage climbs.
Classifying the Different Types of Flat Feet
Not all flat feet present the same way, and classification shapes the treatment plan:
Flexible flat foot
Rigid flat foot
Adult-acquired flat foot
Vertical talus
Conservative Management Before Surgery
The majority of flat foot cases respond well to non-surgical management: orthotic inserts, bracing, and structured physiotherapy. Surgical reconstruction is generally only considered once these approaches have been tried and haven’t resolved the symptoms.
Surgical Approaches to Flat Foot Reconstruction
Reconstructive surgery
Can involve creating a functional arch, repairing damaged tendons, or lengthening a tight Achilles tendon. Depending on the deformity, the surgeon may perform a calcaneal osteotomy to shift the heel bone into corrected alignment, or repair the spring and deltoid ligaments that support the arch.
Minimally invasive techniques
Offer a less invasive alternative in select cases, creating natural space between the ankle and heel bone to correct alignment without the more extensive exposure that open reconstruction requires.
What Happens Before, During and After Flat Foot Surgery
Before Flat Foot Surgery
Your surgeon assesses the foot and ankle for visible signs of arch collapse, such as a flattened arch or inward heel roll during gait, tests strength and flexibility, and typically orders radiographic imaging to identify any underlying bone or joint abnormalities.
During Flat Foot Surgery
Depending on your specific deformity, the surgeon may reposition the heel bone into correct alignment beneath the leg, remove or reconstruct a damaged posterior tibial tendon, repair the spring and deltoid ligaments, or perform an osteotomy to recreate the arch structure.
Anaesthesia for Flat Foot Surgery
Flat foot reconstruction is generally performed under general anaesthesia to keep the foot numb and manage post-operative pain. Your anaesthesia team will confirm this approach with you beforehand.
After Flat Foot Surgery
Soreness, swelling, and bruising are common in the days following surgery and are typically temporary. Once the initial discomfort eases, most patients need up to four months before transitioning back into regular footwear. Complete recovery can take up to two years, guided throughout by a structured rehabilitation plan.
Who Is a Candidate for Flat Foot Surgery?
Flat foot reconstruction may be considered for patients with:
- Persistent foot pain interfering with daily activity
- Flat feet preventing normal participation in sport or exercise
- Foot and ankle stiffness making movement difficult
- Ongoing symptoms despite orthotics or physiotherapy
- Posterior tibial tendon dysfunction contributing to arch collapse
- A need for reconstruction after prior conservative treatment has been exhausted
Surgical candidacy is confirmed through a comprehensive orthopaedic assessment, weighing your symptoms, examination findings, the condition of the arch, any associated issues, and your response to non-surgical treatment so far.
Recovery After Flat Foot Surgery: What to Expect
Recovery timelines depend on the surgical technique used, the extent of reconstruction, any procedures performed concurrently, and individual healing.
Expect a protected period before gradually transitioning back to regular footwear, typically around the four-month mark. Physiotherapy plays a significant role throughout this phase, supporting strength, mobility, and a durable outcome.
Return to work, exercise, and sport should be staged and supervised by your surgeon or physiotherapist. Return to sport can take up to 12 months, with full recovery extending to as long as two years in some cases.
About Your Orthopaedic Specialist
Dr Gowreeson Thevendran
MBChB (Bristol), MRCS.Ed, Dip. Sports Med.Ed, FRCS.Ed (Trauma & Orthopaedics), FAMS (Singapore)
Dr Thevendran’s practice centres on lower limb orthopaedic conditions, along with trauma and fracture surgery across both the upper and lower limbs. He trained in medicine at the University of Bristol before completing surgical training in the UK and Canada.
Before entering private practice, he headed Foot & Ankle Surgery within the Department of Orthopaedics at Tan Tock Seng Hospital, Singapore.
Questions patients ask
Frequently Asked Questions
How Can I Improve My Foot Arch?
Targeted exercises, such as heel stretches and arch-lift drills, can help manage symptoms and can often be done at home with minimal equipment. Check with your doctor before starting any exercise programme specific to your condition.
Do Low Arches Cause Overpronation?
Yes. As the arch flattens, the heel bone tends to rotate inward, a pattern known as overpronation, which increases ankle movement and can contribute to knee instability. Flat feet are a significant risk factor for this pattern.
Are Fallen Arches the Same as Flat Feet?
Effectively, yes. “Fallen arches” typically describes a flat foot that developed later in life as the arch gradually collapses, rather than a flat foot present from birth or early childhood.
What Is the Success Rate of Flat Foot Surgery?
When performed by an experienced surgeon, flat foot reconstruction is generally effective at addressing pain and restoring alignment. Swelling can persist for months post-operatively, and return to active sport typically takes up to 12 months.
Book a Flat Foot Assessment in Singapore
If your flat feet continue to cause pain or limit your activity despite treatment, an orthopaedic assessment can help identify the underlying cause and the right treatment path forward.