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Arch Pain & Flat Feet
Comprehensive biomechanical evaluation and treatment for arch pain, flat feet, and overpronation in San Antonio, TX — including precision custom orthotics designed for your specific foot structure. For adults and children.
Andrew Gunter, DPM.
Call (210) 581-9800
Understanding Flat Feet & Arch Pain
Flat feet — medically termed pes planus — describes a foot in which the medial arch sits lower than normal or makes full contact with the ground during standing. The condition exists on a spectrum from mild flexible flatfoot with no symptoms to severe rigid flatfoot causing significant pain and functional limitation.
Flat feet are among the most common foot structural variants — affecting an estimated 20 to 30 percent of the population to some degree. Many people with flat feet experience no symptoms and require no treatment. However, for patients whose flat feet contribute to pain, fatigue, or biomechanical dysfunction, evaluation and management can make a meaningful difference in daily comfort and long-term joint health.
The most common symptoms associated with flat feet arise from the excessive inward rolling of the foot during walking and standing — a pattern called overpronation. This places increased stress on the plantar fascia, the posterior tibial tendon, the Achilles tendon, and the medial ankle structures. Over time, untreated overpronation can contribute to plantar fasciitis, posterior tibial tendon dysfunction, Achilles tendinitis, bunion formation, and knee and hip pain.
In children, flexible flat feet are a normal developmental finding through early childhood — most children develop a visible arch by age six. However, when flat feet persist into later childhood, cause pain, or are associated with in-toeing or gait abnormalities, evaluation is appropriate. Early intervention with custom orthotics can support healthy arch development and prevent secondary problems during growth.
In adults, flat feet may be structural — present since childhood — or acquired, as in adult-acquired flatfoot deformity caused by progressive posterior tibial tendon dysfunction. The distinction matters for treatment, which is why a thorough biomechanical evaluation is the essential first step.
Dr. Gunter performs a comprehensive evaluation of foot structure, gait mechanics, and functional impact before recommending treatment — ensuring that the approach is matched to the actual cause and severity of the patient's condition.
COMMON SYMPTOMS ASSOCIATED WITH FLAT FEET:
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Arch aching or fatigue that builds throughout the day
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Inner heel or ankle pain
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Foot fatigue with prolonged standing or walking
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Swelling along the inner ankle
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Shoes wearing out unevenly on the inner edge
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Knee, hip, or lower back pain linked to foot mechanics
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In children: reluctance to walk, run, or participate in sports
FLAT FEET ARE COMMON IN:
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Children — flexible flat feet are developmentally normal in early childhood
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Adults with hereditary flat foot structure
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Adults with hypermobile joints
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Adults over 40 — posterior tibial tendon weakening
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Patients who are overweight or on their feet all day
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Pregnant women — temporary arch changes from hormonal laxity
Treatment Options for Arch Pain & Flat Feet
Most cases of symptomatic flat feet respond well to conservative treatment. The cornerstone of management is addressing the underlying biomechanics — which is why custom orthotics, rather than generic arch supports, produce the most durable outcomes.
Custom orthotics
The most effective conservative treatment for symptomatic flat feet. Precision custom orthotics designed from a digital 3D scan of your foot correct the specific mechanics driving your symptoms — controlling pronation, supporting the medial arch, and redistributing load across the foot. Generic insoles provide cushioning but cannot address individual biomechanical pathology. Dr. Gunter fabricates custom orthotics in-office with a one-week turnaround.
Biomechanical evaluation & footwear guidance
A thorough assessment of foot structure, gait pattern, and lower limb alignment provides the foundation for an accurate treatment recommendation. Footwear selection is a significant factor in flat foot symptom management — Dr. Gunter provides specific guidance on the appropriate footwear characteristics for your foot type and activity demands.
Physical therapy & strengthening
Targeted strengthening of the posterior tibial muscle, intrinsic foot muscles, and calf complex supports the arch dynamically and reduces the load on passive structures. Particularly important for patients with posterior tibial tendon dysfunction and for pediatric patients where muscle development supports long-term arch function.
Posterior tibial tendon management
For adult-acquired flatfoot deformity driven by posterior tibial tendon dysfunction, treatment addresses both the tendon pathology and the progressive arch collapse — ranging from conservative tendon support and orthotics in early stages to surgical reconstruction in advanced cases. Early evaluation prevents progression to a more complex deformity.
Related conditions: Heel pain & plantar fasciitis · Custom orthotics · Ankle instability · Posterior tibial tendinitis
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Frequently Asked Questions — Arch Pain & Flat Feet
Arch pain or flat feet affecting your daily life?
Let's evaluate what's really going on.
Dr. Andrew Gunter, DPM provides a comprehensive biomechanical evaluation — for adults and children — and builds a treatment plan matched to the actual cause of your symptoms. Custom orthotics fabricated in-office with a one-week turnaround. Serving San Antonio and surrounding communities. Most insurance plans accepted.
Call (210) 581-9800