Extremes in high and flat arch foot posture have been shown to be a strong pathology predictor. Extreme foot postures increase the risk of developing musculoskeletal overuse syndromes, including; Achilles tendinopathy (1), shin-splints/ medial tibial stress syndrome (1-3), generalised foot pain (4), triathlete foot and leg overuse injuries (5), exercise-related lower leg pain (6-8), chronic heel pain (9), ankle injury (10) and knee (10, 11), hip and lower back pain (11).

It is accepted that children are born with flat feet and that their feet mature to form an arch and adult-like foot posture by the age of 6-8 years. (12)


  1. Becker J, James S, Wayner R, Osternig L, Chou L-S. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. The American Journal of Sports Medicine. 2017:0363546517708193.
  2. Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004;32:772 - 80.
  3. Bennett JE, Reinking MF, Pluemer B, Pentel A, Seaton M, Killian C. Factors contributing to the development of medial tibial stress syndrome in high school runners. Journal of Orthopaedic and Sports Physical Therapy. 2001;31(9):504-10.
  4. Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clinical Biomechanics. 2005;20(9):877-82.
  5. Burns J, Keenan AM, Redmond A. Foot type and overuse injury in triathletes. J Am Podiatr Med Assoc. 2005;95(3):235-41.
  6. Reinking MF. Exercise-related leg pain in female collegiate athletes: The influence of intrinsic and extrinsic factors. American Journal of Sports Medicine. 2006;34(9):1500-7.
  7. Willems TM, Witvrouw E, De Cock A, De Clercq D. Gait-related risk factors for exercise-related lower-leg pain during shod running. Medicine and Science in Sports and Exercise. 2007;39(2):330-9.
  8. Willems TM, De Clercq D, Delbaere K, Vanderstraeten G, De Cock A, Witvrouw E. A prospective study of gait related risk factors for exercise-related lower leg pain. Gait and Posture. 2006;23(1):91-8.
  9. Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study. BMC Musculoskeletal Disorders. 2007;8.
  10. Williams Iii DS, McClay IS, Hamill J. Arch structure and injury patterns in runners. Clinical Biomechanics. 2001;16(4):341-7.
  11. Kothari A, Dixon PC, Stebbins J, Zavatsky AB, Theologis T. Are flexible flat feet associated with proximal joint problems in children? Gait and Posture. 2016;45:204-10.
  12. Redmond A, Crane Y, Menz H. Normative values for the Foot Posture Index. Journal of Foot and Ankle Research. 2008;1(1):6.
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