Do Flat Feet Cause Injuries?

Q: Where did the myth that flat feet are harmful come from?

The belief originated from the 'Root Paradigm' of the 1960s, which claimed there was an ideal foot alignment and that any deviation—like pronation or flat arches—was abnormal. Modern science has since disproven that idea.

Q: Should I try to correct my pronation or strengthen my arches?

No. The foot is designed to move naturally. Attempting to 'fix' pronation with rigid orthotics or isolation exercises offers little benefit. Your arch naturally strengthens through normal running and movement.

May 21, 2025
Sports Performance

For many years, the flat-footed athlete has been struck with fear of lower extremity injury. They’ve been advised to get special evaluations and custom footwear to correct their foot “deformity.” But before spending hundreds of dollars on a specific shoe, let’s answer the basic question: Do flat feet cause injuries?

They do not.

The idea that flat feet are inherently harmful stems from a theory proposed in the 1960s by Dr. Merton Root. Root suggested there was a single ideal foot alignment, and any deviation, like pronation or flat arches—was abnormal and needed correcting. This “Root Paradigm” dominated podiatry and orthotics for over three decades.

But modern research has thoroughly debunked this.

A prospective cohort study published in the British Journal of Sports Medicine followed 927 novice runners for one year to answer the question that brought you here – do flat feet cause injuries. Using a foot posture index derived from Root’s theory, participants were categorized as highly supinated, supinated, neutral, pronated, or highly pronated (note: supinated = high arches, pronated = flat feet).

The surprising result? Runners with flat feet actually had fewer running-related injuries than other groups. The study concluded:

“The results of the present study contradict the widespread belief that moderate foot pronation is associated with an increased risk of injury among novice runners.”

This finding has been consistently replicated in other studies—flat feet simply do not increase your risk of running injury.

A Brief Historical Note:

The stigma against flat feet runs deeper than outdated biomechanics. In the early 20th century, flat feet were viewed as a sign of poor health, low socioeconomic status, and physical inferiority. In fact, the U.S. military used to disqualify individuals from service if they had flat feet, considering them unfit for duty. This myth of dysfunction was deeply rooted in societal biases, not science.

Do You Need To Fix Pronation or Strengthen Arches?

Don’t waste your time trying to “correct” pronation through running retraining or rigid orthotics. The foot is meant to move—locking it into a fixed position works against its natural biomechanics.

As for arch strengthening, while it may sound appealing, your arch actually strengthens dynamically during running. Motor control exercises aimed at isolating the arch offer limited benefit compared to just running itself. Wondering what else to not waste time on when it comes to injury prevent or sports rehab? Download your Free Guide Here.

So, What Causes Running Injuries?

Injury risk isn’t about foot shape—it’s about training errors. Here’s what actually matters:

Load Management: Sudden increases in training volume are one of the most consistent predictors of injury. Doubling your weekly mileage or ramping up too quickly can increase your injury risk by over 20%.

Variability: Avoid doing the same type of run over and over. A healthy training plan includes a mix of distances, speeds, and intensities to avoid repetitive strain.

Running Form: You don’t need a treadmill evaluation to fix your form. Research has shown that running at faster speeds over shorter distances naturally improves running mechanics more effectively than slow-motion analysis or cue-based retraining.

Psychosocial Factors: Stress outside of training, like work, relationships, environment, or societal pressures, can impact your metabolic health and reduce your body’s ability to adapt to physical stress, increasing your risk of injury. Interested in taking care of psychosocial factors?

Check out Reclaimed Athlete.

In Summary:

Flat feet are not a problem you need to fix. They are a normal variation of human anatomy and not a predictor of injury. Focus your energy where it counts—smart training, varied workouts, and progressive loading. Your feet, flat or not, will thank you for it.

Prefer to listen to the topic: Here is a podcast on the topic.

FAQ

1. Do flat feet cause injuries?
No. Modern research has shown that flat feet are not linked to a higher risk of injury. In fact, one large study found that runners with flat feet had fewer injuries than those with high or neutral arches.

2. Where did the myth that flat feet are harmful come from?
The belief originated from the “Root Paradigm” of the 1960s, which claimed there was an ideal foot alignment and that any deviation—like pronation or flat arches—was abnormal. Modern science has since disproven that idea.

3. Should I try to correct my pronation or strengthen my arches?
No. The foot is designed to move naturally. Attempting to “fix” pronation with rigid orthotics or isolation exercises offers little benefit. Your arch naturally strengthens through normal running and movement.

4. What actually causes running injuries if not flat feet?
Injury risk is primarily linked to training errors—such as rapid increases in mileage, lack of variety in workouts, and external stress factors. Smart load management and varied training are more effective for injury prevention than focusing on foot shape.

5. Are flat feet considered a deformity?
Not at all. Flat feet are simply a normal variation of human anatomy. The old stigma that labeled them as a deformity or sign of weakness has no basis in science.