Patients with flat feet have little or no arch when they stand. Some patients are born with flat feet and others will develop flat feet as they get older. Not all flat feet are symptomatic and require treatment. However, when flat feet become progressively worse over time or there is pain and instability, treatment is indicated. Patients with symptomatic flat feet tend to complain of generalised foot and ankle fatigue at the end of the day. There can be knee, hip and lower back pain associated with flat feet. When left untreated problems like bunions, hammer toes and arthritic foot and ankle joints can more readily develop in flat feet. In most cases the use of appropriate footwear and prescription orthosis is all that is needed to successfully treat flat feet and make a patient comfortable. In other cases, muscle stretching and strengthening is needed to treat flat feet. There is a small proportion of patients with flat feet who require surgical management in order to eliminate pain and instability.