diff --git a/NEWS.md b/NEWS.md
index 80031441d..c7744d7d7 100644
--- a/NEWS.md
+++ b/NEWS.md
@@ -1,5 +1,7 @@
 # crane 0.3.3
 
+* `add_forest()` now removes the horizontal padding of the forest-plot column in flextable output so the fixed-width plot fits its cell exactly and wide forest tables no longer spill off the page in docx. (#270)
+
 * Fixed minor typo in the DESCRIPTION file.
 
 # crane 0.3.2
diff --git a/R/add_forest.R b/R/add_forest.R
index f5242412a..cc898735a 100644
--- a/R/add_forest.R
+++ b/R/add_forest.R
@@ -217,13 +217,21 @@ add_forest <- function(x,
       ") |>
       gt::tab_style(style = gt::cell_text(whitespace = "nowrap"), locations = gt::cells_body())
   } else if (table_engine == "flextable") {
+    # The plot column has a fixed width. Render the image to exactly that width
+    # and remove the cell's horizontal padding so the raster fills its content
+    # box instead of being forced wider than the cell (which, under Word's fixed
+    # table layout, pushes the column out and makes the table overflow the page).
+    # The plot's proportions are unchanged; only the cell geometry is matched.
+    ggplot_col_width <- 2.5
     out <- out |>
       gtsummary::as_flex_table() |>
       flextable::mk_par(
         j = "ggplot",
         value = flextable::as_paragraph(
           suppressMessages( # avoid `height` was translated to `width`. message
-            flextable::gg_chunk(value = lst_ggplots_final, height = 0.4, width = 2.5)
+            flextable::gg_chunk(
+              value = lst_ggplots_final, height = 0.4, width = ggplot_col_width
+            )
           )
         )
       ) |>
@@ -231,10 +239,13 @@ add_forest <- function(x,
       flextable::line_spacing(j = "ggplot", space = 0, part = "body") |>
       flextable::valign(valign = "center", part = "body") |>
       flextable::align(j = "ggplot", align = "center", part = "header") |>
-      flextable::width(j = "ggplot", width = 2.5) |>
       flextable::padding(padding.top = 0, part = "body") |>
       flextable::padding(padding.bottom = 7, part = "body") |>
       flextable::padding(j = "ggplot", padding.bottom = 0, part = "body") |>
+      # zero horizontal padding on the plot column so the fixed-width image fits
+      # the cell content box exactly (default 5pt L/R padding would overflow it)
+      flextable::padding(j = "ggplot", padding.left = 0, padding.right = 0, part = "all") |>
+      flextable::width(j = "ggplot", width = ggplot_col_width) |>
       flextable::valign(valign = "bottom", part = "body")
   }
 
diff --git a/inst/WORDLIST b/inst/WORDLIST
index 0a17e3c7f..7cd9efaa7 100644
--- a/inst/WORDLIST
+++ b/inst/WORDLIST
@@ -27,6 +27,7 @@ cardx
 custiomization
 customizations
 de
+docx
 efron
 fleming
 flextable
diff --git a/tests/testthat/test-add_forest.R b/tests/testthat/test-add_forest.R
index 7f7c7ad40..ff72db1a3 100644
--- a/tests/testthat/test-add_forest.R
+++ b/tests/testthat/test-add_forest.R
@@ -28,7 +28,7 @@ test_that("add_forest(table_engine = 'flextable') works", {
   )
 
   expect_error(
-    tbl <- trial |>
+    forest_ft <- trial |>
       tbl_roche_subgroups(
         subgroups = c("grade", "stage"),
         rsp = "response",
@@ -45,6 +45,14 @@ test_that("add_forest(table_engine = 'flextable') works", {
       ),
     NA
   )
+
+  # The plot column has a fixed width and holds an image of exactly that width.
+  # The default 5pt horizontal cell padding would push the image past the column
+  # and overflow the page in docx; zeroing it makes the image fit the cell
+  # content box exactly so the table stays on the page (#270).
+  gg <- which(forest_ft$col_keys == "ggplot")
+  expect_identical(unique(forest_ft$body$styles$pars$padding.left$data[, gg]), 0)
+  expect_identical(unique(forest_ft$body$styles$pars$padding.right$data[, gg]), 0)
 })
 
 test_that("add_forest handles extreme limits and character NA p-values safely", {