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Overview

Adult Acquired Flat Feet

Fallen arches is one way of describing a flat or pronated foot. This can sometimes be implicated in ongoing problems such as lower back pain, knee pain, ankle pain, shin pain etc. The reason for the pronated foot is often due to the alignment of the bones within the foot, but can be increased by such things as ligament laxity, high body weight and a number of other specific conditions. One of these is posterior tibial dysfunction. This is a progressive disorder which allows the foot to pronate or lower on the inside section and can, if left untreated, result in quite debilitating effects.

Causes

Most commonly fallen arches in adulthood can arise due to Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon plays a pivotal role in holding up the arch of the foot, damage to this tendon results in the arch collapsing. Another cause of acquired flat feet in adulthood may be due to Rheumatoid arthritis as this disease attacks the bone, cartilage and ligaments in the foot causing it to change shape and flatten. Injury to the ligament, fracture and/or dislocation of the bones in the mid foot can all lead to a flat foot deformity. Adult acquired flat fleet can also arise in people who have diabetes or a neurological condition which limits normal feeling in the foot, the muscles in feet switch off, the tendons and ligaments weaken, and the arch eventually collapses.

Symptoms

It?s possible to have fallen arches and experience no symptoms whatsoever. But many people do notice some problems with this condition. Their feet, back and legs ache. Standing on their toes is difficult, if not impossible, and they note swelling around the arch and heel.

Diagnosis

There are a few simple ways to assess your foot type, and most include making an imprint of your footprint. The classic way is to stand on a hard floor surface with wet feet to make a wet foot print. Look at the narrowest part of your footprint, which should be between your heel and ball of your foot. If the print of your foot in this part is less than 10% of the width of the widest part then you are likely to have high arches. more than 10% but less than 25% then your foot profile is probably normal, more than 25% or even the widest part, then you have flat feet.

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Non Surgical Treatment

Orthotics. Interpod orthotics re-align and support the foot; therefore reducing any excessive stress when walking or during activity. Orthotics can assist with maintaining arch profile and allow for more effective functioning of joints. Footwear. A strong supportive, well fitted shoe may assist with reducing excessive pronation and support the joints of your feet. A supportive shoe will also help maximise the function of your Interpod orthotic. Padding may be applied to your shoes or feet by your practitioner to reduce excessive stress. Specific taping techniques can be applied by your practitioner to improve foot function. Your practitioner may advise certain stretches or exercises to assist with maintaining foot function and reduce painful symptoms. Pain medication such as NSAIDs (ibuprofen) may be advised by your practitioner. If all conservative options have been exhausted, then surgical correction of flat feet may be undertaken.

Surgical Treatment

Acquired Flat Foot

Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.

Prevention

Orthotic inserts, either prescribed or bought over the counter, can help keep the arches fixed into position, but always wear them as although they support, they don?t strengthen, which is why some experts reccomend avoiding them. Gait analysis at a run specialist can help to diagnose overpronation and flat feet. Most brands produce shoes that will give support and help to limit the negative effects of a poor gait on the rest of the body. Barefoot exercises, such as standing on a towel and making fists with the toes, can help to strengthen the arches. Start easy and build up the reps to avoid cramping. Short barefoot running sessions can help take pressure off the arches by using the natural elasticity of the foot?s tendons to take impact and build strength to help prevent flat feet. These should be done on grass for only a few minutes at a time.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
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