02
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Coping With Pes Planus
02.07.2017 07:24
Overview

Acquired Flat Feet

Most people (approx. 60-70% of the population) suffer from excessive pronation due to flat feet when walking, running and standing. Though the foot may appear normal when sitting down, with a clear arch present under the foot, over-pronation becomes noticeable when we stand or walk as a result of weight bearing. The arches collapse with every step we take, and the ankles roll inwards. This is called overpronation, a biomechanical imbalance that can lead to many painful foot conditions such as heel pain, plantar fasciitis, heel spurs, tendonitis, and can even affect other parts of your body such as the knees and lower back.

Causes

An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. Posterior tibial tendon dysfunction is more common in women and in people older than 40 years of age. Additional risk factors include obesity, diabetes, and hypertension.

Symptoms

Not everyone who has flat feet experiences symptoms. Others, however, feel persistent pain in their feet and wearing shoes can prove additionally painful. Others only feel symptoms when they walk more than normal, go jogging or participate in a sport that involves running or kicking.

Diagnosis

Runners are often advised to get a gait analysis to determine what type of foot they have and so what kind of running shoe they require. This shouldn?t stop at runners. Anyone that plays sports could benefit from this assessment. Sports shoes such as football boots, astro trainers and squash trainers often have very poor arch support and so for the 60-80% of us who do overpronate or have flat feet they are left unsupported. A change of footwear or the insertion of arch support insoles or orthotics can make a massive difference to your risk of injury, to general aches and pains and even to your performance.

fallen arches surgery

Non Surgical Treatment

Some patients with flat feet may automatically align their limbs in such a way that unpleasant symptoms never develop. In such cases treatment is not usually required. Pain in the foot that is caused by flat feet may be alleviated if the patient wears supportive well-fitted shoes. Some patients say that symptoms improve with extra-wide fitting shoes. Fitted insoles or orthotics (custom-designed arch supports) may relieve pressure from the arch and reduce pain if the patient's feet roll or over-pronate. The benefits of an orthotic only exist while it is being worn. Patients with tendonitis of the posterior tibial tendon may benefit if a wedge is inserted along the inside edge of the orthotic - this takes some of the load off the tendon tissue. Wearing an ankle brace may help patients with posterior tibial tendinitis, until the inflammation comes down. Rest, doctors may advise some patients to rest and avoid activities which may make the foot (feet) feel worse, until the foot (feet) feels better. A combination of an insole and some kind of painkiller may help patients with a ruptured tendon, as well as those with arthritis. Patients with a ruptured tendon or arthritis who find insoles with painkillers ineffective may require surgical intervention. Patients, usually children, whose bones did not or are not developing properly, resulting in flat feet from birth, may require surgical intervention to separate fused bones (rare). Bodyweight management, if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with flat feet who successfully lose weight experience considerable improvement of symptoms.

Surgical Treatment

Flat Feet

Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.

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