Karyn Hurm

Foot Conditions

What Are Fallen Arches

Overview

Acquired Flat Foot

flat foot, condition of the human foot in which the entire sole rests on the ground when the person is standing. When the foot muscles are weakened or the ligaments are strained and stretched, the arch lowers, so that instead of the natural curved contour, there is flattening of the entire sole. Sometimes no discomfort accompanies flat foot. However, fallen arches may cause disalignment of other foot structures so that there is pain not only in the arch area but also in the calf muscles and sometimes as far up as the lower back; the discomfort is increased by prolonged standing. Flat foot may be inherited or may be caused by rickets, obesity, metabolic disorder, debilitating disease, or faulty footwear. Treatment and exercise directed by an orthopedic physician are sometimes advisable. Arch supports or other devices to be worn inside the shoe are often prescribed.

Causes

Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat. The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch. An injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity. People with diabetes or with a nerve problem that limits normal feeling in the feet, can have arch collapse. This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet. This is because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate, without the patient feeling any pain. This may result in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.

Symptoms

Some people have fallen arches, and they aren?t even aware of it, fallen arches are sometimes asymptomatic and do not always cause pain. However, for others, the following symptoms may be present. Foot pain, particularly in the arches or heels, leg or back pain, feet feel tired quickly, swelling in the feet and difficulty moving the feet.

Diagnosis

People who have flat feet without signs or symptoms that bother them do not generally have to see a doctor or podiatrist about them. However, if any of the following occur, you should see your GP or a podiatrist. The fallen arches (flat feet) have developed recently. You experience pain in your feet, ankles or lower limbs. Your unpleasant symptoms do not improve with supportive, well-fitted shoes. Either or both feet are becoming flatter. Your feet feel rigid (stiff). Your feet feel heavy and unwieldy. Most qualified health care professionals can diagnose flat feet just by watching the patient stand, walk and examining his/her feet. A doctor will also look at the patient's medical history. The feet will be observed from the front and back. The patient may be asked to stand on tip-toe while the doctor examines the shape and functioning of each foot. In some cases the physician may order an X-ray, CT (computed tomography) scan, or MRI (magnetic resonance imaging) scan.

What does it mean when you have flat feet?

Non Surgical Treatment

Switch activities for a little while. If you?re a super athlete, you don?t want to hear that you need to take a break, but there?s no way around it. You need to lay off the high impact sports like basketball, tennis and running. Don?t panic-there?s no shortage of alternatives. Find a high school track that?s open to the public and try going for a run. Many athletic programs use spongy synthetic materials to pave tracks instead of concrete. This is much easier on all the joints and tendons, not only in your feet but your legs and ankles. You can also try running on dirt trails or stable grassy areas. Take up swimming for a little while. This is actually an ideal activity for your arches. The buoyancy of water takes weight off our feet, but still allows for aerobic activity. Many gyms and activity centers also offer various water sport classes. In no time flat, you?ll be on your way to healthier feet.

Surgical Treatment

Adult Acquired Flat Feet

Since there are many different causes of flatfoot, the types of flatfoot reconstruction surgery are best categorized by the conditions. Posterior tibial tendon dysfunction. In this condition, the tendon connecting the calf muscle to the inner foot is torn or inflamed. Once the tendon is damaged it no longer can serve its main function of supporting the arch of the foot. Flatfoot is the main result of this type of condition and can be treated by the following flatfoot reconstruction surgeries. Lengthening of the Achilles tendon. Otherwise known as gastrocnemius recession, this procedure is used to lengthen the calf muscles in the leg. This surgery treats flatfoot and prevents it from returning in the future. This procedure is often combined with other surgeries to correct posterior tibial tendon dysfunction. Cleaning the tendon. Also known as tenosynovectomy, this procedure is used in the earlier and less severe stages of posterior tibial tendon dysfunction. It is performed before the arch collapses and while the tendon is only mildly affected. The inflamed tissue is cleaned away and removed from the remaining healthy tendon. Tendon transfer. This procedure is done to correct flatfoot and reform the lost arch in the foot. During the procedure, the diseased tendon is removed and replaced by tendon from another area of the foot. If the tendon is only partially damaged, the inflamed part is cleaned and removed then attached to a new tendon. Cutting and shifting bones. Also called an osteotomy, this procedure consists of cutting and reconstructing bones in the foot to reconstruct the arch. The heel bone and the midfoot are most likely reshaped to achieve this desired result. A bone graft may be used to fuse the bones or to lengthen the outside of the foot. Temporary instrumentation such as screws and plates can also be used to hold the bones together while they heal.

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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