Overview
Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground. Some individuals (an estimated 20-30% of the general population) have an arch that simply never develops in one foot (unilaterally) or both feet (bilaterally). Causes Most cases of flatfeet are simply the result of normal development. When that is not the case, the condition can be caused by a number of factors, including the following, Age, disease, injury, obesity or being overweight, physical abnormality, pregnancy. Flattened arches in adults may result from the stresses of aging, weight gain, and the temporary increase in elastin (protein in connective tissue) due to pregnancy. In some cases, flatfeet are caused by a physical abnormality, such as tarsal coalition (two or more bones in the foot that have grown together) or accessory navicular (an extra bone along the side of the foot). The effects of diseases such as diabetes and rheumatoid arthritis can lead to flatfeet. An injury (e.g., bone fracture, dislocation, sprain or tear in any of the tendons and ligaments in the foot and leg) also can cause flatfeet. Symptoms Structural problems in your feet like fallen arches can alter your walking pattern, running pattern and cause pain throughout your body. Clear and accurate assessment of the mechanics of your lower limbs is key to understanding the profound effect that subtle faults in your foot, ankle, knee and hip alignment can cause. Diagnosis If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination. pes planus radiology Non Surgical Treatment Foot orthotic devices can stabilize some of the causes of flat feet, optimize muscle function and reduce the occurrence of painful symptoms. Generally, a custom-made semi-rigid functional posted orthotic is effective for flat feet. These devices are prescribed based on a thorough biomechanical examination by a qualified chiropodist/podiatrist. Over-the-counter arch supports may be helpful for mild cases, but often prove ineffective to relieve symptoms associated with flatfoot. Wear shoes with a good fit in the arch. Keep active and fit to strengthen leg and foot musculature. Control body weight to decrease load on the feet. Avoid prolonged periods weight bearing with bare feet. Taping to support strained ligaments and joints. Physical therapy modalities such as ultrasound. Referral for surgical correction a severe symptomatic flatfoot. Surgical Treatment Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function. After Care Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.
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Overview
Every mile you walk puts tons of stress on each foot. Your feet can handle a heavy load, but too much stress pushes them over their limits. When you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues, you may develop heel pain, the most common problem affecting the foot and ankle. A sore heel will usually get better on its own without surgery if you give it enough rest. However, many people ignore the early signs of heel pain and keep on doing the activities that caused it. When you continue to walk on a sore heel, it will only get worse and could become a chronic condition leading to more problems. Causes In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered. When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury. Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain. Symptoms Both heel pain and heel spurs are frequently associated with an inflammation of the long band of tissue that connects the heel and the ball of the foot. The inflammation of this arch area is called plantar fasciitis. The inflammation maybe aggravated by shoes that lack appropriate support and by the chronic irritation that sometimes accompanies an athletic lifestyle. Achilles Tendinopathy, Pain and inflammation of the tendon at the back of the heel that connects the calf muscle to the foot. Sever?s, Often found in children between the ages of 8 - 13 years and is an inflammation of the calcaneal epiphyseal plate (growth plate) in the back of the heel. Bursitis, An inflamed bursa is a small irritated sack of fluid at the back of the heel. Other types of heel pain include soft tissue growths, Haglunds deformity (bone enlargement at the back of the heel), bruises or stress fractures and possible nerve entrapment. Diagnosis A podiatrist (doctor who specializes in the evaluation and treatment of foot diseases) will carry out a physical examination, and ask pertinent questions about the pain. The doctor will also ask the patient how much walking and standing the patient does, what type of footwear is worn, and details of the his/her medical history. Often this is enough to make a diagnosis. Sometimes further diagnostic tests are needed, such as blood tests and imaging scans. Non Surgical Treatment Calf stretch, Heel cups/lifts, ice, night splint, physical therapy, activity modification. Sometimes immobilization in a cast or boot may be necessary. Topical creams, such as Voltaren or Ketoprofen, have been found to have some benefit. In some cases, the tendon may become degenerative (tendonosis). In these instances, treatment is more difficult. Prolonged periods of immobilization and physical therapy may be required. In resistant cases, surgical debridement of the tendon may be necessary. Rarely does a symptomatic achilles tendon rupture. Most achilles ruptures are not associated with prodromal symptoms. Achilles ruptures are more common in men and "weekend warriors," ie middle aged men who like to play sports (soccer, softball, basketball) on the weekends. Surgical Treatment When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition. deelsonheels Prevention Heel pain is commonly caused from shoes that do not fit properly. In addition, shoes need to have ample cushioning and support, particularly through the heel, ball of the foot, and arch. Shoes should also be replaced if they become too worn. One sure sign of wear and tear is overly worn areas of a shoe's insoles. If the heel or ball of the foot is particularly worn, damage could easily occur since the bottom of the foot is not getting the cushioning it needs. |
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July 2017
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