The human foot is a complex structure that absorbs shock every time we take a step. The foot has to adapt to a variety of movements during different forms of activities such as walking, running and climbing steps. The foot is made up of many different joints, ligaments and muscles which have to work together to allow us to move and balance. The arch of the foot plays and important role in absorbing shock and preventing over stressing of the foot muscles and bones. In this article, we shall briefly discuss flat feet and fallen arches. These two conditions are closely related to each other and can increase the risk of overuse injury to the foot. They can also cause overload of more proximal structures such as ankles, shins, knees and the lower back.
The most common acquired flat foot in adults is due to Posterior Tibial Tendon Dysfunction. This develops with repetitive stress on the main supporting tendon of the arch over a long period of time. As the body ages, ligaments and muscles can weaken, leaving the job of supporting the arch all to this tendon. The tendon cannot hold all the weight for long, and it gradually gives out, leading to a progressively lower arch. This form of flat foot is often accompanied by pain radiating behind the ankle, consistent with the course of the posterior tibial tendon. Compounding matters is the fact that the human foot was not originally designed to withstand the types of terrain and forces it is subjected to today. Nowhere in nature do you see the flat hard surfaces that we so commonly walk on in present times. Walking on this type of surface continuously puts unnatural stress on the arch. The fact that the average American is overweight does not help the arch much either-obesity is a leading cause of flat feet as the arch collapses under the excessive bodyweight. Furthermore, the average life span has increased dramatically in the last century, meaning that not only does the arch deal with heavy weight on hard flat ground, but also must now do so for longer periods of time. These are all reasons to take extra care of our feet now in order to prevent problems later.
Most patients who suffer from flat feet or fallen arches often do not complain of any symptoms whatsoever. However, on some occasions, patients may find that their feet are fatigued fairly easily and following activity on long periods of standing may have a painful foot or arch. On occasions, swelling may be seen on the inner aspect of the foot and performing certain movements may be painful and difficult. Some patients who have flat feet may find that their feet tend to roll in (over-pronate) a lot more when they walk and run. As a result, they may experience damage to the ankle joint and the Achilles tendon, as well as excessive shoe wear.
Your doctor examines your feet to determine two things, whether you have flat feet and the cause or causes. An exam may include the following steps, Checking your health history for evidence of illnesses or injuries that could be linked to flat feet or fallen arches, Looking at the soles of your shoes for unusual wear patterns, Observing the feet and legs as you stand and do simple movements, such as raising up on your toes, Testing the strength of muscles and tendons, including other tendons in the feet and legs, such as the Achilles tendon or the posterior tibial tendon, Taking X-rays or an MRI of your feet.
pes planus orthotics
Non Surgical Treatment
Most cases of fallen arches are not painful and need no form of treatment. However, common symptoms of fallen arches can include pain in your feet (particularly in the area of your heel or arch), pain in your feet that persists after long bouts of physical activity or standing up, achy feet, or arch pain when standing on the tips of your toes. Most cases of fallen arches are not preventable. Treatments for fallen arches include, rest, ice, compression, medication to relieve pain, orthotics, or in some cases surgery.
Rarely does the physician use surgery to correct a foot that is congenitally flat, which typically does not cause pain. If the patient has a fallen arch that is painful, though, the foot and ankle physicians at Midwest Orthopaedics at Rush may perform surgery to reconstruct the tendon and "lift up" the fallen arch. This requires a combination of tendon re-routing procedures, ligament repairs, and bone cutting or fusion procedures.
Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches.
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.