Will Over-Pronation Of The Foot Necessitate Surgery

Overview

Overpronation is a term used to describe excessive flattening of the plantar arch. Pronation is a normal part of our gait (the way we walk), and it comprises three movements: dorsiflexion, eversion, and abduction. Dorsiflexion is the upward movement of the foot, eversion describes the foot rolling in, and abduction is ?out toeing,? meaning your toes are moving away from the midline of your body. When these three motions are extreme or excessive, overpronation results. Overpronation is very common in people who have flexible flat feet. Flatfoot, or pes planus, is a condition that causes collapse of the arch during weight bearing. This flattening puts stress on the plantar fascia and the bones of the foot, resulting in pain and further breakdown.Overpronation

Causes

Over-pronation may happen because the tissue that attaches to your foot bones is loose. You may be born with this problem or it may result from injuries or overuse, like from too much running.

Symptoms

Symptoms can manifest in many different ways. Here is a list of some of the common conditions associated with over-pronation in children. Achilles Pain. Ankle pain. Arch Pain. Low back pain. Heel Pain. Knee Pain (Runner's knee and Chondromalecia of the patella) Osgood Schlatter Disease (pain below the knee) Shin Splints (pain in the front of the lower leg) Over-pronation does not necessarily mean your child has "flat feet." Even though children's arches may be relatively high when they lie down or sit, over-pronation may not be seen until your child is standing. A certain amount of pronation is normal. During normal walking or running ("gait cycle"), the heel strikes the ground and the foot rolls inward to absorb shock and adapt to the surface. This gait cycle is even more important if the running surface is uneven.

Diagnosis

So, how can you tell if you have overpronation, or abnormal motion in your feet, and what plantar fasciitis treatment will work to correct it? Look at your feet. While standing, do you clearly see the arch on the inside of your foot? If not, and if the innermost part of your sole touches the floor, then your feet are overpronated. Look at your (running/walking) shoes. If your shoes are more worn on the inside of the sole in particular, then pronation may be a problem for you. Use the wet foot test. Wet your feet and walk along a section of pavement, then look at the footprints you leave behind. A normal foot will leave a print of the heel connected to the forefoot by a strip approximately half the width of the foot on the outside of the sole. If you?re feet are pronated there may be little distinction between the rear and forefoot.Over Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. This orthotics should be designed with appropriate arch support and medial rear foot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems. If the problem persists, consult your foot doctor.

Prevention

Pronation forces us to bear most of our weight on the inner border of our feet. Custom-made orthotics gently redistributes the weight so that the entire foot bears its normal share of weight with each step we take. The foot will not twist out at the ankle, but will strike the ground normally when the orthotics is used. This action of the custom-made orthotics will help to prevent shin splints, ankle sprains, knee and hip pain, lower back pain, nerve entrapments, tendonitis, muscle aches, bunions, generalized fatigue, hammer toes, and calluses.

Diagnosing Calcaneal Apophysitis

Overview

Sever's disease, also known as calcaneal apophysitis, is a medical condition that causes heel pain in one or both feet of children during the period when their feet are growing. Sever's disease occurs most commonly in boys and girls between the ages of 8 and 14 years of age. Sever's disease occurs when the part of the child's heel known as the growth plate, or the calcaneal epiphysis, an area attached to the Achilles tendon, suffers an injury or when the muscles and tendons of the growing foot do not keep pace with bone growth. The result is constant pain experienced at the back of the heel and the inability to put any weight on the heel, forcing the child to bear weight on their toes while walking. A toe gait develops in which the child must change the way they walk to avoid placing weight on the painful heel, a position that can lead to other developmental problems.

Causes

The heel bone grows faster than the ligaments in the leg. As a result, muscles and tendons can become very tight and overstretched in children who are going through growth spurts. The heel is especially susceptible to injury since the foot is one of the first parts of the body to grow to full size and the heel area is not very flexible. Sever?s disease occurs as a result of repetitive stress on the Achilles tendon. Over time, this constant pressure on the already tight heel cord can damage the growth plate, causing pain and inflammation. Such stress and pressure can result from sports that involve running and jumping on hard surfaces (track, basketball and gymnastics). Standing too long, which puts constant pressure on the heel. Poor-fitting shoes that don?t provide enough support or padding for the feet. Overuse or exercising too much can also cause Sever?s disease.

Symptoms

Symptoms include Heel Pain. Pain at the back of the heels when walking or running. Possibly a lump at the back of the heel, although this might be minimal. Pain and tenderness at the back of the heels, especially if you press on it, or give it a squeeze from the sides. Tight calf muscles resulting in reduced ankle range of motion.

Diagnosis

A physical exam of the heel will show tenderness over the back of the heel but not in the Achilles tendon or plantar fascia. There may be tightness in the calf muscle, which contributes to tension on the heel. The tendons in the heel get stretched more in patients with flat feet. There is greater impact force on the heels of athletes with a high-arched, rigid foot.

Non Surgical Treatment

Treatment includes modifying activities and resting to reduce pain and inflammation and take pressure off the growth center. Ice can also be very helpful in relieving symptoms, as well as anti-inflammatory medication. A physical therapy program should be initiated to stretch tight calf muscles and strengthen the ankle muscles to relieve tension on the growth center. Shoes with padded heel surfaces and good arch support can decrease pain. Cleats may need to be avoided for some time to help reduce symptoms. The doctor may also recommend gel heel cups or supportive shoe inserts.

Surgical Treatment

The surgeon may select one or more of the following options to treat calcaneal apophysitis. Reduce activity. The child needs to reduce or stop any activity that causes pain. Support the heel. Temporary shoe inserts or custom orthotic devices may provide support for the heel. Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Physical therapy. Stretching or physical therapy modalities are sometimes used to promote healing of the inflamed issue. Immobilization. In some severe cases of pediatric heel pain, a cast may be used to promote healing while keeping the foot and ankle totally immobile. Often heel pain in children returns after it has been treated because the heel bone is still growing. Recurrence of heel pain may be a sign of calcaneal apophysitis, or it may indicate a different problem. If your child has a repeat bout of heel pain, be sure to make an appointment with your foot and ankle surgeon.
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Acquired Flat Foot Tibialis Posterior Syndrome

Overview
Adult flatfoot (adult acquired flatfoot) or posterior tibial tendon dysfunction (PTTD) is a common pathology presented to foot and ankle specialists. PTTD is characterized by a valgus (everted) hindfoot, flattening of the longitudinal arch of the foot (collapse) and abduction of the forefoot. This is a progressive deformity that begins flexible and can become rigid over time. The posterior tibial tendon (PT) is one of the main supporting structures of the foot arch. Changes within this tendon cause flattening of the foot. There are four stages of this deformity that begins flexible and progressives, with no treatment, to a rigid deformity and with time may involve the ankle joint. Patients usually present with pain in the foot or ankle stating the ?ankle? is rolling. It?s also common for patients to state they have difficulty walking barefoot. Pain is exacerbated after physical activities. Pain is usually isolated to the inside of the foot along the course of the PT tendon. Acquired Flat Foot

Causes
As the name suggests, adult-acquired flatfoot occurs once musculoskeletal maturity is reached, and it can present for a number of reasons, though one stands out among the others. While fractures, dislocations, tendon lacerations, and other such traumatic events do contribute to adult-acquired flatfoot as a significant lower extremity disorder, as mentioned above, damage to the posterior tibial tendon is most often at the heart of adult-acquired flatfoot. One study further elaborates on the matter by concluding that ?60% of patients [presenting with posterior tibial tendon damage and adult-acquired flatfoot] were obese or had diabetes mellitus, hypertension, previous surgery or trauma to the medial foot, or treatment with steroids?.

Symptoms
Your feet tire easily or become painful with prolonged standing. It's difficult to move your heel or midfoot around, or to stand on your toes. Your foot aches, particularly in the heel or arch area, with swelling along the inner side. Pain in your feet reduces your ability to participate in sports. You've been diagnosed with rheumatoid arthritis; about half of all people with rheumatoid arthritis will develop a progressive flatfoot deformity.

Diagnosis
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.

Non surgical Treatment
Orthoses (insoles, functional orthoses, ankle supports, braces, ankle foot orthoses (AFOs)) - are usually custom-made to increase the functional stability of the foot and improve the mechanical properties of the tendon as well as reducing the actual degree of strain on the tendon. This reduces pain and inflammation. Physiotherapy - exercises and physiotherapy are often used to increase mobility, strengthen the tendon itself, stretch your Achilles tendon as well as reduce pain. Once the tendon has been stretched (stage one), the heel starts rolling outwards. Total immobilisation in a cast may help the symptoms to subside and prevent progression of the deformity in a smaller percentage of patients. Long-term use of orthoses may help stop progression of the deformity and reduce pain without surgery. Non-surgical treatment is unlikely to prevent progression to stage three and four but may be chosen by some patients who either are unsuitable for surgery or prefer not to have surgery. Flat Foot

Surgical Treatment
For those patients with PTTD that have severe deformity or have not improved with conservative treatments, surgery may be necessary to return them to daily activity. Surgery for PTTD may include repair of the diseased tendon and possible tendon transfer to a nearby healthy tendon, surgery on the surrounding bones or joints to prevent biomechanical abnormalities that may be a contributing factor or both.

Foot Pain In The Arch From Running

Overview

Pain across the bottom of the foot at any point between the heel and the ball of the foot is often referred to as "arch pain." Although this description is non-specific, most arch pain is due to strain or inflammation of the plantar fascia (a long ligament on the bottom of the foot). This condition is known as plantar fasciitis and is sometimes associated with a heel spur. In most cases, arch pain develops from overuse, unsupportive shoes, weight gain, or acute injury. If arch pain persists beyond a few days, see a foot and ankle surgeon for treatment to prevent this condition from becoming worse.

Pain In Arch

Causes

Spending a lot of time on your feet. Especially when you are not used to doing so. For example you may have started a new job such as waiting tables where you are on your feet all day and wake up the next day with sore feet. This is a sign of damage and over time could lead to plantar fasciitis. Being Over-Weight. Never an easy topic to discuss but in simple terms, the heavier you are, the greater the burden on your feet. There are times when you're walking when your entire body weight is borne on one leg and therefore one foot, placing great strain on the plantar fascia. Wearing shoes with poor arch support or cushioning. A tight Achilles tendon. This is the big tendon at the bottom of your calf muscles above your heel. If this is excessively tight this can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Suddenly changing your exercise routine. Using running as an example if you suddenly run many more miles than your are used to or change to a new running surface e.g. grass to tarmac - these factors can put excessive strain on the plantar fascia and lead to plantar fasciitis. All of these risk factors ultimately lead to a specific change in foot structure. The term given is over-pronation and this basically describes rolling in of the foot and lowering of the arches. It is this change that excessively elongates the plantar fascia which can lead to plantar fasciitis.

Symptoms

If you've ever seen your footprints in the sand and they looked more like bricks than feet, then you probably have flat feet. Simply stated, a flat foot is a foot that does not have an arch when standing. In the medical world, flat feet are associated with "pronated" feet. Pronated is merely the term used to describe the position of the foot when it is flexed upward (dorsiflexed), turned away from the body (abducted), and the heel is rolled outward (everted), all at the same time. A certain amount of pronation is required for normal walking, but too much pronation is often considered a foot's "worst enemy." Over time, excessive pronation can lead to many unpleasant problems including heel pain, bunions, hammertoes, shin splints, and even knee, hip, or back pain. In fact, one orthopedic surgeon discovered that 95% of his total knee replacement patients and 90% of his total hip replacement patients had flat feet. An easy way to tell if you pronate too much is to take a look at your athletic shoes-excessive wearing of the inside heel (arch side of the shoe) as compared to the outside is a classic indication of excessive pronation.

Diagnosis

Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.

Non Surgical Treatment

There are many different causes of and treatments for flat foot. The most important part of treatment is determining the exact flat foot type on an individual basis, and doing so early on. The main objective is to become educated on the potential problems, so that you can stop them before they start. Conservative treatment is often successful if initiated early. The old adage "a stitch in time saves nine" definitely applies to the human body, hopefully more figuratively than literally. Do not ignore what your common sense and your body are telling you. Yes, you can live without an arch, but never neglect a symptomatic foot. If you neglect your feet, they will make you pay with every literal step you take.

Foot Arch Pain

Surgical Treatment

If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.

Prevention

So how do you prevent plantar fasciitis? Factors which can be controlled include training progression, environmental factors, shoes, and strength and flexibility exercises. A useful guideline for a safe training progression is ?the 10% rule.? Limit increases in distance or intensity to 10% a week. For example, if a person is running 60 minutes at a session, 4 times a week, or 240 minutes, she or he can probably increase the running time to 264 minutes (240 + 10%), the following week if all else remains the same. Terrain is also an important factor in training. Running 30 minutes on hills is very different from running 30 minutes on flat surfaces in terms of the forces on the legs and feet. Work up gradually to increase your running time on hills. Also lean forward when running downhill. If you run on a banked or crowned surface, vary the direction you run in so you alternate which leg is higher and which leg is lower on the bank. If you know concrete or asphalt is causing you discomfort, try running on a cinder or composite track. If you are going on vacation and are not used to running on sand or grass, don?t spend your whole vacation doing it.

Stretching Exercises

Inchworm. Stand with your weight on one foot. Raise the metatarsal heads of the unweighted foot while you pull its heel closer to your toes. Next, raise your toes toward the ceiling, and then relax your whole foot with it flat on the floor. Your foot should move like an inchworm across the floor. Reps 6-7 for each foot. Horsepawing. Stand with your weight on one foot and the other foot slightly in front of you. Raise the metatarsal heads on the front foot. Lift your heel ever so slightly off the ground, maintaining the raised metatarsal heads, and pull your foot toward you so that it ends up behind you. Return this foot to the starting position in front of you. You should really feel this one in your arch. Reps. 6-7 for each foot. Toe pushups. Sit in a chair with your feet resting on the floor. Raise your heel as high as you can while keeping your toes flat on the floor. This is the starting position. Using your toe muscles, roll your foot upward until the weight of your foot is resting on the ends of your toes, like a dancer standing on point in toe shoes. Roll back down to the starting position. Reps. 10-20 for each foot. Sand scraping. Pretend you are at the beach standing in loose sand. Use your big toe to pull sand inward toward your body, with your little toe off the ground. Then use your little toe to push it away, with your big toe off the ground. Reps. 10 for each foot. Now reverse the exercise: pull the sand inward with your little toe and push it away with your big toe. Reps. 10 for each foot.
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What Causes Posterior Tibial Tendon Dysfunction ?

Overview
Adult-acquired flatfoot (AAF) is the term used to describe the progressive deformity of the foot and ankle that, in its later stages, results in collapsed and badly deformed feet. Although the condition has been described and written about since the 1980s, AAF is not a widely used acronym within the O&P community-even though orthotists and pedorthists easily recognize the signs of the condition because they treat them on an almost daily basis. AAF is caused by a loss of the dynamic and static support structures of the medial longitudinal arch, resulting in an incrementally worsening planovalgus deformity associated with posterior tibial (PT) tendinitis. Over the past 30 years, researchers have attempted to understand and explain the gradual yet significant deterioration that can occur in foot structure, which ultimately leads to painful and debilitating conditions-a progression that is currently classified into four stages. What begins as a predisposition to flatfoot can progress to a collapsed arch, and then to the more severe posterior tibial tendon dysfunction (PTTD). Left untreated, the PT tendon can rupture, and the patient may then require a rigid AFO or an arthrodesis fixation surgery to stabilize the foot in order to remain capable of walking pain free. Acquired Flat Foot

Causes
The cause of posterior tibial tendon insufficiency is not completely understood. The condition commonly does not start from one acute trauma but is a process of gradual degeneration of the soft tissues supporting the medial (inner) side of the foot. It is most often associated with a foot that started out somewhat flat or pronated (rolled inward). This type of foot places more stress on the medial soft tissue structures, which include the posterior tibial tendon and ligaments on the inner side of the foot. Children nearly fully grown can end up with flat feet, the majority of which are no problem. However, if the deformity is severe enough it can cause significant functional limitations at that age and later on if soft tissue failure occurs. Also, young adults with normally aligned feet can acutely injure their posterior tibial tendon from a trauma and not develop deformity. The degenerative condition in patients beyond their twenties is different from the acute injuries in young patients or adolescent deformities, where progression of deformity is likely to occur.

Symptoms
The first stage represents inflammation and symptoms originating from an irritated posterior tibial tendon, which is still functional. Stage two is characterized by a change in the alignment of the foot noted on observation while standing (see above photos). The deformity is supple meaning the foot is freely movable and a ?normal? position can be restored by the examiner. Stage two is also associated with the inability to perform a single-leg heel rise. The third stage is dysfunction of the posterior tibial tendon is a flatfoot deformity that becomes stiff because of arthritis. Prolonged deformity causes irritation to the involved joints resulting in arthritis. The fourth phase is a flatfoot deformity either supple (stage two) or stiff (stage 3) with involvement of the ankle joint. This occurs when the deltoid ligament, the major supporting structure on the inside of the ankle, fails to provide support. The ankle becomes unstable and will demonstrate a tilted appearance on X-ray. Failure of the deltoid ligament results from an inward displacement of the weight bearing forces. When prolonged, this change can lead to ankle arthritis. The vast majority of patients with acquired adult flatfoot deformity are stage 2 by the time they seek treatment from a physician.

Diagnosis
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise. A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet - the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.

Non surgical Treatment
Treating PTTD is almost always easier the earlier you catch it. So, the first step in treatment is to see your doctor as soon as you begin experiencing painful symptoms. However, once your condition has been diagnosed, your podiatrist will likely try to give the upset tendon a bit of a break so it?ll calm down and stop being so painful. This can often be accomplished by immobilizing the foot using tape and padding, braces, or casts, depending on what your podiatrist believes will work best for you, and depending on the severity of your condition. You may also be instructed to reduce inflammation by applying ice to the area (usually 40 minutes on and 20 minutes off, with a thin towel between you and the ice). Or, you might take anti-inflammatory medications like ibuprofen (steroidal anti-inflammatory meds are actually likely to make this problem worse, and are not usually recommended in treating PTTD), or use ultrasound therapy. Once the inflammation has gone down a bit, your podiatrist may recommend using orthotics (prescription shoe inserts) to support your damaged arch. Ankle braces can also be helpful. Flat Feet

Surgical Treatment
Types of surgery your orthopaedist may discuss with you include arthrodesis, or welding (fusing) one or more of the bones in the foot/ankle together. Osteotomy, or cutting and reshaping a bone to correct alignment. Excision, or removing a bone or bone spur. Synovectomy, or cleaning the sheath covering a tendon. Tendon transfer, or using a piece of one tendon to lengthen or replace another. Having flat feet is a serious matter. If you are experiencing foot pain and think it may be related to flat feet, talk to your orthopaedist.

Do Fallen Arches Require Surgery?

Overview

Acquired Flat Feet

There are three types of flat feet: flexible flatfoot, painful rigid flatfoot, and spasmodic flatfoot. Flexible flat feet have some arch, even if the arch only appears while the person is flexing the foot or standing on their toes. Flexible flat feet may not cause pain or require treatment. Painful rigid flatfoot, on the other hand, is abnormal and causes pain, stiffness, and the inability to flex the foot. This often indicates that there is a problem with the bones in the foot, a disease is present, or an injury has occurred. Spasmodic flatfoot involves the foot being forced outward by spasmodic contractions of the peroneal muscle.




Causes

Having low or no arches is normal for some people. In these cases, flat feet are usually inherited and the feet are fairly flexible. Occasionally, flat feet can be caused by an abnormality that develops in the womb, such as a problem with a joint or where two or more bones are fused together. This is known as tarsal coalition and results in the feet being flat and stiff. Flat feet that develop in later life can be caused by a condition that affects the joints, such as arthritis, or an injury to a muscle, tendon or joint in the foot. Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. Over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this can occur include cerebral palsy, spina bifida and muscular dystrophy. Adult-acquired flat feet often affect women over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time. It's not fully understood what causes the tendon to become stretched, but some experts believe that wearing high heels and standing or walking for long periods may play a part. Obesity, high blood pressure (hypertension) and diabetes are all risk factors. Recent research has found a link with changes to the tendon in the foot and an increase in a type of protein called proteolytic enzyme. These enzymes can break down some areas of the tendon, weakening it and causing the foot arch to fall. Similar changes are also seen in other conditions, such as Achilles tendonitis. This could have important implications for treating flat feet because medication that specifically targets these enzymes could provide an alternative to surgery. However, further research is needed and this type of treatment is thought to be about 10 to 15 years away.




Symptoms

Fallen arches may induce pain in the heel, the inside of the arch, the ankle, and may even extend up the body into the leg (shin splints), knee, lower back and hip. You may also experience inflammation (swelling, redness, heat and pain) along the inside of the ankle (along the posterior tibial tendon). Additionally, you may notice some changes in the way your foot looks. Your ankle may begin to turn inward (pronate), causing the bottom of your heel to tilt outward. Other secondary symptoms may also show up as the condition progresses, such as hammertoes or bunions. You may also want to check your footprint after you step out of the shower. (It helps if you pretend you?re in a mystery novel, and you?re leaving wet, footprinty clues that will help crack the case.) Normally, you can see a clear imprint of the front of your foot (the ball and the toes) the heel, and the outside edge of your foot. There should be a gap (i.e. no footprinting) along the inside where your arches are. If your foot is flat, it?ll probably leave an imprint of the full bottom of your foot-no gap to be had. Your shoes may also be affected: because the ankle tilts somewhat with this condition, the heel of your shoes may become more worn on one side than another.




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.




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.




Surgical Treatment

Flat Foot

Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.




Prevention

It?s time to take a long hard look at what?s in your closet. Now is the time to toss out shoes that are well worn. You also need to say good-bye to thin-soled shoes that offer zero arch support. If you?re overweight, fallen arches may be a sign the universe is trying to tell you something. You need to lose weight, and odds are, fallen arches are but one of many physical discomforts you are experiencing.
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Does Arch Pain Require Surgical Treatment ?

Overview

Arch pain is the term used to describe pin under the arch of the foot. Arch pain is common in people with flat feet. When this occurs it means the person has some inflammation in the mid foot. The arch is supported by a tight band of tissue called the Planter fascia, running from the toes to the heel bone. When this is inflamed it is known as Plantar Fasciitis.

Foot Arch Pain

Causes

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

Symptoms

Arch pain may have a variety of different causes. Proper evaluation and diagnosis of arch pain is essential in planning treatment. A good general guideline is to compare the injured side to the uninjured side. Injury may present itself as a distinguishable lump, a gap felt at that location, or a "crunchy" feeling on that spot caused by inflammation. The type, causes, and severity of pain are also good indicators of the severity of the injury.

Diagnosis

To come to a correct diagnosis, your podiatrist will examine your foot by using his or her fingers to look for a lump or stone bruise in the ball of your foot. He or she will examine your foot to look for deformities such as high or low arches, or to see if you have hammertoes. He or she may use x-rays, MRIs (magnetic resource imaging), and CT scans to rule out fractures and damage to ligaments, tendons, and other surrounding tissues. Your doctor will also inquire about your daily activities, symptoms, medical history, and family history. If you spend a lot of time running or jumping, you may be at a higher risk for pain in the bottom of your foot. These diagnostic tests will help your doctor come to a proper diagnosis and create an appropriate treatment plan.

Non Surgical Treatment

When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.

Foot Arch Pain

Surgical Treatment

Surgery may be necessary in situations where the symptoms are likely to get worse over time, or when pain and instability cannot be corrected with external orthopedic devices. There are many types of surgical procedures, including cavus foot reconstruction, which can be performed to correct the foot and the ankle and restore function and muscle balance.

Prevention

To prevent arch pain, it is important to build up slowly to your exercise routine while wearing arch supports inside training shoes. By undertaking these simple measures you can prevent the discomfort of arch pain which can otherwise linger for many months. While you allow the foot to recover, it will help to undertake low impact exercises (such as swimming or water aerobics).