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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