Pes Planus Explained

posted on 01 Apr 2015 07:34 by blairgrunder
Overview

Acquired Flat Feet

Fallen arches, or flatfoot, is a condition in which the arch on the inside of the foot is flat and the entire sole of the foot rests on the ground. It affects about 40% of the general population. Although flat feet in themselves are not usually problematic, they can create problems in the feet, hips, ankles and knees. Pain may be experienced in the lower back if there are alignment problems and if the individual is engaged in a lot of heavy, high impact activities that put stress on the bones and muscles in the lower legs. The arches of most individuals are fully developed by the age of 12 to 13. While some people are born with flat arches, for others the arches fall over time. The tibial tendon, which runs along the inside of the ankle from above the ankle to the arch, can weaken with age and with heavy activity. The posterior tendon, main support structure for the arch, can become inflamed (tendonitis) or even tear if overloaded. For women, wearing high heels can affect the Achilles tendon and alter the structure and function of the ankle. The posterior tibial tendon may compensate for this stress and break down, causing the arches to fall. Obesity is another contributing factor, as well as a serious injury to the ankle or foot, arthritis and bad circulation such as occurs with diabetes.




Causes

A fallen arch occurs because one of the main structures that support the arch has broken or torn. Usually it occurs without trauma, although a small injury associated with the onset of the pain is often recalled, it is sometimes difficult to determine whether the injury was clearly big enough to permanently injure the leg. I suspect that even before the symptoms that the structure that broke was weakening and the injury was simply the ?needle that broke the camels back?. The structure that is most commonly torn is the posterior tibial tendon. This tendon is attached to a muscle on the inside of the back of the ankle, and runs along the medial malleolus, the bony prominence on the inside of the ankle, to attach to a bone in the arch called the navicular bone. It usually begins to weaken and stretch along the back of the medial malleolus. It often begins as a swelling and the arch flattens over the next several weeks to months. As the arch flattens, other structures that support the arch begin to stretch and tear. The bones along the outside of the ankle begin to crush together, causing pain and swelling in this are, and the toes may tilt to the outside as the arch collapses. It is not known why this process begins. It is often associated with diabetes and rheumatoid arthritis and other inflammatory diseases. It also is more common as a person enters the fifty to seventy year age range. ?Fallen arches? are much more common in people who are already flat footed.




Symptoms

Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.




Diagnosis

Many medical professionals can diagnose a flat foot by examining the patient standing or just looking at them. On going up onto tip toe the deformity will correct when this is a flexible flat foot in a child with lax joints. Such correction is not seen in the adult with a rigid flat foot. An easy and traditional home diagnosis is the "wet footprint" test, performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. In more extreme cases, known as a kinked flatfoot, the entire inner edge of the footprint may actually bulge outward, where in a normal to high arch this part of the sole of the foot does not make contact with the ground at all.




Non Surgical Treatment

What we want to do is support the arch and maintain it in that curved position. So what you want is to bring the foot into a position where you hold and support the arch so you can get that correct heel-midfoot-big toe contact. You would achieve that with a level of arch support. People will take different levels of support, if you?re somebody who has movement in your arch, a strong level of support will hold and maintain you whereas if you?re someone whose arch has collapsed it could need more support and a level of correction built into the support to realign you. If you think of it, when your arch drops, it affects your foot but it also has a biomechanical effect on the rest of the body. But nothing that can?t be solved.




Surgical Treatment

Acquired Flat Feet

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

Flat feet or Fallen Arches cannot be prevented due to congenital of nature or from underlying disease process; however, painful symptoms and future pathology from Flat Feet or Fallen Arches may be prevented by the following. Continue to wear your orthotics for work and exercise to provide stability and maintain function of your feet. Footwear. Continue to wear supportive shoes to maximise the function of your orthotic and prevent excessive movement of the joints in your feet.




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.