Candice Groshans

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Are Fallen Arches Flat Feet?

Overview

Adult Acquired Flat Foot

When sitting, an over-pronating foot appears quite normal, i.e. showing a normal arch with room under the underside of the foot. The moment you get up and put weight on your feet the situation changes: the arches lower and the ankle slightly turns inwards. When you walk or run more weight is placed on the feet compared to standing and over-pronation will become more evident. When walking barefoot on tiles or timber floors over-pronation is more visible, compared to walking on carpet or grass.

Causes

Factors that increase your chance of flat feet include family history, diseases that cause muscle or nerve damage, such as peripheral neuropathy, diabetes, cerebral palsy, spina bifida, or muscular dystrophy. Foot injuries. Conditions of the feet that can injure foot tissue such as osteoarthritis. Conditions present at birth, such as excess laxity of joint capsules and ligaments, such as Ehlers-Danlos syndrome. Obesity.

Symptoms

Fallen arches symptoms may include the following. Being unable to slip fingers underneath arches. Inwards rolling of foot and ankle when running. Knee problems due to lack of support from feet.

Diagnosis

You can test yourself to see if you have flat feet or fallen arches by using a simple home experiment. First, dip your feet in water. Then step on a hard flat surface, like a dry floor or a piece of paper on the floor, where your footprints will show. Step away and examine your foot prints. If you see complete/full imprints of your feet on the floor, you may have fallen arches. However, it?s important to seek a second option from a podiatrist if you suspect you have fallen arches so they can properly diagnose and treat you.

pes planus radiology

Non Surgical Treatment

During walking and running, there is a small natural inward drop (slight pronation) that is part of the spring and propulsion. Allowing exaggerated sagging is like rounding your shoulders too much. Legs and feet have posture that you can control yourself. Use your own muscles and get free built-in exercise and arch support all day, and stop painful poor positioning. Some people with existing abnormality or growths in the ball of the foot will roll inward (or outward) to get the pressure off the deformed area because standing straight hurts. See your doctor first. Remember, don't force. If it hurts, it's wrong. All you are doing is learning how to stand neutral, not tilted so much that you compress the joints. The concept is to hold your feet in the same healthful position that shoe supports would. It is like an ice skater holds their skates straight at the ankle, not angled.

Surgical Treatment

Flat Foot

Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
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