The terms fallen arches and flat feet are used interchangeably to refer to a condition in which there is no arch of the foot. An arch is formed by tendons in the foot that stretch from the heel of the foot to the base of the toes, or metatarsals. There are also supporting tendons that originate in the lower leg. Together, these tendons work to form an arch, noticeable as a slight rise in the inner midsole of the foot. This rise or arch can be classified as a normal arch, a high arch, or a fallen arch. When tendons do not work together to pull properly, this results in a fallen arch or flat foot. Aside from the occasional pain associated with flat feet, problems with fallen arches can extend upwards to the ankles, knees, hips, and even the back, altering the biomechanics of the body.
Turning 40 doesn?t necessarily have anything to do with it, but over time you?ve likely engaged in certain activities or developed some unhealthy habits that led to this condition. If you are overweight, you are placing excess burdens on your feet, causing the tendons to strain. Some women experience fallen arches because of weight gain during pregnancy. You also may have damaged these tendons while exercising. If you suffered a serious injury to the foot, you may have weakened the tendons, which can also lead to this development.
Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot. Associated discomfort within and near the ankle joint. The knees, hips, and lower back may be the primary source of discomfort. Feet may often feel tired and achy. Painful shin splints may develop with activity. Gait may be awkward.
Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.
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Non Surgical Treatment
If you have flat feet and foot pain, especially if one foot is flatter than the other, you should have an evaluation by an orthopedic surgeon . You may have a problem with the posterior tibial tendon , the main tendon that supports the arch. Factors that can contribute to this problem are obesity, diabetes , high blood pressure , certain types of arthritis and athletic overuse. In some cases a shoe insert/orthotic can be used to alleviate the symptoms of flat feet.
Surgery is typically offered as a last resort in people with significant pain that is resistant to other therapies. The treatment of a rigid flatfoot depends on its cause. Congenital vertical talus. Your doctor may suggest a trial of serial casting. The foot is placed in a cast and the cast is changed frequently to reposition the foot gradually. However, this generally has a low success rate. Most people ultimately need surgery to correct the problem. Tarsal coalition. Treatment depends on your age, extent of bone fusion and severity of symptoms. For milder cases, your doctor may recommend nonsurgical treatment with shoe inserts, wrapping of the foot with supportive straps or temporarily immobilizing the foot in a cast. For more severe cases, surgery is necessary to relieve pain and improve the flexibility of the foot. Lateral subtalar dislocation. The goal is to move the dislocated bone back into place as soon as possible. If there is no open wound, the doctor may push the bone back into proper alignment without making an incision. Anesthesia is usually given before this treatment. Once this is accomplished, a short leg cast must be worn for about four weeks to help stabilize the joint permanently. About 15% to 20% of people with lateral subtalar dislocation must be treated with surgery to reposition the dislocated bone.
oll away pain. If you're feeling pain in the arch area, you can get some relief by massaging the bottom of your foot. A regular massage while you're watching TV can do wonders" Stretch out. Doing the same type of stretching exercises that runners do in their warm-up can help reduce arch pain caused by a tight heel cord. One of the best exercises is to stand about three feet from a wall and place your hands on the wall. Leaning toward the wall, bring one foot forward and bend the knee so that the calf muscles of the other leg stretch. Then switch legs. Stretching is particularly important for women who spend all week in heels and then wear exercise shoes or sneakers on weekends. Get measured each time you buy new shoes. Don't assume that since you always wore a particular size, you always will. Too many people try to squeeze into their 'regular' shoe size and wind up with serious foot problems or sores on their feet. When your arch is falling, your feet may get longer or wider and you may or may not feel pain, so getting your foot measured each time you buy shoes is a good indicator of your arch's degeneration. Examine your shoes. If the heel is worn down, replace it. But if the back portion of the shoe is distorted or bent to one side, get yourself into a new pair of supportive shoes like those made specifically for walking. That's because flat feet can affect your walking stride, and failing to replace worn shoes may lead to knee or hip pain.
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.