Fallen Arches Causes, Signs And Treatment Solution

posted on 03 Apr 2015 00:12 by madelinwean
Overview

Flat Foot

The medical term for fallen arches is pes planus. Pes planus can occur from birth and is not always a medical problem (pathologic). It can also occur over time from degeneration of the cartilage and ligaments that support the arch of the foot. It is especially important for persons with pes planus that is caused by degeneration to use comfortable footwear.




Causes

There are many reasons why flat feet develop. Here?s a look at some of the most common causes. Genetics, weak arches, injury, arthritis, diabetes, age, wear and tear on feet, tibialis posterior (ruptured tendon). Nervous system or muscle diseases such as cerebral palsy. Weakness and tightness of other muscles and tendons higher up in the lower extremity. The way our arches form depends on several factors. Our feet are complex structures that comprise twenty-six bones, thirty-three joints, and more than 100 muscles, tendons, and ligaments each. Each foot forms two arches. The arch that runs from the heel to the toe is known as the longitudinal arch, while the one that runs the width is known as the transverse arch. Ligaments (fibrous tissues) give our arches their shape and hold our bones together. The plantar fascia (the long, strong band of connective tissue that runs along the sole of your foot) and muscles add secondary support. There are also foot pads that absorb impact and assist with weight-bearing functions. How these things intertwine and work together determines the formation of our arches. A structural abnormality or injury to one of these components can result in flatfoot.




Symptoms

It?s possible to have fallen arches and experience no symptoms whatsoever. But many people do notice some problems with this condition. Their feet, back and legs ache. Standing on their toes is difficult, if not impossible, and they note swelling around the arch and heel.




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

If you have fallen arches, but you are not experiencing any symptoms, then you probably do not need to seek treatment. If you are experiencing discomfort due to fallen arches, there are several treatment options. These treatment options include elevating the feet and applying ice to ease discomfort and reduce swelling, rest, exercises to stretch the feet, physical therapy, medication, such as anti-inflammatories, steroid injections and orthotic devices or customised arch supportsto wear in the shoes. If you have fallen arches and periodically experience pain related to that condition, it is a good idea to get orthotic devicesor custom arch supports, to wear in your shoes. The other treatment options, like medication and ice, will help to ease pain from fallen arches after you have already begun to experience pain. However, orthotic devices or(custom arch supports)can help to prevent pain from occurring at all. This preventative measure helps many people with fallen arches to avoid pain and prevent worsening of their condition. In severe cases of fallen arches, surgery may be required to correct the problem. You can also help to prevent pain and exacerbation of fallen arches by reducing your risk factors. If you are overweight, try to lose weight. Even a small weight loss can reduce the pressure on your feet significantly. If you are diabetic, manage your blood sugar as best as possible. Losing weight often also improves the condition of diabetics. You should also avoid high-impact activities, like running on the road, tennis, and sports that involve jumping. Try a gentler form of exercise, like swimming, instead. If you have fallen arches, orthotic devices or(custom arch supports)are an important component of your treatment and can help to prevent pain.




Surgical Treatment

Acquired 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.