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Combating Pes Planus

Overview

Flat Foot

he belly isn't the only part of your body subject to middle-age spread. As we get older, the years of walking and standing can cause feet to spread and flatten out as ligaments that support the arch lose their holding power. The result: the condition known as fallen arches, or flat feet. "Keep in mind that we're talking about 26 bones in the foot that are supported by a series of ligaments, muscle tendons and other connective tissue," says Glenn Gastwirth, D.P.M., deputy executive director of the American Podiatric Medicine Association in Bethesda, Maryland. "Over a period of time, the ligaments stretch out or 'give' under the pressure of your weight-especially if you're overweight. So what usually happens is you go shopping for new shoes one day and suddenly realize that you now need a size 8 when you've always worn a size 6. You may think your foot has grown, but what really happens is that the foot has spread out, both in width and length."

Causes

You can have a tendency towards fallen arches from birth. Up through the toddler stage, it is common to have flat feet. Throughout childhood, arches tend to normally develop. For reasons not well understood, however, in some cases the feet stay flat and the arch never forms. In many cases this abnormality does not cause symptoms or require any treatment. In other cases, it is due to a condition called tarsal coalition. This occurs when some of the foot bones fuse.

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

There are a few simple ways to assess your foot type, and most include making an imprint of your footprint. The classic way is to stand on a hard floor surface with wet feet to make a wet foot print. Look at the narrowest part of your footprint, which should be between your heel and ball of your foot. If the print of your foot in this part is less than 10% of the width of the widest part then you are likely to have high arches. more than 10% but less than 25% then your foot profile is probably normal, more than 25% or even the widest part, then you have flat feet.

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Non Surgical Treatment

Treatment of flat feet may be appropriate if there is associated foot or lower leg pain, or if the condition affects the knees or the lower back. Treatment may include using Orthoses such as an arch support, foot gymnastics or other exercises as recommended by a podiatrist/orthotist or physical therapist. In cases of severe flat feet, orthoses should be used through a gradual process to lessen discomfort. Over several weeks, slightly more material is added to the orthosis to raise the arch. These small changes allow the foot structure to adjust gradually, as well as giving the patient time to acclimatise to the sensation of wearing orthoses. Once prescribed, orthoses are generally worn for the rest of the patient's life. In some cases, surgery can provide lasting relief, and even create an arch where none existed before; it should be considered a last resort, as it is usually very time consuming and costly.

Surgical Treatment

Flat Feet

Rarely does the physician use surgery to correct a foot that is congenitally flat, which typically does not cause pain. If the patient has a fallen arch that is painful, though, the foot and ankle physicians at Midwest Orthopaedics at Rush may perform surgery to reconstruct the tendon and "lift up" the fallen arch. This requires a combination of tendon re-routing procedures, ligament repairs, and bone cutting or fusion procedures.
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