Pain In The Arch Causes Symptoms And Treatments
Overview
Arch pain(medically known as plantar pain)is a broad term many people use to describe pain in their muscles, tendons, ligaments, bones, or nerves. All these components are connected to the bottom of the foot; therefore, damage to any one of these can cause pain on the bottom of the foot. This pain may only last for short time, but can progressively worsen if untreated. Most people who suffer from this pain are between the ages of 30 and 80, but many younger athletes are also susceptible, particularly those who participate in high-impact sports.
Causes
A common cause of foot arch pain is a stress fracture. They tend to occur from repeated overloading of one of the foot bones from activities such as jumping and running especially if you have suddenly increased your activity level. The breaks in the bone may be small but they can be extremely painful. Stress fractures of the metatarsal bones or the navicular can cause anything from mild to severe foot arch pain. The Tibialis Posterior muscle plays a very important role in supporting the medial arch of the foot. Posterior Tibial Tendonitis can occur either through repetitive use e.g. high impact sports such as soccer or tennis, or from an injury e.g. a fall. This causes the tendon to become inflamed or even torn, resulting in pain on bottom of foot. This pain usually gets worse with activity or when standing for long periods. If the problem persists, the inner side of the foot (known as the medial longitudinal arch of the foot) gradually collapses down, causing flat feet. A simple test for this condition is to stand on one leg and rise up onto your tiptoes. If you cannot, it indicates a problem with the Posterior Tibial tendon. Treatment usually consists of rest, ice, exercises, orthotics and physical therapy.
Symptoms
The primary symptom is pain or aching in the arch area. This can be accompanied by inflammation and tenderness. If the pain is caused by the plantar fascia, it is likely to be considerably more severe in the mornings due to the muscles being unused.
Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
Posterior tibial tendon dysfunction is a common cause of fallen arches in adults. The tendon runs along the bottom of the foot and up the back of the ankle, connecting to the tibialis posterior muscle in the calf. The posterior tibial tendon is an important support for the foot arch. Overuse, inflammation and tears of the tendon may cause progressive foot and ankle pain and the development of flat feet. The American College of Foot and Ankle Surgeons states that an ankle brace, leg cast or removable boot may be used to temporarily immobilize the posterior tibial tendon, facilitating healing. Physical therapy typically follows immobilization to strengthen the foot and restore normal foot structure and function.
Surgical Treatment
With flat feet, there is a tendon on the inside of the foot than can often become weakened, injured, split and/or ruptured. This tendon, is called the posterior tibial tendon, and is the main arch supporting tendon. Obviously damage to this tendon can cause collapse of the arch. Some people have genetically inefficient tendon, and tends to be the case in younger people. In mild cases, such as tendon splits, the posterior tibial tendon can be repaired to restore its strength. Acute incontinuity of the tendon can be primarily repaired. Often the posterior tibial tendon is augmented with a tendon transfer of an adjacent tendon to provide both strength and continuity. In any tendon repair, advanced or retensioning of the tendon is performed. In most flat foot surgery a tendon augmentation is often combined with other boney procedures to restore structure and balance to the foot.
Prevention
The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place hands on a wall and drop affected leg back into a lunge step while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold stretch for 15 seconds and repeat three times.
Arch pain(medically known as plantar pain)is a broad term many people use to describe pain in their muscles, tendons, ligaments, bones, or nerves. All these components are connected to the bottom of the foot; therefore, damage to any one of these can cause pain on the bottom of the foot. This pain may only last for short time, but can progressively worsen if untreated. Most people who suffer from this pain are between the ages of 30 and 80, but many younger athletes are also susceptible, particularly those who participate in high-impact sports.
Causes
A common cause of foot arch pain is a stress fracture. They tend to occur from repeated overloading of one of the foot bones from activities such as jumping and running especially if you have suddenly increased your activity level. The breaks in the bone may be small but they can be extremely painful. Stress fractures of the metatarsal bones or the navicular can cause anything from mild to severe foot arch pain. The Tibialis Posterior muscle plays a very important role in supporting the medial arch of the foot. Posterior Tibial Tendonitis can occur either through repetitive use e.g. high impact sports such as soccer or tennis, or from an injury e.g. a fall. This causes the tendon to become inflamed or even torn, resulting in pain on bottom of foot. This pain usually gets worse with activity or when standing for long periods. If the problem persists, the inner side of the foot (known as the medial longitudinal arch of the foot) gradually collapses down, causing flat feet. A simple test for this condition is to stand on one leg and rise up onto your tiptoes. If you cannot, it indicates a problem with the Posterior Tibial tendon. Treatment usually consists of rest, ice, exercises, orthotics and physical therapy.
Symptoms
The primary symptom is pain or aching in the arch area. This can be accompanied by inflammation and tenderness. If the pain is caused by the plantar fascia, it is likely to be considerably more severe in the mornings due to the muscles being unused.
Diagnosis
In a person of any age, the doctor will ask about occupational and recreational activities, previous foot trauma or foot surgery and the type of shoes worn. The doctor will examine your shoes to check for signs of excessive wear. Worn shoes often provide valuable clues to gait problems and poor bone alignment. The doctor will ask you to walk barefoot to evaluate the arches of the feet, to check for out-toeing and to look for other signs of poor foot mechanics.
Non Surgical Treatment
Posterior tibial tendon dysfunction is a common cause of fallen arches in adults. The tendon runs along the bottom of the foot and up the back of the ankle, connecting to the tibialis posterior muscle in the calf. The posterior tibial tendon is an important support for the foot arch. Overuse, inflammation and tears of the tendon may cause progressive foot and ankle pain and the development of flat feet. The American College of Foot and Ankle Surgeons states that an ankle brace, leg cast or removable boot may be used to temporarily immobilize the posterior tibial tendon, facilitating healing. Physical therapy typically follows immobilization to strengthen the foot and restore normal foot structure and function.
Surgical Treatment
With flat feet, there is a tendon on the inside of the foot than can often become weakened, injured, split and/or ruptured. This tendon, is called the posterior tibial tendon, and is the main arch supporting tendon. Obviously damage to this tendon can cause collapse of the arch. Some people have genetically inefficient tendon, and tends to be the case in younger people. In mild cases, such as tendon splits, the posterior tibial tendon can be repaired to restore its strength. Acute incontinuity of the tendon can be primarily repaired. Often the posterior tibial tendon is augmented with a tendon transfer of an adjacent tendon to provide both strength and continuity. In any tendon repair, advanced or retensioning of the tendon is performed. In most flat foot surgery a tendon augmentation is often combined with other boney procedures to restore structure and balance to the foot.
Prevention
The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place hands on a wall and drop affected leg back into a lunge step while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold stretch for 15 seconds and repeat three times.
What Are The Primary Treatment And Cause Of Achilles Tendonitis Problems ?
Overview
Achilles Tendinitis is the inflammation of the Achilles Tendon located in the heel, and is typically caused by overuse of the affected limb. Most often, it occurs in athletes who are not training with the proper techniques and/or equipment. When the Achilles Tendon is injured, blood vessels and nerve fibers from surrounding areas migrate into the tendon, and the nerve fibers may be responsible for the discomfort. Healing is often slow in this area due to the comparably low amount of cellular activity and blood flowing through the area.
Causes
There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a "watershed zone," an area when the blood supply to the tendon is weakest. In these watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing, that's why we see common tendon problems in the same parts of the body. Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force. Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.
Symptoms
The pain associated with Achilles tendonitis can come on gradually or be caused by some type of leg or foot trauma. The pain can be a shooting, burning, or a dull ache. You can experience the pain at either the insertion point on the back of the heel or upwards on the Achilles tendon within a few inches. Swelling is also common along the area with the pain. The onset of discomfort at the insertion can cause a bump to occur called a Haglund's deformities or Pump bump. This can be inflammation in the bursa sac that surrounds the insertion of the Achilles tendon, scar tissue from continuous tares of the tendon, or even some calcium buildup. In this situation the wearing of closed back shoes could irritate the bump. In the event of a rupture, which is rare, the foot will not be able to go through the final stage of push off causing instability. Finally, you may experience discomfort, even cramping in the calf muscle.
Diagnosis
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Nonsurgical Treatment
Most cases of Achilles tendonitis can be treated at home. Here's what to do. Stop doing the activity that led to the injury. Avoid putting stress on your legs and feet, and give your tendon plenty of time to fully recover. Use the RICE formula. Don't exercise for a few days, or try an exercise that doesn't stress your feet, such as swimming. If necessary, your doctor may recommend that you use crutches or wear a walking boot to keep weight off your foot. Apply an ice pack wrapped in a towel or a cold compress to your tendon for 15 minutes or more after you exercise or if you feel pain in the tendon. Use tape or an athletic wrap to keep swelling down and help support and immobilize the tendon. Lie down and raise your foot above the level of your heart, and if possible, try to sleep with your foot elevated. This will help keep the swelling to a minimum. Take anti-inflammatory medications. Pain relievers like ibuprofen can help ease pain and reduce swelling in the affected area. Stretch and exercise your ankles and calf muscles while you recover. Keeping your muscles, tendons, and ligaments strong and flexible will aid in your recovery and help you keep from reinjuring your Achilles tendon. A doctor or a physical therapist can help you come up with a good exercise program. Try a pair of prescription orthotic inserts for your shoes if your doctor thinks it will help. Sometimes orthotics can be helpful. Talk to your doctor or someone trained in fitting orthotics to find out if they might work for you. Achilles tendon surgery is rarely needed. It's usually only done if the tendon breaks, and then only as a last resort after other methods of therapy have been tried. Most cases of Achilles tendonitis will get better on their own with rest and minor treatment.
Surgical Treatment
There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren't effective. Gastrocnemius recession - The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair - During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.
Prevention
While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.
Achilles Tendinitis is the inflammation of the Achilles Tendon located in the heel, and is typically caused by overuse of the affected limb. Most often, it occurs in athletes who are not training with the proper techniques and/or equipment. When the Achilles Tendon is injured, blood vessels and nerve fibers from surrounding areas migrate into the tendon, and the nerve fibers may be responsible for the discomfort. Healing is often slow in this area due to the comparably low amount of cellular activity and blood flowing through the area.
Causes
There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a "watershed zone," an area when the blood supply to the tendon is weakest. In these watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing, that's why we see common tendon problems in the same parts of the body. Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force. Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.
Symptoms
The pain associated with Achilles tendonitis can come on gradually or be caused by some type of leg or foot trauma. The pain can be a shooting, burning, or a dull ache. You can experience the pain at either the insertion point on the back of the heel or upwards on the Achilles tendon within a few inches. Swelling is also common along the area with the pain. The onset of discomfort at the insertion can cause a bump to occur called a Haglund's deformities or Pump bump. This can be inflammation in the bursa sac that surrounds the insertion of the Achilles tendon, scar tissue from continuous tares of the tendon, or even some calcium buildup. In this situation the wearing of closed back shoes could irritate the bump. In the event of a rupture, which is rare, the foot will not be able to go through the final stage of push off causing instability. Finally, you may experience discomfort, even cramping in the calf muscle.
Diagnosis
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Nonsurgical Treatment
Most cases of Achilles tendonitis can be treated at home. Here's what to do. Stop doing the activity that led to the injury. Avoid putting stress on your legs and feet, and give your tendon plenty of time to fully recover. Use the RICE formula. Don't exercise for a few days, or try an exercise that doesn't stress your feet, such as swimming. If necessary, your doctor may recommend that you use crutches or wear a walking boot to keep weight off your foot. Apply an ice pack wrapped in a towel or a cold compress to your tendon for 15 minutes or more after you exercise or if you feel pain in the tendon. Use tape or an athletic wrap to keep swelling down and help support and immobilize the tendon. Lie down and raise your foot above the level of your heart, and if possible, try to sleep with your foot elevated. This will help keep the swelling to a minimum. Take anti-inflammatory medications. Pain relievers like ibuprofen can help ease pain and reduce swelling in the affected area. Stretch and exercise your ankles and calf muscles while you recover. Keeping your muscles, tendons, and ligaments strong and flexible will aid in your recovery and help you keep from reinjuring your Achilles tendon. A doctor or a physical therapist can help you come up with a good exercise program. Try a pair of prescription orthotic inserts for your shoes if your doctor thinks it will help. Sometimes orthotics can be helpful. Talk to your doctor or someone trained in fitting orthotics to find out if they might work for you. Achilles tendon surgery is rarely needed. It's usually only done if the tendon breaks, and then only as a last resort after other methods of therapy have been tried. Most cases of Achilles tendonitis will get better on their own with rest and minor treatment.
Surgical Treatment
There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren't effective. Gastrocnemius recession - The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair - During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.
Prevention
While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.
Fallen Arches?
Overview
A variety of foot problems can lead to adult acquired flatfoot deformity (AAFD), a condition that results in a fallen arch with the foot pointed outward. Most people - no matter what the cause of their flatfoot - can be helped with orthotics and braces. In patients who have tried orthotics and braces without any relief, surgery can be a very effective way to help with the pain and deformity. This article provides a brief overview of the problems that can result in AAFD. Further details regarding the most common conditions that cause an acquired flatfoot and their treatment options are provided in separate articles. Links to those articles are provided.
Causes
As children grow, their legs will experience developmental changes that can result in excess flattening of the arches with weight bearing. One example is genu valgum, or knock-knees, a usually normal, temporary condition in children at different stages of growth. A tight calf muscle or Achilles tendon can also contribute to a flat foot. Many children will experience tight calf muscles as they go through growth spurts. Conditions that are present at birth and are often diagnosed early include: metatarsus adductus, calcaneovalgus and congenital vertical talus. Tarsal coalitions are congenitally fused foot bones that cause a rigid flat foot often associated with painful muscle spasms. This type of flat foot is usually diagnosed later in childhood or in adulthood. Any condition that causes loose ligaments can result in a flat foot or lower-than-normal arch. Ligaments are bands of tissue that connect bones to each other and have an important role in giving form to foot arches. An example of a condition that causes loosening of ligaments is pregnancy, where normal hormonal changes relax the ligaments. Diseases that cause loose ligaments include Ehlers-Danlos syndrome, Marfan's syndrome and rheumatoid arthritis. If one leg is longer than the other, one foot may be flat in relation to the other to compensate. Usually the foot on the longer limb will have a flatter arch in an effort to shorten that limb, balancing-out the unevenness. Leg length inequality can be caused by spinal abnormalities such as scoliosis. It can also be due to an actual difference in length of one leg bone compared to the other.
Symptoms
Feet tire easily and become painful and achy, especially around the arch, ankle and heel. Swelling on the inside bottom of your feet. Back and leg pain. Difficulty standing on toes.
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.
Non Surgical Treatment
If the flat foot is rigid and causing problems, you will be referred to a foot specialist. Talk with your doctor about the best treatment plan for you. Options include the following. Physical Therapy and Exercises. Physical therapy may relieve discomfort. You may be given a specific stretching and strength program. You may also have treatment to help manage the discomfort. Exercises can help with the strength of the surrounding muscles. It may relieve some of the pressure in the foot. Orthotics are shoe inserts that support the foot. These inserts may help to reduce pain and disability in some people. In mild cases, a well-fitting pair of shoes with arch support may be all that is needed. Flat feet caused by nerve or muscle disease may need special braces. Fallen arches are usually treated using stretching exercises, physical therapy and medication (to reduce inflammation). In extreme cases however, surgery is recommended.
Surgical Treatment
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.
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.
A variety of foot problems can lead to adult acquired flatfoot deformity (AAFD), a condition that results in a fallen arch with the foot pointed outward. Most people - no matter what the cause of their flatfoot - can be helped with orthotics and braces. In patients who have tried orthotics and braces without any relief, surgery can be a very effective way to help with the pain and deformity. This article provides a brief overview of the problems that can result in AAFD. Further details regarding the most common conditions that cause an acquired flatfoot and their treatment options are provided in separate articles. Links to those articles are provided.
Causes
As children grow, their legs will experience developmental changes that can result in excess flattening of the arches with weight bearing. One example is genu valgum, or knock-knees, a usually normal, temporary condition in children at different stages of growth. A tight calf muscle or Achilles tendon can also contribute to a flat foot. Many children will experience tight calf muscles as they go through growth spurts. Conditions that are present at birth and are often diagnosed early include: metatarsus adductus, calcaneovalgus and congenital vertical talus. Tarsal coalitions are congenitally fused foot bones that cause a rigid flat foot often associated with painful muscle spasms. This type of flat foot is usually diagnosed later in childhood or in adulthood. Any condition that causes loose ligaments can result in a flat foot or lower-than-normal arch. Ligaments are bands of tissue that connect bones to each other and have an important role in giving form to foot arches. An example of a condition that causes loosening of ligaments is pregnancy, where normal hormonal changes relax the ligaments. Diseases that cause loose ligaments include Ehlers-Danlos syndrome, Marfan's syndrome and rheumatoid arthritis. If one leg is longer than the other, one foot may be flat in relation to the other to compensate. Usually the foot on the longer limb will have a flatter arch in an effort to shorten that limb, balancing-out the unevenness. Leg length inequality can be caused by spinal abnormalities such as scoliosis. It can also be due to an actual difference in length of one leg bone compared to the other.
Symptoms
Feet tire easily and become painful and achy, especially around the arch, ankle and heel. Swelling on the inside bottom of your feet. Back and leg pain. Difficulty standing on toes.
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical and foot exam will be done. Flat feet can be diagnosed by appearance. To determine if the foot is rigid, you may be asked to do some simple tasks.
Non Surgical Treatment
If the flat foot is rigid and causing problems, you will be referred to a foot specialist. Talk with your doctor about the best treatment plan for you. Options include the following. Physical Therapy and Exercises. Physical therapy may relieve discomfort. You may be given a specific stretching and strength program. You may also have treatment to help manage the discomfort. Exercises can help with the strength of the surrounding muscles. It may relieve some of the pressure in the foot. Orthotics are shoe inserts that support the foot. These inserts may help to reduce pain and disability in some people. In mild cases, a well-fitting pair of shoes with arch support may be all that is needed. Flat feet caused by nerve or muscle disease may need special braces. Fallen arches are usually treated using stretching exercises, physical therapy and medication (to reduce inflammation). In extreme cases however, surgery is recommended.
Surgical Treatment
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.
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.
Does Pain In The Arches Need Surgical Procedures ?
Overview
A person with flat feet (fallen arches) has low arches or no arches at all. Most cases don't cause problems and treatment isn't usually needed. The arch, or instep, is the inside part of the foot that's usually raised off the ground when you stand, while the rest of the foot remains flat on the ground. Most people have a noticeable space on the inner part of their foot (the arch). The height of the arch varies from person to person.
Causes
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Symptoms
Repetitive exertive activity arch pain is usually sharp, and localized to a specific area, rather than the entire arch. Usually the pain occurs in the area just in front of the heel. It is present when first standing on the foot in the morning, but may decrease once you start walking around, but will, gradually becomes worse with continued walking or running. Swelling may be present. The pain subsides with rest, but stretching the arch while resting may cause the pain to return. Injury pain is constantly present, but worse when standing on the foot. This pain is localized to a specific area, but may radiate out from this area to the entire foot. The pain is sharp, and usually accompanied by swelling and occasionally "black and blue" discolorations. The pain due to the natural aging process is usually dull and aching, or stiff, and can be felt throughout the entire arch area, rather then in just one spot. This pain is present whenever weight bearing, and usually becomes worse with continued walking. The pain gradually subsides when resting, and usually does not return with stretching. Biomechanical defect pain is usually localized to a section of the arch, such as the inner, middle, outer, front, or back of the arch. This pain may be sharp or dull, but is always worse with continued walking.
Diagnosis
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.
Non Surgical Treatment
Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain. Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
Surgical Treatment
There are two types of bone procedure for flat feet, those where bone cuts and bone grafts are used to alter the alignment by avoiding any joint structures, or joint invasive procedures (called fusions or arthrodeses) that remove a joint to reshape the foot. With joint fusion procedures, there are those procedures that involve non-essential joints of the foot versus those that involve essential joints. All bone procedures have their place in flat foot surgery, and Dr. Blitz carefully evaluates each foot to preserve as much motion and function while obtaining proper and adequate alignment. In many cases a flat foot reconstruction involves both soft tissue procedures and bone procedures to rebuild and restore the arch. There are several joints in the arch of the foot that can collapse - and these joints are non-essential joints of the foot. This does not mean that they do not have a purpose, but rather become inefficient is providing a stable platform for function. As such, locking these non-essential non-functioning joints into place is commonly recommended. These joints are fused together with screws and/or plates. A heel bone that is no longer in proper position and pushed outwards away from the foot can be corrected with a bone cut and realignment procedure, so long as the displacement is not too significant. A benefit of this surgery is that it keeps the back portion of the foot mobile, and helps the surrounding tendons work for efficiently in maintaining the arch. In certain flat feet, the foot is deviated outwards and away from the midline of the body. Sometimes, this is due to the outer portion of the foot being shorter than the inner portion. Here bone graft can be added to the outer edge of the foot to lengthen the foot to swing the foot over into a corrected position. This procedure is most commonly performed in children and young adults. A bone graft is inserted into the top part of the arch to realign a component of the flat foot, medically known as forefoot varus or medial column elevatus. The back part of the foot (called the rearfoot complex) can be the cause (or source) of the flat foot or the simply affected by the flat foot foot. In simple terms, the back part of the foot can be made to flatten out due to arch problems - and vica versa for that matter. Dr. Blitz specifically identifies the cause of the flat foot as this will determine the best treatment plan, as each flat foot needs to be evaluated individually. The rearfoot is made up of three joints, and depending on the extent and most importantly the rigidity of these joints, they may require fusion to restore alignment. When all three joints require fusion - this call is a triple arthrodesis. For completeness, isolated fusion of any of the three joints can be performed (such as subtalar joint arthrodesis, talonavicular arthrodesis, and calcaneaocuboid joint arthrodesis). The medical decision making for isolated fusions is beyond the scope this article, but Dr. Blitz tries to avoid any rearfoot fusion for flexible feet because these are joints are essential joints of the foot, especially in younger people. Those in severe cases, it may be advantageous to provide re-alignment.
Prevention
Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.
Stretching Exercises
Stretching your calf and Achilles tendon may also help as a tight Achilles can make your foot overpronate. To stretch your calf and Achilles tendon, step forwards with your left leg and bend it, with your right leg straight and both feet pointing forwards. Push your right heel into the ground while keeping your right leg straight; you should feel the stretch at the back of your right leg, below the knee. Hold the stretch for 15 to 30 seconds and repeat with the opposite leg. Repeat the stretch two to four times on each leg, and repeat the overall exercise three to four times a day.
A person with flat feet (fallen arches) has low arches or no arches at all. Most cases don't cause problems and treatment isn't usually needed. The arch, or instep, is the inside part of the foot that's usually raised off the ground when you stand, while the rest of the foot remains flat on the ground. Most people have a noticeable space on the inner part of their foot (the arch). The height of the arch varies from person to person.
Causes
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Symptoms
Repetitive exertive activity arch pain is usually sharp, and localized to a specific area, rather than the entire arch. Usually the pain occurs in the area just in front of the heel. It is present when first standing on the foot in the morning, but may decrease once you start walking around, but will, gradually becomes worse with continued walking or running. Swelling may be present. The pain subsides with rest, but stretching the arch while resting may cause the pain to return. Injury pain is constantly present, but worse when standing on the foot. This pain is localized to a specific area, but may radiate out from this area to the entire foot. The pain is sharp, and usually accompanied by swelling and occasionally "black and blue" discolorations. The pain due to the natural aging process is usually dull and aching, or stiff, and can be felt throughout the entire arch area, rather then in just one spot. This pain is present whenever weight bearing, and usually becomes worse with continued walking. The pain gradually subsides when resting, and usually does not return with stretching. Biomechanical defect pain is usually localized to a section of the arch, such as the inner, middle, outer, front, or back of the arch. This pain may be sharp or dull, but is always worse with continued walking.
Diagnosis
The adult acquired flatfoot, secondary to posterior tibial tendon dysfunction, is diagnosed in a number of ways with no single test proven to be totally reliable. The most accurate diagnosis is made by a skilled clinician utilizing observation and hands on evaluation of the foot and ankle. Observation of the foot in a walking examination is most reliable. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit. An easy test to perform in the office is the single foot raise.
Non Surgical Treatment
Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain. Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
Surgical Treatment
There are two types of bone procedure for flat feet, those where bone cuts and bone grafts are used to alter the alignment by avoiding any joint structures, or joint invasive procedures (called fusions or arthrodeses) that remove a joint to reshape the foot. With joint fusion procedures, there are those procedures that involve non-essential joints of the foot versus those that involve essential joints. All bone procedures have their place in flat foot surgery, and Dr. Blitz carefully evaluates each foot to preserve as much motion and function while obtaining proper and adequate alignment. In many cases a flat foot reconstruction involves both soft tissue procedures and bone procedures to rebuild and restore the arch. There are several joints in the arch of the foot that can collapse - and these joints are non-essential joints of the foot. This does not mean that they do not have a purpose, but rather become inefficient is providing a stable platform for function. As such, locking these non-essential non-functioning joints into place is commonly recommended. These joints are fused together with screws and/or plates. A heel bone that is no longer in proper position and pushed outwards away from the foot can be corrected with a bone cut and realignment procedure, so long as the displacement is not too significant. A benefit of this surgery is that it keeps the back portion of the foot mobile, and helps the surrounding tendons work for efficiently in maintaining the arch. In certain flat feet, the foot is deviated outwards and away from the midline of the body. Sometimes, this is due to the outer portion of the foot being shorter than the inner portion. Here bone graft can be added to the outer edge of the foot to lengthen the foot to swing the foot over into a corrected position. This procedure is most commonly performed in children and young adults. A bone graft is inserted into the top part of the arch to realign a component of the flat foot, medically known as forefoot varus or medial column elevatus. The back part of the foot (called the rearfoot complex) can be the cause (or source) of the flat foot or the simply affected by the flat foot foot. In simple terms, the back part of the foot can be made to flatten out due to arch problems - and vica versa for that matter. Dr. Blitz specifically identifies the cause of the flat foot as this will determine the best treatment plan, as each flat foot needs to be evaluated individually. The rearfoot is made up of three joints, and depending on the extent and most importantly the rigidity of these joints, they may require fusion to restore alignment. When all three joints require fusion - this call is a triple arthrodesis. For completeness, isolated fusion of any of the three joints can be performed (such as subtalar joint arthrodesis, talonavicular arthrodesis, and calcaneaocuboid joint arthrodesis). The medical decision making for isolated fusions is beyond the scope this article, but Dr. Blitz tries to avoid any rearfoot fusion for flexible feet because these are joints are essential joints of the foot, especially in younger people. Those in severe cases, it may be advantageous to provide re-alignment.
Prevention
Strap the arches into the anatomically correct positions with athletic tape and leave them like this for some time. If the fallen arches are an issue with the muscular structure, this may give the muscles an opportunity to strengthen. This is definitely not a fallen arches cure all the time but it can help prevent it more times than not. Ask a doctor or physical therapists to show you how to do this taping. Find shoes that fit. This may require that you get your foot measured and molded to ensure that the shoe will fit. Shoes that are too big, too tight or too short, may not directly cause the fallen arches, but they can assist with the damage to the area. These shoes should have thick cushioning inside and have plenty of room for your toes. Walk without shoes as much as possible. Shoes directly assist with weakening and distorting the arches of the feet so going without shoes can actually help strengthen your arches and prevent fallen arches. Walking on hard and bumpy surfaces barefooted makes the muscles in your feet strengthen in order to prevent injury. It is a coping mechanism by your body. Insert heel cups or insoles into the shoes that you wear the most. Many people wear uncomfortable shoes to work and these are the same shoes that cause their arches the most problems. Inserting the heel cups and insoles into these shoes can prevent fallen arches from occurring. Many people place these inserts into all their shoes to ensure support. Ask a medical professional, either your doctor or a physical therapist, about daily foot exercises that may keep the arches stronger than normal. Many times, you can find exercises and stretches on the Internet on various websites. Curling your toes tightly and rotating your feet will help strengthen your longitudinal arches. Relax your feet and shake them for a minute or so before you do any arch exercises. This will loosen the muscles in your feet that stay tight due to normal daily activities. Wear rigid soled sandals whenever possible to provide a strong support for your arches. Wooden soled sandals are the best ones if available. Walk or jog on concrete as much as you can. This will create a sturdy support for your arches. Running or walking in sandy areas or even on a treadmill, does not give rigid support. Instead, these surfaces absorb the step, offering no support for arches.
Stretching Exercises
Stretching your calf and Achilles tendon may also help as a tight Achilles can make your foot overpronate. To stretch your calf and Achilles tendon, step forwards with your left leg and bend it, with your right leg straight and both feet pointing forwards. Push your right heel into the ground while keeping your right leg straight; you should feel the stretch at the back of your right leg, below the knee. Hold the stretch for 15 to 30 seconds and repeat with the opposite leg. Repeat the stretch two to four times on each leg, and repeat the overall exercise three to four times a day.
Adult Aquired Flat Feet
Overview
Most flat feet aren't painful, especially individuals flat feet observed in children. Throughout the actual adult acquired flatfoot, pain occurs since soft tissues (tendons and also ligaments) happen to end up being able to be torn. the deformity progresses or perhaps worsens because when the important ligaments along with posterior tibial tendon tend to be lost, absolutely nothing will take their own location to carry up the arch of the foot. Your painful, progressive adult acquired flatfoot affects ladies 4 times as frequently as men. The idea occur in center in order to older age group people with a imply ages of 60 years. most those who develop the particular situation already have flat feet. The alter occurs in one foot where the arch starts to flatten a lot more than before, along with pain and also swelling creating around the inside in the ankle. Why this event occur in some people (female more than male) and only in a new single foot remains poorly understood. Contributing aspects helping the likelihood of adult acquired flatfoot are generally diabetes, hypertension, along with obesity.
Causes
Several risk aspects are usually associated using PTT dysfunction, including high blood pressure, obesity, diabetes, previous ankle surgery or perhaps trauma as well as exposure in order to steroids. The one who suspects they tend to be suffering coming from PTT dysfunction should seek health-related attention earlier instead of later. It is much easier to treat early and avoid a new collapsed arch of computer would become to repair one. Whenever the pain sensation 1st happens there is no significant flatfoot deformity, first treatments contain rest, oral anti-inflammatory medications and, depending about the severity, a special boot or brace.
Symptoms
Not everyone along with adult flatfoot has issues with pain. These whom do usually feel it around the ankle or within the heel. the pain is usually a whole lot worse using activity, such as walking or perhaps standing with regard to extended periods. Sometimes, if the situation develops through arthritis within the foot, bony spurs across the top and side of the foot develop and also make wearing shoes much more painful. Diabetic patients must watch pertaining to swelling or perhaps significant lumps inside the feet, while they may not notice just about any pain. they are also in higher risk regarding developing significant deformities via their own flatfoot.
Diagnosis
The diagnosis associated with tibialis posterior dysfunction is essentially clinical. However, plain radiographs of the foot and ankle are usually ideal for assessing your amount of deformity and furthermore to confirm the existence as well as deficiency of degenerative changes inside the subtalar along with ankle articulations. the radiographs may additionally be useful to exclude additional leads to of an acquired flatfoot deformity. Your the majority of beneficial radiographs are generally bilateral anteroposterior and lateral radiographs in the foot along together with a mortise (true anteroposterior) take a peek at the particular ankle. Just About All radiographs needs to be done with almost all the affected person standing. Inside many cases we have seen no role pertaining to magnetic resonance imaging or perhaps ultrasonography, because the diagnosis can end up being produced clinically.
Non surgical Treatment
Medical or even nonoperative therapy with regard to posterior tibial tendon dysfunction involves rest, immobilization, nonsteroidal anti-inflammatory medication, physical therapy, orthotics, along with bracing. This kind of treatment can be especially attractive with regard to patients who're elderly, which location lower demands about the tendon, as well as who might have got underlying healthcare problems that preclude operative intervention. during stage one posterior tibial tendon dysfunction, pain, rather than deformity, predominates. Cast immobilization will be indicated pertaining to acute tenosynovitis with the posterior tibial tendon or regarding patients whose main presenting feature will be chronic pain along the tendon sheath. A New well-molded short leg walking cast or perhaps removable cast boot ought for you to be employed for 6-8 weeks. Excess Weight bearing is actually permitted in the wedding the individual can be in a new position to ambulate without pain. In the event that improvement will be noted, your individual then might end up being placed in custom full-length semirigid orthotics. The Particular patient might then always be referred to always be able to physical therapy regarding stretching of the Achilles tendon and also strengthening of the posterior tibial tendon. Steroid injection in in order to the posterior tibial tendon sheath isn't suggested due to the possibility of causing a tendon rupture. in stage two dysfunction, a painful flexible deformity develops, plus more control of hindfoot motion will be required. Within these cases, any rigid University Or College regarding California at Berkley (UCBL) orthosis or even brief articulated ankle-foot orthosis (AFO) is indicated. When any rigid flatfoot deformity develops, as with stage 3 or perhaps 4, bracing is extended higher than the ankle using a molded AFO, double upright brace, or patellar-tendon-bearing brace. the objectives associated with this therapy are likely to accommodate the actual deformity, avoid or even slow further collapse, as well as enhance strolling ability through transferring load towards the proximal leg away from the collapsed medial midfoot along with heel.
Surgical Treatment
Many operations are obtainable for that remedy regarding dysfunction of the posterior tibial tendon following a thorough plan involving non-operative treatment provides failed. The Actual type of operation that is selected will be decided through the age, weight, along with amount of activity of the individual too because the extent of the deformity. the clinical phases defined formerly are a helpful help guidebook to operative care (Table I). in general, the actual clinician ought to carry out minimal invasive procedure that may lower pain as well as enhance function. one should think about the results of each procedure, particularly those regarding arthrodesis, about the operate involving the rest of the foot and also ankle.
Most flat feet aren't painful, especially individuals flat feet observed in children. Throughout the actual adult acquired flatfoot, pain occurs since soft tissues (tendons and also ligaments) happen to end up being able to be torn. the deformity progresses or perhaps worsens because when the important ligaments along with posterior tibial tendon tend to be lost, absolutely nothing will take their own location to carry up the arch of the foot. Your painful, progressive adult acquired flatfoot affects ladies 4 times as frequently as men. The idea occur in center in order to older age group people with a imply ages of 60 years. most those who develop the particular situation already have flat feet. The alter occurs in one foot where the arch starts to flatten a lot more than before, along with pain and also swelling creating around the inside in the ankle. Why this event occur in some people (female more than male) and only in a new single foot remains poorly understood. Contributing aspects helping the likelihood of adult acquired flatfoot are generally diabetes, hypertension, along with obesity.
Causes
Several risk aspects are usually associated using PTT dysfunction, including high blood pressure, obesity, diabetes, previous ankle surgery or perhaps trauma as well as exposure in order to steroids. The one who suspects they tend to be suffering coming from PTT dysfunction should seek health-related attention earlier instead of later. It is much easier to treat early and avoid a new collapsed arch of computer would become to repair one. Whenever the pain sensation 1st happens there is no significant flatfoot deformity, first treatments contain rest, oral anti-inflammatory medications and, depending about the severity, a special boot or brace.
Symptoms
Not everyone along with adult flatfoot has issues with pain. These whom do usually feel it around the ankle or within the heel. the pain is usually a whole lot worse using activity, such as walking or perhaps standing with regard to extended periods. Sometimes, if the situation develops through arthritis within the foot, bony spurs across the top and side of the foot develop and also make wearing shoes much more painful. Diabetic patients must watch pertaining to swelling or perhaps significant lumps inside the feet, while they may not notice just about any pain. they are also in higher risk regarding developing significant deformities via their own flatfoot.
Diagnosis
The diagnosis associated with tibialis posterior dysfunction is essentially clinical. However, plain radiographs of the foot and ankle are usually ideal for assessing your amount of deformity and furthermore to confirm the existence as well as deficiency of degenerative changes inside the subtalar along with ankle articulations. the radiographs may additionally be useful to exclude additional leads to of an acquired flatfoot deformity. Your the majority of beneficial radiographs are generally bilateral anteroposterior and lateral radiographs in the foot along together with a mortise (true anteroposterior) take a peek at the particular ankle. Just About All radiographs needs to be done with almost all the affected person standing. Inside many cases we have seen no role pertaining to magnetic resonance imaging or perhaps ultrasonography, because the diagnosis can end up being produced clinically.
Non surgical Treatment
Medical or even nonoperative therapy with regard to posterior tibial tendon dysfunction involves rest, immobilization, nonsteroidal anti-inflammatory medication, physical therapy, orthotics, along with bracing. This kind of treatment can be especially attractive with regard to patients who're elderly, which location lower demands about the tendon, as well as who might have got underlying healthcare problems that preclude operative intervention. during stage one posterior tibial tendon dysfunction, pain, rather than deformity, predominates. Cast immobilization will be indicated pertaining to acute tenosynovitis with the posterior tibial tendon or regarding patients whose main presenting feature will be chronic pain along the tendon sheath. A New well-molded short leg walking cast or perhaps removable cast boot ought for you to be employed for 6-8 weeks. Excess Weight bearing is actually permitted in the wedding the individual can be in a new position to ambulate without pain. In the event that improvement will be noted, your individual then might end up being placed in custom full-length semirigid orthotics. The Particular patient might then always be referred to always be able to physical therapy regarding stretching of the Achilles tendon and also strengthening of the posterior tibial tendon. Steroid injection in in order to the posterior tibial tendon sheath isn't suggested due to the possibility of causing a tendon rupture. in stage two dysfunction, a painful flexible deformity develops, plus more control of hindfoot motion will be required. Within these cases, any rigid University Or College regarding California at Berkley (UCBL) orthosis or even brief articulated ankle-foot orthosis (AFO) is indicated. When any rigid flatfoot deformity develops, as with stage 3 or perhaps 4, bracing is extended higher than the ankle using a molded AFO, double upright brace, or patellar-tendon-bearing brace. the objectives associated with this therapy are likely to accommodate the actual deformity, avoid or even slow further collapse, as well as enhance strolling ability through transferring load towards the proximal leg away from the collapsed medial midfoot along with heel.
Surgical Treatment
Many operations are obtainable for that remedy regarding dysfunction of the posterior tibial tendon following a thorough plan involving non-operative treatment provides failed. The Actual type of operation that is selected will be decided through the age, weight, along with amount of activity of the individual too because the extent of the deformity. the clinical phases defined formerly are a helpful help guidebook to operative care (Table I). in general, the actual clinician ought to carry out minimal invasive procedure that may lower pain as well as enhance function. one should think about the results of each procedure, particularly those regarding arthrodesis, about the operate involving the rest of the foot and also ankle.
Pain In The Arches Everything You Need To Understand
Overview
Like flat feet, high arches may be present from birth, or caused by conditions such as stroke or Charcot-Marie-Tooth disease. Usually, high arches do not cause pain, although you may need custom orthotic cushions made for your shoes. Surgery may become necessary if your high arch foot becomes too painful or leads to arthritis or a stress fracture. Surgery may include reconstructing a ligament, fusing the hindfoot, shifting bones to better alignment, and transferring a tendon from one part of the foot to another.
Causes
There are a variety of causes of flat feet. Flat feet can be genetic, acquired and develop over time. Young children and teens can have no arches. Injury can lead to flat feet. Tendon problems, and arthritis can lead to flat feet. Rigid flat feet may occur from a condition called tarsal coalition, where the bones in the back of the foot are genetically fused or locked together.
Symptoms
Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.
Diagnosis
The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma.
Non Surgical Treatment
A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed.
Surgical Treatment
Although most patients with plantar fasciitis respond to non- surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstays of long-term treatment for plantar fasciitis.
Prevention
Arch pain occurs when the plantar fascia becomes worn down due to constant strain or excessive exercising. This may be caused by increasing your running or hiking mileage too fast, wearing inadequate footwear, lack of stretching, running on steep hills, standing on your feet for too long and abnormal anatomy such as flat foot. Stretching is an important exercise that should not be overlooked because the tightness or lack of tightness of the joints in the foot can also cause pain in the arch.
Stretching Exercises
Plantar Fasciitis stretches can be incorporated into a comprehensive treatment regime which may involve: ice, heel wedge support, taping, massage, muscle strengthening, orthotic inserts for shoes, topical anti inflammatory gel or oral medication and/or corticosteroid injections. If you suspect you may have Plantar Fasciitis seek accurate diagnosis and treatment from a health professional to ensure a correct diagnosis and reduce the likelihood of developing chronic foot pain. Treatment interventions may be provided by your Physical Therapist, Podiatrist and/or doctor.
Like flat feet, high arches may be present from birth, or caused by conditions such as stroke or Charcot-Marie-Tooth disease. Usually, high arches do not cause pain, although you may need custom orthotic cushions made for your shoes. Surgery may become necessary if your high arch foot becomes too painful or leads to arthritis or a stress fracture. Surgery may include reconstructing a ligament, fusing the hindfoot, shifting bones to better alignment, and transferring a tendon from one part of the foot to another.
Causes
There are a variety of causes of flat feet. Flat feet can be genetic, acquired and develop over time. Young children and teens can have no arches. Injury can lead to flat feet. Tendon problems, and arthritis can lead to flat feet. Rigid flat feet may occur from a condition called tarsal coalition, where the bones in the back of the foot are genetically fused or locked together.
Symptoms
Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.
Diagnosis
The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma.
Non Surgical Treatment
A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed.
Surgical Treatment
Although most patients with plantar fasciitis respond to non- surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstays of long-term treatment for plantar fasciitis.
Prevention
Arch pain occurs when the plantar fascia becomes worn down due to constant strain or excessive exercising. This may be caused by increasing your running or hiking mileage too fast, wearing inadequate footwear, lack of stretching, running on steep hills, standing on your feet for too long and abnormal anatomy such as flat foot. Stretching is an important exercise that should not be overlooked because the tightness or lack of tightness of the joints in the foot can also cause pain in the arch.
Stretching Exercises
Plantar Fasciitis stretches can be incorporated into a comprehensive treatment regime which may involve: ice, heel wedge support, taping, massage, muscle strengthening, orthotic inserts for shoes, topical anti inflammatory gel or oral medication and/or corticosteroid injections. If you suspect you may have Plantar Fasciitis seek accurate diagnosis and treatment from a health professional to ensure a correct diagnosis and reduce the likelihood of developing chronic foot pain. Treatment interventions may be provided by your Physical Therapist, Podiatrist and/or doctor.
Pain In The Arch What Are The Triggers ?
Overview
Arch pain occurs with an inflammation of the plantar arch or fascia. It is the thick membrane that covers and supports all the muscles of the sole of the foot from the heel bone to the base of the toes that is called plantar arch. When this membrane pulls excessively (constant strain), pain developes in the arch of the foot or heel.
Causes
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition. Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin. Obesity. Very high arch. Repetitive impact activity (running/sports). New or increased activity.Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.
Symptoms
Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot and may manifest either as a specific or general area of tenderness. Plantar fascia pain may be increased or decreased by stretching of the arch. Generally, in mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot "warm up"; however, pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed. A more specific pain (point tenderness) is an indicator that something is wrong in that specific area. Pain with movement of the affected area is also an indicator of the particular body part affected.
Diagnosis
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch. An area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle.
Non Surgical Treatment
When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.
Surgical Treatment
If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.
Prevention
There are several things you can do to prevent pain on the bottom of the foot. Here are some tips to help you avoid this condition. Do simple stretches each day (See Plantar Fasciitis Exercises for a list of all exercises). Wear good shoes that fit properly and are appropriate for the activity you are participating in. Lose excess weight if possible. Build your stamina slowly, especially with new exercises. Rest and elevate your feet, whenever possible, keeping them at least twelve inches above your heart. Always follow your doctor?s instructions for treatment. Each day do a different activity. For example: one day ride your bike, and swim the next day.
Stretching Exercises
Calf Raises. Strengthens the tendons in your heels and calf muscles, which support your arch. Raise up on the balls of your feet as high as possible. Slowly lower down. Do three sets of 10 reps. Progress to doing the raises on stairs (with heels hanging off), and then to single-leg raises. Step Stretch. Improves flexibility in your Achilles tendon and calf-when these areas become tight, the arch gets painfully overloaded. Stand at the edge of a step, toes on step, heels hanging off. Lower your heels down, past the step, then raise back up to the start position. Do three sets of 10 reps. Doming. Works the arch muscles and the tibialis posterior (in the calf and foot) to control excess pronation. While standing, press your toes downward into the ground while keeping the heel planted, so that your foot forms an arch (or dome). Release, and do three sets of 10 reps on each foot. Toe Spread and Squeeze. Targets the interossei muscles of the foot, which support the arch. While sitting, loop a small resistance band around your toes. Spread toes; release. Then place a toe separator (used at nail salons) in between toes. Squeeze toes in; release. Do three sets of 10 reps of each exercise on both feet. Towel Curls. Works the toe-flexor muscles that run along your arch to increase overall foot strength. Lay a small hand towel on the floor, and place one foot on the towel. Using just your toes, scrunch the towel toward you, hold, then slowly push the towel away from you back to start position. Do three sets of 10 reps on each foot.
Arch pain occurs with an inflammation of the plantar arch or fascia. It is the thick membrane that covers and supports all the muscles of the sole of the foot from the heel bone to the base of the toes that is called plantar arch. When this membrane pulls excessively (constant strain), pain developes in the arch of the foot or heel.
Causes
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition. Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin. Obesity. Very high arch. Repetitive impact activity (running/sports). New or increased activity.Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.
Symptoms
Pain and tenderness associated with plantar fascia strains are usually felt on the bottom of the foot and may manifest either as a specific or general area of tenderness. Plantar fascia pain may be increased or decreased by stretching of the arch. Generally, in mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot "warm up"; however, pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed. A more specific pain (point tenderness) is an indicator that something is wrong in that specific area. Pain with movement of the affected area is also an indicator of the particular body part affected.
Diagnosis
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch. An area of maximum tenderness on the bottom of your foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion of your ankle.
Non Surgical Treatment
When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.
Surgical Treatment
If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.
Prevention
There are several things you can do to prevent pain on the bottom of the foot. Here are some tips to help you avoid this condition. Do simple stretches each day (See Plantar Fasciitis Exercises for a list of all exercises). Wear good shoes that fit properly and are appropriate for the activity you are participating in. Lose excess weight if possible. Build your stamina slowly, especially with new exercises. Rest and elevate your feet, whenever possible, keeping them at least twelve inches above your heart. Always follow your doctor?s instructions for treatment. Each day do a different activity. For example: one day ride your bike, and swim the next day.
Stretching Exercises
Calf Raises. Strengthens the tendons in your heels and calf muscles, which support your arch. Raise up on the balls of your feet as high as possible. Slowly lower down. Do three sets of 10 reps. Progress to doing the raises on stairs (with heels hanging off), and then to single-leg raises. Step Stretch. Improves flexibility in your Achilles tendon and calf-when these areas become tight, the arch gets painfully overloaded. Stand at the edge of a step, toes on step, heels hanging off. Lower your heels down, past the step, then raise back up to the start position. Do three sets of 10 reps. Doming. Works the arch muscles and the tibialis posterior (in the calf and foot) to control excess pronation. While standing, press your toes downward into the ground while keeping the heel planted, so that your foot forms an arch (or dome). Release, and do three sets of 10 reps on each foot. Toe Spread and Squeeze. Targets the interossei muscles of the foot, which support the arch. While sitting, loop a small resistance band around your toes. Spread toes; release. Then place a toe separator (used at nail salons) in between toes. Squeeze toes in; release. Do three sets of 10 reps of each exercise on both feet. Towel Curls. Works the toe-flexor muscles that run along your arch to increase overall foot strength. Lay a small hand towel on the floor, and place one foot on the towel. Using just your toes, scrunch the towel toward you, hold, then slowly push the towel away from you back to start position. Do three sets of 10 reps on each foot.
