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Pes Planus Explained

Overview

Flat Foot

Most people (approx. 60-70% of the population) suffer from excessive pronation due to flat feet when walking, running and standing. Though the foot may appear normal when sitting down, with a clear arch present under the foot, over-pronation becomes noticeable when we stand or walk as a result of weight bearing. The arches collapse with every step we take, and the ankles roll inwards. This is called overpronation, a biomechanical imbalance that can lead to many painful foot conditions such as heel pain, plantar fasciitis, heel spurs, tendonitis, and can even affect other parts of your body such as the knees and lower back.

Causes

There are several reasons why arches fall. It can be genetic, it can be a result of unsupported shoes, a product of our lives and the pressure we put on the feet. Some people have active lifestyles so the wear and tear effect on the muscles there that runs down the back of the calf and wraps around the arch can slacken as we get older. It can be a number of things.

Symptoms

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

Diagnosis

If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination.

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Non Surgical Treatment

For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. Flexible Flatfoot. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot.

Surgical Treatment

Adult Acquired Flat Feet

In cases of flat feet that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required and in some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.

Prevention

Going barefoot, particularly over terrain such as a beach where muscles are given a good workout, is good for all but the most extremely flatfooted, or those with certain related conditions such as plantar fasciitis. Ligament laxity is also among the factors known to be associated with flat feet. One medical study in India with a large sample size of children who had grown up wearing shoes and others going barefoot found that the longitudinal arches of the bare footers were generally strongest and highest as a group, and that flat feet were less common in children who had grown up wearing sandals or slippers than among those who had worn closed-toe shoes. Focusing on the influence of footwear on the prevalence of pes planus, the cross-sectional study performed on children noted that wearing shoes throughout early childhood can be detrimental to the development of a normal or a high medial longitudinal arch. The vulnerability for flat foot among shoe-wearing children increases if the child has an associated ligament laxity condition. The results of the study suggest that children be encouraged to play barefooted on various surfaces of terrain and that slippers and sandals are less harmful compared to closed-toe shoes. It appeared that closed-toe shoes greatly inhibited the development of the arch of the foot more so than slippers or sandals. This conclusion may be a result of the notion that intrinsic muscle activity of the arch is required to prevent slippers and sandals from falling off the child?s foot.

After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.