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Flat foot Defined & Detailed
When the entire length of the sole of the foot remains in complete or partial contact with the ground surface while in the standing posture, the condition is referred to as a flat foot where there is absence (flattening) of arch to the foot.
Flat foot is a fairly common disorder and a complex deformity. There are types and stages that present in varying and diverse degree of symptoms and disability. The various other names flat feet are also referred to as are pes planus, posterior tibial tendon dysfunction, and fallen arches.
The heel tilts toward the lateral side and the ankle appears to turn in while the frontal foot and the toes point outward. The Achilles tendon becomes tight which causes the heel to lift off the ground earlier when walking and may make the problem worse. Flat foot often leads to the development of bunions and hammertoes. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and can become inflamed.
The Underlying Causes Of Flat foot
The causes giving rise to flat foot and the associated pain are listed below:
- Posterior Tibial Tendon Dysfunction (PTTD) that may cause the arch to slowly collapse if the tendon becomes inflamed or torn. The people more likely to develop problems with the posterior tibial tendon include the following:
- Age Over 40
- Congenital Flat feet
- Repetitive Use In High Impact Sports
- Hormonal Changes During Pregnancy
- Tarsal Coalitions that is a condition where joints bridge or fuse together, restricting or prohibiting movement of that joint, giving rise to flat foot
- Accessory Navicular Bone (Os Tibiale Externum) that is a small extra bone outgrowth in the posterior tibial tendon which causes a weakening of support to the arch
- Ligament Laxity that in diseases such as Marfan syndrome or Ehlers-Danlos syndrome causes the flat foot condition
- Arthritis that attacks not only the cartilage in the joints, but also the foot supportive ligaments causing pain and the foot to alter its shape and become flat. Either the back or the middle of the foot can be affected by arthritis, producing fallen arch.
- Injury to the ligaments within the foot, tearing them partially or completely, can cause the joints to break up and lose their proper alignment, resulting in pain and flat foot. Apart from ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to flat foot deformity.
- Charcot Arthropathy (Diabetic Collapse) that develops in people suffering from diabetes or neuropathy as their arches collapse due to loosened ligaments and fractured, crumbling bones quite unknowingly. The product is a severely deformed foot whose correction presents as a surgical challenge.
The Symptoms & Indications Of Flat foot
- General Aching Or Fatigue in the affected foot or leg
- Persistent Pain in the inside arch, heel, or ankle and on the outside of the foot just below the ankle
- Rolling In of the foot and ankle (overpronation) and tilting outward of the heel
- Other Discomforts such as shin pain (shin splints), and aching of the knee, hip, and/or lower back
- Probable Swelling on the side of the affected ankle
The Contraindications Of Flat foot
Flat foot surgery is not advisable and should better be avoided in patients having the following conditions:
- People Suffering From Diabetes
- People Suffering From Blood Clots Formation
- People With Wound Problems
- People With Obesity Issues
- People Under Smoking Or Other Drug Addictions
- People Taking Steroids Either Orally, Injectable Or Topical
- People Not Willing Or Able To Follow The Lengthy Recovery Process
The Diagnostic Process Of Flat foot
Your Flat foot Doctor in New York would perform a thorough medical examination of your foot and ankle that usually includes the following:
- A Thorough Medical History for careful decision-making
- A Detailed Physical Examination for general assessment while standing barefoot
- Imaging Techniques that include:
- MRI Scans
The Treatment Course Of Flat foot
Flat foot treatment solely depends on the type of flat foot, its stage of progression, and the associated symptoms. Early treatment is always advised whether one’s flat foot condition is flexible, rigid, or adult acquired. Treatment ranges from nonsurgical methods, such as orthotics and braces, to surgical procedures.
Your podiatric specialist would be able to create a viable treatment plan for you based on the causes of your flat foot issue.
The Nonsurgical Method
If symptoms with flexible (pediatric) flat foot are experienced, your orthopedic surgeon may prefer nonsurgical treatment options over the surgical ones, including:
- Footwear Modifications are requiredby wearing shoes that support the arches in the case of flat foot.
- Immobilization might be necessary in some cases by using a walking cast or to completely avoid weight bearing for several weeks.
- Activity Modifications have to be done by restricting activities that fetch pain & discomfort.
- Prolonged Walking And Standing should be avoided to give your arches a rest.
- Ankle Foot Orthoses (AFO) devices may be recommended byour foot and ankle surgeon that includes advanced bracing to modify your gait and to support your arches.
- Orthotic Devices, usually custom-made, can be provided byyour podiatric surgeon for your shoes to impart more support to the arches.
- Weight Loss is deemed essentialin case you are overweight since exerting excessive weight on your arches may aggravate your symptoms.
- Medications in the form of NSAIDs help reduce pain and inflammation.
- Physical Or Ultrasound Therapy Modalities may be employed to provide temporary relief.
The Surgical Method
In patients whose pain is not adequately relieved by conservative treatments, surgery has be considered as the last resort. Several surgical techniques are available at your surgeon’s disposal to correct the flat foot, and one or a combination of procedures that repair the tendons and ligaments supporting your arch may be required to relieve the symptoms and improve foot shape and function.
The procedure is divided into several categories that repair your damaged tendons and ligaments or correct deformities of the bones (or both). Your podiatric expert would typically perform the procedure under local or general anesthesia. The length of the recovery period would vary depending on the procedure(s) carried out. The specific techniques employed to reconstruct the flat foot are outlined as under:
- Medializing Calcaneal Osteotomy is used when the calcaneus (heel bone) has shifted out from underneath the leg.
- Lateral Column Lengthening procedure is sometimes performed in patients in whom outward rotation of the foot has occurred.
- Tendon & Ligament Procedures usually involve removal of the PTT if it is thickened or torn, repairing damaged structures such as the spring ligament and the deltoid ligament, and treating the tightness of the Achilles tendon by stretching the calf muscle fibers.
- Medial Cuneiform Dorsal Opening Wedge Osteotomy Or First Tarsal-Metatarsal Fusion are performed to treat the condition of the big toe side of the foot hovering over the ground level.
- Double Or Triple Arthrodesis is the fusion of one or more of the foot joints and is undertaken in case of inflexible or rigid deformities, often resulting in arthritis.
The Postsurgical Recovery Phase
Flat foot surgery is often an outpatient procedure so that the operation and discharge take place the same day.
- The leg should be kept elevated for the first two weeks by getting it placed in a splint or cast.
- Sutures are removed at this point.
- A new cast or a removable boot is then placed.
- Patients are required to remain non-weight bearing for 6 to 8 weeks following the procedure.
- If needed, patients may begin bearing weight at 8 weeks and gradually progress to full weight bearing by 10 to 12 weeks.
- After 3 months, patients generally can resort to wearing a shoe, usually with inserts and ankle braces.
- Smoking and taking anti-inflammatory medications should be avoided as this may delay or even interfere with the fusion of the bones together.
- Physiotherapy is often recommended to regain strength and balance lost during the long recovery.
The Risks & Complications Involved
The general complications and risks associated with any surgical procedure include the following:
- Bacterial Infection In The Wound
- Damage To Nerves & Blood Vessels
- Excessive Bleeding
- Blood Clot Formation
- A Bad Reaction To The Anesthesia
- Delayed Wound Healing
The complications associated specifically with the flat foot surgery (foot lift) are as beneath:
- Wound Breakdown Or Nonunion (Incomplete Healing Of The Bones)
- Feeling Of Discomfort Due To Prominent Hardware