Flat feet can also develop as an adult ("adult acquired flatfoot") due to injury, illness, unusual or prolonged stress to the foot, faulty biomechanics or as part of the normal aging process. This is most common in women over 40 years of age. Known risk factors include obesity, hypertension and diabetes.Flat feet can also occur in pregnant women as a result of temporary changes, due to increased elastin (elasticity) during pregnancy. However, if developed by adulthood, flat feet generally remain flat permanently.
Footwear: shoes which limit toe movement; high heels. Barefoot walking may be protective. A tight Achilles tendon or calf muscles (heel cord contracture). This may help to cause Pes Planus, or may contribute to symptoms such as foot pain when there is existing Pes Planus. Obesity. Other bony abnormalities, eg rotational deformities, tibial abnormalities, coalition (fusion) of tarsal bones, equinus deformity. Ligamentous laxity, eg familial, Marfan's syndrome, Ehlers-Danlos syndrome, Down's syndrome. Other factors causing foot pronation, eg hip abductor weakness and genu valgum.
Most patients who suffer from flat feet or fallen arches often do not complain of any symptoms whatsoever. However, on some occasions, patients may find that their feet are fatigued fairly easily and following activity on long periods of standing may have a painful foot or arch. On occasions, swelling may be seen on the inner aspect of the foot and performing certain movements may be painful and difficult. Some patients who have flat feet may find that their feet tend to roll in (over-pronate) a lot more when they walk and run. As a result, they may experience damage to the ankle joint and the Achilles tendon, as well as excessive shoe wear.
Determining whether you have fallen arches may be as easy as looking at the shape of the middle bottom of your foot. Is there any kind of arch there? If you cannot find any kind of arch, you may have a flat foot. There are, however, other ways to decide in case you're still not sure. Another way to figure out if you have flat feet is to look at a few pairs of your shoes. Where do you see the most wear on the heels? If you notice significant wear in the heel and the ball of the foot extending to the big toe, this means you are overpronating. Overpronators roll their feet too far inward and commonly have fallen arches. To figure out if you have flat feet, you can also do an easy test. Get the bottoms of your feet wet and then step on to a piece of paper carefully. Step off the paper and take a look at the print your foot made. If your print looks like the entire bottom of a foot, your feet are flat. People with an arch will be missing part of the foot on their print since the arch is elevated off of the paper. Regular visits to your podiatrist are highly recommended.
Non Surgical Treatment
Most cases of flatfeet do not require treatment. However, if there is pain, or if the condition is caused by something other than normal development, there are several treatment options. Self-care options include rest, choosing non-weight-bearing exercise (e.g., swimming, cycling), weight loss, and avoiding high heels. Flexible flatfeet with some pain can be relieved with the use of orthotics-shoe inserts that support the arch-and/or heel wedges (in some cases). If pronation is a factor, special shoes can be worn that lift the arch and correct the inward leaning. Physical therapy may also be prescribed to stretch or lengthen the heel cord and other tendons. For rigid or inflexible flatfeet, treatment varies depending on the cause. Tarsal coalition if often treated with rest and the wearing of a cast. If this is ineffective, surgery can be done to separate the bones or to reset the bones into a correct position. If the flatfoot is caused by an injury to the tendons in the foot or ankle, rest, anti-inflammatory medications (e.g., ibuprofen), and the use of shoe inserts and ankle braces often relieve symptoms. In severe cases, surgery is performed to repair the tendon or to fuse some joints in the foot into a corrected position to reduce stress on the tendon. The prognosis after surgery is generally good. Complications include pain and some loss of ankle motion, especially when trying to turn the foot in or out. This may be improved with physical therapy.
Surgical procedures for flat feet vary depending on the root cause of the condition. Surgical correction to control pronation may include bone implants or Achilles tendon lengthening. Tendon transfer, which is a procedure to re-attach a tendon to another area of bone, may also be used to reduce pronation and improve foot function.
Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches.
Plantar Fasciitis is a common condition that involves degenerative changes (wear and tear) of the thick fibrous band of tissue that runs from the heel bone beneath the arches through to the ball of the foot. Plantar Fasciitis can be caused by a range of factors including: high impact exercises, excessive body weight, hormonal changes and/or foot biomechanics (foot alignment with weight bearing including high arches or flat feet).
Spending a lot of time on your feet. Especially when you are not used to doing so. For example you may have started a new job such as waiting tables where you are on your feet all day and wake up the next day with sore feet. This is a sign of damage and over time could lead to plantar fasciitis. Being Over-Weight. Never an easy topic to discuss but in simple terms, the heavier you are, the greater the burden on your feet. There are times when you're walking when your entire body weight is borne on one leg and therefore one foot, placing great strain on the plantar fascia. Wearing shoes with poor arch support or cushioning. A tight Achilles tendon. This is the big tendon at the bottom of your calf muscles above your heel. If this is excessively tight this can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Suddenly changing your exercise routine. Using running as an example if you suddenly run many more miles than your are used to or change to a new running surface e.g. grass to tarmac - these factors can put excessive strain on the plantar fascia and lead to plantar fasciitis. All of these risk factors ultimately lead to a specific change in foot structure. The term given is over-pronation and this basically describes rolling in of the foot and lowering of the arches. It is this change that excessively elongates the plantar fascia which can lead to plantar fasciitis.
Common symptoms of plantar fasciitis include pain in the morning when you first get out of bed, pain and stiffness when you start to walk after sitting for a while, increasing arch or heel pain toward the end of the day, tired feet at the end of the day. Other causes of arch and heel pain include arthritis, infection, fractures and sprains, and even certain systemic diseases. Since there are multiple possible causes, you should see your podiatrist for a thorough evaluation if you are experiencing arch or heel pain that does not respond quickly to early treatment.
Flat feet are easy to identify while standing or walking. When someone with flat feet stands, their inner foot or arch flattens and their foot may roll over to the inner side. This is known as overpronation. To see whether your foot overpronates, stand on tiptoes or push your big toe back as far as possible. If the arch of your foot doesn't appear, your foot is likely to overpronate when you walk or run. It can be difficult to tell whether a child has flat feet because their arches may not fully develop until they're 10 years of age.
Non Surgical Treatment
Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability.
As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include Pain. Inability to function. Failure to improve after a six-month course of specific, directed physical therapy. Failure to improve after using arch supports, orthotics, or ankle and foot bracing. Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. In the past, surgeons would realign and fuse the three hind joints, which would cause patients to lose motion, leaving them with a significantly stiff hind foot, With these newer procedures, if the foot is still flexible, surgeons can realign it and usually restore a close-to-normal or functional range of motion in the joints.
Warm up properly. This means not only stretching prior to a given athletic event, but a gradual rather than sudden increase in volume and intensity over the course of the training season. A frequent cause of plantar fasciitis is a sudden increase of activity without suitable preparation. Avoid activities that cause pain. Running on steep terrain, excessively hard or soft ground, etc can cause unnatural biomechanical strain to the foot, resulting in pain. This is generally a sign of stress leading to injury and should be curtailed or discontinued. Shoes, arch support. Athletic demands placed on the feet, particularly during running events, are extreme. Injury results when supportive structures in the foot have been taxed beyond their recovery capacity. Full support of the feet in well-fitting footwear reduces the likelihood of injury. Rest and rehabilitation. Probably the most important curative therapy for cases of plantar fasciitis is thorough rest. The injured athlete must be prepared to wait out the necessary healing phase, avoiding temptation to return prematurely to athletic activity.
Gastroc stretch. Stand on the edge of a step. Rise slowly on your toes. Lower yourself slowly as far as you can until you feel a stretch in your calf. Don?t roll your foot inward or outward. Hold for 1-2 seconds. Reps:10-20 (stop before you fatigue). Soleus stretch. Same as above, but start with your knee bent so that you feel a slight stretch in your calf or achilles. Maintain the angle of your knee throughout the stretch. Bicycle stretch. Lie on your side. Keeping your top leg straight, bring your knee toward your nose until you feel a slight stretch in the hamstring. Maintaining this angle at your hip, start pretending you are pedalling a bicycle with the top leg. Make sure you feel a slight stretch each time your knee is straight. Reps: 10-30 for each leg. If you feel any pops or clicks in your hip or back, try raising the top leg a little (making the thighs further apart) to eliminate the popping. Foot Intrinsic Exercises. Assisted metatarsal head raising. Sit in a chair. Find the bumps at the ball of your foot just before your big toe and just before the little toe. These are the first (big toe) and fifth (little toe) metatarsal heads. Place your second and third fingers from one hand under the first metatarsal head, and the second and third fingers from the other hand under the fifth metatarsal head. Now lay the thumbs from each hand in a diagonal across your toes so that they form a right angle meeting at the nail of the second toe. Your hands are now in position to assist your toes. Keep your toes straight, with the toe pads on the floor. Use your fingers to help raise all the metatarsal heads (the ball of your foot). Do not let your toes curl under keep them long. Now relax. Reps 7-10 for each foot. As this exercise gets easier, let your fingers do less of the work until your toes can do the exercise unassisted. This can take up to three weeks. When your strength has improved to this point, you can progress to the following three exercises, which are best done in stocking feet on a slippery floor. Active metatarsal head raising. Stand with your weight on both feet. Raise your metatarsal heads (the ball of your foot) while keeping your toes from curling under and maintaining your heel on the ground. Relax. Reps 6-7. Do one foot at a time. If you do more reps than you are ready for, you may well develop cramping in your foot. I once had a client who thought if seven reps were good, 10 were better. For good measure, she did the 10 reps 10 times in a day, and then she was unable to walk the next day from having used a set of muscles she had never exercised before. Don?t overdo it.
The Achilles tendon is the confluence of the independent tendons of the gastrocnemius and soleus, which fuse to become the Achilles tendon approximately 5 to 6 cm proximal to its insertion on the posterior surface of the calcaneus. The gastrocnemius and soleus muscles, via the Achilles tendon, function as the chief plantarflexors of the ankle joint. This musculotendinous unit provides the primary propulsive force for walking, running, and jumping. The normal Achilles tendon can withstand repetitive loads near its ultimate tensile strength, which approach 6 to 8 times body weight.
The cause of Achilles tendon ruptures besides obviously direct trauma, is multifactorial. In many instances the rupture occurs about 2-6 cm before its attachment to the calcaneous (heel bone). In this area there is a weaker blood supply making it more susceptible to injury and rupture. Rigid soled shoes can also be the causative factor in combination with the structure of your foot being susceptible to injury.
Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or "push off" the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.
Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.
Non Surgical Treatment
Nonsurgical method is generally undertaken in individuals who are old, inactive, and at high-risk for surgery. Other individuals who should not undergo surgery are those who have a wound infection/ulcer around the heel area. A large group of patients who may not be candidates for surgery include those with diabetes, those with poor blood supply to the foot, patients with nerve problems in the foot, and those who may not comply with rehabilitation. Nonsurgical management involves application of a short leg cast to the affected leg, with the ankle in a slightly flexed position. Maintaining the ankle in this position helps appose the tendons and improves healing. The leg is placed in a cast for six to 10 weeks and no movement of the ankle is allowed. Walking is allowed on the cast after a period of four to six weeks. When the cast is removed, a small heel lift is inserted in the shoe to permit better support for the ankle for an additional two to four weeks. Following this, physical therapy is recommended. The advantages of a nonsurgical approach are no risk of a wound infection or breakdown of skin and no risk of nerve injury. The disadvantages of the nonsurgical approach includes a slightly higher risk of Achilles tendon rupture and the surgery is much more complex if indeed a repair is necessary in future. In addition, the recuperative period after the nonsurgical approach is more prolonged.
Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under Procedure in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.