Overview
The condition known as ?fallen arches? is also referred to as flat feet or pes planus. It arises when the arch of the foot collapses to the point that the entire sole is flat to the ground. It is commonly seen in young children who have yet to develop the muscles in the sole of their feet. In most cases as a child develops and learns how to walk the finer intrinsic muscles that support the sole of the foot will develop normally and an arch forms. However in a small number of cases these muscles don?t form properly and thus neither does the arch. Fallen arches which are acquired in adulthood may be due to a number of factors.
Causes
Some people develop fallen arches because they tend to pronate, or roll inwards on the ankles, says the Instep Foot Clinic. Other people may simply have under-developed muscles in their arches. Your arches help your feet bear weight and are supported in this job by muscles and tendons in your feet and ankles. So, while fallen arches aren?t usually serious, they can cause pain in your feet, ankles, knees and/or hips due to your reduced weight-bearing ability. In these cases, treatment may be required. Orthotics that sit in your shoes and support your arches are a common solution, as are exercises to strengthen and stretch your feet and leg muscles.
Symptoms
Arches can be seen as ?rolling downward? or collapsing when walking. Pain may present in lower back, hips or knees. Pain may be present on the bottom of the heels, within the arch, within the ankles or even the forefoot. Swelling can occur. Pain may occur in the anterior leg muscles.
Diagnosis
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.
flat feet exercises
Non Surgical Treatment
The simplest form of treatment is the use of custom fitted orthotics. For this, it is best to see a podiatrist, who is a trained medical professional that assesses feet and gives you a prescription for the orthotic. If the orthotics do not work - or if the deformity is very severe - then surgical management may be needed. There is a very wide range of procedures available, with varying downtimes and complexity. The simplest procedure of all is a simple calf release. This can be done at the back of the knee or the calf, and has a very quick recovery. It is a day-surgery procedure, and the patient can walk immediately after the surgery without the need for a cast. Recovery back to jogging can be as early as three weeks. The calf release stops the deforming force but obviously does not correct the arch itself. It is usually done in combination with some of the other procedures mentioned below. Done by itself, the patient will probably still require orthotics but by releasing the calf, it allows the orthotics to be much more effective. The other end of the spectrum is a complete reconstruction of the arch with bone work and screws to fuse joints.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
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
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.
The condition known as ?fallen arches? is also referred to as flat feet or pes planus. It arises when the arch of the foot collapses to the point that the entire sole is flat to the ground. It is commonly seen in young children who have yet to develop the muscles in the sole of their feet. In most cases as a child develops and learns how to walk the finer intrinsic muscles that support the sole of the foot will develop normally and an arch forms. However in a small number of cases these muscles don?t form properly and thus neither does the arch. Fallen arches which are acquired in adulthood may be due to a number of factors.
Causes
Some people develop fallen arches because they tend to pronate, or roll inwards on the ankles, says the Instep Foot Clinic. Other people may simply have under-developed muscles in their arches. Your arches help your feet bear weight and are supported in this job by muscles and tendons in your feet and ankles. So, while fallen arches aren?t usually serious, they can cause pain in your feet, ankles, knees and/or hips due to your reduced weight-bearing ability. In these cases, treatment may be required. Orthotics that sit in your shoes and support your arches are a common solution, as are exercises to strengthen and stretch your feet and leg muscles.
Symptoms
Arches can be seen as ?rolling downward? or collapsing when walking. Pain may present in lower back, hips or knees. Pain may be present on the bottom of the heels, within the arch, within the ankles or even the forefoot. Swelling can occur. Pain may occur in the anterior leg muscles.
Diagnosis
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.
flat feet exercises
Non Surgical Treatment
The simplest form of treatment is the use of custom fitted orthotics. For this, it is best to see a podiatrist, who is a trained medical professional that assesses feet and gives you a prescription for the orthotic. If the orthotics do not work - or if the deformity is very severe - then surgical management may be needed. There is a very wide range of procedures available, with varying downtimes and complexity. The simplest procedure of all is a simple calf release. This can be done at the back of the knee or the calf, and has a very quick recovery. It is a day-surgery procedure, and the patient can walk immediately after the surgery without the need for a cast. Recovery back to jogging can be as early as three weeks. The calf release stops the deforming force but obviously does not correct the arch itself. It is usually done in combination with some of the other procedures mentioned below. Done by itself, the patient will probably still require orthotics but by releasing the calf, it allows the orthotics to be much more effective. The other end of the spectrum is a complete reconstruction of the arch with bone work and screws to fuse joints.
Surgical Treatment
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss. Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.
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
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.