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Flatfoot
What is A Flatfoot
Flatfoot is a complex foot deformity resulting in a partial or total collapse of the arch. This can be hereditary as seen in kids who have flat feet but also develop during later childhood or even as an adult. There are flexible flatfeet which have a normal arch height when not standing but flatten out when standing. Then there are rigid flatfeet which remain flat even when not standing.
Flatfoot is also associated with Posterior Tibial Tendon Dysfunction (PTTD).
PTTD is often caused by inflammation and breakdown of the posterior tibial tendon which is a result of overuse. PTTD is often seen in post-menopausal women because during the post-menopausal period, there is increase breakdown of bone (osteoporosis). This can occur in the ankle around where the posterior tibial tendon comes down from the leg and attaches to the foot. This breakdown of bone causes bone spurs that can irritate the posterior tibial tendon and eventually cause tearing of the tendon. This weakening and eventual tearing of the tendon results in progressive collapse of the arch and thus flatten of the foot.
Causes
Flatfoot deformity seen in kids can be attributed to genetics, laxity in their ligaments or a lack of flexibility in the achilles tendon. In cases of rigid flatfoot deformity in kids, it can be secondary to a joint that is abnormally fused (synostosis). In adults that develop a flatfoot deformity, it is often associated with tendinitis of the posterior tibial tendon.
Signs and Symptoms
- Pain in heel, arch, ankle, or along outside of foot
- Rolled in ankle (over-pronation)
- Toe drift (toes and front of foot point outward)
- Loss of medial (inside) arch
Diagnosis
Diagnosis is confirmed clinical examination of the patient seated, standing and during gait. X-rays and advanced imaging can help determine the cause .
Treatment
Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike- some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs
Non-surgical
- Orthotics
- Bracing
- Physical therapy
- Shoe gear modifications
- Medications- NSAIDs
Surgical
Surgery is considered in cases that are more severe. These cases are either unbraceable or a wound is present. Procedures may include repair of the posterior tibial tendon and any other ligaments that are damaged, osteotomies of bones to realign the foot, or fusions of joints if arthritis develops in the joints.
HIGH ARCHED FOOT/PES CAVUS
What is A HIGH ARCHED FOOT/PES CAVUS
Pes cavus is a condition in which the foot has a very high arch. A high arch can place excessive amounts of weight and pressure on the ball and heel of the foot. Additionally, it causes a shortened foot which causes tight tendons and fascia. This can be hereditary or can develop over time.
Causes
Pes cavus can be inherited in which case is a normal variant of different foot types. It can also be associated with a neurologic disorder or other medical condition.
Signs and Symptoms
- High arch
- Toe contractures- hammertoes or claw toes
- Pain under the ball of the foot and/or heel
- Calluses on the ball, side or heel of the foot
- Unstable foot due to heel tilting inward which can cause recurrent ankle sprains
Diagnosis
Diagnosis of cavus foot includes a review of the patient’s family history. The foot and ankle surgeon examines the foot, looking for a high arch and possible calluses, hammertoes and claw toes. The foot is tested for muscle strength, and the patient’s walking pattern and coordination are observed. If a neurologic condition appears to be present, the entire limb may be examined. The surgeon may also study the pattern of wear on the patient's shoes.
X-rays are sometimes ordered to further assess the condition. In addition, the surgeon may refer the patient to a neurologist for a complete neurologic evaluation.
Treatment
Because bunions are progressive, they don't go away, and will usually get worse over time. But not all cases are alike- some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs
Non-surgical
- Orthotics
- Bracing
- Physical therapy
- Shoe gear modifications
- Medications- NSAIDs
Surgical
If nonsurgical treatment fails to adequately relieve pain and improve stability, surgery may be needed. Surgery can include lengthening/transfer of tendons, repair of ligaments, osteotomies/cutting of bones and fusion of joints.