Adult flat foot

Tue, Jun 14th 2016, 10:52 AM

If your arches are flat and the feet point outward, you have flat feet. If you have pain in the heel, arch or ankle, you may have painful flat feet and need to be seen by a podiatrist for relief.

Adult flat foot
Flat feet, or fallen arches, is when the arch on the inside of the foot flattens and the entire sole of the foot touches the floor when the person stands up or walk. Flat feet is a common and usually painless condition where the arches do not develop during childhood or may be flattened due to an injury or other foot changes over the years. Flat feet can sometimes cause problems in the ankles, knees and even the back because of the changes in the alignment and functioning of these joints.

Anatomy
There are two main arches on the bottom of the foot -- the long arch in the middle of the foot and short side arches; they are maintained by the shape of the bones, muscle activity, tendons and ligaments of the feet; the posterior tibial tendon and the spring ligaments are vital to maintain the arches, and when they are damaged it can lead to flat feet. It is estimated that 20 to 30 percent of the general population never develops an arch in one or both feet. Three studies of military recruits showed no increase in injury or foot problems because of flat feet in people without prior foot problems.

Causes of adult flat feet
A flat foot is normal in infants and toddlers, because the foot hasn't yet developed the arches. In most people the arches develop throughout childhood, but in some people the arches never develop. This is a normal foot type, and some of these people without arches may or may not have foot problems.

On the other hand, arches can also fall over time (adult acquired flatfoot). Years of wear and tear can weaken the posterior tibial tendon, which runs along the inside of your ankle and maintains the arch. Flat feet can also develop as a result of an injury, illness, biomechanics (excessive pronation or rolling inwards of the foot), or as part of the normal aging process. Dysfunction and injury to the posterior tibial tendon is one of the most common causes of flat foot. Other known risk factors include obesity, aging, arthritis and chronic diseases (hypertension and diabetes). Temporary flat foot can also occur in pregnant women as a result of hormonal changes and weight gain, but can become permanent. Flat foot is most common in woman over the age of 40.

Symptoms
In individuals with flexible flat feet, the arch will be absent on standing (weight-bearing), however when standing on tiptoes or with flexing the toes, the arch reappears. These persons may not have any foot complaints. However, some people experience foot pain, particularly in the heel or arch area, difficulty standing on tiptoes, swelling along the inside of the ankle, the foot turns outward and can cause pain in the ankles and knees. If the foot pain continues, it is time to see the podiatrist.

Diagnosis
The podiatrist will also observe your feet from the front and the back, you will be asked to stand on your toes and walk to see the way the foot works. Your shoes will also be observed for wear pattern. Sometimes, X-rays are ordered to examine the joints and bones of the feet.

Treatment
No treatment is necessary for flexible flat feet if there is no pain. Oftentimes over the counter insoles and supportive shoes may be recommended to assist in supporting the foot and prevent future foot pain.

For persons experiencing acute foot pain, rest is important. Your podiatrist will recommend rest and avoiding activities such as walking bare feet or sporting activities that may aggravate your condition until your feet feel better. The use of medications such as non-steroidal anti-inflammatory (NSAIDS) can assist with pain relief.

For persons experiencing foot pain, the podiatrist will prescribe shoe inserts (orthoses or orthotic devices). Based on the severity of the flat foot, these can be over-the-counter arch supports or custom made insoles, which are molded to the contours of the feet and are designed to support the foot and relieve pain. Shoe inserts won't cure the flat feet, but they will reduce the symptoms, raise the arch and give the support the foot needs while wearing them to prevent foot pain. Once ordered, orthoses are generally worn for life to support the feet and prevent pain. They will need to be replaced or refurbished over time.

Wearing the right type of shoes is also important to support the feet. Sneakers or well-constructed, supportive shoes with good arches are the best type of shoes to wear. If you are overweight, weight loss is also a very important strategy to help in the treatment of flat feet. Stretching exercises are also important to improve strength and flexibility in the tight or shortened tendons in the feet.

If foot pain persists, surgery may be needed to provide long-lasting relief. Surgery is necessary to relieve the symptoms as well as correct the foot structure and function. The surgical procedure or procedures are selected depending on the severity of the symptoms, the type of flat foot and the degree of deformity. Surgery can be performed to realign tendons, ligaments, muscles and bones to create a permanent arch where none existed before.

By Dr. Monique Mitchell

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

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