Adult flat feet is a common condition

Tue, Apr 17th 2012, 03:51 PM

If your arches are flat and the feet points 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.

What is 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. Flat foot 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. Flat feet can sometimes cause problems in the ankles and knees because it changes the alignment and functioning of these joints.

Anatomy
There are two main arches on the bottom of the foot, the longitudinal and transverse 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 arch and when they are damaged lead to flat feet. It is estimated that 20 to 30 percent of the general population never develop an arch in one or both feet. Three studies of military recruits showed no increased injury, or foot problems, due to 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 people without arches may or may not have foot problems.
On the other hand, arches can also fall over time. This is known as 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 flatfoot can also occur in pregnant women as a result of hormonal changes but can become permanent. Flatfoot 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 foot pain persists, it is time to see the podiatrist.

Diagnosis
When you go and see the podiatrist, your medical and family history will be reviewed and your feet examined. 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 structures 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 barefoot or sporting activities that may aggravate your condition until your feet feel better. The use of medications such as non steroidal anti-inflammatories 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 flatfoot, these can be over-the-counter arch supports or custom-designed arch supports, which are molded to the contours of the feet and will relieve foot 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 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 because some people with flat feet have a tight or shortened Achilles tendon (heel cord). Exercises to stretch this tendon may help.
If disabling foot pain persists, surgery may be needed to provide long-lasting relief. Surgery is necessary to relieve the symptoms as well as improve the foot structure and function. The surgical procedure or procedures are selected depending on the severity of the symptoms, the type of flatfoot and the degree of deformity. Surgery can be performed to realign tendons, ligaments, muscles and bones which will create a permanent arch where none existed before. If you have flat feet and continue to have foot pain, you need to see a podiatrist.

oFor more information on flat feet, email me at foothealth242@gmail.com or visit www.foothealth.org or www.mayoclinic.com. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates on Albury Lane, telephone 394-5820.

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