What Causes Mortons Neuroma

Overview

Morton neuromaNeuromas are generally benign or non-cancerous growths of nerve tissue, developing in various parts of the body. Morton?s Neuromas are confined to the nerves of the foot, most commonly, between the third and fourth toes. The condition involves a thickening of the tissue around one of the digital nerves leading to the toes and does not qualify as an actual tumor. The affliction causes a sharp, burning pain, usually in the region of the ball of the foot. A patient?s toes may also sting, burn or exhibit numbness. Often, the symptoms have been likened to ?walking on a marble.?

Causes

A Morton?s Neuroma are a result of complex biomechanical changes that occur in your feet. There are a number of theories as to the exact cause of the scarring and thickening, but it basically boils down to overload of the tissue structure. The body lays down scar tissue to try to protect the overloaded structure. Tight-fitting shoes may exacerbate a Morton?s Neuroma. Shoes such as high heels and shoes with tight toe boxes (eg womens fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight. The angle of the toe box then squeezes your toes together. Footwear is not the only cause of a Morton?s Neuroma. Injuries to the foot can also be a factor in developing the condition by changing your foot biomechanics. Poor foot arch control leading to flat feet or foot overpronation does make you biomechanically susceptible to a neuroma.

Symptoms

Symptoms include: pain on weight bearing, frequently after only a short time. The nature of the pain varies widely among individuals. Some people experience shooting pain affecting the contiguous halves of two toes. Others describe a feeling like having a pebble in their shoe or walking on razor blades. Burning, numbness, and paresthesia may also be experienced. Morton’s neuroma lesions have been found using MRI in patients without symptoms.

Diagnosis

Plain x-rays of the foot may demonstrate that one or more of the metatarsals are long (Figure #5). Not uncommonly, the second and/or third metatarsal may be long relative to the third or fourth. This can create a situation where excessive load is occurring in and around the vicinity of the interdigital nerve.

Non Surgical Treatment

In most cases, initial treatment for this condition consists of padding and taping to disperse weight away from the neuroma. If the patient has flatfeet, an arch support is incorporated into footwear. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient’s foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. Another type of therapy that may be used is alcohol sclerosing injections. In this treatment, the doctor injects a small amount of alcohol in the area of the neuroma area to help harden (sclerose) the nerve and relieve the pain. Injections are given every 7-10 days and, in many cases, 4-7 injections are needed for maximum relief. Please ask your physician for more information regarding this type of treatment.Morton neuroma

Surgical Treatment

Majority of publications including peer review journal articles, surgical technique description and textbooks promote surgical excision as a gold standard treatment. Surgical excision is described as the most definitive mode of treatment for symptomatic Morton?s neuroma with reported success rates varying between 79% and 93%. Various surgical techniques are described, essentially categorised as dorsal versus plantar incision approaches. Beyond this the commonest technical variation described as influencing the outcome of surgery involves burying and anchoring transacted nerve into soft tissue such as muscle.

Prevention

How can Morton?s neuroma be prevented? Do not wear tight shoes or high-heeled shoes for prolonged periods. Do wear shoes with a wide toe box so that your toes are not squeezed or cramped. Do wear athletic footwear with enough padding to cushion the balls of the feet when exercising or participating in sports.

Learn How To Treat Calcaneal Spur

Posterior Calcaneal Spur

Overview

Heel spurs are usually under the heel and are generally caused by excessive forces acting on the bone. By far the most common cause of heel spurs is abnormal biomechanics – often the same biomechanics that cause plantar fasciitis. Heel spurs are not a direct cause of heel pain. They grow in response to the forces of the soft tissue pulling on the bone. Any condition where the foot has excessive motion can produce tension within the soft tissues acting on the heel.

Causes

Heel Spur typically occurs in people who have a history of foot pain, and is most often seen in middle-aged men and women. The bony growth itself is not what causes the pain associated with heel spur. The pain is typically caused by inflammation and irritation of the surrounding tissues. Approximately 50% of patients with a heel spur also experience Plantar Fasciitis.

Heel Spur

Symptoms

Heel spurs are most noticeable in the morning when stepping out of bed. It can be described as sharp isolated pain directly below the heel. If left untreated heel spurs can grow and become problematic long-term.

Diagnosis

A thorough medical history and physical exam by a physician is always necessary for the proper diagnosis of heel spurs and other foot conditions. X rays of the heel area are helpful, as excess bone production will be visible.

Non Surgical Treatment

Treatment of Heel Spurs is the same as treatment of plantar fasciitis. To arrive at an accurate diagnosis, our foot and ankle Chartered Physiotherapists will obtain your medical history and examine your foot. Throughout this process the physio will rule out all the possible causes for your heel pain other than plantar fasciitis. The following treatment may be used. Orthotics/Insoles. Inflammation reduction. Mobilisation. Taping and Strapping. Rest.

Surgical Treatment

Surgery, which is a more radical treatment, can be a permanent correction to remove the spur itself. If your doctor believes that surgery is indicated, he will recommend an operation – but only after establishing that less drastic methods of treatment are not successful.

What Is A Calcaneal Spur

Heel Spur

Overview

A heel spur is a buildup of calcium or a bone hook on the heel bone. This is typically the source of most heel pain. It usually takes an X-ray to see the heel spur protruding from the heel. Without proper heel spur treatment, a heel spur cause inflammation and lead to other ailments like plantar fasciitis and Achilles tendonitis. It is important to be examined by an orthopedic specialist.

Causes

A heel spur usually develops as a result of wear and tear over time, which leads to the degeneration of connective tissue called fascia. Standing for prolonged periods and wearing shoes that do not provide the right type of arch support can also lead to connective tissue damage in the heel. The body attempts to repair the damaged tissue by delivering calcium to the affected region, but sometimes too much calcium begins to accumulate and this results in painful plantar fasciitis.

Inferior Calcaneal Spur

Symptoms

An individual with the lower legs turning inward, a condition called genu valgus or “knock knees,” can have a tendency toward excessive pronation. This can lead to a fallen arch and problems with the plantar fascia and heel spurs. Women tend to suffer from this condition more than men. Heel spurs can also result from an abnormally high arch. Other factors leading to heel spurs include a sudden increase in daily activities, an increase in weight, or a thinner cushion on the bottom of the heel due to old age. A significant increase in training intensity or duration may cause inflammation of the plantar fascia. High-heeled shoes, improperly fitted shoes, and shoes that are too flexible in the middle of the arch or bend before the toe joints will cause problems with the plantar fascia and possibly lead to heel spurs.

Diagnosis

Your doctor, when diagnosing and treating this condition will need an x-ray and sometimes a gait analysis to ascertain the exact cause of this condition. If you have pain in the bottom of your foot and you do not have diabetes or a vascular problem, some of the over-the-counter anti-inflammatory products such as Advil or Ibuprofin are helpful in eradicating the pain. Pain creams, such as Neuro-eze, BioFreeze & Boswella Cream can help to relieve pain and help increase circulation.

Non Surgical Treatment

Many treatment options exist, and good results are often observed. Generally, a calcaneal spur develops when proper care is not given to the foot and heels. It is often seen as a repetitive stress injury, and thus lifestyle modification is typically the basic course of management strategies. To alleviate heel spur pain, a person should begin doing foot and calf workouts. Strong muscles in the calves and lower legs will help take the stress off the bone and thus help cure or prevent heel spurs. Icing the area is an effective way to get immediate pain relief.

Surgical Treatment

Heel spur surgery should only be considered after less invasive treatment methods have been explored and ruled insufficient. The traditional surgical approach to treating heel spurs requires a scalpel cut to the bottom of the food which allows the surgeon to access the bone spur. Endoscopic plantar fasciotomies (EPF) involve one or two small incisions in the foot which allow the surgeon to access and operate on the bone spur endoscopically. Taking a surgical approach to heel spur treatment is a topic to explore with a foot and ankle specialist.

Prevention

Choose new shoes that are the right size. Have your foot measured when you go to the shoe store instead of taking a guess about the size. Also, try on shoes at the end of the day or after a workout, when your feet are at their largest. To ensure a good fit, wear the same type of socks or nylons that you would normally wear with the type of shoe that you are trying on.

Bursitis Of The Feet A Surgical Procedure

Overview

Whenever tissues rub against one another, a bursa forms to allow for smooth gliding. A bursa is a fluid-filled sac and occurs normally throughout the body. Only a few cell layers thick, a bursa is filled with a lubricating fluid. However, when irritated, a bursa can become markedly thickened and painful. This is often referred to as bursitis. The retrocalcaneal bursa is positioned to allow the Achilles tendon to glide over the back part (posterior aspect) of the heel bone. When this bone becomes enlarged, inflammation of the retrocalcaneal bursa occurs. This inflammation results in exquisite tenderness along the posterior aspect of the heel.

Causes

Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, scleroderma, systemic lupus erythematosus, pancreatitis, Whipple disease, oxalosis, uremia, hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome have also been associated with bursitis.

Symptoms

Pain at the back of the heel at the attachment site of the Achilles tendon when running. Pain on palpation of the back of the heel or bottom of heel. Pain when standing on tiptoes. Swelling and redness at the back and bottom of the heel.

Diagnosis

Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon. Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.

Non Surgical Treatment

Treatment consists of anti-inflammatory therapy with the use of ice, short term non steroidal therapy including ibuprofen and naproxen and selective use of cortisone injections. Cortisone injections have been shown to be a highly effective anti-inflammatory measure for relieving foot and ankle pain. Care must always be taken by the physician to insure that the injection is administered into the bursal sac and not the Achilles tendon which can cause tendon injury. Treatment also consists of the use of heel lifts or the temporary use of a shoe with a low heel. The heel lift decreases the mechanical load on the Achilles tendon. Gentle stretching of the Achilles tendon, the possible use of a splint that is worn at night as well as physical therapy as directed by your physician can be employed. Temporary activity limitations for fitness must be incorporated into the treatment plan. Any weight bearing activity for exercise that actively lifts your heel off of the ground including running, walking stair stepper will interfere with effective conservative care. Low impact activity including biking and pool tend to be safe exercises during your recovery.

Prevention

Protect that part of the body that may be most vulnerable, If you have to kneel a lot, get some knee pads. Elbow braces can protect tennis and golf players. If you are an athlete or avid walker, invest in some good walking or running shoes. When doing repetitive tasks have breaks. Apart from taking regular breaks, try varying your movements so that you are using different parts of your body. Warm up before exercise. Before any type of vigorous exercise you should warm up for at least 5 to 10 minutes. The warm up could include walking at a good speed, slow jogging, or a cycling machine. Strong muscles add extra protection to the area. If you strengthen the muscles in the area where you had bursitis (after you are better), especially the area around the joint, you will have extra protection from injury. Make sure you do this well after your bursitis has gone completely.

What Are The Causes Of Hammertoes

HammertoeOverview

Patients and doctors often refer to all forms of toe abnormalities as a Hammer toes. There are in fact four main forms of toe abnormalities, hammer toes, claw toes, mallet toes and trigger toes. A hammertoe can be best described as an abnormal contraction or “buckling” of a toe. This occurs due to a partial or complete dislocation of one of the joints that form the toe. As the toe continues to be deformed, it will press up against the shoe and may cause corns.

Causes

People who are born with long bones in their toes are more likely to develop hammer toe. Children who wear shoes they have outgrown may develop this condition. People who wear very narrow shoes or high-heeled shoes are also more likely to develop a hammer toe. Sometimes, pressure from a bunion can cause hammer toe. Rheumatoid arthritis is another a risk factor.

HammertoeSymptoms

The symptoms of a hammer toe include the following. Pain at the top of the bent toe upon pressure from footwear. Formation of corns on the top of the joint. Redness and swelling at the joint contracture. Restricted or painful motion of the toe joint. Pain in the ball of the foot at the base of the affected toe.

Diagnosis

Your healthcare provider will examine your foot, checking for redness, swelling, corns, and calluses. Your provider will also measure the flexibility of your toes and test how much feeling you have in your toes. You may have blood tests to check for arthritis, diabetes, and infection.

Non Surgical Treatment

A number of approaches can be undertaken to the manage a hammer toe. It is important that any footwear advice is followed. The correct amount of space in the toe box will allow room for the toes to function without excessive pressure. If a corn is present, this will need to be treated. If the toe is still flexible, it may be possible to use splints or tape to try and correct the toe. Without correct fitting footwear, this is often unsuccessful. Padding is often used to get pressure off the toe to help the symptoms. If conservative treatment is unsuccessful at helping the symptoms, surgery is often a good option.

Surgical Treatment

Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe problem have become so tight that the joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and ligament abnormalities that define each hammertoe’s make-up. To correct a hammertoe deformity, the surgeon’s goal is to restore the normal alignment of the toe joint, relieving the pressure that led to the hammertoe’s development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates hammertoes a prominence at the top of the joint. Tighten or loosen the muscles, tendons and ligaments around the toe joints. Realign the toe bones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use screws, wires or plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.

Is Overpronation

Overview

Pronation is the inward movement of the foot as it rolls to distribute the force of impact of the ground as you run. The foot “rolls” inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. Pronation is critical to proper shock absorption, and it helps you push off evenly from the front of the foot. Although pronation is a natural movement of the foot, the size of the arch can affect its ability to roll, causing either supination (underpronation) or overpronation. If you have a normal arch, you’re likely a normal pronator, meaning you’ll do best in a shoe that offers moderate pronation control. People with flat feet normally overpronate, so they do well in a motion-control shoe that controls pronation. High-arched people typically underpronate, so they do best in a neutral-cushioned shoe that encourages a more natural foot motion.Overpronation

Causes

Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness, ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak, the muscle cannot adequately slow the natural pronation cycle.

Symptoms

Overpronation can be a contributing factor in other lower extremity disorders, such as foot pain, plantar fasciitis, ankle injuries, medial tibial stress syndrome (shin splints), periostitis, stress fractures and myofascial trigger points. Overpronation increases the degree of internal tibial rotation, thereby contributing to various knee disorders such as meniscal injury or ligament sprains. The effects of the postural deviation are exaggerated in athletes due to the increase in foot strikes while running and the greater impact load experienced. When running, three to four times the body weight is experienced with each foot strike.2 If overpronation exists, the shock force is not adequately absorbed by the foot and is transmitted further up the kinetic chain.

Diagnosis

If you have flat feet or low arches, chances are you overpronate. Although not always the case, the lower your arches the greater the overpronate. Stand on a hard surface (in front of a mirror if you need to) and look at your feet, flat feet or low arches are easy to spot. If your feet look flatter than a pancake, have a look at your ankles and see if they seem collapsed or straight. If they are, you’re overpronating.Over Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. This orthotics should be designed with appropriate arch support and medial rear foot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems. If the problem persists, consult your foot doctor.

Prevention

Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.

Is Overpronation

Overview

Pronation is the inward movement of the foot as it rolls to distribute the force of impact of the ground as you run. The foot “rolls” inward about fifteen percent, comes in complete contact with the ground, and can support your body weight without any problem. Pronation is critical to proper shock absorption, and it helps you push off evenly from the front of the foot. Although pronation is a natural movement of the foot, the size of the arch can affect its ability to roll, causing either supination (underpronation) or overpronation. If you have a normal arch, you’re likely a normal pronator, meaning you’ll do best in a shoe that offers moderate pronation control. People with flat feet normally overpronate, so they do well in a motion-control shoe that controls pronation. High-arched people typically underpronate, so they do best in a neutral-cushioned shoe that encourages a more natural foot motion.Overpronation

Causes

Unless there is a severe, acute injury, overpronation develops as a gradual biomechanical distortion. Several factors contribute to developing overpronation, including tibialis posterior weakness, ligament weakness, excess weight, pes planus (flat foot), genu valgum (knock knees), subtalar eversion, or other biomechanical distortions in the foot or ankle. Tibialis posterior weakness is one of the primary factors leading to overpronation. Pronation primarily is controlled by the architecture of the foot and eccentric activation of the tibialis posterior. If the tibialis posterior is weak, the muscle cannot adequately slow the natural pronation cycle.

Symptoms

Overpronation can be a contributing factor in other lower extremity disorders, such as foot pain, plantar fasciitis, ankle injuries, medial tibial stress syndrome (shin splints), periostitis, stress fractures and myofascial trigger points. Overpronation increases the degree of internal tibial rotation, thereby contributing to various knee disorders such as meniscal injury or ligament sprains. The effects of the postural deviation are exaggerated in athletes due to the increase in foot strikes while running and the greater impact load experienced. When running, three to four times the body weight is experienced with each foot strike.2 If overpronation exists, the shock force is not adequately absorbed by the foot and is transmitted further up the kinetic chain.

Diagnosis

If you have flat feet or low arches, chances are you overpronate. Although not always the case, the lower your arches the greater the overpronate. Stand on a hard surface (in front of a mirror if you need to) and look at your feet, flat feet or low arches are easy to spot. If your feet look flatter than a pancake, have a look at your ankles and see if they seem collapsed or straight. If they are, you’re overpronating.Over Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. This orthotics should be designed with appropriate arch support and medial rear foot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems. If the problem persists, consult your foot doctor.

Prevention

Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.

Calcaneal Apophysitis Therapy

Overview

As children reach their growth spurt in early puberty, the heel is one of the first body parts to grow to full size. Because children’s bones are growing so fast, the muscles or tendons can’t keep up and often become tight. The tight heel tendons can put a lot of stress on the heel, especially if a child is involved in athletics or other weight-bearing activity. Over time, too much pressure on the heel can injure it and result in Sever’s disease, also called calcaneal apophysitis.

Causes

Sever?s disease is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season. Children who are going through adolescence are also at risk of getting it because the heel bone grows quicker than the leg. Too much weight bearing on the heel can also cause it, as can excessive traction since the bones and tendons are still developing. It occurs more commonly in children who over-pronate, and involves both heels in more than half of patients.

Symptoms

Most children with Sever’s complain of pain in the heel that occurs during or after activity (typically running or jumping) and is usually relieved by rest. The pain may be worse when wearing cleats. Sixty percent of children’s with Sever’s report experiencing pain in both heels.

Diagnosis

Low-grade inflammation of the calcaneal apophysis cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in children with Sever’s disease these x-rays are usually normal. Advanced Sever’s disease can be seen on x-ray but usually the problem is treated before it reaches this point. Other diagnostic tests, such as bone scans or MRI’s, are not usually required in typical cases of Sever’s disease. These, or other tests, may be required to rule out other conditions, such as stress fractures of the calcaneus or other bony abnormalities that can mimic Severs disease.

Non Surgical Treatment

Treatment for Sever?s disease is mainly supportive, to stop inflammation and reduce pain. The condition will resolve on its own when the growth in the growth plate is complete, but until then, measures can be taken to resolve pain and discomfort. Applying ice to the painful or swollen areas on the foot may provide some short-term relief from pain and prevent further inflammation. Ice can be applied for about 20 minutes two or three times a day. Footwear that is too big, too small, or does not provide proper support can exacerbate the symptoms of Sever?s disease. Supportive footwear is important to prevent discomfort, especially in children who participate in sports and activities that take place on a hard surface (such as pavement or a basketball court). Shoes should also have adequate padding and not rub against the heel. In some cases, shoes that do not have heels (such as sandals) may be more comfortable to wear while the heel is healing, but care should be taken that the shoe provides proper support to the rest of the foot. Children with Sever?s disease should avoid going barefoot.Children with flat feet, high arches, or over-pronation may need treatment to resolve these underlying conditions. In many cases, an orthotic worn inside the shoe can help put the foot into a better alignment and provide relief to the foot or the arch. Children who are overweight or obese may be counseled to lose weight. Being overweight can contribute to the development of several conditions, including Sever?s disease. Resting the foot and discontinuing sports and other activities until the pain and stiffness is resolved may be recommended. In extreme cases, a walking boot or a cast might be used to completely immobilize the foot. A physical therapist may recommend stretching exercises for the muscles in the calf and the Achilles tendon. A stretching routine is usually done several times a day. Stretching these muscles can help improve strength and decrease the stress on the heel plate. Some physicians may recommend over-the-counter pain relievers such as ibuprofen or acetaminophen. Care must be taken when administering these medications to children, especially with acetaminophen, as overdoses are possible when using more than one medication containing acetaminophen. Aspirin should never be given to children. The utility of pain relievers in children must be weighed against their possible side effects. For small variations-less than an inch or so-shoe lifts can help equalize the length of the legs. In cases with more variation between legs, surgical solutions may be considered. Research indicates that targeted manual therapy techniques performed by a licensed physical therapist can help to reduce pain from Sever?s Disease and to improve muscle function. When the larger calf muscles and the smaller ankle and foot muscles become tight, this tightness can affect the mechanics of the ankle joint. Manual therapy includes both joint and muscle release techniques to restore optimal function to the calf, ankle, and foot muscles, and results can generally be achieved within a few months.

The Causes And Treatment

Overview
Have you noticed the arch in your foot collapse over a fairly short period of time as an adult? Or Do you suffer from pain on the inside and sole of your arch? If it does, then you may be suffering from a condition known as adult acquired flat foot. As one of the main support structures of the foot?s arch, the tibilais posterior tendon, along with other muscles, tendons and ligaments, play a very important role in its mechanical function.
Acquired Flat Foot

Causes
The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction. What causes adult acquired flat foot? Fracture or dislocation. Tendon laceration. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness.

Symptoms
Not everyone with adult flatfoot has problems with pain. Those who do usually experience it around the ankle or in the heel. The pain is usually worse with activity, like walking or standing for extended periods. Sometimes, if the condition develops from arthritis in the foot, bony spurs along the top and side of the foot develop and make wearing shoes more painful. Diabetic patients need to watch for swelling or large lumps in the feet, as they may not notice any pain. They are also at higher risk for developing significant deformities from their flatfoot.

Diagnosis
Diagnostic testing is often used to diagnose the condition and help determine the stage of the disease. The most common test done in the office setting are weightbearing X-rays of the foot and ankle. These assess joint alignment and osteoarthritis. If tendon tearing or rupture is suspected, the gold standard test would be MRI. The MRI is used to check the tendon, surrounding ligament structures and the midfoot and hindfoot joints. An MRI is essential if surgery is being considered.

Non surgical Treatment
Initial treatment consists of supporting the medial longitudinal arch (running the length of the foot) to relieve strain on the medial soft tissues. The most effective way to relieve pain on the tendon is to use a boot or brace, and once tenderness and pain has resolved, an orthotic device. A boot, brace, or orthotic has not been shown to correct or even prevent the progression of deformity. Orthotics can alleviate symptoms and may slow the progression of deformity, particularly if mild. The deformity may progress despite orthotics.
Acquired Flat Foot

Surgical Treatment
A new type of surgery has been developed in which surgeons can re-construct the flat foot deformity and also the deltoid ligament using a tendon called the peroneus longus. A person is able to function fully without use of the peroneus longus but they can also be taken from deceased donors if needed. The new surgery was performed on four men and one woman. An improved alignment of the ankle was still evident nine years later, and all had good mobility 8 to 10 years after the surgery. None had developed arthritis.

Adult Aquired Flat Feet Do I Suffer AAF?

Overview

The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn?t treated early.Flat Feet


Causes

Obesity – Overtime if your body is carrying those extra pounds, you can potentially injure your feet. The extra weight puts pressure on the ligaments that support your feet. Also being over weight can lead to type two diabetes which also can attribute to AAFD. Diabetes – Diabetes can also play a role in Adult Acquired Flatfoot Deformity. Diabetes can cause damage to ligaments, which support your feet and other bones in your body. In addition to damaged ligaments, uncontrolled diabetes can lead to ulcers on your feet. When the arches fall in the feet, the front of the foot is wider, and outer aspects of the foot can start to rub in your shoe wear. Patients with uncontrolled diabetes may not notice or have symptoms of pain due to nerve damage. Diabetic patient don?t see they have a problem, and other complications occur in the feet such as ulcers and wounds. Hypertension – High blood pressure cause arteries narrow overtime, which could decrease blood flow to ligaments. The blood flow to the ligaments is what keeps the foot arches healthy, and supportive. Arthritis – Arthritis can form in an old injury overtime this can lead to flatfeet as well. Arthritis is painful as well which contributes to the increased pain of AAFD. Injury – Injuries are a common reason as well for AAFD. Stress from impact sports. Ligament damage from injury can cause the bones of the foot to fallout of ailment. Overtime the ligaments will tear and result in complete flattening of feet.


Symptoms

Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.


Diagnosis

Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.


Non surgical Treatment

Footwear has an important role, and patients should be encouraged to wear flat lace-up shoes, or even lace-up boots, which accommodate orthoses. Stage I patients may be able to manage with an off the shelf orthosis (such as an Orthaheel or Formthotics). They can try a laced canvas ankle brace before moving to a casted orthosis. The various casted, semirigid orthoses support the medial longitudinal arch of the foot and either hold the heel in a neutral alignment (stage I) or correct the outward bent heel to a neutral alignment (stage II). This approach is meant to serve several functions: to alleviate stress on the tibialis posterior; to make gait more efficient by holding the hindfoot fixed; and thirdly, to prevent progression of deformity. Devices available to do this are the orthosis of the University of California Biomechanics Laboratory, an ankle foot orthosis, or a removable boot. When this approach has been used, two thirds of patients have good to excellent results.

Adult Acquired Flat Feet


Surgical Treatment

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, tendon transfers, realigning the bones of the foot, joint fusions, or both. Dr. Piccarelli will determine the best approach for your specific case. A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, or insertion of implant devices. Whether you have flexible flatfoot or PTTD, to select the procedure or combination of procedures for your particular case, Dr. Piccarelli will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.