A variety of foot problems can lead to adult acquired flatfoot deformity (AAFD), a condition that results in a fallen arch with the foot pointed outward. Most people - no matter what the cause of their flatfoot - can be helped with orthotics and braces. In patients who have tried orthotics and braces without any relief, surgery can be a very effective way to help with the pain and deformity. This article provides a brief overview of the problems that can result in AAFD. Further details regarding the most common conditions that cause an acquired flatfoot and their treatment options are provided in separate articles. Links to those articles are provided.
Fallen arches in adults are caused by several things. Below are some of the most common causes. Abnormalities present from birth. Torn or stretched tendons (resulting from foot injuries or foot strains). Inflammation or damage of the PTT (posterior tibial tendon). The PTT is responsible for connecting the middle of the arch to the ankle and lower leg. Dislocated or broken bones (also as a result of injury). Health problems like rheumatoid arthritis. Nerve problems. Other factors like diabetes, obesity, aging and pregnancy (these factors are known to increase the risk of fallen arches).
Knee/Hip/Back Pain - When the arch collapses in the foot, it triggers a series of compensations up the joint chain, leading to increased stress on the knee, pelvis and low back. Plantar fasciitis - This condition is characterized by heel pain, especially with the first few steps you take. The plantar fascia stretches as the arch falls, putting stress on the heel. Bunions - If you see a bony bump developing at the base of your big toe, you are likely developing a bunion. It may be swollen, red or painful when it rubs against your shoe. A flattened arch spreads the forefoot and causes the big toe to deviate toward the second toe. Shin splints - This term generally refers to pain anywhere along the shinbone. It is typically due to overuse and is aggravated after exercise and activity.
Your doctor examines your feet to determine two things, whether you have flat feet and the cause or causes. An exam may include the following steps, Checking your health history for evidence of illnesses or injuries that could be linked to flat feet or fallen arches, Looking at the soles of your shoes for unusual wear patterns, Observing the feet and legs as you stand and do simple movements, such as raising up on your toes, Testing the strength of muscles and tendons, including other tendons in the feet and legs, such as the Achilles tendon or the posterior tibial tendon, Taking X-rays or an MRI of your feet.
Non Surgical Treatment
Most cases of flatfeet do not require treatment. However, if there is pain, or if the condition is caused by something other than normal development, there are several treatment options. Self-care options include rest, choosing non-weight-bearing exercise (e.g., swimming, cycling), weight loss, and avoiding high heels. Flexible flatfeet with some pain can be relieved with the use of orthotics-shoe inserts that support the arch-and/or heel wedges (in some cases). If pronation is a factor, special shoes can be worn that lift the arch and correct the inward leaning. Physical therapy may also be prescribed to stretch or lengthen the heel cord and other tendons. For rigid or inflexible flatfeet, treatment varies depending on the cause. Tarsal coalition if often treated with rest and the wearing of a cast. If this is ineffective, surgery can be done to separate the bones or to reset the bones into a correct position. If the flatfoot is caused by an injury to the tendons in the foot or ankle, rest, anti-inflammatory medications (e.g., ibuprofen), and the use of shoe inserts and ankle braces often relieve symptoms. In severe cases, surgery is performed to repair the tendon or to fuse some joints in the foot into a corrected position to reduce stress on the tendon. The prognosis after surgery is generally good. Complications include pain and some loss of ankle motion, especially when trying to turn the foot in or out. This may be improved with physical therapy.
Feet that do not respond to the treatments above may need surgery. The surgery will help to create a supportive arch.
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.