Pes planus is the scientific term that describes low arch or "flat" feet. As podiatric physicians, we are very interested not only in structure but also in function of the feet. While very few people have 20-20 vision, it is also true that very few people have perfect arch structure. High and low arch feet are just the two ends of the spectrum of foot structure. The more deviation from what is considered perfect, the worse the function becomes. We describe deviation from "the ideal" as imbalance in structure. It is the imbalance in structure that leads to abnormal function. Abnormal function causes pain and/or deformity. Deformity can manifest itself in a variety of foot problems such as bunions or hammertoes. Likewise, pain How can you get taller in a week? manifest itself in a variety of ways such as heel pain ( plantar fasciitis or heel spur), corns or calluses, metatarsalgia or pain in the ball of the foot ( neuromas, stress fractures, or tendonitis), or even in pediatric problems. Invariably, we can treat most foot imbalance or biomechanical insufficiencies with orthotic therapy.
A common cause of foot arch pain is a stress fracture. They tend to occur from repeated overloading of one of the foot bones from activities such as jumping and running especially if you have suddenly increased your activity level. The breaks in the bone may be small but they can be extremely painful. Stress fractures of the metatarsal bones or the navicular can cause anything from mild to severe foot arch pain. The Tibialis Posterior muscle plays a very important role in supporting the medial arch of the foot. Posterior Tibial Tendonitis can occur either through repetitive use e.g. high impact sports such as soccer or tennis, or from an injury e.g. a fall. This causes the tendon to become inflamed or even torn, resulting in pain on bottom of foot. This pain usually gets worse with activity or when standing for long periods. If the problem persists, the inner side of the foot (known as the medial longitudinal arch of the foot) gradually collapses down, causing flat feet. A simple test for this condition is to stand on one leg and rise up onto your tiptoes. If you cannot, it indicates a problem with the Posterior Tibial tendon. Treatment usually consists of rest, ice, exercises, orthotics and physical therapy.
Symptoms of plantar fasciitis may occur anywhere along the arch, but it is most common near its attachment to the heel bone. Symptoms of plantar fasciitis vary, but the classic symptom is pain after rest--when you first get out of bed in the morning, or when you get up after sitting down for a while during the day. This is known as "post-static dyskinesia." The pain usually diminishes after a few minutes of walking, sometimes even disappearing, but the pain is commonly felt again the longer you're on the foot. Fasciitis can be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation of long-periods of standing, especially on concrete, and by being overweight. Other factors which influence this condition are gender (females get this more than men), age (30s to 50s are most common), and those with flatter-than-normal feet. It doesn't help that fascia doesn't heal particularly quickly. This is because it has relatively poor circulation, which is why it's white in colour.
A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to "raise up on the tip toes" of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.
Non Surgical Treatment
Treatment for flat feet and fallen arches depends on the severity and cause of the problem. If flat feet cause no pain or other difficulties, then treatment is probably not needed. In other cases, your doctor may suggest one or more of these treatments. Rest and ice to relieve pain and reduce swelling. Stretching exercises. Pain relief medications, such as nonsteroidal anti-inflammatories. Physical therapy. Orthotic devices, shoe modifications, braces, or casts. Injected medications to reduce inflammation, such as cortiغير مجاز مي باشدteroids.
With flat feet, there is a tendon on the inside of the foot than can often become weakened, injured, split and/or ruptured. This tendon, is called the posterior tibial tendon, and is the main arch supporting tendon. Obviously damage to this tendon can cause collapse of the arch. Some people have genetically inefficient tendon, and tends to be the case in younger people. In mild cases, such as tendon splits, the posterior tibial tendon can be repaired to restore its strength. Acute incontinuity of the tendon can be primarily repaired. Often the posterior tibial tendon is augmented with a tendon transfer of an adjacent tendon to provide both strength and continuity. In any tendon repair, advanced or retensioning of the tendon is performed. In most flat foot surgery a tendon augmentation is often combined with other boney procedures to restore structure and balance to the foot.
Stretch and strengthen important muscles in your feet, ankles and legs in order to guard against future strain. Make sure to acquire suitable arch supports and inserts if necessary, and that your shoes are shock absorbent and in good condition. Wearing tattered shoes provides no protection, and runners should replace their footwear before exceeding 500 miles of uغير مجاز مي باشدe. Athletes new to arch supports should gradually build their training routine, allowing their feet to become accustomed to a new stance.
Start in an L-Sit position. (If you?re hips and hamstrings are tight sit up on a box or phone book to be able to achieve a tall back position. You can even sit on a box with your back supported against a wall!) Keeping the legs straight, but not locked, reach both heels out away from your body to ?Flex? the ankles. Try to avoid pulling back with the toes to flex. Keep the toes relaxed and lead from the heel to hinge the foot into the flexed position. Hold the flexed foot and breathe. Take 3-5 breaths and see if you can reach farther through the heel to deepen the flex on each exhale. To transition to the pointed position, begin by pointing the foot to move the ankles as far as possible in the other direction. Once the ankles have reached their endpoint, use the muscles along the sole of the foot to point the toes. Inhale to continue lengthening out through the top of the foot, exhale to deepen the contraction under the sole of the foot to point the toes. Take 3-5 breaths. Then release the toes, and begin reaching out through the heel to hinge the ankle into the flexed position to repeat the exercise. Continue to flex and the point for 5-10 repetitions.
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