Overview



Flat feet (also called pes planus or fallen arches) is a postural deformity in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground. Some individuals (an estimated 20-30% of the general population) have an arch that simply never develops in one foot (unilaterally) or both feet (bilaterally).

Causes

Family history, experts say fallen arches can run in families. Weak arch, the arch of the foot may be there when no weight is placed on it, for example, when the person is sitting. But as soon as they stand up the foot flattens (falls) onto the ground. Injury, arthritis, tibialis posterior (ruptured tendon), pregnancy, nervous system or muscle diseases, such as cerebral palsy, muscular dystrophy, or spina bifida. Tarsal Coalition, the bones of the foot fuse together in an unusual way, resulting in stiff and flat feet. Most commonly diagnosed during childhood. Diabetes. Age and wear and tear, years of using your feet to walk, run, and jump eventually may take its toll. One of the eventual consequences could be fallen arches. The posterior tibial tendon may become weakened after long-term wear a tear. The postario tibial tendon is the main support structure of the arch of our feet. The tendon can become inflamed (tendinitis) after overuse - sometimes it can even become torn. Once the tendon is damaged, the arch shape of the foot may flatten.

Symptoms

The majority of children and adults with flexible flatfeet never have symptoms. However, their toes may tend to point outward as they walk, a condition called out-toeing. A person who develops symptoms usually complains of tired, aching feet, especially after prolonged standing or walking. Symptoms of rigid flatfoot vary depending on the cause of the foot problem. Congenital vertical talus. The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body. Tarsal coalition. Many people have no symptoms, and the condition is discovered only by chance when an X-ray of the foot is obtained for some other problem. When symptoms occur, there is usually foot pain that begins at the outside rear of the foot. The pain tends to spread upward to the outer ankle and to the outside portion of the lower leg. Symptoms usually start during a child's teenage years and are aggravated by playing sports or walking on uneven ground. In some cases, the condition is discovered when a child is evaluated for unusually frequent ankle sprains. Lateral subtalar dislocation. Because this often is caused by a traumatic, high-impact injury, the foot may be significantly swollen and deformed. There also may be an open wound with bruising and bleeding.

Diagnosis

Determining whether you have fallen arches may be as easy as looking at the shape of the middle bottom of your foot. Is there any kind of arch there? If you cannot find any kind of arch, you may have a flat foot. There are, however, other ways to decide in case you're still not sure. Another way to figure out if you have flat feet is to look at a few pairs of your shoes. Where do you see the most wear on the heels? If you notice significant wear in the heel and the ball of the foot extending to the big toe, this means you are overpronating. Overpronators roll their feet too far inward and commonly have fallen arches. To figure out if you have flat feet, you can also do an easy test. Get the bottoms of your feet wet and then step on to a piece of paper carefully. Step off the paper and take a look at the print your foot made. If your print looks like the entire bottom of a foot, your feet are flat. People with an arch will be missing part of the foot on their print since the arch is elevated off of the paper. Regular visits to your podiatrist are highly recommended.

Is flat footedness genetic?

Non Surgical Treatment

Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch-supporting insert in the shoe) can bring relief. With the increased interest in running, many shoe stores carry shoes for normal feet and pronated feet. The shoes designed for pronated feet make long distance running easier and less tiring because they correct for the abnormality. Rigid or painful flat feet require evaluation by a health care provider. The treatment depends on the cause of the flat feet. For tarsal coalition, treatment starts with rest and possibly a cast. If this fails to improve the pain, surgery may be necessary. For problems with the posterior tibial tendon, treatment may start with rest, anti-inflammatory medications, and shoe inserts or ankle braces. In more advanced cases, surgery may be needed to clean or repair the tendon, or fuse some of the joints of the foot into a corrected position. Flat feet in older adults can be treated with pain relievers, orthotics, and sometimes surgery.

Surgical Treatment



Generally one of the following procedures is used to surgically repair a flat foot or fallen arch. Arthrodesis. One or more of your bones in the foot or ankle are fused together. Osteotomy. Correcting alignment by cutting and reshaping a bone. Excision. Removing a bone or a bone spur. Synovectomy. Cleaning the sheath that covers the tendon. Tendon transfer. Using a piece of one tendon to lengthen or replace another. Arthroereisis. placing a small device in the subtalar joint to limit motion. For most people, treatment is successful, regardless of the cause, although the cause does does play a major role in determining your prognosis. Some causes do not need treatment, while others require a surgical fix.

Prevention

Well-fitted shoes with good arch support may help prevent flat feet. Maintaining a healthy weight may also lower wear and tear on the arches.

Overview



Heel pain may develop when you pound your feet on hard surfaces playing sports or wear shoes that irritate sensitive tissues. A sore heel will usually get better on its own if you give it enough rest. Unfortunately, many people try to ignore the early signs of heel pain and keep on doing the activities that caused it and this can lead to chronic pain. Conditions that cause heel pain generally fall into two main categories: pain beneath the heel and pain behind the heel. Pain beneath the Heel. If it hurts under your heel, you may have one or more conditions that cause inflammation of the tissues on the bottom of your foot. Stone bruise. By stepping on a hard object, you can bruise the fat pad on the bottom side of your heel. It may or may not look discoloured. With rest, the pain subsides gradually.

Causes

Here are a few in-depth explanations of heel pain causes and potential remedies for those that are afflicted Plantar Fascitis, One of the most well-known causes of heel pain, plantar fascitis occurs when the thick tissue along the arch of the foot becomes tight and inflamed. The foot itself can feel cramped when this tissue is inflamed, causing the afflicted person to feel as if they have a muscle cramp that flexing the foot doesn?t seem to alleviate. Plantar fascitis is most common among men over the age of 40. Warning Signs, The first steps in the morning are extremely painful. Pain flares up after activities like stair or steep hill climbing. Pain continues to occur regardless of the type of shoes or lack of shoes worn.

Symptoms

The primary symptom is pain in the heel area that varies in severity and location. The pain is commonly intense when getting out of bed or a chair. The pain often lessens when walking.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

Non Surgical Treatment

Treatment for plantar fasciitis should be directed at resting the plantar fascia, providing support for the arch area and limiting pronation. This is often accomplished with the use of supportive strapping with athletic tape, arch supports and orthotics. Heel lifts may also be helpful. Anti-inflammatories, pills as well as cortisone injections, may be effective as an adjunctive treatment by speeding up the reduction of inflammation. However, if used alone, anti-inflammatories rarely lead to resolution of the condition. Stretching exercises, physical therapy and night splints may also be helpful. The majority of cases respond to non-surgical treatment although it may take several weeks to reach a comfortable level. In those cases that do not respond adequately to conservative measures, surgical release of the plantar fascia may be considered. However, a new non-surgical treatment called Extracorporeal Shockwave Therapy (ESWT) is now available as an option for recalcitrant plantar fasciitis. ESWT was approved by the FDA recently for the treatment of chronic heel pain. It has been in use for several years on thousands of patients in Europe and has been successfully used to restore patients with chronic plantar fasciitis to a normal, active lifestyle. ESWT is a non-invasive procedure that uses high intensity sound waves similar to what is routinely used to treat kidney stones. The treatment is usually performed in the office or in an outpatient surgical center. The procedure is performed under local anesthesia and takes about 25 minutes. The shockwaves are directed at the plantar fascia and stimulate an inflammatory healing response.

Surgical Treatment

It is rare to need an operation for heel pain. It would only be offered if all simpler treatments have failed and, in particular, you are a reasonable weight for your height and the stresses on your heel cannot be improved by modifying your activities or footwear. The aim of an operation is to release part of the plantar fascia from the heel bone and reduce the tension in it. Many surgeons would also explore and free the small nerves on the inner side of your heel as these are sometimes trapped by bands of tight tissue. This sort of surgery can be done through a cut about 3cm long on the inner side of your heel. Recently there has been a lot of interest in doing the operation by keyhole surgery, but this has not yet been proven to be effective and safe. Most people who have an operation are better afterwards, but it can take months to get the benefit of the operation and the wound can take a while to heal fully. Tingling or numbness on the side of the heel may occur after operation.

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Prevention



It may not be possible to prevent all cases of heel pain. However, there are some easy steps that you can take to avoid injury to the heel and prevent pain. Whenever possible, you should wear shoes that fit properly and support the foot, wear the right shoes for physical activity, stretch your muscles before exercising, pace yourself during physical activity, maintain a healthy diet, rest when you feel tired or when your muscles ache, maintain a healthy weight.

Overview

Leg length discrepancy, or as it has been alternatively termed, the short leg syndrome, is by far the most important postural asymmetry. Limb length discrepancy is simply defined as a condition where one leg is shorter than the other. If a substantial difference exists, disruptive effects on gait and posture can occur. Leg length discrepancy can be divided into two etiological groups. Structural. True shortening of the skeleton from congenital, traumatic or diseased origins. Functional. Development from altered mechanics of the lower body, such as foot hyperpronation or supination, pelvic obliquity, muscle/joint imbalances, poor trunk stabilization and deep fascial strain patterns.

Causes

A patient?s legs may be different lengths for a number of reasons, including a broken leg bone may heal in a shorter position, particularly if the injury was severe. In children, broken bones may grow faster for a few years after they heal, resulting in one longer leg. If the break was near the growth center, slower growth may ensue. Children, especially infants, who have a bone infection during a growth spurt may have a greater discrepancy. Inflammation of joints, such as juvenile arthritis during growth, may cause unequal leg length. Compensation for spinal or pelvic scoliosis. Bone diseases such as Ollier disease, neurofibromatosis, or multiple hereditary exostoses. Congenital differences.

Symptoms

The effects vary from patient to patient, depending on the cause of the discrepancy and the magnitude of the difference. Differences of 3 1/2 to 4 percent of the total length of the lower extremity (4 cm or 1 2/3 inches in an average adult), including the thigh, lower leg and foot, may cause noticeable abnormalities while walking and require more effort to walk. Differences between the lengths of the upper extremities cause few problems unless the difference is so great that it becomes difficult to hold objects or perform chores with both hands. You and your physician can decide what is right for you after discussing the causes, treatment options and risks and benefits of limb lengthening, including no treatment at all. Although an LLD may be detected on a screening examination for curvature of the spine (scoliosis), LLD does not cause scoliosis. There is controversy about the effect of LLD on the spine. Some studies indicate that people with an LLD have a greater incidence of low back pain and an increased susceptibility to injuries, but other studies refute this relationship.

Diagnosis

A qualified musculoskeletal expert will first take a medical history and conduct a physical exam. Other tests may include X-rays, MRI, or CT scan to diagnose the root cause.

Non Surgical Treatment

Treatments for limb-length discrepancies and differences vary, depending on the cause and severity of the condition. At Gillette, our orthopedic surgeons are experts in typical and atypical growth and development. Our expertise lets us plan treatments that offer a lifetime of benefits. Treatments might include monitoring growth and development, providing noninvasive treatments or therapy, and providing a combination of orthopedic surgical procedures. To date, alternative treatments (such as chiropractic care or physical therapy) have not measurably altered the progression of or improved limb-length conditions. However, children often have physical or occupational therapy to address related conditions, such as muscle weakness or inflexibility, or to speed recovery following a surgical procedure. In cases where surgical treatment isn?t necessary, our orthopedists may monitor patients and plan noninvasive treatments, such as, occupational therapy, orthoses (braces) and shoe inserts, physical therapy, prostheses (artificial limbs).



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Surgical Treatment

Epiphysiodesis is a surgical option designed to slow down the growth of the long leg over a period of months to years. It is only used in growing children. The operation involves a general anaesthetic. Small incisions are made around the knee near the growth plates of the thigh bone and the shin bone. The growth plates are prevented from growing by the use of small screws and plates (?8 - plates?). The screws are buried beneath the skin and are not visible. Stitches are buried beneath the skin and do not need to be removed. The child is normally in hospital for 2-3 days. The child can weight bear immediately and return back to normal activity within a few weeks. Long term follow up is required to monitor the effects of the surgery. The timing of the surgery is based on the amount of growth predicted for the child. Therefore, this procedure can under- and over-correct the difference in leg length. Occasionally the screws have to be removed to allow growth to continue. This procedure can be used on one half of the growth plate to correct deformity in a limb e.g. knock-knees or bow legs. This is known as hemiepiphysiodesis.

Overview

Morton?s neuroma is inflammation, thickening, or enlargement of the nerve between the bones of the toes (metatarsal bones). The condition is also called intermetatarsal neuroma. The thickening is usually found between bones of the third and fourth toes of the foot, but sometimes it may develop between the second and third toes. It occurs when the medial plantar nerve near the bones of those toes becomes compressed or irritated, possibly because the metatarsal bones press against the nerve in the narrow gap between the toes. If left untreated, Morton?s neuroma can cause a sharp, burning, or shooting pain that often gets worse over time. The pain becomes worse when a person walks or stands on the ball of the foot. Sometimes the pain reaches the toes next to the neuroma and a sensation of tingling or numbness is felt.

Causes

Inappropriate footwear is one of the principle causes of Morton?s neuroma. Toe spring and tapering toe boxes are the most problematic shoe design features that contribute to this health problem. Morton?s neuroma occurs when one of your nerves is stretched and pinched, which happens with great frequency in people who wear shoes incorporating these design features. A professional shoe fitting should always be sought if you are struggling with neuroma-related symptoms.

Symptoms

The symptoms of a Morton's neuroma are classic in nature. The patient complains of a burning , tingling, slightly numb feeling (dysesthesias) which radiates out to the toes on either side of the interspace that is involved. For instance, a Morton's neuroma of the third interspace will result in pain between the third and fourth toes, and a neuroma in the second interspace will cause pain between the second and third toes. The symptoms are usually aggravated by wearing shoes, particularly those with high heels. Symptoms are relieved by walking in flat, wide shoes or going barefoot. Rarely will the patient experience pain when sitting or laying down.

Diagnosis

Your health care provider can usually diagnose this problem by examining your foot. A foot x-ray may be done to rule out bone problems. MRI or ultrasound can successfully diagnose the condition. Nerve testing (electromyography) cannot diagnose Morton neuroma. But it may be used to rule out conditions that cause similar symptoms. Blood tests may be done to check for inflammation-related conditions, including certain forms of arthritis.

Non Surgical Treatment

There are various options for treating the condition, depending on its severity. Self-treatment. Here are some simple steps that may improve symptoms. Wear supportive shoes with a wide toe box. Do not lace the forefoot of the shoe too tightly. Shoes with shock-absorbent soles and proper insoles are recommended. Do not wear tight or pointed toed shoes or shoes with heels more than 2 inches high. Use over-the-counter shoe pads to relieve pressure. Apply an ice pack to the affected area to reduce pain and swelling. Rest your feet and massage the painful area. There are drugs that may temporarily relieve the pain and other symptoms of Morton?s neuroma. Long-term use of these medications is not recommended. Anti-inflammatory drugs-Nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin, may be taken orally to reduce pain and inflammation. Anti-inflammatory drugs can also be administered by direct injection into the skin. Local anesthetic. An anesthetic injection will temporarily relieve pain by numbing the affected nerve. Orthotics. These are custom-designed shoe inserts that can reduce some of the pain associated with Morton?s neuroma. Sometimes padding is placed around the toe area, and tape is applied to hold the padding in place.

Surgical Treatment

If other therapies have not worked it may be necessary to perform surgery. As surgery may result in permanent numbness in the affected toe, doctors ten to use this procedure as a last resort. However, in most cases surgery is extremely effective. The patient usually receives a local anesthetic. Surgery involves either removing the nerve, or removing the pressure on the nerve. Two surgical approaches are possible. The dorsal approach, the surgeon makes an incision on the top of the foot, allowing the patient to walk soon after surgery, because the stitches are not on the weight-bearing side of the foot. The plantar approach, the surgeon makes an incision on the sole of the foot. In most cases the patient will be in crutches for about three weeks. The resulting scar may make walking uncomfortable. However, with this approach the neuroma can be reached easily and resected without cutting any structures. There is a small risk of infection around the toes after surgery.

There are two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is structurally shorter than the other. Through developmental stages of aging, the brain senses the stride pattern and identifies some variance. The body typically adapts by dipping one shoulder over to the "short" side. A difference of under a quarter inch isn't blatantly abnormal, doesn't need Shoe Lifts to compensate and normally won't have a serious effect over a lifetime.



Leg length inequality goes typically undiagnosed on a daily basis, however this condition is easily fixed, and can reduce numerous cases of upper back pain.

Treatment for leg length inequality typically consists of Shoe Lifts. Many are economical, often priced at under twenty dollars, in comparison to a custom orthotic of $200 or more. Differences over a quarter inch can take their toll on the spine and should probably be compensated for with a heel lift. In some cases, the shortage can be so extreme that it requires a full lift to both the heel and sole of the shoe.

Upper back pain is the most widespread ailment afflicting people today. Over 80 million people experience back pain at some point in their life. It's a problem which costs companies vast amounts of money every year as a result of time lost and production. Fresh and improved treatment solutions are continually sought after in the hope of decreasing the economical impact this issue causes.



Men and women from all corners of the earth experience foot ache due to leg length discrepancy. In a lot of these situations Shoe Lifts might be of worthwhile. The lifts are capable of easing any pain in the feet. Shoe Lifts are recommended by many specialist orthopaedic orthopedists.

So that they can support the body in a nicely balanced manner, the feet have a significant part to play. In spite of that, it is sometimes the most overlooked zone in the human body. Many people have flat-feet meaning there is unequal force placed on the feet. This causes other parts of the body like knees, ankles and backs to be affected too. Shoe Lifts guarantee that suitable posture and balance are restored.