Arch Disorders Treatment
Flat Foot Pain
CAUSES
Flat foot is most commonly a genetic condition passed on from generation to generation. The ankle bone (talus) rests atop the heel bone (calcaneus) and moves back and forth when putting weight on and taking weight off your foot with every step. Flat feet happen when the ankle bone falls off the shelf and unlocks the middle arch of the foot causing the arch to collapse. This condition is called talo-tarsal dislocation. This condition will ultimately lead to a weaking of the posterior tibial tendon causing the foot to further collapse because the posterior tibial tendon was meant to help hold the arch upwards and also plantar flex and invert the foot. Other causes can include trauma induced flat foot deformity from damage caused to the bones or muscles altering their function.
DIAGNOSIS
Diagnosis is made using x-rays to check the structure of the foot and the alignment of the bones as well as possible fusions. Also a physical exam is done to check for the flexibility of the arch by lifting the big toe while weight bearing and standing on your toes to see if the heel bone is movable. Occassionally an MRI is performed to check for possible fusions that most commonly form between the ages of 8-12 and cause a rigid flatfoot. We also check for conditions such as posterior tibial tendonitis that may lead to a flat foot deformity. Most commonly associated with an enlargement of the navicular bone located on the inside of the arch in the middle of the foot.
TREATMENT
Most commonly hard rigid orthotics are recommended to help support the arch but unfortunately research shows that only about 3% of the dislocation is addressed. This means that eventually those expensive inserts you purchased will be worthless in a month or a year(s) depending on the severity of the deformity.
Once conservative treatment has failed other physicians will recommend a fusion of the subtalar joint (which is the ankle bone fused to the heel bone) and possible additional fusions to control the flattening of the foot. This requires a non weight bearing status for 6-8 weeks with 3-6 months of physical therapy and 4-6 months off work if you have a job that requires you to stand. This is per foot. Also this procedure is fraught with complications and cannot be reversed if the correction was inadequate.
HYPROCURE
At Mid-Ohio Foot & Ankle Specialists we recommend the hyprocure procedure on patients as young as 8 and as old as 80 which can be performed through a one centimeter incision on an outpatient basis and allows you to bear full weight the same day. After 2 weeks you are placed back into your shoe and the other foot can then have the same surgery performed if needed. You will be able to return to work in 4-6 weeks if you have a stand-up job.
It has been my experience that 98% of patients do well with the stabilization procedure and the other 2% actually require fusions because their condition is so severe.
When considering your options remember this, you can always remove the implant and then fuse the joints if needed, but you can’t remove the fusion once it is performed.
For more information please visit: https://www.hyprocure.com
TENDONITIS Posterior Tibial
CAUSES
Posterior tibial tendonitis is most commonly caused from the excess pressure place on the arch of the foot during walking or running and without proper support. Since the arch is one of the foots shock absorbers, if you have an extremely flexible foot there will be more motion in the arch which causes the tendon to over stretch and eventually micro-tear leading to inflammation and subsequent pain with any weight bearing. Other conditions that can lead to posterior tibial tendonitis are talo-tarsal dislocation (flat foot) which has a genetic link from birth. Also an enlarged or accessory navicular where the posterior tibial tendon attachment changes the fulcrum point of the pull of the muscle and will eventually weaken the muscle leading to a collapse of the arch. Any or all of these will lead to pain, swelling, redness and a decrease in the motion of the foot and subsequent decrease in activities.
DIAGNOSIS
Posterior tibial tendonitis can be diagnosed by a hands on evaluation of the foot testing the muscle strength, usually the patient is unable to point their toes forward and inward without pain or raise up on their toes on the affected foot. Also there is pain to palpation along the tendon from the insertion point going up the inside of the ankle and leg. Patients often relate pain on the inside of the arch when trying to stand or walk. X-rays are taken to obtain views of the bone structure to check for fractures, overgrowth of the navicular bone, accessory bones in the tendon or most commonly a flat foot deformity from the displacement of the ankle bone on the heel bone. Diagnostic ultrasound will also be used to check for thickening, change in the color or tearing of the tendon. Finally an MRI may be performed to confirm the suspicions of the doctor that there may be a tear and to what degree and location of the damaged tissue.
Tendonitis Posterior Tibial Treatment
Initial treatment consists of rest, ice, compression and elevation which most people have tried before coming to the doctor. Our medical treatment varies depending on the severity of the condition.
Mild tendonitis can be treated using a soft arch support with a compression anklet stocking and anti-inflammatories or steroid injections with a decrease in activities for a few weeks. Laser therapy may also be recommended to help decrease the inflammation and increase the blood flow to the area to heal the tissues.
Moderate to severe tendonitis may require immobilization in a cam walker with an arch support so that the patient is able to continue to bear light weight and recommended amniotic injections to help repair the tendon and decrease the inflammatory process to allow healing along with laser therapy.
Severe tendonitis or tears may require surgical intervention to repair the tendon or remove the hypertrophic or accessory bone that may be causing the tendon to be inflamed.
After a period of 4 -6 months and / or having failed conservative therapy options mentioned above, Mid-Ohio Foot & Ankle Specialists recommends high intensity shock wave therapy (ESWT). ESWT can be beneficial is reducing the calcifications in the tendon caused from injury and induce the inflammatory process leading to the reparative process. A decrease in pain is felt within hours to days.
