Adult Acquired Flatfoot

Article Featured on AAOS

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, braces and physical therapy. In patients who have tried these treatments 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.

Adult acquired flatfoot

One of the more common signs of flatfoot is the “too many toes” sign. Even the big toe can be seen from the back of this patient’s foot. In a normal foot, only the fourth and fifth toes should be visible.

Symptoms

Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms below:

  • Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle.
  • Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time.
  • When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle. Arthritis in the heel also causes this same type of pain.
  • Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoewear very difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes.
  • Diabetics may only notice swelling or a large bump on the bottom of the foot. Because their sensation is affected, people with diabetes may not have any pain. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoewear is not used.

Cause

As discussed above, many health conditions can create a painful flatfoot.

Posterior Tibial Tendon Dysfunction (PTTD)

Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot.

The main function of this tendon is to hold up the arch and support your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse.

Anatomy of the foot

The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot.

Women and people over 40 are more likely to develop problems with the posterior tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition, people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use.

Arthritis

Inflammatory arthritis, such as rheumatoid arthritis, can cause a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the foot to change shape and become flat.

The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch.

Injury

An injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot.

In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.

Diabetic Collapse (Charcot Foot)

People with diabetes or with a nerve problem that limits normal feeling in the feet, can have arch collapse.

This type of arch collapse is typically more severe than that seen in patients with normal feeling in their feet. This is because patients do not feel pain as the arch collapses. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate – without the patient feeling any pain. This may result in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.

Summary

Adult acquired flatfoot is one of the most common problems affecting the foot and ankle. Treatment ranges from nonsurgical methods — such as orthotics and braces — to surgery. Your doctor will create a treatment plan for you based on what is causing your AAFD.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Causes and treatments for pain in the arch of the foot

Causes and treatments for pain in the arch of the foot

The arch of the foot is an area along the bottom of the foot between the ball and the heel. Pain in the arch of the foot is a common problem, especially among athletes. The arch is made up of three separate arches that form a triangle. Each arch is made up of bones, ligaments, and tendons.

There are many potential causes of pain in the arch of the foot. Keep reading for more information on these causes, as well as the possible treatments.

Causes

The two most common causes of pain in the arch of the foot involve injury and structural issues. Structural issues typically refer to high or low arches or other abnormalities in the foot and surrounding area.

In both cases, several factors can trigger or aggravate these issues, including:

  • aging
  • overuse
  • weight gain
  • physical stress
  • neurological conditions

Causes of pain in the arch of the foot include:

Overpronation

Overpronation refers to how a person’s foot moves while walking, running, or jogging. A person who overpronates strikes the ground with the outer portion of the heel first. As the person completes the step, the foot rolls too far onto the arch. The extra pressure causes the arch to flatten.

Long term, overpronation can damage the tendons, muscles, and ligaments. This damage can lead to pain in the arch, knee, hip, or back. It may also cause hammertoe and calluses. A person who overpronates often benefits from extra support when walking. Support can include stability shoes and prescription arch supports.

Plantar fasciitis

Plantar fasciitis is a degenerative condition of the plantar fascia and a common causes of heel pain. The plantar fascia is a ligament that connects the back of the foot to the front.

Common causes of plantar fasciitis include:

  • injury
  • overuse
  • inflammation

Anyone can get plantar fasciitis, but activities such as running can increase the risk. If a person has plantar fasciitis, they often feel pain when waking up. The pain typically gets worse throughout the day with walking and standing. In addition to arch pain, a person may feel stiffness in the heel or ball of their foot.

People with plantar fasciitis may need to stop doing activities such as running to let the foot heal. They can also consider wearing support shoes or using inserts to help take pressure off the arch.

Cavus foot

Cavus foot is a structural abnormality that causes a high arch. Causes of cavus foot include:

  • genetics
  • stroke
  • cerebral palsy
  • Charcot-Marie-Tooth disease

If a person has cavus foot, they may feel pain when walking or standing. They may also have reduced stability, which can lead to ankle sprains and injuries.

A person may have other issues related to cavus foot, including:

  • claw toe
  • hammertoe
  • calluses

People with cavus foot can consider support shoes or inserts to help stabilize their feet and avoid pain and possible injury.

Posterior tibial tendon dysfunction

The posterior tibial tendon connects one of the calf muscles to the inner part of the foot. Posterior tibial tendon dysfunction (PTTD) occurs when this tendon is injured or inflamed. If the posterior tibial tendon cannot support the arch, a person may feel pain there as a result.

PTTD pain typically occurs in the inner part of the ankle and back of the calf. The pain usually occurs while running or walking briskly and goes away once a person stops. An ankle brace or specially designed inserts can help correct PTTD.

Flat feet

Flat feet can occur in children or adults. In many cases, flat feet cause no issues, but they can also cause a person to experience pain in the arch, other areas of the foot, legs, ankles, and back.

A person may not realize they have flat feet until symptoms occur. A doctor may recommend using supportive shoes or inserts to help provide additional support for the arch.

Treatment

In some cases, home treatments and stretching are not enough to relieve pain. If this is the case, a doctor or podiatrist may recommend one or more of the following:

  • physical therapy
  • night splints
  • braces
  • casts
  • surgery
  • cortisone injections
  • prescription pain relievers (prescription non-steroidal anti-inflammatory medications)
  • prescription orthotics, support shoes, or inserts

Home remedies and stretches

While undergoing treatment, a person should still consider home remedies and stretches to help alleviate the pain. A person should not attempt these if a doctor advises them not to move the foot.

Some home remedies include:

  • Resting: Stop or significantly reduce doing any activity that aggravates the arch.
  • Applying ice: Apply an ice pack wrapped in a cloth to the arch and other tender areas to help reduce swelling.
  • Wearing socks: Avoid walking around in bare feet.
  • Using support: Consider using cushions, inserts, and support shoes.
  • Splinting: Ask a doctor about splinting the foot at night to help keep it supported while sleeping.
  • Using medication: Try over-the-counter pain relievers, such as ibuprofen.

In addition, there are a few different techniques a person can do to help alleviate pain and make the arch less prone to injury. These include:

Foot Stretch

To perform this stretch:

  • sit down
  • place the foot on the opposite thigh
  • hold the toes with one hand while pushing in and down on the heel with the other
  • gently push the toes towards the heel and hold for 3–5 minutes

Calf stretch

When a person stretches their calves, they can relieve pain and pressure on the arch of the foot. To perform a calf stretch:

  • stand facing the wall and place both hands shoulder width apart on the wall
  • take a step back with one foot
  • bend the front knee forward while keeping the back knee straight and the heel on the floor
  • hold the stretch for 20–30 seconds, repeat three times and then switch legs

Roller or ball foot massage

A person can use a small tennis ball or foam roller to perform a massaging stretch on the foot. This technique is easiest to do while sitting. To use this technique, a person should:

  • take off their shoes and sit in a chair
  • place the ball or roller under the arch of the foot
  • roll it back and forth from the ball of the foot to the heel over the arch

About the arch of the foot

The arch is responsible for several functions in the foot. Some things the arch does include:

  • helps bear weight
  • helps stabilize movements
  • allows the foot to adapt to changes in the terrain as a person walks or runs
  • helps absorb shock
  • helps maintain balance

A person may feel an injury to the arch directly in the area. It is also possible to feel pain or discomfort in other areas, including the:

  • heel
  • ball of foot
  • top of foot
  • hips
  • legs
  • knees
  • back
  • ankles

In some cases, a person may feel the worst pain in the morning. However, most people will experience worse pain during activities, including standing, that directly involves the feet.

When to see a doctor

For occasional pain, resting, ice, and stretching are usually sufficient. However, if the pain does not go away after a few days, is severe, or frequently comes back, a person should talk to a doctor.

A doctor may refer a person to an orthopedic surgeon who specializes in the feet and ankles or a podiatrist, who is a foot specialist. They can examine the person’s foot, how they walk, and other factors to determine what the underlying issue is.

An examination may include:

  • looking for inflammation, tenderness, swelling, deformities,
  • checking balance, coordination, reflexes, sensation, and muscle tone
  • tests such as X-rays, CT scans, MRIs, or ultrasounds

Once a doctor determines the underlying cause of the pain, they will recommend treatments that specifically target the underlying cause and help alleviate pain.

Summary

Arch pain is a common problem, especially among athletes. In many cases, a person can stretch, rest, and ice the arch of their foot until the pain goes away.

Problems with the arch of the foot can also cause pain in different parts of the body, including the ankle, heel, legs, knee, and back. It is essential to treat the problem early to ensure that foot problems do not lead to back or knee injuries.

If the pain persists, gets worse, or is chronic, a person should talk to their doctor about additional treatment options.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Flexible Flatfoot in Children

Flexible Flatfoot in Children

Article Featured on AAOS

When a child with flexible flatfoot stands, the arch of the foot disappears. Upon sitting or when the child is on tiptoes, the arch reappears. Although called “flexible flatfoot,” this condition always affects both feet.

Flexible flatfoot is common in children. While parents often worry that an abnormally low or absent arch in a child’s foot will lead to permanent deformity or disability, most children eventually outgrow flexible flatfoot without developing any problems in adulthood. The condition is usually painless and does not interfere with walking or participation in sports. If your child’s flexible flatfoot does not cause pain or discomfort, no treatment is needed.

Flexible flatfoot

Flexible flatfoot, showing the absence of an arch when standing. The arch reappears when the patient is sitting or on tiptoes.

Description

A flexible flatfoot is considered to be a variation of a normal foot. The muscles and joints of a flexible flatfoot function normally. Most children are born with very little arch in the feet. As they grow and walk, the soft tissues along the bottom of the feet tighten, which gradually shapes the arches of the feet.

Children with flexible flatfoot often do not begin to develop an arch until the age of 5 years or older. Some children never develop an arch. If flexible flatfoot continues into adolescence, a child may experience aching pain along the bottom of the foot. A doctor should be consulted if a child’s flatfeet cause persistent pain.

Doctor Examination

To make the diagnosis, your doctor will examine your child to rule out other types of flatfeet that may require treatment. These include flexible flatfoot with a tight heel cord (Achilles tendon), or rigid flatfoot, which may be a more serious condition.

Tell your doctor if anyone else in the family is flatfooted, as this may be an inherited condition. Your doctor will need to know about any known neurological or muscular disease in your child.

Your doctor will look for patterns of wear on your child’s everyday shoes. He or she may ask your child to sit, stand, raise the toes while standing, and stand on tiptoe. In addition, your doctor will probably examine your child’s heel cord (Achilles tendon) for tightness and may check the bottom of your child’s foot for calluses.

Flexible flatfoot

The arch disappears when standing (left) and reappears when the child is on tiptoes (right)Reproduced from Sullivan JA: Pedatric Flatfoot: Evaluation and Management. J Am Acad Orthop Surg 1999;7:44-53.

Treatment

Nonsurgical Treatment

Treatment for flexible flatfoot is required only if your child is experiencing discomfort from the condition.

Stretching exercises. If your child has activity-related pain or tiredness in the foot, ankle, or leg, your doctor may recommend stretching exercises for the heel cord.

Heel cord stretch

Heel cord stretch.

  • Heel Cord Stretch
    Lean forward against a wall with one leg in front of the other. Straighten your back leg and press your heel into the floor. Your front knee is bent. Hold for 15 to 30 seconds. Keep both heels flat on the floor. Point the toes of your back foot toward the heel of your front foot.  This stretch should be performed three times on each leg.

Shoe inserts (orthotics). If discomfort continues, your doctor may recommend shoe inserts. Soft-, firm-, and hard-molded arch supports may help relieve your child’s foot pain and fatigue. They can also extend the life of your child’s shoes, which may otherwise wear unevenly.

In most cases, there is little benefit to using custom-molded arch supports.  Over-the-counter arch supports, which are available at most sporting goods and running shoe stores, can be just as effective and are much less expensive to replace as your child grows. Online retailers often have inserts in difficult-to-find sizes.

Additional treatment. Your doctor may prescribe physical therapy or casting if your child has flexible flatfoot with tight heel cords.

Flexible flatfoot corrected over time

A child at age 3 years (left) with flexible flatfoot. The same child at age 15 years (right) has a normal arch despite having received no treatment. Reproduced from Sullivan JA: Pedatric Flatfoot: Evaluation and Management. J Am Acad Orthop Surg 1999;7:44-53.

Surgical Treatment

Occasionally, surgical treatment may be recommended for an adolescent with persistent pain. Surgery is typically performed to create an arch in the foot and lengthen tendons that may be tight and causing pain. The surgery is usually performed in stages. One foot is corrected then, after several months of recovery, the second surgery takes place.

In a small number of children, flexible flatfeet become rigid instead of correcting with growth. These cases may need further medical evaluation.

What May Cause Foot Pain After Running

What May Cause Foot Pain After Running

By Christine Luff| Featured on Verywellfit

Are you feeling post-run pain in your arch, top of foot, toes, heel, side of foot, toenails, or maybe more than one spot? Foot pain is a common ailment among runners and also one that can be confusing because the causes and treatments for the pain can vary widely.

Read more

How to Tell if Your Toe is Broken

How to Tell if Your Toe is Broken

Is it a sprain or a break?

If you’ve ever stubbed your toe hard, the immediate, severe pain can leave you wondering if your toe is broken. In many cases, the injury winds up being a sprain. This is painful, but it means the bone itself is still intact.

If the toe bone breaks into one or more pieces, then you have a broken toe.

Learning to recognize the symptoms and treatment of a broken toe is important. If a broken toe is left untreated, it can lead to problems that may affect your ability to walk and run. A poorly treated broken toe may also leave you in a lot of pain.

Symptoms of a Broken Toe

Throbbing pain in the toe is the first sign that it may be broken. You may also hear the bone break at the time of injury. A broken bone, also called a fracture, may also cause swelling at the break.

If you’ve broken your toe, the skin near the injury may looked bruised or temporarily change color. You’ll also have difficulty putting any weight on your toe. Walking, or even just standing, can be painful. A bad break can also dislocate the toe, which can cause it to rest at an unnatural angle.

A sprained toe shouldn’t look dislocated. It will still swell, but will likely have less bruising. A sprained toe may be painful for several days, but should then begin to improve.

One other key difference between a break and a sprain is the location of the pain. Usually a break will hurt right where the bone has fractured. With a sprain, the pain may be felt in a more general area around the toe.

The only way to tell for sure if the injury is a break or a sprain is to see your doctor. They can examine your toe and determine the type of injury.

Causes

The two most common causes of a broken toe are stubbing it into something hard or having something heavy land on it. Going barefoot is a major risk factor, especially if you’re walking in the dark or in an unfamiliar environment.

If you carry heavy objects without proper foot protection, such as thick boots, you’re also at a higher risk for a broken toe.

What to expect when you see your doctor

A broken toe can usually be diagnosed with the use of an X-ray. If the pain and discoloration don’t ease up after a few days, you should definitely see your doctor.

A broken toe that doesn’t heal properly could lead to osteoarthritis, a painful condition that causes chronic pain in one or more joints.

Your doctor will examine your toe and ask for your medical history. Tell your doctor as many details as you can about the injury and your symptoms. Be sure to tell your doctor if you notice a loss of feeling or tingling in your toe. This could be a sign of nerve damage.

If there’s a chance the toe is broken, your doctor will likely want to get one or more X-rays of the injured toe. Getting images from different angles is important to understand the extent of the break.

Information from the X-ray will also help your doctor decide whether surgery is necessary.

Treatment of a Broken Toe

With most cases of a broken toe, there’s little your doctor can do. It’s mostly up to you to rest your toe and keep it stable.

Even before you know whether your toe is broken, you should ice the injured toe and keep it elevated. You may also take over-the-counter painkillers, such as acetaminophen (Tylenol), ibuprofen (AdvilMotrin), or naproxen (Aleve).

If you have surgery to repair the toe, your doctor may prescribe stronger pain medicines.

Splinting your toe

Typical treatment for a broken toe is called “buddy taping.” This involves taking the broken toe and carefully securing it to the toe next to it with medical tape. Usually, a gauze pad is placed between the toes to prevent skin irritation.

The non-broken toe is basically used as a splint to help keep the broken toe from moving too much. By taping the broken toe to its neighbor, you give the injured toe the support it needs to begin healing.

Surgery and additional treatment options

More serious breaks may require additional treatment. If you have bone fragments in the toe that need to heal, taping may not be enough.

You may be advised to wear a walking cast. This helps keep the injured toe stable while also giving your foot enough support to reduce some of the pain you may have while walking.

In very serious cases, surgery may be necessary to reset the broken bone or bones. A surgeon can sometimes put a pin or a screw into the bone to help it heal properly. These pieces of hardware will remain in the toe permanently.

Your toe is likely to be tender and swollen, even after a few weeks. You’ll likely need to avoid running, playing sports, or walking long distances for one to two months after your injury.

Recovery time can be longer if the break is in one of the metatarsals. The metatarsals are the longer bones in the foot that connect to the phalanges, which are the smaller bones in the toes.

Your doctor can give you a good estimate of recovery time based on the severity and location of your injury. A mild fracture, for example, should heal faster than a more severe break.

With a walking cast, you should be able to walk and resume most non-strenuous activities within a week or two after injuring your toe. The pain should diminish gradually if the bone is healing properly.

If you feel any pain in your broken toe, stop the activity that’s causing the pain and tell your doctor.

Outlook

The key to a good outcome is following through on your doctor’s advice. Learn how to tape your toe properly so you can change the tape regularly.

Carefully try to put more pressure on your broken toe each day to see how it’s recovering. Take any slight improvements in pain and discomfort as signs that your injury is healing.

Tips for recovery

Here are some things you can do to improve your recovery.

Footwear

You may temporarily need a bigger or wider shoe to accommodate your swollen foot. Consider getting a shoe with a hard sole and a lightweight top that will put less pressure on the injured toe, but still provide plenty of support.

Velcro fasteners that you can easily adjust can provide additional comfort.

Ice and elevation

Continue to ice and elevate your foot if your doctor recommends it. Wrap the ice in a cloth so that it doesn’t come into direct contact with your skin.

Take it slow

Ease back into your activities, but listen to your body. If you sense that you’re putting too much weight or stress on the toe, back off. It’s better to have a longer recovery and avoid any painful setbacks than to rush back into your activities too quickly.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Orthopedic Shoes: What To Look for When Buying

Orthopedic Shoes: What To Look for When Buying

Article Featured on HealthyFeet

If there’s a recurring theme in the report, it’s that buying the right orthopedic shoeis an investment in foot health. But how do you find an orthopedic shoe that fits properly and provides adequate support, without falling prey to commercial claims by shoe stores and manufacturers that may have no scientific basis?

Read more