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Caring For Fallen Arches

7/2/2017

 
Overview

Acquired Flat Foot

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.

Causes

Footwear: shoes which limit toe movement; high heels. Barefoot walking may be protective. A tight Achilles tendon or calf muscles (heel cord contracture). This may help to cause Pes Planus, or may contribute to symptoms such as foot pain when there is existing Pes Planus. Obesity. Other bony abnormalities, eg rotational deformities, tibial abnormalities, coalition (fusion) of tarsal bones, equinus deformity. Ligamentous laxity, eg familial, Marfan's syndrome, Ehlers-Danlos syndrome, Down's syndrome. Other factors causing foot pronation, eg hip abductor weakness and genu valgum.

Symptoms

Having flat feet can be painless and is actually normal in some people. But others with flat feet experience pain in the heel or arch area, difficulty standing on tiptoe, or have swelling along the inside of the ankle. They may also experience pain after standing for long periods of time or playing sports. Some back problems can also be attributed to flat feet.

Diagnosis

There are a few simple ways to assess your foot type, and most include making an imprint of your footprint. The classic way is to stand on a hard floor surface with wet feet to make a wet foot print. Look at the narrowest part of your footprint, which should be between your heel and ball of your foot. If the print of your foot in this part is less than 10% of the width of the widest part then you are likely to have high arches. more than 10% but less than 25% then your foot profile is probably normal, more than 25% or even the widest part, then you have flat feet.

Is flat footedness genetic?

Non Surgical Treatment

Some of the aspects of the pain with a ?fallen arch? are related to the crushing of the joints of the outside of the foot and from the stretching of ligaments and tendons of the inside of the foot. Unfortunately, some parts of the damage from the fallen arch, the weakness in the tendons and the new shape of the foot, are not correctable without surgical reconstruction. The first goal is to stabilize the collapsed arch. This can be done through braces. If the deformity is mild, an over-the-counter arch support may be sufficient. In more severe deformities an hinged or solid ankle brace may be necessary. Rehabilitative exercises under the supervision of a physical therapist will help increase the strength of the remaining muscles. Stiffness of certain tendons including the Achilles and hamstring is also very helpful as tightness in these structures is very common in people with ?fallen arches?. Postural training is necessary. A short period of casting or walking in a cast boot will improve swelling of a recent partial tear of the tendons and ligaments on the inside of the ankle. Nonsteroidal anti-inflammatory medications such as ibuprofen, and naprosyn can help to relieve the pain, but do not heal the injuries associated with this or decrease the swelling significantly. Surgical reconstruction is available if the pain cannot be controlled reasonably with these measures.

Surgical Treatment

Adult Acquired Flat Feet

Fallen arches may occur with deformities of the foot bones. Tarsal coalition is a congenital condition in which the bones of the foot do not separate from one another during development in the womb. A child with tarsal coalition exhibits a rigid flat foot, which can be painful, notes the patient information website eOrthopod. Surgery may prove necessary to separate the bones. Other foot and ankle conditions that cause fallen arches may also require surgery if noninvasive treatments fail to alleviate pain and restore normal function.

Leg Length Discrepancy And Orthotics

7/1/2017

 
Overview

Many people undergo surgery for various reasons - arthritis, knee replacement, hip replacement, even back surgery. However, the underlying cause of leg length inequality still remains. So after expensive and painful surgery, follow by time-consuming and painful rehab, the true culprit still remains. Resuming normal activities only continues to place undue stress on the already overloaded side. Sadly so, years down the road more surgeries are recommended for other joints that now endure the excessive forces.Leg Length Discrepancy

Causes

LLDs are very common. Sometimes the cause isn?t known. But the known causes of LLD in children include, injury or infection that slows growth of one leg bone. Injury to the growth plate (a soft part of a long bone that allows the bone to grow). Growth plate injury can slow bone growth in that leg. Fracture to a leg bone that causes overgrowth of the bone as it heals. A congenital (present at birth) problem (one whole side of the child?s body may be larger than the other side). Conditions that affect muscles and nerves, such as polio.

Symptoms

The symptoms of limb deformity can range from a mild difference in the appearance of a leg or arm to major loss of function of the use of an extremity. For instance, you may notice that your child has a significant limp. If there is deformity in the extremity, the patient may develop arthritis as he or she gets older, especially if the lower extremities are involved. Patients often present due to the appearance of the extremity (it looks different from the other side).

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

Non-surgical treatment can be effective. A shoe lift may be recommended if the leg length difference is less than 1 inch. More significant leg length discrepancies may require a surgical procedure. In children, surgical procedures are available to help make leg lengths more equal.

LLD Shoe Inserts

how to grow taller at 16

Surgical Treatment

Large leg length inequalities can be treated by staged lengthenings or by simultaneous ipsilateral femoral and tibial lengthenings. Additionally, lengthenings can be combined with appropriately timed epiphysiodesis in an effort to produce leg length equality. Staged lengthenings are often used for congenital deficiencies such as fibular hemimelia, in which 15 cm or more may be needed to produce leg length equality. We typically plan for the final lengthening to be completed by age 13 or 14 years, and allow at least 3 years between lengthenings. Lengthening of both the tibia and femur simultaneously requires aggressive therapy and treatment of soft tissue contractures. Curran et al[57] reported the need for surgical release of soft tissue contractures in 3 of 8 patients treated with simultaneous ipsilateral femoral and tibial lengthenings. Lengthening over an IM nail can be done in an effort to decrease the amount of time the fixator needs to be worn and to prevent angular malalignment. This technique requires that the patient be skeletally mature and it carries a higher risk of osteomyelitis (up to 15%). Additionally, if premature consolidation occurs, a repeat corticotomy is more difficult.

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