What Are Fallen Arches

Overview

Flat Feet

Flat feet and fallen arches refer to the same thing. It’s a downward sagging of the inside edge of the foot during standing or walking. The front-to-back arches (called the longitudinal arches) are natural curves along the bottoms of both feet that are supported by muscles and ligaments. When these muscles and ligaments give way, the arches sag with each step. When the arches sag, your weight is shifted toward your big toes.


Causes

Fallen arches in adults are caused by several things. Below are some of the most common causes. Abnormalities present from birth. Torn or stretched tendons (resulting from foot injuries or foot strains). Inflammation or damage of the PTT (posterior tibial tendon). The PTT is responsible for connecting the middle of the arch to the ankle and lower leg. Dislocated or broken bones (also as a result of injury). Health problems like rheumatoid arthritis. Nerve problems. Other factors like diabetes, obesity, aging and pregnancy (these factors are known to increase the risk of fallen arches).


Symptoms

Arches can be seen as ?rolling downward? or collapsing when walking. Pain may present in lower back, hips or knees. Pain may be present on the bottom of the heels, within the arch, within the ankles or even the forefoot. Swelling can occur. Pain may occur in the anterior leg muscles.


Diagnosis

Many medical professionals can diagnose a flat foot by examining the patient standing or just looking at them. On going up onto tip toe the deformity will correct when this is a flexible flat foot in a child with lax joints. Such correction is not seen in the adult with a rigid flat foot. An easy and traditional home diagnosis is the “wet footprint” test, performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. In more extreme cases, known as a kinked flatfoot, the entire inner edge of the footprint may actually bulge outward, where in a normal to high arch this part of the sole of the foot does not make contact with the ground at all.


Non Surgical Treatment

Normally, flat feet disappear by age six as the feet become less flexible and the arches develop. Only about 1 or 2 out of every 10 children will continue to have flat feet into adulthood. For children who do not develop an arch, treatment is not recommended unless the foot is stiff or painful. Shoe inserts won?t help your child develop an arch, and may cause more problems than the flat feet themselves. However, certain forms of flat feet may need to be treated differently. For instance, a child may have tightness of the heel cord (Achilles tendon) that limits the motion of his foot. This tightness can result in a flat foot, but it usually can be treated with special stretching exercises to lengthen the heel cord. Rarely, a child will have truly rigid flat feet, a condition that can cause problems.


Surgical Treatment

Flat Foot

This is rare and usually only offered if patients have significant abnormalities in their bones or muscles. Treatments include joint fusion, reshaping the bones in the foot, and occasionally moving around tendons in the foot to help balance out the stresses (called tendon transfer).


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.


After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or non-union (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.

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