A flat foot is a term used to described a collapsed arch. Medically, the term is pes planovalgus (for foot flatten and pushed outwards). There are varying degrees of ?flatness?. Though not all flat feet are problematic, however, when there are painful flat feet can cause significant discomfort and activity limitations. There are two kinds of flat feet - flexible (mobile) or rigid (stiff). A flexible flat foot is one where the foot retains motion, and the arch is able to be recreated when there is no weight on the foot. In contrast, a rigid flat foot is ?stuck? in the flat position regardless of whether or not there is pressure placed on the foot.
The most common cause of arch pain is plantar fasciitis. Plantar fasciitis is the name that describes inflammation of the fibrous band of tissue that connects the heel to the toes. Symptoms of plantar fasciitis include pain early in the morning and pain with long walks or prolonged standing. Arch pain early in the morning is due to the plantar fascia becoming contracted and tight as you sleep through the night. When awakening and walking in the morning, the fascia is still tight and prone to irritation when stretched. When walking or standing for long periods, the plantar fascia becomes inflamed and painful. Treatment of plantar fasciitis is best accomplished with some simple stretching exercises, anti-inflammatory medications, and inserts for your shoes.
Intense heel pain, especially first thing in the morning and after a long day. Difficulty walking or standing for long periods without pain. Generally, the sharp pain associated with plantar fasciitis is localized to the heel, but it can spread forward along the arch of the foot and back into the Achilles tendon. While severe cases can result in chronic pain that lasts all day, the most common flare ups occur first thing in the morning, making those first steps out of bed a form of torture, and in the evening after having spent a day on your feet. Overpronation (a foot that naturally turns too far inward), high arches, and flat feet (fallen arches) can all cause similar arch pain. In these cases, however, the pain is more likely to continue throughout the day rather than being worst in the morning.
The doctor will examine your feet for foot flexibility and range of motion and feel for any tenderness or bony abnormalities. Depending on the results of this physical examination, foot X-rays may be recommended. X-rays are always performed in a young child with rigid flatfeet and in an adult with acquired flatfeet due to trauma.
Non Surgical Treatment
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods. Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics). Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day. Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor. Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
The procedure involves cutting and shifting the bone, and then performing a tendon transfer. First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position. Second, the surgeon transfers the tendon. Reroute the flexor digitorum to replace the troublesome posterior tibial tendon. Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient?s specific foot deformity. Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten. Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot. Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.
Inchworm. Stand with your weight on one foot. Raise the metatarsal heads of the unweighted foot while you pull its heel closer to your toes. Next, raise your toes toward the ceiling, and then relax your whole foot with it flat on the floor. Your foot should move like an inchworm across the floor. Reps 6-7 for each foot. Horsepawing. Stand with your weight on one foot and the other foot slightly in front of you. Raise the metatarsal heads on the front foot. Lift your heel ever so slightly off the ground, maintaining the raised metatarsal heads, and pull your foot toward you so that it ends up behind you. Return this foot to the starting position in front of you. You should really feel this one in your arch. Reps. 6-7 for each foot. Toe pushups. Sit in a chair with your feet resting on the floor. Raise your heel as high as you can while keeping your toes flat on the floor. This is the starting position. Using your toe muscles, roll your foot upward until the weight of your foot is resting on the ends of your toes, like a dancer standing on point in toe shoes. Roll back down to the starting position. Reps. 10-20 for each foot. Sand scraping. Pretend you are at the beach standing in loose sand. Use your big toe to pull sand inward toward your body, with your little toe off the ground. Then use your little toe to push it away, with your big toe off the ground. Reps. 10 for each foot. Now reverse the exercise: pull the sand inward with your little toe and push it away with your big toe. Reps. 10 for each foot.