Fallen arches symptoms

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Pes planus is a condition where the arch of the foot collapses and causes a "flat foot."

Flatfeet can contribute to problems in the feet, ankles and knees. Treatments are available to help prevent complications of flatfeet.

Because the feet support all of a person's weight and help with balance when standing, they're subject to substantial pressure and risk of injury.

With flatfeet, the following signs and symptoms may be experienced:

•A flat appearance of one or both of feet (absence of longitudinal arch of foot when standing)
•Uneven shoe wear and collapse of the shoe toward the inside of the flat foot
•Foot pain
•Heel tilt away from the midline of the body
•Lower leg pain
•Pain on the inside of the ankle
•Swelling along the inside of your ankle

Feet are highly specialized structures. Each foot is made up of 26 bones held together by 33 joints and more than 100 muscles, tendons and ligaments.

Arches help distribute body weight across the feet. Arches also play an integral role in walking. They act as rigid support for mobility, but they must also be resilient and flexible in order to adapt to various surfaces.

Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood, and by adulthood, most people have developed normal arches.

But some people never develop arches. This is a normal variation in foot type, and people may or may not have problems without arches. Lax ligaments can cause flatfeet, as can congenital conditions that affect the foot.

Painful flat feet in children are often caused by a condition called tarsal coalition. In tarsal coalition, two or more of the bones in the foot fuse together limiting motion leading to a flat foot.

Flat feet may be associated with pronation, an inward diversion of the ankle bones toward the center line.

Arches can also fall with age. Years of wear and tear can weaken the posterior tibial tendon, which runs along the inside of the ankle, from above the ankle to the arch. The posterior tibial tendon is the main support structure for the arch. Prolonged loading of this tendon can cause inflammation of the tendon (tendinitis) as well as tearing of the tendon. Once the tendon is damaged the foot's arch loses support and can flatten.

Loss of support in the arches can be due to:

•Stressed feet. One of these stresses may be wearing of high heeled shoes, which can affect the Achilles tendon and change the mechanics of the ankles. Compensation by the posterior tibial tendon may eventually cause it to degenerate and tear.
•Rheumatoid arthritis.
•Wearing shoes that don’t provide enough arch support.

Besides history and physical examination, other diagnostic studies such as MRI scanning can be helpful in defining the problem.

Flatfeet may contribute to or worsen other foot ailments such as:

•Plantar fasciitis
•Achilles and posterior tibial tendinitis
•Shin splints
•Stress fractures in the lower leg

The primary symptoms of flat fleet are discomfort and pain. As the normal arch begins to drop, walking can become very uncomfortable. The foot can also turn outward at the ankle, causing a walk that’s concentrated on the inner side of the foot.

Due to the flat foot, postural strain and misalignment can cause consistent daily discomfort in the leg and even the low back.

Over-the-counter insoles or arch supports can be helpful for reducing symptoms.

Custom-designed arch supports-foot orthotics- are may last longer than other more temporary supports. Foot orthotics, which are molded to the contours of the feet, slip into footwear like other types of ready-made shoe inserts. Orthotics come in three types: rigid, semi-rigid and soft. The type depends on what kind of support that is needed. Insoles that support the arch and help stabilize the heel are key.

Tendinitis of the posterior tibial tendon may be treated with a wedge along the inside edge of the orthotic to take some of the load off the tendon tissue. An ankle brace or a walking boot may help. Ultrasound-guided needle tenotomy with injection of platelet-rich plasma may help cure the posterior tibial tendon problem. In severe cases, you may need tendon surgery.

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