Flat Feet or Fallen Arches Treatment in Melbourne
Flat feet or fallen arches is a medical condition where the foot's contact with the ground is flatter than the normal person.
These two conditions are closely related to each other and can increase the risk of overuse injury to the foot.
They can also cause an overload of more proximal structures such as ankles, shins, knees and the lower back.
The arch of the foot plays and important role in absorbing shock and preventing over-stressing of the foot muscles and bones.
The human foot is a complex structure that absorbs shock every time we take a step.
The foot has to adapt to a variety of movements during different forms of activities such as walking, running and climbing steps.
The foot is made up of many different joints, ligaments, and muscles which have to work together to allow us to move and balance.
Therefore people with flat feet may experience pain or stiffness after completing an exercise.
What are Flat Feet and Fallen Arches?
The loss of the arch of the foot (also known in some cases as the ‘instep’) is called a flatfoot.
People may have a very low arch or absolutely no arch whatsoever.
Whilst most people with flat feet have been that way since a young age, in some people the arch height reduces over time.
This can be due to systemic health concerns, degeneration of muscles and joints, hormonal changes or specific injury.
What are the Causes of Flat Feet and Fallen Arches?
There are a number of different causes that can lead to flat feet or fallen arches. These include:
- Birth defects - while technically not a defect as such, flat feet can be a normal finding in patients from birth. However, a condition called tarsal coalition may occur where some of the bones in the foot are fused together resulting in a flatfoot;
- Inflammation or damage of the posterior tibial tendon. This tendon forms the end of a muscle that connects the lower leg to the foot, winding around the ankle and attaching to the inner aspect where the arch is normally present. The main role of the posterior tibial tendon is to invert the foot and maintain the arch height throughout the gait cycle;
- Torn muscles of the leg and foot can cause flat feet;
- Problems with the nerve supply to the muscles can result in reduction in tone and fallen arches;
- Fracture dislocation of the bones in the foot; and
- Severe arthritis
While these are the common causes that can result in fallen arches and flat feet, it is important to recognise that there are certain risk factors that can also lead to this condition.
These include advancing age, diabetes mellitus, high blood pressure, obesity and pregnancy.
Symptoms and Signs of Flat Feet or Fallen Arches
Most patients who suffer from flat feet or fallen arches often do not complain of any symptoms whatsoever.
However, on some occasions, patients may find that their feet are fatigued fairly easily and following activity on long periods of standing may have a painful foot or arch.
On occasions, swelling may be seen on the inner aspect of the foot and performing certain movements may be painful and difficult.
Some patients who have flat feet may find that their feet tend to roll in (over-pronate) a lot more when they walk and run.
As a result, they may experience damage to the ankle joint and the Achilles tendon, as well as excessive shoe wear.
Diagnosing a FlatFoot - What the Podiatrist Will Look For...
Podiatrists are trained in assessing flat feet and identifying different risk factors and the causes for it.
The initial assessment will begin with a detailed history attempting to find out if any underlying illness has resulted in this.
A detailed clinical examination normally follows.
The patient may be asked to perform certain movements such as walking or standing on their toes to assess the function of the foot.
Footwear will also be analysed to see if there has been excessive wear or if they are contributing to the pronation of the foot.
To assess the structure of the foot further, the podiatrist may perform certain x-rays to get a detailed idea of the way the bones are arranged and how the muscle tissues may be affecting them. It also helps assess any potential birth defects in a bit more detail.
Treatment of Flat Feet and Fallen Arches
There are different modalities of treatment that are available to manage flat feet and fallen arches.
The type of treatment that is chosen depends on how severe the condition is and what symptoms the patients are experiencing.
Below is a brief description of the available treatment modalities:
1. Conservative therapy
In the event that the patient is experiencing swelling of the feet, rest and ice application is usually the initial treatment step. Oral anti-inflammatories may be offered which can help reduce inflammation as well as associated pain. Physical therapy has good outcomes and can include different exercises such as stretches and strengthening of the surrounding muscles. Changes in footwear and activity modification are also important when dealing with a painful flat (pronated) foot.
2. Orthotics for Flat Feet
These days, orthotic insoles are easily available either over the counter or through your Podiatrist which can effectively help maintain the arch of the foot and reduce the amount of stress placed on the foot. Podiatrists are able to prescribe a variety of different devices from prefabricated to customized and are trained to determine the most appropriate device for each individual.
In order to offer the right kind of orthotic insole, podiatrists may perform a test called gait analysis. This involves asking the patient to walk and videoing the different movements that the foot of forms during the walking. Features such as over pronation can be easily seen on this and orthotic insoles can be prescribed to correct the specific abnormalities that are picked up on this analysis. Overall, orthotic treatment can result in a significant improvement in foot movement and reduction in foot discomfort.
3. Surgical therapy
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).
Conclusion on Flat Feet and Fallen Arches
Flat feet and fallen arches are common conditions that are in most cases asymptomatic.
However, in patients who do have symptoms, treatments are available that can help reduce pain and promote efficient movement.
Orthotic devices are well recognised as an excellent treatment of flat feet and podiatrists can offer these different treatment modalities as individualised treatments for patients.