Adult Aquired FlatFeet Causes
Overview
When we have foot pain, it isn?t always easy to pinpoint the source because we can?t visualize the structure of all the bones, muscles, and tendons on the inside. The posterior tibial tendon plays an important supportive role within the structure of the foot. It attaches to your calf muscle and then comes down along the inside of your ankle, connecting to the bones inside your foot at the other side. This tendon?s main function is to hold up your arch and support your foot during each and every movement. Every step, run, walk, or jump is made possible with the support from this crucial tendon. While it is designed to perform such an important role, it is vulnerable to stress and injury. A tear during a traumatic injury or stress from overuse can injure the tissues within the tendon. This kind of injury is referred to as posterior tibial tendon dysfunction (PTTD). A really hard fall during a sports game or exposure to a repetitive motion, such as the impact on feet during soccer, tennis, football or basketball, can cause an injury. Flat foot and flat feet in adults can exacerbate this condition. The tendon can experience small tears and become inflamed. If the inflammation is allowed to continue and worsen over time, it will weaken further and could rupture completely. 
Causes
Rheumatoid arthritis This type of arthritis attacks the cartilage in the foot, leading to pain and flat feet. It is caused by auto-immune disease, where the body?s immune system attacks its own tissues. Diabetes. Having diabetes can cause nerve damage and affect the feeling in your feet and cause arch collapse. Bones can also fracture but some patients may not feel any pain due to the nerve damage. Obesity and/or hypertension (high blood pressure) This increases your risk of tendon damage and resulting flat foot.
Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. Symptoms, which may occur in some persons with flexible flatfoot, include. Pain in the heel, arch, ankle, or along the outside of the foot. ?Turned-in? ankle. Pain associated with a shin splint. General weakness / fatigue in the foot or leg.
Diagnosis
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured, you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an initial diagnosis.
Non surgical Treatment
Conservative treatment is indicated for nearly all patients initially before surgical management is considered. The key factors in determining appropriate treatment are whether acute inflammation and whether the foot deformity is flexible or fixed. However, the ultimate treatment is often determined by the patients, most of whom are women aged 40 or older. Compliance can be a problem, especially in stages I and II. It helps to emphasise to the patients that tibialis posterior dysfunction is a progressive and chronic condition and that several fittings and a trial of several different orthoses or treatments are often needed before a tolerable treatment is found. 
Surgical Treatment
When conservative care fails to control symptoms and/or deformity, then surgery may be needed. The goal of surgical treatment is to obtain good alignment while keeping the foot and ankle as flexible as possible. The most common procedures used with this condition include arthrodesis (fusion), osteotomy (cutting out a wedge-shaped piece of bone), and lateral column lengthening. Lateral column lengthening involves the use of a bone graft at the calcaneocuboid joint. This procedure helps restore the medial longitudinal arch (arch along the inside of the foot). A torn tendon or spring ligament will be repaired or reconstructed. Other surgical options include tendon shortening or lengthening. Or the surgeon may move one or more tendons. This procedure is called a tendon transfer. Tendon transfer uses another tendon to help the posterior tibial tendon function more effectively. A tendon transfer is designed to change the force and angle of pull on the bones of the arch. It's not clear yet from research evidence which surgical procedure works best for this condition. A combination of surgical treatments may be needed. It may depend on your age, type and severity of deformity and symptoms, and your desired level of daily activity.
Does Adult Aquired Flat Feet Always Necessitate Surgical Teatment ?
Overview
Adult-acquired flatfoot or collapsed arch occurs because the large tendon on the inside of the ankle - the posterior tibial tendon - becomes stretched out and no longer supports the foot?s arch. In many cases, the condition worsens and and the tendon thickens, becoming painful, especially during activities. Flatfoot or collapsed arch is also known as posterior tibial tendon dysfunction. This condition is different than having flat feet since birth (known as congenital flatfoot), although sometimes these patients develop similar symptoms and require similar treatments. 
Causes
Rheumatoid arthritis This type of arthritis attacks the cartilage in the foot, leading to pain and flat feet. It is caused by auto-immune disease, where the body?s immune system attacks its own tissues. Diabetes. Having diabetes can cause nerve damage and affect the feeling in your feet and cause arch collapse. Bones can also fracture but some patients may not feel any pain due to the nerve damage. Obesity and/or hypertension (high blood pressure) This increases your risk of tendon damage and resulting flat foot.
Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.
Diagnosis
Posterior Tibial Tendon Dysfunction is diagnosed with careful clinical observation of the patient?s gait (walking), range of motion testing for the foot and ankle joints, and diagnostic imaging. People with flatfoot deformity walk with the heel angled outward, also called over-pronation. Although it is normal for the arch to impact the ground for shock absorption, people with PTTD have an arch that fully collapses to the ground and does not reform an arch during the entire gait period. After evaluating the ambulation pattern, the foot and ankle range of motion should be tested. Usually the affected foot will have decreased motion to the ankle joint and the hindfoot. Muscle strength may also be weaker as well. An easy test to perform for PTTD is the single heel raise where the patient is asked to raise up on the ball of his or her effected foot. A normal foot type can lift up on the toes without pain and the heel will invert slightly once the person has fully raised the heel up during the test. In early phases of PTTD the patient may be able to lift up the heel but the heel will not invert. An elongated or torn posterior tibial tendon, which is a mid to late finding of PTTD, will prohibit the patient from fully rising up on the heel and will cause intense pain to the arch. Finally diagnostic imaging, although used alone cannot diagnose PTTD, can provide additional information for an accurate diagnosis of flatfoot deformity. Xrays of the foot can show the practitioner important angular relationships of the hindfoot and forefoot which help diagnose flatfoot deformity. Most of the time, an MRI is not needed to diagnose PTTD but is a tool that should be considered in advanced cases of flatfoot deformity. If a partial tear of the posterior tibial tendon is of concern, then an MRI can show the anatomic location of the tear and the extensiveness of the injury.
Non surgical Treatment
The adult acquired flatfoot is best treated early. Accurate assessment by your doctor will determine which treatment is suitable for you. Reduce your level of activity and follow the RICE regime. R - rest as often as you are able. Refrain from activity that will worsen your condition, such as sports and walking. I - ice, apply to the affected area, ensure you protect the area from frostbite by applying a towel over the foot before using the ice pack. C - compression, a Tubigrip or elasticated support bandage may be applied to relieve symptoms and ease pain and discomfort. E - elevate the affected foot to reduce painful swelling. You will be prescribed pain relief in the form of non-steroidal antiinflammatory medications (if you do not suffer with allergies or are asthmatic). Immobilisation of your affected foot - this will involve you having a below the knee cast for four to eight weeks. In certain circumstances it is possible for you to have a removable boot instead of a cast. A member of the foot and ankle team will advise as to whether this option is suitable for you. Footwear is important - it is advisable to wear flat sturdy lace-up shoes, for example, trainers or boots. This will not only support your foot, but will also accommodate orthoses (shoe inserts). 
Surgical Treatment
Surgery should only be done if the pain does not get better after a few months of conservative treatment. The type of surgery depends on the stage of the PTTD disease. It it also dictated by where tendonitis is located and how much the tendon is damaged. Surgical reconstruction can be extremely complex. Some of the common surgeries include. Tenosynovectomy, removing the inflamed tendon sheath around the PTT. Tendon Transfer, to augment the function of the diseased posterior tibial tendon with a neighbouring tendon. Calcaneo-osteotomy, sometimes the heel bone needs to be corrected to get a better heel bone alignment. Fusion of the Joints, if osteoarthritis of the foot has set in, fusion of the joints may be necessary.
Posterior Tibial Tendon Dysfunction (PTTD) Treatments And Causes
Overview
Adult acquired is a very serious condition that can lead to many secondary deformities, not only within the foot but also in the knees, hips and back. This presentation discusses a new scientifically proven procedure that may be able to help realign and fix this problem at its root. 
Causes
There are a number of theories as to why the tendon becomes inflamed and stops working. It may be related to the poor blood supply within the tendon. Increasing age, inflammatory arthritis, diabetes and obesity have been found to be causes.
Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
Diagnosis
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.
Non surgical Treatment
Non-surgical treatment includes rest and reducing your activity until the pain improves. Orthotics or bracing help support the tendon to reduce its pull along the arch, thus reducing pain. In moderate to severe cases, a below knee cast or walking boot may be needed to allow the tendon to rest completely and heal. Physical therapy is an integral part of the non-surgical treatment regimen to reduce inflammation and pain. Anti-inflammatory medication is often used as well. Many times evaluation of your current shoes is necessary to ensure you are wearing appropriate shoe gear to prevent re-injury. 
Surgical Treatment
If initial conservative therapy of posterior tibial tendon insufficiency fails, surgical treatment is considered. Operative treatment of stage 1 disease involves release of the tendon sheath, tenosynovectomy, debridement of the tendon with excision of flap tears, and repair of longitudinal tears. A short-leg walking cast is worn for 3 weeks postoperatively. Teasdall and Johnson reported complete relief of pain in 74% of 14 patients undergoing this treatment regimen for stage 1 disease. Surgical debridement of tenosynovitis in early stages is believed to possibly prevent progression of disease to later stages of dysfunction.
Running With Achilles Tendon Strain
Overview
If you have pain along the back of your leg near your heel, you may have Achilles tendonitis. Achilles tendonitis is an overuse injury that commonly occurs in runners and ?weekend warriors?. The Achilles tendon is the largest tendon in the body. Named after a tragic hero from Greek mythology, it connects your calf muscle to your heel bone to allow you to jump, run and walk. Achilles tendonitis is most common in middle-aged men, but it can happen to anyone who has a sudden increase in physical activity. The risk is increased if you also have tight calf muscles and/or a flat arch in your foot. Other risk factors include running in worn out shoes, cold weather, frequently running uphill or if you suffer from medical conditions such as diabetes or high blood pressure. There are two main types of Achilles tendinitis: insertional and noninsertional. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches to the heel bone. Noninsertional Achilles tendinitis is when the fibers in the middle portion of the tendon have started to break down with tiny tears, swell, and/or thicken. This type is more often seen in younger, active people. Both types can also cause bone spurs. Achilles tendonitis should be diagnosed by your doctor. However, if you experienced a sudden ?pop? in the back of your calf or heel, this might be something more serious like a ruptured or torn Achilles tendon. If this happens, see your doctor immediately.
Causes
Hill running or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing mileage or speed. Starting up too quickly after a layoff. Trauma caused by sudden and hard contraction of the calf muscles when putting out extra effort such as in a final sprint. Achilles tendinitis often begins with mild pain after exercise or running that gradually worsens.
Symptoms
In most cases, symptoms of Achilles tendonitis, also sometimes called Achilles tendinitis, develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period. Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule).
Diagnosis
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Nonsurgical Treatment
The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naprosyn, can reduce pain and swelling. Physical therapy and the use of an orthosis (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.
Surgical Treatment
Surgery is considered when non-operative measures fail. Patient compliance and postoperative management is an important aspect of the operative management to prevent ankle stiffness or recurrence of the symptoms. Surgery usually requires a removal of the damaged tissue (debridement) and meticulous repair of the tendon. Post-operative immobilization is required, followed by gradual range of motion and strengthening exercises start. It may require 6 months for the full recovery. Some known complication are recurrence, stiffness of the ankle and deep vein thrombosis.
Prevention
By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.
If you have pain along the back of your leg near your heel, you may have Achilles tendonitis. Achilles tendonitis is an overuse injury that commonly occurs in runners and ?weekend warriors?. The Achilles tendon is the largest tendon in the body. Named after a tragic hero from Greek mythology, it connects your calf muscle to your heel bone to allow you to jump, run and walk. Achilles tendonitis is most common in middle-aged men, but it can happen to anyone who has a sudden increase in physical activity. The risk is increased if you also have tight calf muscles and/or a flat arch in your foot. Other risk factors include running in worn out shoes, cold weather, frequently running uphill or if you suffer from medical conditions such as diabetes or high blood pressure. There are two main types of Achilles tendinitis: insertional and noninsertional. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches to the heel bone. Noninsertional Achilles tendinitis is when the fibers in the middle portion of the tendon have started to break down with tiny tears, swell, and/or thicken. This type is more often seen in younger, active people. Both types can also cause bone spurs. Achilles tendonitis should be diagnosed by your doctor. However, if you experienced a sudden ?pop? in the back of your calf or heel, this might be something more serious like a ruptured or torn Achilles tendon. If this happens, see your doctor immediately.
Causes
Hill running or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing mileage or speed. Starting up too quickly after a layoff. Trauma caused by sudden and hard contraction of the calf muscles when putting out extra effort such as in a final sprint. Achilles tendinitis often begins with mild pain after exercise or running that gradually worsens.
Symptoms
In most cases, symptoms of Achilles tendonitis, also sometimes called Achilles tendinitis, develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period. Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule).
Diagnosis
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Nonsurgical Treatment
The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naprosyn, can reduce pain and swelling. Physical therapy and the use of an orthosis (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.
Surgical Treatment
Surgery is considered when non-operative measures fail. Patient compliance and postoperative management is an important aspect of the operative management to prevent ankle stiffness or recurrence of the symptoms. Surgery usually requires a removal of the damaged tissue (debridement) and meticulous repair of the tendon. Post-operative immobilization is required, followed by gradual range of motion and strengthening exercises start. It may require 6 months for the full recovery. Some known complication are recurrence, stiffness of the ankle and deep vein thrombosis.
Prevention
By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.
