What Causes Contracted Toes
Overview
Hammer toes is most common in women, and a big part of this is poor shoe choices, which are a big factor in the development of many foot problems. Tight toe boxes and high heels are the biggest culprits. Genetics certainly plays a role in some cases of hammertoes, as does trauma, infection, arthritis, and certain neurological and muscle disorders. Most cases of contracted toes are associated with various biomechanical abnormalities in how a patient walks. This causes the muscles and tendons to be used excessively or improperly, which deforms the toes over time.
Causes
The incorrect position of the person's toes inside of their shoes also causes the formation of calluses or corns on the surfaces of their toes which are constantly bent as they are wearing inappropriate shoes because the surfaces are consistently rubbing against the hard materials of the interior of the shoes causing regular friction.
Symptoms
A soft corn, or heloma molle, may exist in the web space between toes. This is more commonly hammertoes caused by an exostosis, which is basically an extra growth of bone possibly due to your foot structure. As this outgrowth of excessive bone rubs against other toes, there is friction between the toes and a corn forms for your protection.
Diagnosis
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.
Non Surgical Treatment
Non-surgical methods for hammer toes (claw toes) are aimed at decreasing symptoms (i.e., pain and/or calluses) and/or limiting the progression into a larger problem. Simple treatments patients can do are wear supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify activities. Spot stretch shoes. Periodic callus care.
Surgical Treatment
Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain. Severe hammertoes, which are not fully reducible, may require more complex surgical procedures. Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.
Causes Of Hammer Toes
Overview
A Hammer toe is a contracture-or bending-of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.
Causes
Hammer toe results from shoes that don?t fit properly or a muscle imbalance, usually in combination with one or more other factors. Muscles work in pairs to straighten and bend the toes. If the toe is bent and held in one position long enough, the muscles tighten and cannot stretch out. Some other causes are diabetes, arthritis, neuromuscular disease, polio or trauma.
Symptoms
A toe (usually the second digit, next to the big toe) bent at the middle joint and clenched into a painful, clawlike position. As the toe points downward, the middle joint may protrude upward. A toe with an end joint that curls under itself. Painful calluses or corns. Redness or a painful corn on top of the bent joint or at the tip of the affected toe, because of persistent rubbing against shoes Pain in the toes that interferes with walking, jogging, dancing, and other normal activities, possibly leading to gait changes.
Diagnosis
First push up on the bottom of the metatarsal head associated with the affected toe and see if the toe straightens out. If it does, then an orthotic could correct the problem, usually with a metatarsal pad. If the toe does not Hammer toe straighten out when the metatarsal head is pushed up, then that indicates that contracture in the capsule and ligaments (capsule contracts because the joint was in the wrong position for too long) of the MTP joint has set in and surgery is required. Orthotics are generally required post-surgically.
Non Surgical Treatment
Inserts in your shoes can be used to help relieve pressure on the toes from the deformity. Splints/Straps. These can be used to help re-align and stretch your toes and correct the muscle imbalance and tendon shortening. One of the most common types are toe stretchers like the yogatoe. Chiropody. A chiropodist can remove calluses or corns, areas of hard skin that have formed to make the foot more comfortable.Steroid injections can help to reduce pain and inflammation.
Surgical Treatment
If pinning the toe is not required during the procedure, then the surgery could be preformed in the doctor's office under a local anesthesia. Some patients prefer the comfort of sedation during the surgery and if this is the case or if a pin must be placed, then the surgery could be preformed in an outpatient surgery center.
Prevention
Skin creams can help maintain skin softness and pliability. A pumice stone or loofah sponge can help get rid of dead skin. Taking a warm footbath for 10 minutes two or three times a week will keep the feet relaxed and help prevent mild foot pain caused by fatigue. Adding 1/2 cup of Epsom salts increases circulation and adds other benefits. Taking footbaths only when the feet are painful is not as helpful.
Bunions Cause And Effect
Overview
A bunion is a bony growth in the lower joint of your big toe. It usually forms where the big toe pushes over against the second toe, forcing the joint to stick out. As a weight-bearing joint, this can be extremely painful. Calluses and blisters can form on the edge of the bunion, doubling the pain. This crippling foot affliction usually gets worse with time. Surgery for bunions can be complicated, expensive, painful and does not guarantee a well-formed foot as the outcome.
Causes
Bunions are a common problem that can cause foot pain and difficulty wearing shoes. Bunions occur in about 30% of the population of most Western countries. They are seen most commonly in women and become more common as people get older. Patients with bunions generally have one of two problems that can cause pain. As the big toe becomes more and more angled (pointing toward the other toes), the base of the toe becomes more and more prominent, forming the bunion. The bunion forms in part because of the new angle of the toe, and in part due to inflammation over the bunion surface. As the inflammation worsens, people can experience pain with shoe wear and walking. The big toe may eventually come to lie over, or more commonly under, the second toe. This may cause further irritation while wearing shoes and more pain. The second toe of patients who have bunions commonly forms a hammer toe.
Symptoms
The skin over your big toe may be red and tender. Wearing any type of shoe may be painful. This joint flexes with every step you take. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful. Pressure from your big toe may force your second toe out of alignment, sometimes overlapping your third toe. If this condition gets severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.
Diagnosis
Your doctor will be able to diagnose a bunion by asking about your symptoms and examining your feet. You may also have blood tests to rule out any other medical conditions, such as rheumatoid arthritis or gout, although this is rare. Your doctor may refer you to a podiatrist or chiropodist (healthcare professionals who specialise in conditions that affect the feet).
Non Surgical Treatment
A bunion treatment must address the underlying cause of the deformity, not just the bump (bunion) itself but also the functions of the foot. The up and down motion of the longitudinal arches in the foot. The sideways motion of the transverse arch. Bunion aids effectively treat this underlying foot function while straightening the big toe because the mid-foot strap stabilizes the longitudinal arches and transverse arch. The toe strap gradually and gently pulls the big toe away from the second toe. The metatarsal pad helps align the transverse arch. The hinged splint enables the big toe to flex while walking and adapts to the contour of the foot, especially around the inflamed area of the joint. 
Surgical Treatment
Larger bunions are commonly treated with the Lapidus Bunionectomy, which involves realigned the displaced bone at its bottom, through a bone mending/fusion procedure. It is with this technique where the the walking advances have been made int he past decade. The Lapidus Bunionectomy has become a popular surgical method since surgeons have become more comfortable with mobilizing their patients post-operatively. Though not all surgeons who perform this procedure have adopted this postoperative protocol.
Prevention
If these exercises cause pain, don't overdo them. Go as far as you can without causing pain that persists. This first exercise should not cause pain, but is great for stimulating blood and lymphatic circulation. Do it as often as you can every day. Only do this exercise after confirming it is OK with your doctor. Lie on your back and lift up your legs above you. Wiggle your toes and feet. Eventually you may be able to rapidly shake your feet for a minute at a time. Use your fingers to pull your big toe into proper alignment. Stretch your big toe and the rest of your toes. Curl them under for 10 seconds, then relax and let them point straight ahead for 10 seconds. Repeat several times. Do this at least once a day, and preferably several times. Flex your toes by pressing them against the floor or a wall until they are bent back. Hold them for 10 seconds, then release. Repeat several times. Grip with your toes. Practice picking up an article of clothing with your toes, dropping it, and then picking it up again. Warm water. Soak your feet for 20 minutes in a bowl of warm water. Try doing the foot exercises while soaking, and also relax and rest your feet. Epsom salts. Add it to your warm foot bath soak.
The Facts Regarding Overpronation
Overview
Overpronation still continues to be misused and misunderstood. For example, there was a study that got a lot of recent mileage in the mainstream media and the blogosphere that claimed to show that foot pronation was not associated with injury risk. It was intriguing following comments on the study in mainstream media and in social media, especially the parroting of the press release without any critical appraisal. The study actually eliminated the ?overpronators? that were probably at high risk from the study then found that ?overpronation? was not a risk factor. What is more intriguing was that there was another study from around the same time that found the exact opposite. Clearly, the data on ?overpronation? and risk for injury in runners is mixed, so we need to rely on the more formal systematic reviews and meta-analyses of all the data. The most recent one of those concluded that ?overpronation? is just a small risk factor for running injury risk, but it is still statistically significant.
Causes
Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding stress to other parts of the foot. As a result, over-pronation, often leads to Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Often people with flat feet do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
Symptoms
If you overpronate, your symptoms may include discomfort in the arch and sole of foot. Your foot may appear to turn outward at the ankle. Your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running.Unfortunately, overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions (hallux valgus) patello femoral pain syndrome, heel spurs, metatarsalgia. You do not have to be a runner or athlete to suffer from overpronation. Flat feet can be inherited, and many people suffer from pain on a day-to-day basis. Flat feet can also be traumatic in nature and result from tendon damage over time. Wearing shoes that do not offer enough arch support can also contribute to overpronation.
Diagnosis
People who overpronate have flat feet or collapsed arches. You can tell whether you overpronate by wetting your feet and standing on a dry, flat surface. If your footprint looks complete, you probably overpronate. Another way to determine whether you have this condition is to simply look at your feet when you stand. If there is no arch on the innermost part of your sole, and it touches the floor, you likely overpronate. The only way to truly know for sure, however, is to be properly diagnosed by a foot and ankle specialist.
Non Surgical Treatment
Flat feet and fallen arches can be treated effectively by wearing an orthotic insert in your shoes. Orthotics can be custom-made and prescribed by your foot specialist (podiatrist), or you can use a so called pre-made foot orthotic. Most people do not require expensive custom-made orthotics to combat excess pronation, unless they have a specific medical foot condition. Footlogics orthotic insoles were developed to correct excess pronation, thereby providing sustainable, long-lasting pain relief to many aches and pains in a natural way. Footlogics Comfort, Casual and Sports are products which promote excellent biomechanical control of the foot.
Prevention
Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.
Overpronation still continues to be misused and misunderstood. For example, there was a study that got a lot of recent mileage in the mainstream media and the blogosphere that claimed to show that foot pronation was not associated with injury risk. It was intriguing following comments on the study in mainstream media and in social media, especially the parroting of the press release without any critical appraisal. The study actually eliminated the ?overpronators? that were probably at high risk from the study then found that ?overpronation? was not a risk factor. What is more intriguing was that there was another study from around the same time that found the exact opposite. Clearly, the data on ?overpronation? and risk for injury in runners is mixed, so we need to rely on the more formal systematic reviews and meta-analyses of all the data. The most recent one of those concluded that ?overpronation? is just a small risk factor for running injury risk, but it is still statistically significant.
Causes
Over-pronation is very prominent in people who have flexible, flat feet. The framework of the foot begins to collapse, causing the foot to flatten and adding stress to other parts of the foot. As a result, over-pronation, often leads to Plantar Fasciitis, Heel Spurs, Metatarsalgia, Post-tib Tendonitis and/or Bunions. There are many causes of flat feet. Obesity, pregnancy or repetitive pounding on a hard surface can weaken the arch leading to over-pronation. Often people with flat feet do not experience discomfort immediately, and some never suffer from any discomfort at all. However, when symptoms develop and become painful, walking becomes awkward and causes increased strain on the feet and calves.
Symptoms
If you overpronate, your symptoms may include discomfort in the arch and sole of foot. Your foot may appear to turn outward at the ankle. Your shoes wear down faster on the medial (inner) side of your shoes. Pain in ankle, shins, knees, or hips, especially when walking or running.Unfortunately, overpronation can lead to additional problems with your feet, ankles, and knees. Runners in particular find that overpronation can lead to shin splints, tarsal tunnel syndrome, plantar fasciitis, compartment syndrome, achilles tendonitis, bunions (hallux valgus) patello femoral pain syndrome, heel spurs, metatarsalgia. You do not have to be a runner or athlete to suffer from overpronation. Flat feet can be inherited, and many people suffer from pain on a day-to-day basis. Flat feet can also be traumatic in nature and result from tendon damage over time. Wearing shoes that do not offer enough arch support can also contribute to overpronation.
Diagnosis
People who overpronate have flat feet or collapsed arches. You can tell whether you overpronate by wetting your feet and standing on a dry, flat surface. If your footprint looks complete, you probably overpronate. Another way to determine whether you have this condition is to simply look at your feet when you stand. If there is no arch on the innermost part of your sole, and it touches the floor, you likely overpronate. The only way to truly know for sure, however, is to be properly diagnosed by a foot and ankle specialist.
Non Surgical Treatment
Flat feet and fallen arches can be treated effectively by wearing an orthotic insert in your shoes. Orthotics can be custom-made and prescribed by your foot specialist (podiatrist), or you can use a so called pre-made foot orthotic. Most people do not require expensive custom-made orthotics to combat excess pronation, unless they have a specific medical foot condition. Footlogics orthotic insoles were developed to correct excess pronation, thereby providing sustainable, long-lasting pain relief to many aches and pains in a natural way. Footlogics Comfort, Casual and Sports are products which promote excellent biomechanical control of the foot.
Prevention
Many of the prevention methods for overpronation-orthotics, for example-can be used interchangeably with treatment methods. If the overpronation is severe, you should seek medical attention from a podiatrist who can cast you for custom-made orthotics. Custom-made orthotics are more expensive, but they last longer and provide support, stability, and balance for the entire foot. You can also talk with a shoe specialist about running shoes that offer extra medial support and firm heel counters. Proper shoes can improve symptoms quickly and prevent them from recurring. Surgery can sometimes help cure and prevent this problem if you suffer from inherited or acquired pes planus deformity. Surgery typically involves stabilizing the bones to improve the foot?s support and function.
Physical Therapy And Severs Disease
Overview
Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or trauma. This condition is most common in children ages 10 to 15 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone (calcaneus). Treatment includes cutting back on sports activities, calf muscle stretching exercises, heel cushions in the shoes, icing, and/or anti-inflammatory medications. Note: Please consult your physician before taking any medications.
Causes
Your child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty. Sever's disease is most common in physically active girls 8 years to 10 years of age and in physically active boys 10 years to 12 years of age. Soccer players and gymnasts often get Sever's disease, but children who do any running or jumping activity may also be at an increased risk. Sever's disease rarely occurs in older teenagers because the back of the heel has typically finished growing by 15 years of age.
Symptoms
Some of the common symptoms of Sever's disease are pain in one or both heels with running and walking. The pain is originates from the point of the heel where the tendo-achilles inserts into the heel bone. Heel pain that goes away when resting. Swollen heel. Calf muscle stiffness first thing in the morning.
Diagnosis
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.
Non Surgical Treatment
Heel pain, unlike the heel spurs, that occur in adults is very uncommon in children. Of those children who do get heel pain, by far the most common cause is a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong achilles tendon attaches to it. This is known as Sever's disease or calcaneal apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age. These are one of several different 'osteochondroses' that can occur in other parts of the body, such as at the knee (Osgood-Schlatters Disease).
Sever's Disease, also known as calcaneal apophysitis, is a disease of the growth plate of the bone and is characterized by pain in the heel of a child's foot, typically brought on by some form of injury or trauma. This condition is most common in children ages 10 to 15 and is frequently seen in active soccer, football, or baseball players. Sport shoes with cleats are also known to aggravate the condition. The disease mimics Achilles tendonitis, an inflammation of the tendon attached to the back of the heel. A tight Achilles tendon contributes to Sever's Disease by pulling excessively on the growth plate of the heel bone (calcaneus). Treatment includes cutting back on sports activities, calf muscle stretching exercises, heel cushions in the shoes, icing, and/or anti-inflammatory medications. Note: Please consult your physician before taking any medications.
Causes
Your child is most at risk for this condition when he or she is in the early part of the growth spurt in early puberty. Sever's disease is most common in physically active girls 8 years to 10 years of age and in physically active boys 10 years to 12 years of age. Soccer players and gymnasts often get Sever's disease, but children who do any running or jumping activity may also be at an increased risk. Sever's disease rarely occurs in older teenagers because the back of the heel has typically finished growing by 15 years of age.
Symptoms
Some of the common symptoms of Sever's disease are pain in one or both heels with running and walking. The pain is originates from the point of the heel where the tendo-achilles inserts into the heel bone. Heel pain that goes away when resting. Swollen heel. Calf muscle stiffness first thing in the morning.
Diagnosis
In Sever's disease, heel pain can be in one or both heels. It usually starts after a child begins a new sports season or a new sport. Your child may walk with a limp. The pain may increase when he or she runs or jumps. He or she may have a tendency to tiptoe. Your child's heel may hurt if you squeeze both sides toward the very back. This is called the squeeze test. Your doctor may also find that your child's heel tendons have become tight.
Non Surgical Treatment
Heel pain, unlike the heel spurs, that occur in adults is very uncommon in children. Of those children who do get heel pain, by far the most common cause is a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong achilles tendon attaches to it. This is known as Sever's disease or calcaneal apophysitis (inflammation of the growth plate). It is most common between the ages of 10 to 14 years of age. These are one of several different 'osteochondroses' that can occur in other parts of the body, such as at the knee (Osgood-Schlatters Disease).
Posterior Tibial Tendon Dysfunction Treatment
Overview
Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations. 
Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.
Symptoms
The first stage represents inflammation and symptoms originating from an irritated posterior tibial tendon, which is still functional. Stage two is characterized by a change in the alignment of the foot noted on observation while standing (see above photos). The deformity is supple meaning the foot is freely movable and a ?normal? position can be restored by the examiner. Stage two is also associated with the inability to perform a single-leg heel rise. The third stage is dysfunction of the posterior tibial tendon is a flatfoot deformity that becomes stiff because of arthritis. Prolonged deformity causes irritation to the involved joints resulting in arthritis. The fourth phase is a flatfoot deformity either supple (stage two) or stiff (stage 3) with involvement of the ankle joint. This occurs when the deltoid ligament, the major supporting structure on the inside of the ankle, fails to provide support. The ankle becomes unstable and will demonstrate a tilted appearance on X-ray. Failure of the deltoid ligament results from an inward displacement of the weight bearing forces. When prolonged, this change can lead to ankle arthritis. The vast majority of patients with acquired adult flatfoot deformity are stage 2 by the time they seek treatment from a physician.
Diagnosis
Clinicians need to recognize the early stage of this syndrome which includes pain, swelling, tendonitis and disability. The musculoskeletal portion of the clinical exam can help determine the stage of the disease. It is important to palpate the posterior tibial tendon and test its muscle strength. This is tested by asking patient to plantarflex and invert the foot. Joint range of motion is should be assessed as well. Stiffness of the joints may indicate longstanding disease causing a rigid deformity. A weightbearing examination should be performed as well. A complete absence of the medial longitudinal arch is often seen. In later stages the head of the talus bone projects outward to the point of a large "lump" in the arch. Observing the patient's feet from behind shows a significant valgus rotation of the heel. From behind, the "too many toes" sign may be seen as well. This is when there is abducution of the forefoot in the transverse plane allowing the toes to be seen from behind. Dysfunction of the posterior tibial tendon can be assessed by asking the patient to stand on his/her toes on the affected foot. If they are unable to, this indicates the disease is in a more advanced stage with the tendon possibly completely ruptured.
Non surgical Treatment
Treatment depends very much upon a patient?s symptoms, functional goals, degree and specifics of deformity, and the presence of arthritis. Some patients get better without surgery. Rest and immobilization, orthotics, braces and physical therapy all may be appropriate. With early-stage disease that involves pain along the tendon, immobilization with a boot for a period of time can relieve stress on the tendon and reduce the inflammation and pain. Once these symptoms have resolved, patients are often transitioned into an orthotic that supports the inside aspect of the hindfoot. For patients with more significant deformity, a larger ankle brace may be necessary. 
Surgical Treatment
Until recently, operative treatment was indicated for most patients with stage 2 deformities. However, with the use of potentially effective nonoperative management , operative treatment is now indicated for those patients that have failed nonoperative management. The principles of operative treatment of stage 2 deformities include transferring another tendon to help serve the role of the dysfunctional posterior tibial tendon (usually the flexor hallucis longus is transferred). Restoring the shape and alignment of the foot. This moves the weight bearing axis back to the center of the ankle. Changing the shape of the foot can be achieved by one or more of the following procedures. Cutting the heel bone and shifting it to the inside (Medializing calcaneal osteotomy). Lateral column lengthening restores the arch and overall alignment of the foot. Medial column stabilization. This stiffens the ray of the big toe to better support the arch. Lengthening of the Achilles tendon or Gastrocnemius. This will allow the ankle to move adequately once the alignment of the foot is corrected. Stage 3 acquired adult flatfoot deformity is treated operatively with a hindfoot fusion (arthrodesis). This is done with either a double or triple arthrodesis - fusion of two or three of the joints in hindfoot through which the deformity occurs. It is important when a hindfoot arthrodesis is performed that it be done in such a way that the underlying foot deformity is corrected first. Simply fusing the hindfoot joints in place is no longer acceptable.
Do I Suffer Adult Aquired FlatFoot?
Overview
Many foot problems can be contributed to Adult Acquired Flatfoot Deformity (AAFD), a foot and ankle condition that causes fallen arch of the foot. AAFD is also referred to as Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon serves as the principal supporting structure of your foot. When this ligament is injured overtime the arches start to flatten, leaving you with a painful foot condition. AAFD is more common in women ages 39 - 65 than men.
Causes
Adult flatfoot typically occurs very gradually. If often develops in an obese person who already has somewhat flat feet. As the person ages, the tendons and ligaments that support the foot begin to lose their strength and elasticity.
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
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot.
Non surgical Treatment
Nonoperative therapy for posterior tibial tendon dysfunction has been shown to yield 67% good-to-excellent results in 49 patients with stage 2 and 3 deformities. A rigid UCBL orthosis with a medial forefoot post was used in nonobese patients with flexible heel deformities correctible to neutral and less than 10? of forefoot varus. A molded ankle foot orthosis was used in obese patients with fixed deformity and forefoot varus greater than 10?. Average length of orthotic use was 15 months. Four patients ultimately elected to have surgery. The authors concluded that orthotic management is successful in older low-demand patients and that surgical treatment can be reserved for those patients who fail nonoperative treatment.
Surgical Treatment
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Symptomatic flexible flatfoot conditions are common entities in both the adolescent and adult populations. Ligamentous laxity and equinus play a significant role in most adolescent deformities. Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult acquired flatfoot. One should consider surgical treatment for patients who have failed nonoperative therapy and have advancing symptoms and deformities that significantly interfere with the functional demands of daily life. Isolated Joint Fusion. This technique is used for well reducible flat foot by limiting motion at one or two joints that are usually arthritic. The Evans Anterior Calcaneal Osteotomy. This is indicated for late stage II adult acquired flatfoot and the flexible adolescent flatfoot. This procedure will address midtarsal instability, restore the medial longitudinal arch and reduce mild hind foot valgus. The Posterior Calcaneal Displacement Osteotomy (PCDO). This technique is indicated for late stage I and early stage II PTTD with reducible Calcaneal valgus. This is often combined with a tendon transfer. A PCDO is also indicated as an adjunctive procedure in the surgical reconstruction of the severe flexible adolescent flatfoot. Soft tissue procedure. On their own these are not very effective but in conjunction with an osseous procedure, soft tissue procedures can produce good outcome. Common ones are tendon and capsular repair, tendon lengthening and transfer procedures. Flat foot correction requires lengthy post operative period and a lot of patience. Your foot may need surgery but you might simply not have the time or endurance to go through the rehab phase of this type of surgery. We will discuss these and type of procedures necessary for your surgery in length before we go further with any type of intervention.
Many foot problems can be contributed to Adult Acquired Flatfoot Deformity (AAFD), a foot and ankle condition that causes fallen arch of the foot. AAFD is also referred to as Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon serves as the principal supporting structure of your foot. When this ligament is injured overtime the arches start to flatten, leaving you with a painful foot condition. AAFD is more common in women ages 39 - 65 than men.
Causes
Adult flatfoot typically occurs very gradually. If often develops in an obese person who already has somewhat flat feet. As the person ages, the tendons and ligaments that support the foot begin to lose their strength and elasticity.
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
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot.
Non surgical Treatment
Nonoperative therapy for posterior tibial tendon dysfunction has been shown to yield 67% good-to-excellent results in 49 patients with stage 2 and 3 deformities. A rigid UCBL orthosis with a medial forefoot post was used in nonobese patients with flexible heel deformities correctible to neutral and less than 10? of forefoot varus. A molded ankle foot orthosis was used in obese patients with fixed deformity and forefoot varus greater than 10?. Average length of orthotic use was 15 months. Four patients ultimately elected to have surgery. The authors concluded that orthotic management is successful in older low-demand patients and that surgical treatment can be reserved for those patients who fail nonoperative treatment.
Surgical Treatment
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Symptomatic flexible flatfoot conditions are common entities in both the adolescent and adult populations. Ligamentous laxity and equinus play a significant role in most adolescent deformities. Posterior tibial tendon dysfunction (PTTD) is the most common cause of adult acquired flatfoot. One should consider surgical treatment for patients who have failed nonoperative therapy and have advancing symptoms and deformities that significantly interfere with the functional demands of daily life. Isolated Joint Fusion. This technique is used for well reducible flat foot by limiting motion at one or two joints that are usually arthritic. The Evans Anterior Calcaneal Osteotomy. This is indicated for late stage II adult acquired flatfoot and the flexible adolescent flatfoot. This procedure will address midtarsal instability, restore the medial longitudinal arch and reduce mild hind foot valgus. The Posterior Calcaneal Displacement Osteotomy (PCDO). This technique is indicated for late stage I and early stage II PTTD with reducible Calcaneal valgus. This is often combined with a tendon transfer. A PCDO is also indicated as an adjunctive procedure in the surgical reconstruction of the severe flexible adolescent flatfoot. Soft tissue procedure. On their own these are not very effective but in conjunction with an osseous procedure, soft tissue procedures can produce good outcome. Common ones are tendon and capsular repair, tendon lengthening and transfer procedures. Flat foot correction requires lengthy post operative period and a lot of patience. Your foot may need surgery but you might simply not have the time or endurance to go through the rehab phase of this type of surgery. We will discuss these and type of procedures necessary for your surgery in length before we go further with any type of intervention.
