Tendons do a lot of work. In fact, a great deal of what happens when you walk can be related to tendons tugging and pulling in appropriate ways in their proper places. With this in mind, it’s hardly surprising that on occasion, (probably because we too often forget to send them Thank you cards), tendons may decide that they’ve had it. They may buck their responsibilities, shirk their work, and in all other ways cease to function properly. And that may mean bad news for you. Take the posterior tibial tendon: it runs from the bottom of the calf, goes right under that bump on the inside of the ankle (the medial malleolus) and ends up attaching itself to a bone on the inside of the middle of your foot (the navicular bone). It’s the main tendon that keeps the arch of your foot in place, and it helps a bunch in walking, too. Over time, though, we tend to put a lot of stress on this faithful tendon, especially if we’ve put on extra weight, or do a lot of activities that stress it out, walking, running, hiking, or climbing stairs. Sometimes athletes (who do a lot of that walking and running stuff) may put so much stress on the tendon that it tears suddenly. But for many of us, damage may take place gradually (i.e. the tendon stretches out) until the tendon tells us that it flat out quits. (It sometimes doesn’t even give two weeks notice.) In short, you may develop posterior tibial tendon dysfunction (PTTD).
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.
Not everyone with adult flatfoot has problems with pain. Those who do usually experience it around the ankle or in the heel. The pain is usually worse with activity, like walking or standing for extended periods. Sometimes, if the condition develops from arthritis in the foot, bony spurs along the top and side of the foot develop and make wearing shoes more painful. Diabetic patients need to watch for swelling or large lumps in the feet, as they may not notice any pain. They are also at higher risk for developing significant deformities from their flatfoot.
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
The adult acquired flatfoot is best treated early. There is no recommended home treatment other than the general avoidance of prolonged weightbearing in non-supportive footwear until the patient can be seen in the office of the foot and ankle specialist. In Stage I, the inflammation and tendon injury will respond to rest, protected ambulation in a cast, as well as anti-inflammatory therapy. Follow-up treatment with custom-molded foot orthoses and properly designed athletic or orthopedic footwear are critical to maintain stability of the foot and ankle after initial symptoms have been calmed. Once the tendon has been stretched, the foot will become deformed and visibly rolled into a pronated position at the ankle. Non-surgical treatment has a significantly lower chance of success. Total immobilization in a cast or Camwalker may calm down symptoms and arrest progression of the deformity in a smaller percentage of patients. Usually, long-term use of a brace known as an ankle foot orthosis is required to stop progression of the deformity without surgery. A new ankle foot orthosis known as the Richie Brace, offered by PAL Health Systems, has proven to show significant success in treating Stage II posterior tibial dysfunction and the adult acquired flatfoot. This is a sport-style brace connected to a custom corrected foot orthotic device that fits well into most forms of lace-up footwear, including athletic shoes. The brace is light weight and far more cosmetically appealing than the traditional ankle foot orthosis previously prescribed.
For those patients with PTTD that have severe deformity or have not improved with conservative treatments, surgery may be necessary to return them to daily activity. Surgery for PTTD may include repair of the diseased tendon and possible tendon transfer to a nearby healthy tendon, surgery on the surrounding bones or joints to prevent biomechanical abnormalities that may be a contributing factor or both.
Most people can help treat over-pronation just by wearing the proper shoes. If you have over-pronation, your shoes should offer great support and stability through the arch. People with over-pronation can also use insoles that support the arch and help stabilize the heel. Also, if you have over-pronation, consider using custom orthotics to aid in arch support. Shop any of the 250 Foot Solutions locations for arch supports and receive a free digital foot analysis. There has been only weak correlation between pronated feet and low back pain so I was happy to see some evidence of this in the study,” said Christopher Kevin Wong.
We don’t tend to think of our feet until they exhibit some problem. These trusty, pyramid-shaped stabilizers of the body do their job virtually unthought of as we go about our tasks from day to day. But your whole body knows it when your feet hurt. Their pain is radiated to other areas disturbed by the awkward gait or tentative foot strike of the injured area. To illustrate, let’s consider the common problem of flat feet. The normal foot has nearly the same arch when it is bearing weight and when it is not. Flat feet have various degrees of arch degradation when the body’s weight is on them.
For example, women’s pelvic bones are wider and not as flexible as men’s. In general, women rotate their hips more than men while walking. Women also move their upper bodies more than men when they walk. Women probably don’t know if their foot function contributes to low back pain, but they can find out about it,” Hannan said. Once you have back pain, you’ll want to do core muscle exercises and perhaps take anti-inflammatory medication, but anything that is contributing to asymmetry – you will also want to address that,” Pinney said.
Pediatric flat foot is a deformity in children that can be very disabling. Often children cannot articulate what is bothering them other than it is difficult to play and keep up with other children. Participating in sports or PE can be an anxiety provoking experience. This will result in a decrease in their activity, secondary weight gain, and preference for minimal impact activity. NEWPORT, Wales – Europe could only dream of a Sunday like this at the Ryder Cup. It gave Tiger Woods his worst beating ever, hit all the right shots to spur on its foot-stomping, flag-waving crowd and kept the Americans from winning a single match. read more
It has been found that prevention and treatment of waddling gates depend on the cause. For reducing pain reduction in the body weight is very important. As if your weight will be normal you will not feel discomfort in cases of knee arthritis. On the hand using knee braces can help in providing relief and stability to the knee joint and pain. To support the foot, the orthotic assists the foot and enables it to communicate and align with the rest of the body. The body is then balanced above the foot in midstride as well as when the foot is on the ground.
If you have flat feet, running without the proper shoe support system can lead to injuries. Normally, the foot arch helps absorb the shock of the foot striking the ground while running, but for flat-footed runners, the arches collapse when their feet hit the ground. As a result, flat-footed runners are more likely to get injuries. Choosing the correct shoes can greatly help your form, however, so check out the top 10 running shoes for flat feet. Flat-Footed Dynamics Children have flat feet until about age 4 when the foot arch starts to develop, so if your child is younger than 4, you shouldnt worry much.
Other terms for over-pronation are ‘fallen arches’, ‘dropped arches’ or ‘collapsed arches’. The term ‘flat feet’ is also often used. However, a true ‘flat foot’ is very rare. In fact, less than 5% of the population have completely flat feet (Pes Planus) with no arch present whatsoever. Most of us (90%) have a normal to low arch and only 5% have a high arch. People with a high arch (Pes Cavus) are also called ‘over-supinators’. This means that the foot stays rigid at all times and lacks its natural shock-absorbing mechanism.