Pain In The Arch All You Want To Know
Flat feet is the most common foot deformity known. In fact, sixty million Americans or 25% of the U.S. population have flat feet. Some of these people may experience problems that limit their activities, while others can run marathons or play in the NBA.
The most common cause of arch pain is plantar fasciitis. Plantar fasciitis is inflammation of the fibrous band of tissue that connects the heel to the toes. Sufferers of plantar fasciitis typically feel pain early in the morning when they first get out of bed. Another common cause of arch pain is fallen arches or flat feet. Fallen arches result in the sole of the foot becoming flat so that the entire sole of the foot touches the ground. Fallen arches can lead to pain in the ankles, knees, feet, and even in the legs. While fallen arches are often inherited, for some it develops as a result of wear and tear on your feet. Wearing shoes without proper metatarsal support, or arch support, can overstretch the tendon that supports the arch causing the arch to flatten out.
The foot of a newborn with congenital vertical talus typically has a convex rocker-bottom shape. This is sometimes combined with an actual fold in the middle of the foot. The rare person who is diagnosed at an older age often has a "peg-leg" gait, poor balance and heavy calluses on the soles where the arch would normally be. If a child with congenital vertical talus has a genetic disorder, additional symptoms often are seen in other parts of the body.
In more difficult cases of plantar fasciitis you should see your foot health professional for a thorough examination. They will find out why your arch or heel pain occurred in the first place and devise a treatment plan to relieve your pain and prevent it from reoccurring. They will evaluate your feet, walking pattern (gait), shoes, activities, exercise methods, and other relevant information and then devise your treatment plan.
Non Surgical Treatment
Treatment for these injuries varies depending on the severity of the injury. Most strains and sprains can be treated with rest, ice, compression and elevation (RICE). Moderate to severe cases, however, may require some form of immobilization such as a brace or a cast. Certain injuries that don't heal within the expected time frame may require surgery. It is important to seek medical attention as soon as possible for foot and ankle injuries, especially if it is causing you to limp or there is swelling. Prompt and appropriate treatment and rehabilitation ensures the best possible recovery.
There are two types of bone procedure for flat feet, those where bone cuts and bone grafts are used to alter the alignment by avoiding any joint structures, or joint invasive procedures (called fusions or arthrodeses) that remove a joint to reshape the foot. With joint fusion procedures, there are those procedures that involve non-essential joints of the foot versus those that involve essential joints. All bone procedures have their place in flat foot surgery, and Dr. Blitz carefully evaluates each foot to preserve as much motion and function while obtaining proper and adequate alignment. In many cases a flat foot reconstruction involves both soft tissue procedures and bone procedures to rebuild and restore the arch. There are several joints in the arch of the foot that can collapse - and these joints are non-essential joints of the foot. This does not mean that they do not have a purpose, but rather become inefficient is providing a stable platform for function. As such, locking these non-essential non-functioning joints into place is commonly recommended. These joints are fused together with screws and/or plates. A heel bone that is no longer in proper position and pushed outwards away from the foot can be corrected with a bone cut and realignment procedure, so long as the displacement is not too significant. A benefit of this surgery is that it keeps the back portion of the foot mobile, and helps the surrounding tendons work for efficiently in maintaining the arch. In certain flat feet, the foot is deviated outwards and away from the midline of the body. Sometimes, this is due to the outer portion of the foot being shorter than the inner portion. Here bone graft can be added to the outer edge of the foot to lengthen the foot to swing the foot over into a corrected position. This procedure is most commonly performed in children and young adults. A bone graft is inserted into the top part of the arch to realign a component of the flat foot, medically known as forefoot varus or medial column elevatus. The back part of the foot (called the rearfoot complex) can be the cause (or source) of the flat foot or the simply affected by the flat foot foot. In simple terms, the back part of the foot can be made to flatten out due to arch problems - and vica versa for that matter. Dr. Blitz specifically identifies the cause of the flat foot as this will determine the best treatment plan, as each flat foot needs to be evaluated individually. The rearfoot is made up of three joints, and depending on the extent and most importantly the rigidity of these joints, they may require fusion to restore alignment. When all three joints require fusion - this call is a triple arthrodesis. For completeness, isolated fusion of any of the three joints can be performed (such as subtalar joint arthrodesis, talonavicular arthrodesis, and calcaneaocuboid joint arthrodesis). The medical decision making for isolated fusions is beyond the scope this article, but Dr. Blitz tries to avoid any rearfoot fusion for flexible feet because these are joints are essential joints of the foot, especially in younger people. Those in severe cases, it may be advantageous to provide re-alignment.
The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place hands on a wall and drop affected leg back into a lunge step while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold stretch for 15 seconds and repeat three times.
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