Overview
Flat feet and fallen arches are terms used to describe lowering of the long inner arch of the foot. In the past, we thought that flat feet were a sign of a poorly developed or poorly structured foot. Now we know that people with flat feet function generally well and that flat feet don?t cause many foot problems. The most important factor in foot soreness and injury is not how flat or high your arches are, but the way you walk and move. If your feet move abnormally while you are walking or standing, this can make you more prone to injuries and foot soreness.
Causes
The plantar fascia is a thick, fibrous band which runs along the sole of the feet. It helps to support the foot arches and transmits forces through the foot as you move. Plantar fasciitis is one of the most common causes of foot arch pain. The most common problem to develop here is plantar fasciitis. If there is too much strain on the plantar fascia (e.g. from long periods on your feet, suddenly increasing activity levels or your foot position is altered), the plantar fascia becomes inflamed and swollen. It is often accompanied by a bone spur, excess growth of the bone which develops due to repeated tension on the area where the plantar fascia attaches to the bone. Plantar fasciitis is one of the most common causes of foot arch pain. It is usually painful after activity or prolonged rest e.g. first thing in the morning. A less common problem with the plantar fascia which casues foot arch pain is plantar fibromatosis. This is when a small nodular growth develops on the plantar fascia, usually in the middle of the foot arch. It often causes pain when walking due to pressure through the lump.
Symptoms
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. The condition is diagnosed with the classic symptoms of pain well focused deep in the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking. Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. It is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.
Diagnosis
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.
Surgical Treatment
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.
Prevention
Arch pain occurs when the plantar fascia becomes worn down due to constant strain or excessive exercising. This may be caused by increasing your running or hiking mileage too fast, wearing inadequate footwear, lack of stretching, running on steep hills, standing on your feet for too long and abnormal anatomy such as flat foot. Stretching is an important exercise that should not be overlooked because the tightness or lack of tightness of the joints in the foot can also cause pain in the arch.
Stretching Exercises
Calf Stretching in Bed. As you may already know, the first few steps out of bed in the morning can be the worst of the day. Those first few steps can be enough to reaggravate your condition putting you into a cycle of inflammation and pain. The best way to help break that cycle is to stretch your calf before taking those first steps in the morning. When the muscles in your calf are tight, they pull on the heel bone, making your plantar fascia very taut and prone to injury. To help loosen those muscles, take a towel or belt and loop it around the ball of your foot. Keeping your leg straight, gently pull towards your body until you feel a stretch in the lower part of your leg. Hold that for 30 seconds and repeat up to 5 times before taking your first step out of bed. Plantar Fascia Stretching. Loosening up the tissues that are irritated probably makes sense to you, but you may not know how to do so. Luckily, there?s a very simple way. All you have to do is pull your toes up with your hand until you feel a stretch along the ball of your foot. You may feel the stretch anywhere from the ball of your foot to your heel. Holding this position for 30 seconds a few times can make a world of difference in your pain levels. Calf Stretching. I know, it probably seems like overkill, but stretching out the muscles in the lower leg is an integral step to recovery. There are two main muscles in the lower leg that attach to the heel, so we?ll work on stretching them both out. Stand against a wall and slide one leg back, pushing the heel down towards the floor (first picture). When you feel a stretch in the lower part of your leg, hold it for 30 seconds. After those 30 seconds are up, bend your knees until a deeper stretch is felt a bit lower in the leg (second photo). Again, hold this stretch for 30 seconds and repeat this until you?ve done it 3 times on each leg. Who doesn?t love a good massage? I suppose you could pay for someone to rub out the tissues in the bottom of your foot, but if you?re looking for a cheaper alternative, look no further than the humble tennis ball. Placing a tennis ball on the ground and gently rolling it under foot for a few minutes can help loosen up your plantar fascia, making it much less likely to become irritated. Put enough pressure on the ball to get a deep massage. You may feel some soreness, but back off if you feel any pain.Tennis Ball Massage While using the tennis ball is great for keeping things loose, sometimes it?s worth doing some icing at the same time for some inflammation control. Freezing a water bottle and rolling it under your foot for 10 minutes at the end of the day can be a very effective way to keep inflammation in check while staying loose. It might not be the most comfortable thing in the world, but ?Brrr? is better than ?Ouch? any day. One thing to keep in mind is that while these tips have been proven to work, they?re not an instant fix. It can take a few weeks of consistency with them before your pain levels begin to change. If you?re not seeing any improvement after making an honest effort, it may be time to look into some different treatment methods with your doctor such as formal PT, orthotics, a weight-loss plan, or others.
Flat feet and fallen arches are terms used to describe lowering of the long inner arch of the foot. In the past, we thought that flat feet were a sign of a poorly developed or poorly structured foot. Now we know that people with flat feet function generally well and that flat feet don?t cause many foot problems. The most important factor in foot soreness and injury is not how flat or high your arches are, but the way you walk and move. If your feet move abnormally while you are walking or standing, this can make you more prone to injuries and foot soreness.
Causes
The plantar fascia is a thick, fibrous band which runs along the sole of the feet. It helps to support the foot arches and transmits forces through the foot as you move. Plantar fasciitis is one of the most common causes of foot arch pain. The most common problem to develop here is plantar fasciitis. If there is too much strain on the plantar fascia (e.g. from long periods on your feet, suddenly increasing activity levels or your foot position is altered), the plantar fascia becomes inflamed and swollen. It is often accompanied by a bone spur, excess growth of the bone which develops due to repeated tension on the area where the plantar fascia attaches to the bone. Plantar fasciitis is one of the most common causes of foot arch pain. It is usually painful after activity or prolonged rest e.g. first thing in the morning. A less common problem with the plantar fascia which casues foot arch pain is plantar fibromatosis. This is when a small nodular growth develops on the plantar fascia, usually in the middle of the foot arch. It often causes pain when walking due to pressure through the lump.
Symptoms
Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. The condition is diagnosed with the classic symptoms of pain well focused deep in the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking. Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. It is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.
Diagnosis
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain. Rest will allow the tissues to heal themselves by preventing any further stress to the affected area. Ice should be applied no longer than 20 minutes. The ice may be put in a plastic bag or wrapped in a towel. Commercial ice packs are not recommended because they are usually too cold. Compression and elevation will help prevent any swelling of the affected tissues. There are two types of over-the-counter medication that may help with the pain and swelling of arch pain. Acetaminophen (Tylenol) will help with the pain, and a nonsteroidal anti-inflammatory such as aspirin, ibuprofen, or naproxen will help with the pain and battle the inflammatory response. Caution should be taken when using these drugs, and dosage should not exceed the labeled directions. Special care should be taken and a physician consulted if you have a history of stomach ulcers. Those who have chronic medical conditions or who are taking other medications should consult with their doctor regarding the most appropriate type of pain and/or anti-inflammatory medications. Commercial over-the-counter arch supports or orthotics may also help to ease arch pain.
Surgical Treatment
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.
Prevention
Arch pain occurs when the plantar fascia becomes worn down due to constant strain or excessive exercising. This may be caused by increasing your running or hiking mileage too fast, wearing inadequate footwear, lack of stretching, running on steep hills, standing on your feet for too long and abnormal anatomy such as flat foot. Stretching is an important exercise that should not be overlooked because the tightness or lack of tightness of the joints in the foot can also cause pain in the arch.
Stretching Exercises
Calf Stretching in Bed. As you may already know, the first few steps out of bed in the morning can be the worst of the day. Those first few steps can be enough to reaggravate your condition putting you into a cycle of inflammation and pain. The best way to help break that cycle is to stretch your calf before taking those first steps in the morning. When the muscles in your calf are tight, they pull on the heel bone, making your plantar fascia very taut and prone to injury. To help loosen those muscles, take a towel or belt and loop it around the ball of your foot. Keeping your leg straight, gently pull towards your body until you feel a stretch in the lower part of your leg. Hold that for 30 seconds and repeat up to 5 times before taking your first step out of bed. Plantar Fascia Stretching. Loosening up the tissues that are irritated probably makes sense to you, but you may not know how to do so. Luckily, there?s a very simple way. All you have to do is pull your toes up with your hand until you feel a stretch along the ball of your foot. You may feel the stretch anywhere from the ball of your foot to your heel. Holding this position for 30 seconds a few times can make a world of difference in your pain levels. Calf Stretching. I know, it probably seems like overkill, but stretching out the muscles in the lower leg is an integral step to recovery. There are two main muscles in the lower leg that attach to the heel, so we?ll work on stretching them both out. Stand against a wall and slide one leg back, pushing the heel down towards the floor (first picture). When you feel a stretch in the lower part of your leg, hold it for 30 seconds. After those 30 seconds are up, bend your knees until a deeper stretch is felt a bit lower in the leg (second photo). Again, hold this stretch for 30 seconds and repeat this until you?ve done it 3 times on each leg. Who doesn?t love a good massage? I suppose you could pay for someone to rub out the tissues in the bottom of your foot, but if you?re looking for a cheaper alternative, look no further than the humble tennis ball. Placing a tennis ball on the ground and gently rolling it under foot for a few minutes can help loosen up your plantar fascia, making it much less likely to become irritated. Put enough pressure on the ball to get a deep massage. You may feel some soreness, but back off if you feel any pain.Tennis Ball Massage While using the tennis ball is great for keeping things loose, sometimes it?s worth doing some icing at the same time for some inflammation control. Freezing a water bottle and rolling it under your foot for 10 minutes at the end of the day can be a very effective way to keep inflammation in check while staying loose. It might not be the most comfortable thing in the world, but ?Brrr? is better than ?Ouch? any day. One thing to keep in mind is that while these tips have been proven to work, they?re not an instant fix. It can take a few weeks of consistency with them before your pain levels begin to change. If you?re not seeing any improvement after making an honest effort, it may be time to look into some different treatment methods with your doctor such as formal PT, orthotics, a weight-loss plan, or others.