How You Can Diagnose Pes Planus

Overview

Flat Foot

Pes planus is a condition in which the arch or instep of the foot collapses and comes in contact with the ground. In some individuals, this arch never develops while they are growing. Alternative names include pes planovalgus, flat feet, fallen arches, pronation of the feet.




Causes

Fallen arches may be caused by a number of causes, including increased elastin during pregnancy, arthritis, injury, excessive stress on the foot, fused bones in the foot, or an extra bone. They may cause not only foot pain, but also pain in the legs, knees, and back and a loss of mobility. The condition is most often treated with orthotics, structures placed in the shoes to support the feet, but this may not be enough for severe cases. Exercises to strengthen and rebuild the arches can also be helpful. Surgery is sometimes the best method of treatment, as it can completely rebuild the arches and has lasting results, but it is quite expensive and considered a last resort.




Symptoms

Many people have flat feet and notice no problems and require no treatment. But others may experience the following symptoms, Feet tire easily, painful or achy feet, especially in the areas of the arches and heels, the inside bottom of your feet become swollen, foot movement, such as standing on your toes, is difficult, back and leg pain, If you notice any of these symptoms, it's time for a trip to the doctor.




Diagnosis

Many medical professionals can diagnose a flat foot by examining the patient standing or just looking at them. On going up onto tip toe the deformity will correct when this is a flexible flat foot in a child with lax joints. Such correction is not seen in the adult with a rigid flat foot. An easy and traditional home diagnosis is the "wet footprint" test, performed by wetting the feet in water and then standing on a smooth, level surface such as smooth concrete or thin cardboard or heavy paper. Usually, the more the sole of the foot that makes contact (leaves a footprint), the flatter the foot. In more extreme cases, known as a kinked flatfoot, the entire inner edge of the footprint may actually bulge outward, where in a normal to high arch this part of the sole of the foot does not make contact with the ground at all.




Non Surgical Treatment

For mild pain or aching, acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil, Motrin and others) may be effective. Flexible Flatfoot. When there are no symptoms, treatment is not needed. If a child older than age 3 develops symptoms, the doctor may prescribe a therapeutic shoe insert made from a mold of the child's foot or a corrective shoe. As an alternative, some doctors recommend store-bought arch supports. These appear to work as well as more expensive treatments in many children. With any conservative, nonsurgical treatment, the goal is to relieve pain by supporting the arch and correcting any imbalance in the mechanics of the foot.




Surgical Treatment

Acquired Flat Feet

Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.




After Care

Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weightbearing by 10 to 12 weeks. For some patients, weightbearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended. There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Complications following flatfoot surgery may include wound breakdown or nonunion (incomplete healing of the bones). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
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