Flat Feet Treatment: Key Information and Effective Solutions

In our day-to-day practice, we have discovered that many misconceptions have developed among people, especially about flat feet. People often react to it as if it’s a big disease or some kind of stigma. Many are reluctant to try Flat Feet Treatment, and a lot of misleading concepts have been circulating. Does having flat feet mean the end? No, it’s not over, dear friends.

Recently, I encountered a reel posted by a trainer discussing flat feet. Intriguingly, he suggested that simple exercises could potentially correct this condition and even advised discarding orthotic insoles. Initially, I was taken aback by this notion, wondering why he would make such a claim. However, upon further reflection, I realized that his approach was not entirely without merit. He was simply responding to the prevalent concerns and discomfort associated with flat feet treatment. Recognizing the need to address the stigma and fear surrounding this topic, I have compiled the best answers regarding flat feet based on my knowledge below.

Let’s understand Flat Feet.

Flat feet refer to the absence of the medial (inner side) arch under our feet. It is primarily supported by the Tibialis anterior and posterior, along with the fibularis longus, flexor digitorum longus, flexor hallucis, and the intrinsic foot muscles (and, of course, ligaments too). So, the foot bones, along with the soft tissues mentioned above, collectively support our arch.

This means that muscles alone are not responsible for maintaining or developing the foot's medial arch. Training the muscles won’t be enough to create an arch since it requires strong bones, ligaments, and intrinsic muscles as well. Out of these, only muscles and intrinsic muscles are trainable or can have their strength managed. Hence, Flat Feet Treatment involves more than just exercises.

 

Types and Severity of Flat Feet

Flat feet are broadly classified into structural and functional. In simple terms, functional flat feet mean that when sitting or non-weight-bearing, the arch appears, but it collapses under weight-bearing conditions. Another type is a reduced arch, which lies between the two extremes mentioned above. In this case, the arch is less than normal when standing, but it is still somewhat visible.

The severity of flat feet depends on age and the type of flat feet. For better understanding, we can categorize them into mild, moderate, and severe flat feet.

• Mild flat feet: Often functional flat feet or reduced arches in younger individuals (roughly 5–20 years) with little or no discomfort.
• Moderate flat feet: Reduced arch to structural flat feet with complaints, typically seen in individuals aged 5–40 years.
• Severe flat feet: Structural flat feet with significant complaints, such as ankle pain, knee pain, or lower back pain. Functional flat feet can also fall into this category if pain or deformities in the joints are present.

By focusing on complaints of pain rather than just age or severity, Flat Feet Treatment can be approached more effectively.

Major Approaches to Flat Feet Treatment

Interventions for Flat Feet Treatment are divided into two main categories: invasive and non-invasive.

• Invasive Treatment: Surgical intervention to correct flat feet. This includes procedures like arthrodesis (joint fusion surgery) or wedge osteotomy (bone wedge placement). While these surgeries reconstruct the foot, they require 12–14 weeks of rest, and there’s no guaranteed prognosis or recovery, making surgery a less desirable option in most cases.
• Non-Invasive Flat Feet Treatment: Preventive measures like exercises and orthotics are both effective and affordable. In my opinion, prevention is better than cure, and non-invasive methods should always be the first step in Flat Feet Treatment.

Non-Invasive Approaches

1. Rehabilitative Approach

This method uses exercises and techniques to manage flat feet. The exercises target the soft tissues mentioned earlier, such as:

• Heel raise and hold (starting with sitting, progressing to standing, and eventually adding weight).
• Toe raise and hold (graded similarly).
• Walking on toes and heels.
• Grasping the floor or a towel with the foot (for intrinsic muscles).
• Pressing an accelerator with resistance (a creative name for another foot-strengthening exercise).

While these exercises are part of an effective Flat Feet Treatment, it’s crucial to consult a physiotherapist, occupational therapist, or podiatrist before starting. They will assess your needs and assign the appropriate exercises for your condition.

2. Corrective Approach: Orthotics

When it comes to orthotics in Flat Feet Treatment, many think of soft insoles found in stores, but those won’t provide the necessary support. Orthotics should support not only the fallen arch but the entire foot. The design of these orthotics must be prescribed by a podiatrist or foot specialist after assessing your arches and gait pattern. Properly designed orthotic insoles realign the walking pattern and weight distribution, but users need to gradually adapt to these changes.

If patients start using orthotic insoles without a proper habituation process, they might experience discomfort. This can lead to the misconception that orthotics don’t work. However, when used correctly, they provide significant relief and long-term benefits in Flat Feet Treatment.

The Right Approach

In conclusion, the best approach to Flat Feet Treatment is a combination of appropriate orthotic insoles and exercises. Mild to severe flat feet can be effectively managed with rehabilitative methods. Surgery should only be considered as a last resort, given its high risk of failure.

For individuals aged 60 or above, orthotic insoles may be the only practical solution, as their flat feet might be too rigid for exercises to be effective. Ultimately, a proper Flat Feet Treatment plan requires consulting professionals and making lifestyle adjustments for long-term foot health.

Struggling with foot pain or discomfort from flat feet? Don’t let it impact your daily life any longer! Discover personalized solutions with expert-guided Flat Feet Treatment and start your journey towards better foot health today. Reach out for a consultation and step into a pain-free future!

web- www.footimpact.in

Revolutionizing Podiatry the Power of Computerized Gait Postural Analysis

 

Revolutionizing Podiatry: The Power of Computerized Gait & Postural Analysis

In the dynamic realm of healthcare, technological advancements continue to redefine diagnostic and treatment methodologies. Among these innovations, computerized gait and postural analysis have emerged as transformative tools in the field of podiatry and beyond. This state-of-the-art technology not only delivers precise readings but also streamlines diagnosis and facilitates the creation of effective rehabilitation strategies. Let's explore the profound impact of this cutting-edge tool and its significance in the medical domain.

Exploring Computerized Gait & Postural Analysis

Gait analysis focuses on scrutinizing human movement patterns, particularly during walking or running, while postural analysis assesses body alignment and balance. Traditionally, these evaluations relied on subjective observations and rudimentary measurements, often lacking accuracy and consistency.

Gait Analysis

However, with the advent of computerized gait and postural analysis systems, healthcare practitioners now possess access to comprehensive, objective data that offer unparalleled insights into patients' biomechanics. Employing sophisticated sensors, cameras, and software algorithms, these systems capture and analyze various movement and posture parameters with exceptional precision.

Facilitating Accurate Diagnosis

A pivotal advantage of computerized gait and postural analysis lies in its capacity to furnish precise and reliable measurements. By generating detailed reports and visual representations of a patient's gait and posture, clinicians can discern abnormalities, asymmetries, and imbalances that may underlie musculoskeletal issues or injuries.

Equipped with this wealth of objective data, podiatrists and healthcare professionals can make well-informed diagnoses, pinpointing the root causes of patients' ailments with heightened confidence. Whether detecting gait deviations, foot misalignments, or postural irregularities, the insights gleaned from computerized analysis deepen comprehension of each patient's unique biomechanical profile.

Guiding Rehabilitation Strategies

Beyond diagnosis, computerized gait and postural analysis play a pivotal role in formulating personalized rehabilitation plans. Armed with a comprehensive understanding of a patient's biomechanics, clinicians can devise targeted interventions to rectify deficiencies and optimize movement patterns.

These interventions may range from prescribing orthotic devices and recommending specific exercises to suggesting footwear modifications or gait retraining techniques. Informed by computerized analysis, these tailored rehabilitation plans address the specific needs of each patient. Moreover, by objectively monitoring progress over time, clinicians can adapt treatment strategies as required, ensuring optimal patient outcomes.

Correlating Pre & Post Correction

A striking feature of computerized gait and postural analysis is its ability to quantify changes before and after interventions. By comparing pre- and post-correction data, clinicians can objectively evaluate the efficacy of treatment modalities and measure improvements in patients' gait and posture.

This correlation proves invaluable in podiatry, where interventions such as orthotic therapy, physical therapy, and surgical procedures aim to alleviate pain, enhance mobility, and improve overall function. By demonstrating measurable enhancements in biomechanics and functional outcomes, computerized analysis validates the effectiveness of treatment approaches, instilling confidence in both clinicians and patients alike.

Conclusion

In conclusion, computerized gait and postural analysis represent a revolutionary advancement in podiatry and beyond. By harnessing advanced technology to capture, analyze, and interpret biomechanical data, this innovative tool empowers clinicians to make accurate diagnoses, devise tailored rehabilitation plans, and objectively evaluate treatment outcomes.

As healthcare evolves, the integration of computerized analysis into clinical practice promises to revolutionize patient care, fostering superior outcomes and enhancing the quality of life for individuals with musculoskeletal issues. With its ability to provide precise measurements, streamline diagnosis, and inform effective interventions, computerized gait and postural analysis stand as pillars of modern healthcare, shaping the future of podiatry and beyond.

Plantar fasciitis (Heel Pain)

Plantar fasciitis (Heel Pain)

Is the inflammation of the plantar fascia caused due to repetitive stress applied to it.

It is usually common in active individual, obese, runners or athletes, people who spend most of their day on foot.

The pain is usually characterized by piercing or searing type of heel pain that appears in the first few steps in the morning or after a period of inactivity.

Patient may present with tenderness around the medial calcaneal tuberosity at the plantar aponeurosis.

Pain increases when walking barefoot on toes or while climbing stairs.

Patho-physiology

As the term implies plantar fasciitis is the inflammation of the plantar fascia however in all the samples reviewed there is no evidence of inflammation histologically.

However research shows that plantar fascia is a degenerative condition, hence it is better to be  called “fasciosis” than fasciitis.¹

Biomechanics of the foot during gait

There are 6 phases of gait cycle : heel contact, weight acceptance, mid stance, push off , propulsion and toe off phase. Foot goes for supination during heel contact phase followed by pronation in weight acceptance phase, in order to maintain contact with the surface. From the mid stance to the toe off phase the foot goes for supination thus making the foot as a rigid lever which is necessary for the propulsion of the foot.

Plantar fascia plays a very important role in maintaining this arch during the gait cycle of the foot. Because if plantar fascia fails to work effectively the medial arch arch would disrupt and the force required to control supination and pronation would be altered. Hence plantar fascia plays a very important role in control of supination and pronation of the foot during gait cycle.

Evidence based therapy for plantar fasciitis

• Cryotherapy or NSAIDS – Not much effective in the treatment of plantar fascia, however it provides only temporary pain relief.
•  Taping – No studies have proved the effectiveness of taping.
•  Shoe inserts-  a study was done to compare the effectiveness of the custom made orthotics and prefabricated shoe inserts with stretching. It was found that prefabricated shoe inserts with stretching showed more effect than custom made orthotics.
•  Stretching – A study shows plantar fascia stretch alone more effective than combined stretch of calf muscle and Achilles tendon.
•  Night splints – limited evidence suggesting the effectiveness of night splints.
•  Extra-corporeal shock-wave therapy – No evidence supporting the effectiveness of Extra-corporeal shock wave therapy for reducing night pain and resting pain in short term.
• Corticosteroid injection – According to Cochraine review Steroid iontophersis injecton improved only short term outcomes.²

As mentioned earlier the arch of the foot is very important to maintain stability on the surface when walking or standing. Overpronation or underpronation can have direct influence on the effective working of plantar fascia.

Overpronated foot

Overpronation of the foot is caused due to muscle weakness, tightness in the heel cord and abnormal structure of the foot. Proximal muscles such as gluteus medius, gluteus minimus, tensor fascia latae or quadriceps can contribute to the pronation of the foot. These proximal muscles help in assisting lower extremity response during gait, hence weakness of these muscles will transmit greater shock to the supporting foot structures and decreased pronation control.

Heel cord assist in dorsiflexion of the foot during gait, hence tightness in the heel cord limits the ability to dorsiflex the ankle at heel strike phase of the gait thus making the foot to over pronate more at the midtarsal joints in order to make contact with the surface of the ground.

Structural deformities include excessive sub-talar or forefoot varus.

Treatments for overpronated foot include strengthening of the weak muscles, stretching of the calf muscles, and using appropriate shoes with sufficient toe box and firm ankle grip to control the movement of the ankle within the shoes. Insoles made of polyurethane and ethyl vinyl acetate also enhances shoe support.³

Underpronated foot (Supination)

Supinated foot which is caused due to factors such as increased muscle tightness, decreased mobility within the joints and decreased plantar fascia extensibility.

Highy arched or cavus foot will have limited joint mobility to distribute the force during weight acceptance phase. Hence when foot does not pronate during weight acceptance phase, it indirectly applies a lot of tension force to  the insertion of plantar fascia at the medial tubercle of calcaneum.

Treatment for supinated foot include Stretching of calf muscles, mobilization of joints and increase plantar fascia extensibility. Appropriate shoe wear with ethyl vinyl acetate midsole provides appropriate space for the rearfoot and forefoot to move , offers much shock absorption.

Silicone heel pad can further enhance shock absorption.³

By Dr. Liana Thomas (PT)

Reference –

1. Plantar fasciitis  A degenerative process without Inflammation (Harvey Lemont et al.)
2. Plantar fasciitis (Charles Cole, Craig Seto et al.)
3. Plantar faciitis and the Windlass mechanism : A Biomechanical Link to clinical practice (Lori   A. Bolgia et al. )

SUCCESS STORY OF FLAT FEET WITH POSTERIOR TIBIAL TENDON DYSFUNCTION

CASE STUDY: FLAT FEET WITH POSTERIOR TIBIALTENDON DYSFUNCTION (PTTD)

41 year old female complaints pain & swelling at inner side of left ankle since a year. Pain was gradually increased. Initially it use to hurt on prolong standing & walking eventually pain got worst. Now not even able walk few steps also.

On Examination:

• Swelling was present around left navicular area
• Grade III tenderness at the navicular area

Biomechanical Assessment:
Static-

• Clawing of toes left side
• Medial Arch- Flat Bilaterlly (Flat Feet)
• Transvrse arch reduced
• Subtalar joint- Overpronation bilatrally more on lfert side
   
• Navicular drop- Present bilaterally
• Navicular drift- Present bilaterally
• Calcaneum (Posterior view)- Eversion bilaterally more on left side
• Knee- Valgus

Gait Assessment:

• Gait Pattern- Poor heel to pattern
• Heel Strike- Medial heel strike
• Stance Phase- Overpronation at the sub-talar joint bilaterally
• Limp on left side

Treatment & Advice:
Advice-

Bio-Advance

• Complete rest for one week with cold pack 4 time a day over affected area for 20 min. each time.

Orthotic correction to improve lower limb biomechnical alignment-

• Advised to wear sport shoes (Even indoor) with firm heel counter (Stable Shoes) few days as concidering her pain & sevirity of flat feet.
• Prescribed Bio-Advanced medium density orthotic insole in her shoes & also to reduce stress on Tibialis posterior muscle tendon.

1st Follow up after two week

• Demarkeble changes seen. More than 50% of pain was reduced.
• Added correction in orthotics to further enhance arch support.
• Advised to continue with cold pack. 

2 nd Follow up after one month

Strive

• This time 90% pain reduced.
• Now slight discomfirt only after long stand or walk.
• Adviced Strive orthotic footwear for short distance (Near by) & continue the sports shoes for out door.
• Exercises for strengthening tibialis posterior muscle.

3rd Follow up after 2 months
No pain & Adviced to continue with orthotics

Feedback of Patient's husband

Feedback

Metatarsalgia

METATARSALGIA

 Metatarsalgia is described as excessive pain which occurs over the toes & forefoot.
Most commonly, the first metatarsal head is affected- the ball of the foot just behind the big toe. In the foot there are small toe nerves between the metatarsal bones. When the head of one metatarsal bone is pressed against another, the small nerve is caught between them & start to become inflamed, thus causing metatarsalgia.

These can cause metatarsalgia or Contribute:

• Ill fitting footwears- Footwears that is tight around the toes or has high heels that can add pressure on the ball of the foot as it is forced into tight space.
• Overweight- Overweight people may suffer this pain as the excess weight can strain on the foot.
• Age- As a person ages several degenerative changes occur in the body, one such is reduced shock absorption. Metatarsalgia can subsequently develop as the foot has less protection from the strain of impact & load.
• High Impact Exercise- People who run or play high impact sport are at risk of metatarsalgia. When we running our feet absorb large amounts of force.
  

• Shapes of the foot & toes- Having a high arch in your foot or a second toe longer than the big toe can add to the pressure on the metatarsals.
• Stress fractures- These are small breaks in the toe bones or metatarsals. They can cause pain when weight is put on the foot- the individual compensates by changing the way they put weight on his/her foot.

Medical conditions that can cause Metatarsalgia:

• Bunion- this is a painful swollen bump that occurs at the base of the big toe.
• Rheumatoid Arthritis- swelled joints in the foot can cause metatarsalgia.
• Morton's Neuroma- is entrapment & irritation of the inter digital nerve which passes between 3rd & 4th metatarsal bones.
• Diabetes- the small nerves in the foot can become irritated, thus causing metatarsalgia. 

Common symptoms of metatarsalgia:

• A burning pain
• Sharp aching
• Pain in the ball of the foot.
• Pain increases when walk bare feet.
• Pain that worsens when standing or moving around but decreases at rest.

Treatment:

• Apply ice pack to the area approximately 15-20 minutes 2-3 times a day. Wrap ice in something to protect your skin from direct contact to ice.
• Avoid high impact sports & exercise that puts pressure on the feet. Try something lighter on the feet i.e. Cycling or swimming.
• Try to keep pressure off the feet, when resting try putting your feet up.
• Be sure to exercise your ankle & keep stretching the Achilles tendon.
• Use fitted insoles (Orthotics) as these will reallocate pressure or reduce pressure, improve foot function & guard the ball your foot.
• Change to better fitting flat headed shoes.

Success Story of Metatarsalgia Click here- http://vcarerehab.blogspot.com/2018/03/success-story-of-metatarsalgia.html

HEEL PAIN

If you are waking up with acute pain at your heel, then mostly you are suffering from plantar fasciitis. This is one of the most common foot problems. Many times pain is very severe & disabling.

What is plantar fasciitis?

Plantar Fasciitis (plantar fasciosis) is inflammation of the plantar fascia. The planar fascia is a strong bowstring like ligament that runs from the calcaneus (Heel Bone) to the tip of the foot. When the plantar fascia is stretched too far its soft tissue fibers become inflamed, usually where it attaches to the heel bone. Sometimes the problem may occur in the middle of the foot. The patient experiences pain under the foot, especially after long period of rest. If inflammation persists for longer duration it can lead to calcaneal spur.

Causes: Plantar Fasciitis is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. Still following factors play important role in increasing severity of plantar fasciitis.

1. Arch Type: Flat feet, High arch or in between.
2. Footwear: Wearing too flat or too high heel footwear.
3. Lifestyle: Continuous standing, walking  or running.
4. Body weight: Overweight results in more stress on platar fascia.
5. Osteoporosis: Weak bones will aggravate pain.

Symptoms

• Pain at the heel when standing.
• Throbbing or piercing type of pain.
• Pain in the first few steps in the morning after a period of inactivity.
• Pain while walking barefoot, on toes or while climbing stairs.
• Tenderness along the inferior surface of the heel

Causes: Plantar Fasciitis is not usually caused by a single injury, such as a twist or fall, but rather the result of repetitive stress and pounding of the heel. Still following factors play important role in increasing severity of plantar fasciitis.

Treatment:

• Rest: Temporary rest is important to allow plantar fascia to heal
• Cold pack: Helps to reduce inflammation. Recommended 3-4 times a day, 20 minutes each time (Not recommended for diabetic patient)

• Taping
• Right orthotics: To support your plantar fascia & correct your faulty alignment
• Supportive shoes: Orthotics with proper supportive shoe gives long term relief
• Exercises: Generally higher arched feet require a strict stretching program and flat feet require a gradual strengthening program and more support.  One should not do stretching in acute pain.

What to avoid:

1. Barefeet walking on hard surfaces 
2. Wearing too flat or too high heeled footwear
3. Heel Cushions: Silicone or foam heel cushions commonly available from pharmacies do nothing to actually cure this condition and at best provide temporary comfort.

Success Story- Click this link 

https://youtu.be/YfOE5jx5HVM

For more details visit- www.vcarerehab.in