Do I Suffer Adult Aquired FlatFoot ?

Overview


Adult acquired flatfoot deformity or posterior tibial tendon dysfunction is a gradual but progressive loss of ones arch. The posterior tibial muscle is a deep muscle in the back of the calf. It has a long tendon that extends from above the ankle and attaches into several sites around the arch of the foot. The muscle acts like a stirrup on the inside of the foot to help support the arch. The posterior tibial muscle stabilizes the arch and creates a rigid platform for walking and running. If the posterior tibial tendon becomes damaged or tears the arch loses its stability and as a result, collapses causing a flatfoot. Adult flatfoot deformity can occur in people of all ages and gender however, it occurs most commonly in sedentary middle aged to elderly females. There are several risk factors for posterior tibial tendon dysfunction that include: obesity, steroid use, systemic inflammatory diseases such as rheumatoid arthritis, trauma, being born with a low arch, and diabetes. It occurs most commonly in one foot however, it can occur in both feet especially in people with systemic diseases such as diabetes and rheumatoid arthritis.






Causes


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.






Symptoms


PTTD begins with a gradual stretching and loss of strength of the posterior tibial tendon which is the most important tendon supporting the arch of the human foot. Left untreated, this tendon will continue to lengthen and eventually rupture, leading to a progressive visible collapse of the arch of the foot. In the early stages, patients with PTTD will notice a pain and swelling along the inner ankle and arch. Many times, they are diagnosed with ?tendonitis? of the inner ankle. If the foot and ankle are not properly supported during this early phase, the posterior tibial tendon can rupture and devastating consequences will occur to the foot and ankle structure. The progressive adult acquired flatfoot deformity will cause the heel to roll inward in a ?valgus? or pronated direction while the forefoot will rotate outward causing a ?duckfooted? walking pattern. Eventually, significant arthritis can occur in the joints of the foot, the ankle and even the knee. Early diagnosis and treatment is critical so if you have noticed that one, or both, of your feet has become flatter in recent times come in and have it checked out.






Diagnosis


Looking at the patient when they stand will usually demonstrate a flatfoot deformity (marked flattening of the medial longitudinal arch). The front part of the foot (forefoot) is often splayed out to the side. This leads to the presence of a ?too many toes? sign. This sign is present when the toes can be seen from directly behind the patient. The gait is often somewhat flatfooted as the patient has the dysfunctional posterior tibial tendon can no longer stabilize the arch of the foot. The physician?s touch will often demonstrate tenderness and sometimes swelling over the inside of the ankle just below the bony prominence (the medial malleolus). There may also be pain in the outside aspect of the ankle. This pain originates from impingement or compression of two tendons between the outside ankle bone (fibula) and the heel bone (calcaneus) when the patient is standing.






Non surgical Treatment


Conservative treatment also depends on the stage of the disease. Early on, the pain and swelling with no deformity can be treated with rest, ice, compression, elevation and non-steroidal anti-inflammatory medication. Usually OTC orthotic inserts are recommended with stability oriented athletic shoes. If this fails or the condition is more advanced, immobilization in a rigid walking boot is recommended. This rests the tendon and protects it from further irritation, attenuation, or tearing. If symptoms are greatly improved or eliminated then the patient may return to a supportive shoe. To protect the patient from reoccurrence, different types of devices are recommended. The most common device is orthotics. Usually custom-made orthotics are preferable to OTC. They are reserved for early staged PTTD. Advanced stages may require a more aggressive type orthotic or an AFO (ankle-foot orthosis). There are different types of AFO's. One type has a double-upright/stirrup attached to a footplate. Another is a gauntlet-type with a custom plastic interior surrounded be a lace-up leather exterior. Both require the use of a bulky type athletic or orthopedic shoes. Patient compliance is always challenging with these larger braces and shoes.









Surgical Treatment


For more chronic flatfoot pain, surgical intervention may be the best option. Barring other serious medical ailments, surgery is a good alternative for patients with a serious problem. There are two surgical options depending on a person?s physical condition, age and lifestyle. The first type of surgery involves repair of the PTT by transferring of a nearby tendon to help re-establish an arch and straighten out the foot. After this surgery, patients wear a non-weight bearing support boot for four to six weeks. The other surgery involves fusing of two or three bones in the hind foot below the ankle. While providing significant pain relief, this option does take away some hind foot side-to-side motion. Following surgery, patients are in a cast for three months. Surgery is an effective treatment to address adult-acquired flatfoot, but it can sometimes be avoided if foot issues are resolved early. That is why it is so important to seek help right away if you are feeling ankle pain. But perhaps the best way to keep from becoming flatfooted is to avoid the risk factors altogether. This means keeping your blood pressure, weight and diabetes in check.

What Could Cause Achilles Tendinitis ?

Overview


The Achilles tendon is the largest and strongest tendon in the human body. It is the ?cord? in the back of the leg that inserts into the back of the heel. The Achilles tendon got its name, according to Greek legend, when the Greek warrior, Achilles, was dipped into the River Styx by Thetis, his mother. This rendered him invincible with the exception of his unsubmerged heel. Unfortunately, he went on to get mortally wounded during the siege of Troy when he was struck in that heel by an arrow. Achilles tendinitis is inflammation and partial tearing of the Achilles tendon. It can occur with overuse of the tendon such as when starting or increasing the intensity of an exercise program or performing impact loading activities that include a lot of running and/or jumping.


Causes


Possible factors leading to the development of Achilles tendonitis include the following. Implementing a new exercise regiment such as running uphill or climbing stairs. Change in exercise routine, boosting intensity or increasing duration. Shoes worn during exercise lack support, either because the soles are worn out or poor shoe design. Omitting proper warm-up prior to strenuous exercise. Running on a hard or uneven surface. Deformation in foot such as a flat arch, or any anatomic variation that puts unnecessary strain on the Achilles tendon.


Symptoms


If you have Achilles tendinitis or Achilles enthesopathy, you are likely to experience the following symptoms. Pain. You may notice aching, burning, or tearing pains at the back of your heel or above the ankle. The pain can range from mild to very severe and disabling. It is most noticeable in the following circumstances. After resting. Many people report that pain increases when they first get out of bed in the morning or after sitting for a period of time. After exercise. Pain may increase if you exercise or stand for a period of time. A lump. In some cases, a tender lump can develop at the site of the injured tendon (tendinosis). Bone spurs. When the injury occurs at the point where the tendon attaches to the foot, a bone spur may develop on the heel.


Diagnosis


To diagnose the condition correctly, your doctor will ask you a few questions about the pain and swelling in your heel. You may be asked to stand on the balls of your feet while your doctor observes your range of motion and flexibility. The doctor may also touch the area directly. This allows him to pinpoint where the pain and swelling is most severe.


Nonsurgical Treatment


Treatment for Achilles tendonitis, depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued. If the problem returns or persists, a medical professional should be consulted. If pain develops even with proper stretching and training techniques, the patient should consult a podiatrist to check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain. If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation). Patients are advised to rest the tendon by keeping off their feet as much as possible, apply ice packs for 20 minutes at a time every hour for a day or two to reduce swelling, compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage and elevate the foot whenever possible to minimize swelling. A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation.





Surgical Treatment


If non-surgical treatment fails to cure the condition then surgery can be considered. This is more likely to be the case if the pain has been present for six months or more. The nature of the surgery depends if you have insertional, or non-insertional disease. In non-insertional tendonosis the damaged tendon is thinned and cleaned. The damage is then repaired. If there is extensive damage one of the tendons which moves your big toe (the flexor hallucis longus) may be used to reinforce the damaged Achilles tendon. In insertional tendonosis there is often rubbing of the tendon by a prominent part of the heel bone. This bone is removed. In removing the bone the attachment of the tendon to the bone may be weakened. In these cases the attachment of the tendon to the bone may need to be reinforced with sutures and bone anchors.


Prevention


Although Achilles tendinitis cannot be completely prevented, the risk of developing it can be lowered. Being aware of the possible causes does help, but the risk can be greatly reduced by taking the following precautions. Getting a variety of exercise - alternating between high-impact exercises (e.g. running) and low-impact exercise (e.g. swimming) can help, as it means there are days when the Achilles tendon is under less tension. Limit certain exercises - doing too much hill running, for example, can put excessive strain on the Achilles tendon. Wearing the correct shoes and replacing them when worn - making sure they support the arch and protect the heel will create less tension in the tendon. Using arch supports inside the shoe, if the shoe is in good condition but doesn't provide the required arch support this is a cheaper (and possibly more effective) alternative to replacing the shoe completely. Stretching, doing this before and after exercising helps to keep the Achilles tendon flexible, which means less chance of tendinitis developing. There is no harm in stretching every day (even on days of rest), as this will only further improve flexibility. Gradually increasing the intensity of a workout - Achilles tendinitis can occur when the tendon is suddenly put under too much strain, warming up and increasing the level of activity gradually gives your muscles time to loosen up and puts less pressure on the tendon.