The arch of the foot in children is usually not visible due to the presence of soft and fatty tissues in the feet. With age, the arch of the foot gradually forms. Plantar fasciitis (post-planus) is a complication in which the entire sole of the foot is placed on the ground while standing. Normally, the inside of the foot is slightly off the ground. This distance does not exist in people with flat feet. This complication can cause problems in the ankles and knees and as a result may cause changes in the direction of the legs.
To diagnose flat feet, your doctor will check the position of your foot while standing on your toes and assess the extent of your foot contact with the ground. If there is no arch of the foot, the doctor will use a test to diagnose flat feet.
Specialists of Omid Comprehensive Rehabilitation Center evaluate and evaluate the patient before starting treatment in different ways. The specialists of this clinic determine the severity and type of flat feet with the help of clinical examinations and accurate photographs and scans of the sole of the foot. Based on the results of the examination and imaging of the sole of the foot, a treatment plan appropriate to the specific conditions of each patient is prescribed. Plantar fasciitis is treated in this clinic with a stepwise approach. Treatment begins with simple methods such as medical shoes and insoles, massage, exercise and physiotherapy. If necessary, more complex treatments will be prescribed to the patient.
Types of flat feet
Flexible sole of the foot
This type of flat foot develops in childhood. In the flexible sole of the foot, when sitting and standing on the toe, there is an arch of the foot, but when the foot is on the ground, the arch disappears.
Inflexible smoothness of the soles of the feet
This type of plantar fasciitis (adult plantar fasciitis) is caused by a weakening of the posterior tibialis tendon, which maintains the arch of the sole of the foot.
Reasons for flat feet
Flat feet are caused by a variety of factors such as injury, genetic factors, arthritis or disease. In some cases, excessive pressure on the legs, muscle imbalance or pressure due to body weight can cause abnormalities in the arch of the foot. Reasons for flat feet include:
Injury: Injury to the posterior tendon can cause flat feet.
Genetic factors: There may be flat feet in family members, or people may inherit the condition from their parents.
Neurological problems: Some conditions, such as spina bifida, cerebral palsy, or muscular dystrophy that affect the muscles and nerves, can cause flat feet.
Congenital malformations: Flat feet can be caused by congenital anomalies.
Improper use of shoes: Using inappropriate shoes (for example, high heels) for a long time can cause flat feet.
Symptoms of flat feet
Common symptoms of flat feet include:
sore feet
Fatigue of the legs
Pain in the arch of the sole of the foot and heel
Difficulty standing
Pain in the knees, pelvis or back
Protrusion on the side of the foot
Inability to lift the heel off the ground
Factors affecting the occurrence of flat feet
The following factors are effective in creating flat feet:
Age: People over 50 are more prone to flat feet due to various joint problems such as joint inflammation, weakening of tendons and ligaments.
Diabetes: Bone destruction and fractures are more common in people with diabetes, resulting in decreased sensation in the legs. Therefore, flat feet are more common in these people.
Obesity: Being overweight puts too much strain on many parts of the body, especially the legs. In this case, the tendons and ligaments in the arch of the sole of the foot are stretched and gradually increase the risk of injury.
Rheumatoid arthritis: This complication can cause abnormalities in the toe and damage to the ligaments, resulting in an increased chance of flat feet.
Injury: In some cases, an injury to the foot or ankle can increase the likelihood of flat feet.
Complications of flat feet
If treatment is delayed, flat feet can cause complications. In people with foot and ankle complications, flat feet may exacerbate the symptoms. Flat feet can cause the following complications:
A flat foot puts too much pressure on the muscles and joints of the foot.
Flat feet can cause shin splints. This complication causes pain along the inner edge of the tibia. Athletes with plantar fasciitis are more likely to have a large bone fracture.
Improper use of shoes in people with flat feet can cause bunion complications. This condition affects the big toe joint.
Flat feet can increase the likelihood of tendon inflammation and negatively affect the Achilles tendon due to increased pressure on the heel and ankle.
Flat feet can cause hammer toe problems. This condition is caused by an imbalance in the muscles or ligaments that keep the toes straight.
Ways to diagnose flat feet
Examination of the feet by the patient to diagnose flat feet
The easiest way to detect flat feet is to moisten the soles of the feet and place them on a piece of dark paper. If there is an arch in the sole of the foot, an empty space can be seen on the paper between the heel and under the toe. Since flat feet are usually associated with inward rotation of the ankle, the inner edges of the shoe may also be more worn than the outer edges.
Examination of the foot by a doctor to diagnose flat feet
For this purpose, the doctor examines the patient's legs while standing.
Posterior tibial tendon dysfunction can affect how a patient walks; Because in this case, this tendon is not able to maintain the arch of the sole of the foot when the weight is placed on it. As a result, there is usually swelling and pain on the inside of the ankle below the bony protrusion. There may also be pain on the outside of the ankle when touched. This pain is caused by the compression of two tendons between the outer bone of the ankle (thinning) and the heel bone when standing.
A standing test on one toe is used to assess the condition of the posterior tibial tendon and evaluate its function. If the patient is able to stand on one foot and lift his heel off the ground 3 to 5 times, it is determined that the posterior tibial tendon is healthy. If the patient is unable to perform this movement, the tendon may be in trouble.
Imaging experiments
X-ray imaging: This technique is used to image the bones and joints of the foot. X-rays also help diagnose abnormalities in the joints.
Ultrasound scan: Ultrasound scan is used if there is any possibility of abnormalities in the tendons. This method uses sound waves to create images and examine damaged tendons.
CT scan: A CT scan helps diagnose an injury or fracture in the leg. This method provides more detail than X-ray imaging.
MRI: Magnetic resonance imaging provides more accurate images than CT scans and ultrasound. In this method, radio waves and magnetic fields are used to create images of the internal structures of the body.
Classification of the complication of acquired plantar fasciitis in adults
Adult acquired plantar fasciitis is classified into four groups. Classification of this complication helps to treat flat feet. Of course, there is usually no agreement between physicians regarding the classification of different types of plantar fasciitis.
Flatfoot Stage 1 (Posterior tibial tendon dysfunction)
If the posterior tibial tendon malfunctions, there is swelling and pain in the inside of the injured wrist. Swelling and pain in this area are related to inflammation in the posterior tibial tendon. However, in this case, the posterior tibial tendon still maintains its function, and in the flat foot of stage 1, the patient can stand on his toe, even if this movement causes pain.
Flatfoot Stage 2 (Posterior Tibial Tendon Dysfunction)
In stage 2 plantar fasciitis and dysfunction of the posterior tibial tendon, there is pain and swelling in the inside of the ankle as well as significant flatfoot. However, in this type of flat foot, the posterior tibial tendon does not function due to excessive stretching or rupture. As a result, the patient is unable to stand on his toes. In fact, the inability to stand on one toe is one of the main features of the flat foot's flat foot. In this case, the patient usually walks in a limping position because he is not able to put pressure on the toes. Of course, the foot in this type of flat foot has flexibility and the normal position of the foot can be restored by a doctor.
Flatfoot Stage 3 (Posterior tibial tendon dysfunction)
People with stage 3 plantar fasciitis and posterior tibial tendon dysfunction have all the symptoms of stage 2 plantar fasciitis and also the joints of the back of the foot are stiff in this type of plantar fasciitis and due to the loss of cartilage, the symptoms of inflammation The joint is visible. Flat feet in the long run cause uneven pressure on the joints of the back of the foot and over time leads to dryness and loss of cartilage in these joints. In this case, the person is not able to maintain the normal position of the foot. It is difficult to tell when a flat-footed flat foot will turn into a flat-footed flatbread. Because dryness of the back of the foot and loss of cartilage occur over a long period of time. Orthopedic surgeons may disagree as to whether the patient is in stage 2 or 3 plantar fasciitis.
Flatfoot Stage 4 (Posterior Tibial Tendon Dysfunction)
The hallmark of patients with stage 4 flat feet is inflammation of the ankle joint or ankle deformity. Like stage 3 plantar fasciitis, patients with this type of plantar fasciitis have dryness and joint inflammation in the lower ankle joints. The ankle joints of these patients are also damaged. As a result of this complication for a long time, the ligaments of the inner part of the ankle may be stretched and the weight is disproportionately placed on the outer part of the ankle joint. As a result, the deltoid ligament is over-stretched or the cartilage on the outside of the ankle joint becomes worn. If the dolly ligament is stretched too much on the inside of the wrist, the ankle joint becomes unstable and is oblique and oblique on X-rays. Inflammation of the ankle joint in the sole of the foot Stage 4 is caused by uneven weight applied to the outer part of the ankle joint. The inner part of the ankle joint and the dolphin ligament are also stretched too much.
Treatment of flat feet
The treatment for flat feet depends on the symptoms and the main cause of this complication. In some cases, treatment is not needed unless the sole of the foot causes pain or other problems. If necessary, the doctor recommends the use of the following treatment methods:
Physiotherapy
Treatment of flat feet with physiotherapy
The benefits of physiotherapy for the treatment of flat feet include:
Improve foot position
Improved gait
Reduce pain and the possibility of joint problems
Physiotherapy reduces the problems associated with flat feet by using the following:
Training exercises to stretch stiff muscles and strengthen weak parts of the foot to help improve foot position
Provide guidance to the patient regarding the use of appropriate footwear
Advise the patient to use a suitable medical insole to improve the position of the foot and introduce the patient to a foot treatment specialist if necessary
Teaching how to control pain in adolescents
taking medication
Your doctor may prescribe corticosteroids to reduce inflammation.
Use medical tools to protect the arch of the foot
The doctor recommends the use of special medical instruments, braces or medical insoles to reduce pain when standing or walking. Of course, the use of this medical tool does not cure flat feet, but they are useful to reduce the symptoms of this complication.
Stretching exercises to treat flat feet
The physiotherapist recommends special exercises to reduce the pain caused by flat feet. For this purpose, stretching exercises are taught to the patient to improve leg flexibility.
Treatment of flat feet with surgery
Surgery may be used for patients with stage 2 (and higher) plantar fasciitis and if non-surgical treatments do not work. In stage 2 flatfoot surgery, the following is done:
Use another tendon to help the posterior tibial tendon function
Restore the shape and direction of the foot to return the weight bearing axis to the center of the ankle
Leg deformity is done using one or more of the following methods:
Cut the heel bone and change its direction inwards
Increase the length of the bones of the outer part of the foot to restore the arch and overall direction of the foot
Stabilize the bones of the inside of the foot to tighten a part of the thumb to further protect the arch of the foot
Increased length of the Achilles tendon or gastrocnemius. In this case, after repairing the direction of the foot, the ankle is able to move enough.
Stage 3 plantar fasciitis may be treated with fusion surgery (arthrodesis). This method uses the fusion of two or three joints in the back of the foot. Using this method, the complication that causes flat feet is treated first.