Does Adult Aquired Flat Feet Require Surgical Pocedures ?

posted on 28 Apr 2015 22:40 by colemanghthsxiggu
Overview
Originally known as posterior tibial tendon dysfunction or insufficiency, adult-acquired flatfoot deformity encompasses a wide range of deformities. These deformities vary in location, severity, and rate of progression. Establishing a diagnosis as early as possible is one of the most important factors in treatment. Prompt early, aggressive nonsurgical management is important. A patient in whom such treatment fails should strongly consider surgical correction to avoid worsening of the deformity. In all four stages of deformity, the goal of surgery is to achieve proper alignment and maintain as much flexibility as possible in the foot and ankle complex. However, controversy remains as to how to manage flexible deformities, especially those that are severe. Flat Foot

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
Your feet tire easily or become painful with prolonged standing. It's difficult to move your heel or midfoot around, or to stand on your toes. Your foot aches, particularly in the heel or arch area, with swelling along the inner side. Pain in your feet reduces your ability to participate in sports. You've been diagnosed with rheumatoid arthritis; about half of all people with rheumatoid arthritis will develop a progressive flatfoot deformity.

Diagnosis
Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.

Non surgical Treatment
Footwear has an important role, and patients should be encouraged to wear flat lace-up shoes, or even lace-up boots, which accommodate orthoses. Stage I patients may be able to manage with an off the shelf orthosis (such as an Orthaheel or Formthotics). They can try a laced canvas ankle brace before moving to a casted orthosis. The various casted, semirigid orthoses support the medial longitudinal arch of the foot and either hold the heel in a neutral alignment (stage I) or correct the outward bent heel to a neutral alignment (stage II). This approach is meant to serve several functions: to alleviate stress on the tibialis posterior; to make gait more efficient by holding the hindfoot fixed; and thirdly, to prevent progression of deformity. Devices available to do this are the orthosis of the University of California Biomechanics Laboratory, an ankle foot orthosis, or a removable boot. When this approach has been used, two thirds of patients have good to excellent results. Adult Acquired Flat Foot

Surgical Treatment
When conservative care fails to control symptoms and/or deformity, then surgery may be needed. The goal of surgical treatment is to obtain good alignment while keeping the foot and ankle as flexible as possible. The most common procedures used with this condition include arthrodesis (fusion), osteotomy (cutting out a wedge-shaped piece of bone), and lateral column lengthening. Lateral column lengthening involves the use of a bone graft at the calcaneocuboid joint. This procedure helps restore the medial longitudinal arch (arch along the inside of the foot). A torn tendon or spring ligament will be repaired or reconstructed. Other surgical options include tendon shortening or lengthening. Or the surgeon may move one or more tendons. This procedure is called a tendon transfer. Tendon transfer uses another tendon to help the posterior tibial tendon function more effectively. A tendon transfer is designed to change the force and angle of pull on the bones of the arch. It's not clear yet from research evidence which surgical procedure works best for this condition. A combination of surgical treatments may be needed. It may depend on your age, type and severity of deformity and symptoms, and your desired level of daily activity.
Tags: adult, aquired, flat, foot