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Flat Feet: The Achilles Heel of Middle Age

November 11, 2005 |  By: Shelagh McNally for Knee1 It can run in the family, be caused by old age or result from a trauma. Posterior tibial tendon dysfunction – more commonly known as flat feet – affects 25 percent of Americans. In the past, parents and pediatricians were concerned with flat feet in children. But they seem to fare better than adults do. A recent 2005 study by biomechanics researcher Dara Twomey, at the University of New South Wales found that children born with flat feet had no significant problems. In fact, they were actually better than average at some physical activities. Many were able to jump higher than average and had stronger lower calf muscles.

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Signs and symptoms of posterior tibial tendon dysfunction Stage One: Inflammation, pain and swelling on the inside of the ankle. Non surgical treatment is usually recommended. Stage Two: Visible deformity in one foot as it becomes flatter and more deformed. Surgery not required – still treatable with orthopedic devices and exercise. Stage Three: The foot becomes rigid, non-movable with pain outside the ankle or foot. Surgery may be required. Stage Four: Weakness with inability to stand on the toes. Increased tenderness over the midfoot during any activities. Surgery is needed.

It’s the adults with fallen arches that seem to suffer the most. In a joint research project, researchers at the Naval Health Research Center in San Diego, California, and the Naval Hospital at Camp Lejeune in North Carolina followed 449 Navy SEALS. The study discovered that those with low arches were more likely to develop stress fractures and Achilles tendonitis. The American Academy of Orthopedic Surgeons (AAOS) recommends treatment for progressive adult acquired flat foot syndrome (fallen arches) because as well as causing stress fractures and Achilles tendonitis, flat feet can also result in shin splints and pain in the knees, shoulders, back and neck. Fallen arches are four times more frequent in women over age 50 than in men the same age. Some researchers believe it has something to do with high heel shoes. But flat feet tend to be more prevalent amongst older adults simply because as we age there is an automatic decrease in the muscles, tendons and ligaments in the foot. Blood supply to the foot is also diminished as arteries narrow resulting in a slow, gradual stretching to the tendons and ligaments eventually causing them to tear. Other contributing factors to flat feet are obesity, diabetes and hypertension. Typically, treatment is a good pair of "orthopedic" shoes or inserts combined with exercise and physical therapy. But severe cases need to be treated surgically. The treatment of choice among surgeons has become the Sinus Tarsi Implant procedure. The Sinus Tarsi Implant is small, soft-threaded titanium device inserted into a small opening in the foot called the sinus tarsi, known as the “eye of the foot.” Once the implant has been carefully placed, the opening is stitched up. Patients usually have a walking cast put on for two weeks and they must walk with a cane. In one month the person can return to normal activities The implant acts like an internal orthotic, restoring the arch by preventing the foot from pronating (rolling-in) and stopping the anklebone (talus) from being displaced. As the tissue grows around the implant, it eventually becomes a permanent support. The pain associated with flat feet usually disappears.

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