Texas Foot Doctor's Blog
Posts for: October, 2014
Tarsal Coalitions Are a Cause of FlatFeet!
What is a Tarsal Coalition?
A tarsal coalition is an abnormal connection that develops between two bones in the back of your foot (the tarsal bones). The tarsal bones are the talus, calcaneus, navicular, cuneiforms and the cuboid.
These bones work together to provide the motion necessary for normal foot function.
This abnormal connection—which can be composed of bone, cartilage, or fibrous tissue—may lead to limited or a complete lack of motion and pain in one or both feet. Pain may occur at the affected joint or at surrounding joints as well.
What Causes a Tarsal Coalition?
Tarsal coalition is a condition most often caused by a hereditary defect that occurs during fetal development and results in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or previous trauma or injury in the area.
A tarsal coalition is difficult to identify until a child’s bones begin to mature. Diagnosis includes obtaining information about the duration and development of the symptoms as well as a thorough examination of the foot and ankle. The findings of the exam will differ according to the severity and location of the coalition.
I addition to examining the foot, the surgeon will order x-rays. Additional advanced imaging—such as CT or MRI scan—may also be needed to evaluate the coalition.
What Is Posterior Tibial Tendon Dysfunction (PTTD) and What Causes It?
Posterior Tibial Tendon Dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon’s ability to perform that job is impaired, often resulting in a flattening of the foot (or collapse of the arch). Overuse of the posterior tibial tendon is frequently the cause of PTTD. The symptoms usually occur after activities involving the tendon, such as running, walking, hiking, or climbing the stairs.
The posterior tibial tendon starts as a muscle in the calf and becomes a fibrous cord that stretches down behind the inside of the ankle, and attaches to bones in the middle of the foot near the arch. This tendon helps hold the arch up and provides support when stepping off on your toes when walking. If it becomes inflamed, over-stretched or torn, it can cause pain from the inner ankle. Some patients also exhibit pain in the arch area where that tendon attaches. Over time, it can lead to losses in the inner arch on the bottom of your foot and result in adult-acquired flatfoot.
PTTD is often called adult-acquired flatfoot because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse—especially if it isn’t treated early.
What are some Signs and Symptoms of PTTD?
• Gradually developing pain on the outer side of the ankle or foot.
• Loss of the arch and the development of a flatfoot.
• Pain and swelling on the inside of the ankle.
• Tenderness over the midfoot, especially when under stress during activity.
• Weakness and an inability to stand on the toes.
Signs and symptoms of posterior tibial tendon dysfunction change as the condition progresses.
Early signs are pain on the inside of the foot and ankle (along the course of the tendon). There may be pain, swelling, redness and warmth along the same area. A flattening if the arch may also even be seen in the early stages.
As the condition progresses, the arch begins to flatten more. There may still be pain on the inside of the foot and ankle. At this point, the foot and toes begin to turn outward and the ankle turns inward.
As PTTD becomes more advanced, the arch flattens even more and pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
People who are diabetic, overweight, or hypertensive are particularly at risk. X-rays, ultrasound, or MRI may be used to diagnose this condition.
Left untreated, posterior tibial tendon dysfunction may lead to flatfoot and arthritis in the hindfoot. Pain can increase and spread to the outer side of the ankle.
How is PTTD treated?
Because of the progressive nature of PTTD, it’s best to see your foot and ankle surgeon as soon as possible. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.
Left untreated, posterior tibial tendon dysfunction may lead to an extremely flatfoot and arthritis in the foot and ankle. Pain can increase and spread to the outer side of the ankle. Pain from this condition may increase limitations on walking, running, or other activities.
Treatment for PTTD
• Immobilization: Sometimes a short-leg cast or walking boot is worn to immobilize the foot and ankle to allow the tendon to heal. Some patients may even need to avoid all weight-bearing for a short period of time.
• Weight Loss: This can be an important factor in decreasing painful symptoms of PTTD.
• Orthotic Devices: To provide proper support, your foot and ankle surgeon may recommend an ankle brace or Custom Made Orthotics.
• Physical Therapy: Stretching exercises, icing, formal Physical Therapy by a Physical Therapist, supportive taping and bracing may be necessary as well. Ultrasound is a common modality used to help rehabilitate the posterior tibial tendon.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help reduce pain and inflammation. NOTE: Please consult your physician before taking any medications.
Shoe Modifications: The foot and ankle surgeon will advise you on footwear changes to make with your shoes and may provide special inserts designed to improve arch support.
What is breast cancer?
Flatfoot in children is referred to as “Pediatric Flatfoot.” There are several types of flatfoot, but they all look very similar and they all have a common denominator—collapse of the arch.
Some signs and symptoms of Pediatric Flatfoot:
· Pain, tenderness, or cramping in the foot, leg, or knee
· Generalized leg and foot fatigue
· Muscle cramps in the foot and calf
· Outward tilting of the heel
· Awkwardness or changes in walking (gait)
· Difficulty with fitting in shoes or abnormal shoe wear
· Reduced energy when participating in physical activities
· Voluntary withdrawal from sports/athletics/physical activities
Types of Pediatric Flatfoot
1. Symptomatic versus Asymptomatic
Symptomatic simply means “with symptoms” or pain and asymptomatic means “without symptoms” or without pain. Both types are typically treated conservatively with Custom Orthotics, at least initially. Orthotics help hold the foot in an optimal position to help prevent the progression of the deformity. If a patient is still having pain while wearing Orthotics, surgical correction may be necessary.
2. Flexible versus Rigid
A flexible flatfoot is one that has a normal appearing arch when non-weight bearing, but once the patient stands, the arch collapses. A rigid flatfoot has a stiff, flattened arch when both weight bearing and non-weight bearing. Flexible and Rigid Flatfeet may be either symptomatic or asymptomatic. Rigid Flatfeet typically are caused by an underlying condition (i.e. Tarsal Coalition) and may require special consideration.
3. There are other types of Pediatric Flatfoot, such as those caused by injury or disease.
How is Pediatric Flatfoot Diagnosed?
In diagnosing flatfoot, the foot and ankle surgeon examines the foot and observes how it looks when the child sits and stands. The surgeon also observes how the child walks and evaluates the range of motion of the foot. X-rays are often taken to determine the severity of the deformity. Sometimes an MRI or CT scan and blood work may be ordered.
Treatment for Pediatric Flatfeet
Depending on the type of Flatfoot, treatment may be either non-surgical or surgical.
Some Examples of Non-Surgical Treatment
· Activity Modifications: The patient may need to temporarily stop painful activities.
· Orthotic Devices: Patients with painless flatfeet are typically placed in a Custom Orthotic device and the condition will be observed and re-evaluated by the foot and ankle surgeon.
· Physical Therapy: Stretching exercises, icing, formal Physical Therapy by a Physical Therapist, supportive taping and bracing may be necessary as well.
· Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to help reduce pain and inflammation. NOTE: Please consult your physician before taking any medications.
· Shoe Modifications: The foot and ankle surgeon will advise you on footwear characteristics that are important for the child with a flatfoot condition.
In some cases, surgery is necessary to relieve the symptoms and improve foot function. Foot and ankle surgeons provide a variety of techniques to treat the different types of pediatric flatfoot. The surgical procedure or combination of procedures selected for your child will depend on his or her particular type of Flatfoot.
Flat feet are a common condition of the foot structure in both children and adults. In infants and toddlers, prior to walking, the longitudinal arch is not developed and the appearance of “flat feet” is normal. Most feet are flexible and an arch appears when children begin walking. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.
Flat feet are generally associated with pronation, a leaning inward of the foot and ankle bones toward the center (midline) of the body. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape). Flatfoot may occur on both feet or just one foot.
Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.