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Pain In The Arch Of The Foot Treatment

Overview
Most flat feet are not painful, particularly those flat feet seen in children. In the adult acquired flatfoot, pain occurs because soft tissues (tendons and ligaments) have been torn. The deformity progresses or worsens because once the vital ligaments and posterior tibial tendon are lost, nothing can take their place to hold up the arch of the foot. The painful, progressive adult acquired flatfoot affects women four times as frequently as men. It occurs in middle to older age people with a mean age of 60 years. Most people who develop the condition already have flat feet. A change occurs in one foot where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Why this event occurs in some people (female more than male) and only in one foot remains poorly understood. Contributing factors increasing the risk of adult acquired flatfoot are diabetes, hypertension, and obesity.


Causes
There are a number of other medical conditions that can cause foot arch pain such as diabetes, arthritis and obesity. These can affect the position and strength of the bones, muscles, ligaments and tendons, leading to bottom of foot pain. It sounds simple but footwear plays an important role in how our feet feel. Foot arch pain is commonly caused by ill-fitting shoes, especially ones with little arch support or that are too tight. Footwear is particularly important if you are going to be spending long periods on your feet or for sporting activities such as running. Shoes should be supportive, comfortable, cushioned, provide the appropriate level of arch support and be the correct width.


Symptoms
Arch pain symptoms could include any of the following, a dull, constant ache if the ligaments have been stretched, swelling or tenderness in the foot, redness or bruising in the event of a more serious injury, difficulty putting weight on the foot, sharp pain when the foot is turned or manipulated, tenderness when pressure is applied. Because the arch of the foot is such a complex structure, arch pain could be an indicator of several different types of injuries. Chronic illnesses such as arthritis could also cause arch pain, and depending on the cause or source of your pain, you may experience discomfort in a variety of different areas. Ask a doctor if you believe you may have injured your foot arch.


Diagnosis
A patient is asked to step with full body weight on the symptomatic foot, keeping the unaffected foot off the ground. The patient is then instructed to “raise up on the tip toes” of the affected foot. If the posterior tibial tendon has been attenuated or ruptured, the patient will be unable to lift the heel off the floor and rise onto the toes. In less severe cases, the patient will be able to rise on the toes, but the heel will not be noted to invert as it normally does when we rise onto the toes. X-rays can be helpful but are not diagnostic of the adult acquired flatfoot. Both feet, the symptomatic and asymptomatic - will demonstrate a flatfoot deformity on x-ray. Careful observation may show a greater severity of deformity on the affected side.


Non Surgical Treatment
In mild cases of flatfoot the first line of treatment is often custom orthotics. In patients with a flexible deformity, supporting the arch with a custom arch support will take the strain off the joints and muscles, bringing the heel into a corrected position. Wider shoe gear may be prescribed to accommodate foot pain and motion and stretching exercises to decrease stiffness and stress on the foot. In cases of severe collapse, especially if the patient is not a good surgical candidate or has a mild tear, a brace may be made to accommodate the foot and ankle, thus supporting the arch and ankle.


Surgical Treatment
If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.


Prevention
Maintain a healthy weight, Use insoles to support your arches, Limit how often you wear high heels, Use proper shoes, especially when exercising to evenly distribute weight through your foot.

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