Download Flatfeet - Dr. Phillip Forni

Flatfeet
Flatfeet is often the source of many jokes, but for those who suffer the agony flatfeet can
cause, the jokes cease to be funny. The term flatfoot describes the function of the foot,
not just the appearance. Most people with flatfeet have a normal-looking arch while
sitting in a chair. As soon as they stand up and apply weight to the foot the arch quickly
disappears. The term flexible flatfoot more appropriately applies to this condition.
Genetics are the blueprints of your body. Anatomical alignment, flexibility and shape of
the bones in your feet, determined by your parents’ genes, create the differences between
flatfeet, normal feet or high arched feet (cavus feet). Because the flexibility and
anatomical design are different, the severity and the amount of pain will be different for
each patient. Activities like running or jumping cause the body weight to double or triple
at impact to the foot, resulting in problems not seen during normal walking or standing.
Children with flatfeet are very common. Children with symptomatic flatfeet complain of
arch pain, tired achy feet, and the inability to run and keep up with their playmates. Their
shoes appear stretched out of shape due to excessive pressure from the inside of the foot.
As the child ages and grows arthritic changes and adaptations, occur at the joints and
tendons of the foot, leading to a more rigid flatfoot deformity. The pain, due to the
instability of the foot, may be so severe, that they cannot work or function for any period
of time.
Treatment options will very with the severity and the age of the patient. Traditionally
shoe therapy, orthotics, physical therapy, braces, casting and surgery are all viable
options to treat this problem. The doctor may use a variety of x-rays, CT scans and or
MRI to evaluate the foot.
It is essential that the foot is functioning as a stable tripod supporting the ankle and leg
when walking or standing. A triangular relationship exists between the heel bone
(calcaneus) and the ball of the foot from the large toe side of the foot (medial side) to the
small toe side of the foot (lateral side). When the tripod is stable, the ankle and leg can
function in a vertical position, perpendicular to the ground. The podiatrist must evaluate
the relationship between the heel, the ankle, and the front of the foot and reduce each area
of weakness in the tripod. When surgery is required stabilizing each weakness with
restoration of the anatomical alignment and function are the key goals of flatfoot surgery.
In many cases a combination of procedures achieve successful resolution of the problem.
VOCABULARY:
MEDIAL = a reference point for a part of the body closer to the midline or center of the
body.
LATERAL = a reference point for a part of the body farther away from the midline or
center of the body.
EXAMPLE: The large toe (hallux) is medial to the 2nd toe. The 2nd toe is lateral to the
large toe and medial to the 3rd toe.
PRONATION = the weight on the foot shifts to the medial side of the foot, with the arch
flattening, and the heel bone tilting inwards. During pronation the 28bones in the foot
spread apart
SUPINATION = the weight on the foot shifts to the lateral side of the foot, with the arch
increasing and the heel bone tilting outwards.
Her
Phillip L. Forni DPM
PLANTAR FASCIITIS
Definition
The anatomical term for the bottom of your foot is the plantar surface. The top of your
foot is called the dorsal surface. The plantar fascia is a thick, ligament like tissue, which
connects the heel to the ball of the foot. The plantar fascia, is easily felt with your hand,
lies just below the skin surface. The function of the plantar fascia is to stabilize the bony
arch by acting as the third leg of a triangle. Weight applied to the foot, causes the arch to
flatten, or stretch. The plantar fascia functions to resist flattening or stretching of the
arch.
Symptoms
Classic symptoms are acute pain in the heel with your first step out of bed in the morning,
a decrease in pain as you start to walk around, and an increase in pain throughout the day
as activities on your feet continue. If you stop for lunch or dinner, acute pain returns as
soon as you place weight back on your feet again. You will note improvement if you
take NSAIDs and rest. Women wearing heels will have less pain than those barefoot.
Walking on carpeting will be more comfortable than walking on bare floors. Walking in
tennis shoes will be more comfortable than in dress shoes.
Why
Patients, who are overweight, work standing or walking, wears shoes without proper arch
support and have genetic tendencies for foot problems are prime candidates for this
condition. The cause of the pain is usually inflammation to the plantar fascia.
When the plantar fascia becomes overused, overstretched or torn the response is
inflammation of the plantar fascia, termed plantar fasciitis. Small microscopic tears may
be present within the plantar fascia. These small tears act similar to a blister on the
bottom of your foot. Overnight a blister, like the sore plantar fascia, will tighten as the
body attempts repair. The first steps in the morning stretches or re-tears the repairs that
were made overnight. Just like a blister, if you continue to walk on it, the pain subsides
slightly for a short period of time. The pain returns proportional to the amount of activity
on your feet. Chronic plantar fasciitis leads to thickening of the plantar fascia, which is
more difficult for the body to repair.
Treatment aims at reducing pain and discomfort and improving function. Antiinflammatories like NSAIDs, steroids, ice, and rest help to reduce inflammation to the
plantar fascia. The use of taping and a Patients, who are overweight, work standing or
walking, wears shoes without proper arch support and have genetic tendencies for foot
problems are prime candidates for this problem. strappings, orthotics, braces and physical
therapy control and improve function by reducing the amount the arch can flatten or
plantar fascia can stretch. In severe cases, the use of shock wave therapy, Coblation
therapy, and/or surgery may be required.
Phillip L. Forni DPM
INGROWN TOENAILS
Onychocryptosis is the medical term for an ingrown toenail. The normal nail should
resemble a dinner plate lying upside down, when viewing the foot from the end of the
toe. The outer edges of the toenail should be visible when trimming the toenail. Patients
prone to onychocryptosis usually have outer nail borders that are curved, angulated or
curled making it difficult to trim the toenail. Trimming the toenail less than the full
width of the toenail, leaves a small sliver of a toenail behind. This portion of the toenail
is more vulnerable to shoe pressure and eventually punctures through the skin.
Eventually a bacterial infection starts and a true paronychia (infected ingrown toenail)
develops.
Most patients try brutal, do it yourself, bathroom surgery at home before seeing their
podiatrist. A few try for weeks and months, torturing themselves, while barely scratching
the surface of their problem.
Professional care of an ingrown toenail involves resolution of the infection and
prevention of the problem from returning. A local anesthetic given near the base of the
toe puts the entire toe to sleep, eliminating any pain. Once the toe is numb, it is easy to
trim away the offending portion of the toenail eliminating the cause of the pain and the
infection. The remaining section of the nail root, which grew the painful sliver of toenail,
is treated, preventing only that portion of the nail from growing back. In most cases, a
light dressing or a simple Band-Aid is all that is required. The podiatrist may prescribe
antibiotics if deemed necessary. Patients usually can return to their normal activities the
next day.
Phillip L. Forni DPM
ARCH PAIN
The bottom area of your foot is named, the plantar surface, analogous to the palmer
surface of your hand. When pain emanates from this region one must consider all
anatomical structures within this region that can have problems. A few examples would
be:
Skin: warts, inclusion cysts, foreign body reactions, ulcerations, punctures, melanomas
athlete's foot, infections...
Tendons: Tendinitis, laceration, enthesiopathy, nodules...
Fat: Lipoma
Plantar fascia: Rupture, plantar fibromatosis, plantar fasciitis...
Nerves: Neuromas, laceration, entrapment
Blood vessels: Hemangiomas, phlebitis, phlebothrombosis...
Joints: Subluxed, deviated, dislocated, arthritic...
Bone: Fractures, infections, tumors, periostitis, contusions, bone spurs...
These are just a few of the many problems that can be associated with arch pain. Your
professionally trained podiatrist will evaluate your foot and determine the diagnosis and
treatment that is best for you.
Phillip L. Forni DPM