Painful flat feet, a disabling condition.
We recently had a visit from 64 year old man, who was complaining of pain affecting the inside of his left ankle. He had noticed that his feet had changed shape and his arches were flattening more recently. There was no history of trauma however he did report that he had always had quite flat feet.
He was a very keen golfer, and was worried that he wouldn’t manage to play golf again.
What causes it?
His painful flat feet was being caused by a condition known as Posterior Tibial Tendon Dysfunction (PTTD). This is a painful condition that causes progressive flattening of the arch of the foot. It occurs when the Tibialis Posterior tendon becomes insufficient and fails to support the arch. As in this case there is often no trauma involved. It is most commonly caused by gradual wear and tear to the tendon. As the arch flattens, there is more stress and strain placed on the tendon and the ligaments in the arch of the foot.
What are the symptoms?
Patients will often complain of pain around the inside of the ankle or in the arch of the foot. They may also have noticed a change to the shape of their foot. They will often comment that walking long distances or coping with uneven ground is difficult and also that they have ‘lost the spring in their step’. In more advanced cases they may also complain of pain at the outside of the ankle due to impingement.
Diagnosis is generally made clinically by the combination of symptoms and physical examination; however sometimes a scan is necessary.
How is it treated?
Treatment depends very much on the patients symptoms, degree of deformity and whether or not there is any arthritis present. In the early stages of the condition, specially designed insoles (orthoses) are very successful. In this case a pair of custom orthoses were designed and manufactured to reduce the stress of the painful tendon, allowing it to heal and become pain free. Once the tendon was asymptomatic a course of strengthening exercises were prescribed to allow the tendon to better cope with the stresses and strains that are placed upon it.
Without treatment this can become a very painful and debilitating condition and in the more advanced cases it may be necessary to either utilise a specialist ankle/foot orthotic called a Richie Brace or to refer for surgery (more about that in a further blog post). As with any condition the longer it is left untreated the harder it is to resolve. I’d like to say a huge thank-you to this patient for allowing me to discuss his case with you and share his photos.
I’ll leave you with his thoughts on the treatment process:
“I have just completed my treatment with Alastair and I am very happy with the outcome. My problem tendon has been made more bearable by the use of orthotics to be worn inside my shoes and designed by Alastair. New shoes have been purchased and all seems well. I can now walk without pain! Will go on the golf course soon and hopefully all will be well. Alastair provided a first class service rounded off by his first class manner.”
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