Fallen Arch / Flat Footed
WHAT IS A FALLEN ARCH? HOW DID THIS HAPPEN? Flat feet can occur during childhood if the arches of the feet don't develop, after an injury, or from the wear and tear of aging. Many people have no substantial symptoms associated with flat feet. But some people with flat feet experience foot pain, particularly in the heel or arch area.
Ongoing pain along the inside of the foot and ankle is when you should schedule a trip to a specialist doctor. That pain could be a symptom of fallen arches — a change in the tendon that normally provides stability for walking and support for the foot's arch.
The earlier this problem, known as posterior tibial tendon dysfunction, is identified, the more likely that noninvasive treatment will help. Untreated, the tendon will continue to degenerate.
The posterior tendon is on the inside of the lower leg starting at a muscle in the calf and attaching to bones on the inside of the foot. Injuries to this tendon are among the most common foot and ankle problems. They may occur over time with wear and tear, with overuse during high-impact sports, or during a fall.
Obesity, diabetes, high blood pressure and steroid injections can increase the risk of tibial tendon dysfunction. Fallen arches are more common in adults over 40, and affect women more often than men.
Test Yourself for Flat Feet
You can easily test yourself to see if you might have fallen arches or flat feet. Follow these three steps:
- Get your feet wet.
- Stand on a flat surface where your footprint will show, such as on a concrete walkway.
- Step away and look at the prints. If you see complete imprints of the bottom of your feet on the surface, then you're likely to have flat feet.
COMMON SYMPTOMS
1. Swelling on the inside of the ankle, 2. Difficulty walking or standing for long periods, 3. Pain that worsens with activity or walking on uneven ground and eventually, 4. Pain on the outside of the ankle - due to the heel bone shifting outward.
When the arch of the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle. Arthritis in the heel can cause this type of pain.
Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These problems make wearing shoes difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes.
Will surgical correction of my flatfoot improve the cosmetic appearance of my foot?
Surgical correction of flatfoot is aimed primarily at reducing pain and restoring function. Although surgery will likely improve the cosmetic appearance and natural arch of the foot.
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Fallen arches testimonial details:
SURGICAL OPTIONS
Surgery may be considered if pain doesn't improve after six months of conservative treatment. Surgical options include replacing the damaged tendon with another tendon from the foot, realigning bones to create a more normal arch, or fusing joints to stabilize the back of the foot.
Medializing Calcaneal Osteotomy
A procedure where the heel bone (calcaneal) is cut and shifted inward or outward. This is used when the heel bone has shifted out from underneath the leg and hind foot alignment is offset. After the procedure, metal screws or a plate are used to hold the heel in place. With this procedure, recovery time is at least 6 weeks of non-weight bearing in a cast or boot. After 6 weeks the patient can start applying pressure as they are able and should be wearing shoes by 8-12 weeks. Full recovery generally takes up to a year or more. Potential complications include the possibility of nerve damage, and painful hardware that may need to be removed once the bone is healed.
Lateral Column Lengthening
In this procedure, the lateral column is lengthened by inserting a bone graft. Specifically, the front of the heel bone is cut and a bone graft wedge is placed in to lengthen it. The graft can come from a cadaver or the patient’s hip bone. This is often done alongside the calcaneal osteotomy. Recovery time generally includes non-weight bearing or limited weight bearing in the heel. A patient should be able to transition into a shoe after 10-16 weeks. Full recovery can take up to 18 months.
Dorsal Opening Wedge Osteotomy
With a dorsal opening wedge osteotomy, a bone wedge is placed in the top portion of the medial cuneiform bone to push it downward. In a similar procedure, called the first tarsal metatarsal fusion, the bone is pushed down and the bones are fused into that position.
Tendon and Ligament Procedures
In these procedures, the posterior tibial tendon often requires removal if it is thickened or torn. The ligaments that support the arch may have been torn in the case of a flat foot. If significant damage has been done these structures may need to be repaired. In the case of a tightened Achilles tendon, there is a stretching procedure which lengthens the muscle fibers of the calf.
FUSION / Double or Triple Arthrodesis
To surgically correct stiff and inflexible flatfoot complications with arthritis, a double or triple arthrodesis may be performed. This is basically a fusion of one or more joints. These types of fusions are generally avoided by surgeons, but in severe cases they are used for treatment as a last resort. They can help improve stability in walking and may reduce pain. Recovery time generally includes 6-8 weeks of no weight bearing, and up to 18 months to fully recover. Complications could include nerve injury, or a non-union (where the joint fails to fuse together properly). Non-unions happen in about 5% of cases and may require additional surgery.
MINIMALLY Invasive Titanium Stent
In this treatment, a small titanium stent is placed in a natural opening between the ankle and the heel bone and helps to realign the foot and can relieve foot pain. Recovery time for this type of treatment is less than traditional surgeries. If you are looking at flat feet surgery as a treatment option, you may want to consider the less invasive stent placement.
TYPICAL COSTS
We are working on some standardized pricing ranges for this procedure. Because of the range of procedures and variation in requirements, we are unable to quote a cost range at this time. Please contact our offices for a diagnosis.
REHABILITATION / RECUPERATION / RECOVERY
Patients may go home the day of surgery or they may require an overnight hospital stay. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. At that point, sutures are removed. A new cast or a removable boot is then placed. It is important that patients do not put any weight on the corrected foot for six to eight weeks following the operation. Patients may begin bearing weight at eight weeks and usually progress to full weight bearing by 10 to 12 weeks. For some patients, weight bearing requires additional time. After 12 weeks, patients commonly can transition to wearing a shoe. Inserts and ankle braces are often used. Physical therapy may be recommended.
Your Doctor, nurse and clinician will help monitor and mange your recovery.
Maintaining a healthy diet is a key step in prevention, with some of the key nutrients including:
Protein: consuming protein will greatly assist your body in healing, delivering the cells it needs for wound care.
Vitamin C: This nutrient is found in a number of fruits and vegetables and helps the body to create a protein that helps to make skin, as well as repair and heal wounds.
Zinc: Found in red meat, shellfish, spinach and nuts and seeds. Zinc helps the body structure the cell membranes that are pivotal in healing wounds.
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The Tayton Institute is a group of medical specialists who have joined together to build a practice focused on surgical excellence.
It is difficult for the premier independent doctors to be recognized these days. Anyone can buy a position in your search results, and much is also true of the many of the ratings sites. Tayton has exceptionally high standards for education, residencies, performance statistics and simply being nice.
We work together to define new technological advances and to pool our resources with the goal of ensuring the best possible outcome for each patient.
Many of our doctors are former athletes and active in a range of sports. We can help you to get back in shape and playing your best.
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What are the safest options for pain relief ?
As podiatrists and foot surgeons, we are committed to helping patients understand the surgery process. The type of anesthesia that we use for extremity foot surgery is very light. Patients are out and not conscious, which is what most people want to know. You are not going to wake up during the procedure.
Anesthetic is very light and very safe. The procedures are always around an hour to two hours max so there’s not as much time under sedation and henceforth, less complications and less difficulties waking up and feeling groggy or hungover.
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Costs, Insurance and Financial Concerns
Our office will work with you on costs. When patients come into the office, insurance coverage is discussed and verified. We check to see where their deductible is, what type of out of pocket expenses are required so you know where you are on that level.
Second of all, we look into the type of facility. For example, we have in-network and out of network facilities. I am an In-Network foot doctor and foot surgeon in Houston provider so they don’t have to worry about my coverage on their insurance.
Our office submits each procedure so you know about coverage.
We use surgical and non-surgical techniques to improve the appearance of our patient’s feet
Our physicians are the top practitioners in cosmetic foot surgery. We can correct deformities, improve comfort and appearance of feet and ankles.
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