You come home from a day’s work in agony! Your feet ache, your back hurts and you feel fatigued and cranky. You attribute these feelings t...
You come home from a day’s work in agony! Your feet ache, your back hurts and you feel fatigued and cranky. You attribute these feelings to getting older, working too hard or being too stressed out. But you may actually have a foot problem – and if you continue to ignore it, the pain will just get worse till you find you can’t get through your day without severe pain – or you can no longer do the things you love!
The average person spends at least four hours on their feet every day, taking a minimum of 8,000 to 10,000 steps. Your feet have to carry the weight of your body and they typically support a combined force equivalent to several tons every day!
In addition, your feet act as shock absorbers and levers to propel your leg and body forward. They even provide stability, allowing your body to compensate and balance on uneven surfaces.
Pain in the feet is more than just a nuisance – it can cause real disability – and not just in your feet!
Tibialis posterior tendonitis, or acquired flat foot deformity (AFFD) is a condition where the arches of your foot become flattened. And if your feet are not in proper alignment, it can cause pain throughout your body!
This collapsing of the arch of the foot is so progressive in fact, if left untreated you may experience severe disability, chronic pain and arthritis.
What is Acquired Flat Foot Deformity?
Acquired flat foot deformity involves the muscle tibialis posterior. This muscle starts just below the back of the knee and runs along the back of the leg. The tendon of this muscle then passes under the inner aspect of the ankle and attaches at the inside of the arch of the foot.
This muscle helps to maintain the arch of the foot and aids in lifting the heel off the ground with walking. Tibialis posterior tendonitis or acquired flat foot occurs when the tendons become inflamed, stretched or injured.
Acquired flat foot is most often seen in middle aged, slightly overweight people with sedentary lifestyles, but can occur in just about anyone.
The first sign is usually a medial ankle sprain – trauma to the inside of ankle. (Roughly 90% of ankle sprains are lateral, where the ankle is turned out, not in). Sometimes there is a history of minor twisting injuries to the ankle with pain lasting several months, with a noticeable flattening of the foot and shifting of pain to the outer ankle.
Acquired flat foot can also be caused by things such as continuous stretch of the posterior tendon and ligament that supports the arch or excessive stress on the arch from heavy loads for sudden, brief periods of time or moderate repetitive stress over a long period of time. AFFD can also be caused by injury to the area, rheumatoid arthritis, diabetes, obesity and prolonged standing in high heels over a long period of time.
AFFD can cause pain in the inside of the ankle to the arch when the tendon becomes inflamed or partially torn. With a more severe injury to the area, swelling will occur along the inside of the ankle.
Pain is usually worse with walking, especially up and down stairs. Pain can also be felt with attempting to stand on your toes.
Acquired flat foot usually occurs in stages. Stage one presents with pain, swelling and weakness of the tendon. Stage two is when you notice a flattening of the arch, but the foot still remains flexible. And in the last stage, the arch becomes flattened and rigid.
Acquired flat foot can cause a consistent ache in your feet, especially after a long day standing. But that’s not all! AFFD can cause all-over fatigue!
ADDF causes problems with your body’s alignment – and when alignment is thrown off your body cannot work as efficiently as it should. Acquired flat foot can cause fatigue, not only in your feet, but your entire body! Abnormal body alignment causes your body to have to work harder at normal activities. When your body works harder, it must increase oxygen consumption. In order to increase the amount of oxygen, your circulation speeds up – this can cause an increase in your heart rate and blood pressure, much like aerobic activities such as running.
Flat feet can also cause debilitating back pain! The flattening of the arches causes your lower leg to rotate inward. This in turn causes your pelvis to tilt forward increasing the curvature of your back (think of a heavily-pregnant woman’s stance). This exaggerated arching causes the muscles in your back to stiffen and tighten producing back pain! And this pain is not limited to your back – you can experience pain in the hips and knees as well!
So Now What?
So you think your arches are falling – take this simple test –
Wet your feet and stand on a dry, flat surface. Do you see an almost complete footprint or is there an indentation?
A normal footprint has a wide band connecting the balls of your feet to your heel with an indentation (or no wet mark) in the arch area. A flat footprint has no indentation.
You should consult with your physician if your feet tire easily and become painful in the heel or arch area with prolonged standing or if you have difficulty moving your heel or standing on your toes.
Treatments vary depending on the severity. Conservative treatment consists of nonsteroidal anti-inflammatory medications, ice and physical therapy. Sometimes supportive taping, bracing or orthotics such as custom-made arch supports, are utilized.
Severe cases of acquired flat foot may require casting of the leg and foot. But when no relief is found from these measures, surgery may be necessary to repair the torn tendon and restore normal functioning.
Surgical techniques can also vary with the severity. The least invasive procedure is the use of screws in the joint, but tendon lengthening, tendon transfers and repositioning of the bones are also used. The most invasive, most permanent procedure requires fusion, which locks the joints of the foot.
Recuperation can be lengthy, with two to eight weeks in a foot cast followed by physical therapy to restore flexibility, strength and functioning.
But there are things you can do! The first line of defense is prevention! If you are overweight, try to lose a few pounds to decrease the stressors on your foot. A regular exercise routine can also help. Exercise strengthens the area and keeps it mobile.
Adding a regular stretching routine, especially of the Achilles tendon (the thick, cord-like tendon just above your heel) may help. A shortened Achilles tendon, often seen in women who wear heels most of the time, can cause extra stress on the arch. But care must be taken to avoid overstretching as this may cause a laxity in the tendon, thus resulting in less support for the arch.
Massage may also help. Massage can reduce swelling and tight muscles. It can help maintain range of motion by reducing restrictions of the fascia – the fibrous membrane that covers, supports and separates muscles – and reducing adhesions – fibrous bands holding parts together normally separated, commonly seen with injuries.
So when you have pain in your feet, don’t dismiss it! Ignoring the signs may cause more problems in the long run. Taking care of your feet just may make that chronic back pain, those aching arches and that chronic fatigue a distant memory!
