Niesha Bleichner

Foot Difficulties Explained

Workout Routines For Bursitis Of The Foot

Overview

Bursitis (ber-SEYE-tis) is swelling and pain of a bursa. A bursa is a fluid-filled sac that acts as a cushion or shock absorber between a tendon and a bone. A tendon is a cord of tough tissue that connects muscles to bones. Normally a bursa has a small amount of fluid in it. When injured, the bursa becomes inflamed (red and sore) and may fill with too much fluid. Achilles (ah-KIL-eez) tendon bursitis is a type of ankle bursitis when the bursa between the Achilles tendon and the heel becomes inflamed. You may have Achilles bursitis and tendonitis (inflamed tendon) at the same time.

Causes

A bursa is a fluid-filled sac that acts as a cushion and a lubricant between tendons and muscles sliding over bone. There are bursas around most large joints in the body, including the ankle. The retrocalcaneal bursa is located in the back of the ankle by the heel, where the large Achilles tendon connects the calf muscles to the heel bone (calcaneus). Repetitive or over use of the ankle, for instance by doing excessive walking, running or jumping, can cause this bursa to become irritated and inflamed. This condition is commonly associated with Achilles tendonitis. Sometimes retrocalcaneal bursitis may be mistaken for achilles tendonitis. Those at risk for this condition include people just starting aggressive exercise regimens or having some other sudden increase in activity without proper conditioning.

Symptoms

Patients with this condition typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone. Pain is typically experienced during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes). Often pain may be worse with rest after these activities (especially that night or the following morning). The pain associated with this condition may 'warm up' with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.

Diagnosis

Magnetic resonance imaging (MRI) may demonstrate bursal inflammation, but this modality probably does not offer much more information than that found by careful physical examination. Theoretically, MRI could help the physician to determine whether the inflammation is within the subcutaneous bursa, the subtendinous bursa, or even within the tendon itself, however, such testing is generally not necessary. Ultrasonography may be a potentially useful tool for diagnosing pathologies of the Achilles tendon.

Non Surgical Treatment

Treatment is primarily comprised of relief from the painful activity (running). It is important that shoes do not pinch the heel. If satisfactory progress is not made during the rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or injection of corticosteroid in the bursa. Injections should be performed under ultrasound guidance to ensure optimal effect and reduce the risk of injecting into the Achilles itself. If progress is not made neither through rehabilitation nor medicinal treatment, surgical treatment can be attempted.

Surgical Treatment

Surgery is rarely need to treat most of these conditions. A patient with a soft tissue rheumatic syndrome may need surgery, however, if problems persist and other treatment methods do not help symptoms.

Prevention

Continue to wear your orthotics for work and exercise to provide stability and restore foot function. Select suitable shoes for work and physical activity that provide stability for the heel. Regular stretching of the calf muscle can prevent heel bursitis. Do not suddenly increase activity amount without appropriate conditioning.

New Hammer Toe Surgery

Hammer ToeOverview

When a person has hammertoe, the end of their toe bends downward and the middle joint curls up. Eventually, the toe gets stuck in a stiff, claw-like position. When the inside of your shoe rubs against a hammer toe, corns, blisters or calluses may form on top of the toe or on the bottom of your foot. This can make walking painful. You may also have pain in the joint where your big toe joins your foot. Hammer toe usually affects a person?s second toe (the toe next to the big toe), but it can affect other toes too.

Causes

Flat feet can result in hammertoes, this is due to poor mechanics off the foot. High arched feet can also result in buckling toes. A major cause is in hereditary, all the toe conditions mentioned could be acquired due in hereditary factors. Bunions are a major cause of hammertoes. Claw toes are usually the result of a shoe that is too short. For many people, the second toe is actually longer than the great toe, and if shoes are sized to fit the great toe, the second (and maybe even the third toe) will have to bend to fit into the shoe. Shoes that are pointed make matters even worse. Combine pointed shoes with high heels, the foot is under similar pressure as if it was constantly being pushed downhill into a wall. Rheumatoid arthritis can also lead to bunions, which in turn can lead to hammer toes.

HammertoeSymptoms

Symptoms may include pain in the affected toe or toes when you wear shoes, making it hard or painful to walk. A corn or callus on the top of the joint caused by rubbing against the shoe. Swelling and redness of the skin over the joint. Trouble finding comfortable shoes.

Diagnosis

Some questions your doctor may ask of you include, when did you first begin having foot problems? How much pain are your feet or toes causing you? Where is the pain located? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? What kind of shoes do you normally wear? Your doctor can diagnose hammertoe or mallet toe by examining your foot. Your doctor may also order X-rays to further evaluate the bones and joints of your feet and toes.

Non Surgical Treatment

Non-surgical methods for hammer toes (claw toes) are aimed at decreasing symptoms (i.e., pain and/or calluses) and/or limiting the progression into a larger problem. Simple treatments patients can do are wear supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify activities. Spot stretch shoes. Periodic callus care.

Surgical Treatment

Surgery is the approach that is often necessary to correct hammertoe that fails to respond to nonsurgical management. Surgery is appropriate when the muscles and tendons involved in a hammertoe problem have become so tight that the joints are rigid, misaligned and unmovable. There are a number of surgical techniques for dealing with the complex range of joint, bone, muscle, tendon and ligament abnormalities that define each hammertoe's make-up. To correct a hammertoe deformity, the surgeon's goal is to restore the normal alignment of the toe joint, relieving the pressure that led to the hammertoe's development (this should also relieve the pain, as well). To do this, he or she may remove part of the boney structure that creates a prominence at the top of the joint. Tighten or loosen the muscles, tendons and ligaments around the toe joints. Realign the toe bones by cutting one or more and shifting their position, realigning muscles, tendons and ligaments accordingly. Use screws, wires or Hammer toe plates to hold the joint surfaces together until they heal. Reconstruct a badly damaged joint or replace it with an artificial implant.
Remove all ads

What Causes Overpronation

Overview

To understand "overpronation" it's important to first understand pronation. Pronation is a normal function of the foot. It is the inward motion of the ankle bone and outward motion of the rest of the foot bones, which occurs naturally when the foot hits the ground and weight is applied. Pronation is a good thing; it cushions the foot and the entire body during the walking cycle. It keeps the foot and ankles protected from hard impact and an uneven ground surface. Overpronation occurs when too much pronation is present. In other words, overpronation occurs when the inward motion of the ankle bone is excessive and goes past the healthy point necessary for its intended functions. This excessive motion is caused by a misalignment between the ankle bone and the hindfoot bones. It creates an imbalance of forces and weight distribution in the foot that propagates throughout the entire body. Over time, this functional imbalance causes repetitive damage to joints, ligaments and bone structures. Left untreated, overpronation can lead to foot ailments such as bunions, heel pain (plantar faciitis), hammertoes, etc. Furthermore, the excessive motion in the foot can travel up the body and cause knee, hip and lower back pain.Pronation

Causes

Flat feet don't automatically mean you have a problem. The problem can be divided into a flexible flat foot or rigid flat foot. The rigid flat foot is one that does not change shape when the foot becomes weight bearing. i.e. it does not go through the excessive motion of pronation. Generally speaking this foot does not provide too many problems. The flexible flat foot is the type that when it becomes weight bearing the foot and ankle tends to roll in (pronates) too far. This type of person will often say I have great arches but when I stand up much of this arch disappears as the foot excessively pronates When the foot is excessively pronating and causing problems like sore ankles, feet or knees when standing or exercising then arch support is extremely important to restore the foot structure.

Symptoms

Overpronation can be a contributing factor in other lower extremity disorders, such as foot pain, plantar fasciitis, ankle injuries, medial tibial stress syndrome (shin splints), periostitis, stress fractures and myofascial trigger points. Overpronation increases the degree of internal tibial rotation, thereby contributing to various knee disorders such as meniscal injury or ligament sprains. The effects of the postural deviation are exaggerated in athletes due to the increase in foot strikes while running and the greater impact load experienced. When running, three to four times the body weight is experienced with each foot strike.2 If overpronation exists, the shock force is not adequately absorbed by the foot and is transmitted further up the kinetic chain.

Diagnosis

People who overpronate have flat feet or collapsed arches. You can tell whether you overpronate by wetting your feet and standing on a dry, flat surface. If your footprint looks complete, you probably overpronate. Another way to determine whether you have this condition is to simply look at your feet when you stand. If there is no arch on the innermost part of your sole, and it touches the floor, you likely overpronate. The only way to truly know for sure, however, is to be properly diagnosed by a foot and ankle specialist.Over-Pronation

Non Surgical Treatment

Over-Pronation can be treated conservatively (non-surgical treatments) with over-the-counter orthotics. These orthotics should be designed with appropriate arch support and medial rearfoot posting to prevent the over-pronation. Footwear should also be examined to ensure there is a proper fit. Footwear with a firm heel counter is often recommended for extra support and stability. Improperly fitting footwear can lead to additional foot problems.

Surgical Treatment

The MBA implant is small titanium device that is inserted surgically into a small opening between the bones in the hind-mid foot: the talus (ankle bone) and the calcaneus (heel bone). The implant was developed to help restore the arch by acting as a mechanical block that prevents the foot from rolling-in (pronation). In the medical literature, the success rate for relief of pain is about 65-70%. Unfortunately, about 40% of people require surgical removal of the implant due to pain.
Remove all ads

Treating Calcaneal Apophysitis

Overview

Sever?s disease, also known as calcaneal apophysitis or Osgood-Schlatter syndrome of the foot. This traction apophysitis is secondary to repetitive microtraumata or overuse of the heel in young athletes. The calcaneus is situated at the most plantar posterior aspect of the foot. The Achilles tendon inserts to the lower, posterior and slightly medial aspect of the calcaneus. The plantar fascia originates from the medial tubercle on the plantar aspect of the calcaneus. Proximal to the epiphysis is the apophysis, where the Achilles tendon actually inserts. The calcaneal growth plate and apophysis are situated in an area subject to high stress from the plantar and Achilles tendon.

Causes

Having flatfeet or very pronated feet can make one prone to Sever's disease. But also patient?s that have a very high arch foot structure tend to have a very high shock and high impact heel strike. This also puts extra stress on the heel and apophysis.

Symptoms

Typically, the sports injury occurs where the achilles tendon attaches to the bone. The epiphyseal growth plate is located at the end of a developing bone where cartilage turns into bone cells. As the growth center expands and unites, this area may become inflamed, causing severe pain when both sides of the heel are compressed. There is typically no swelling and no warmth, so it?s not always an easy condition to spot. The child usually has trouble walking, stiffness upon waking, and pain with activity that subsides during periods of rest.

Diagnosis

To diagnose the cause of the child?s heel pain and rule out other more serious conditions, the foot and ankle surgeon obtains a thorough medical history and asks questions about recent activities. The surgeon will also examine the child?s foot and leg. X-rays are often used to evaluate the condition. Other advanced imaging studies and laboratory tests may also be ordered.

Non Surgical Treatment

Management by a health professional of Sever's disease is often wise. There are a few very rare problems that may be causing the pain, so a correct diagnosis is extremely important. Advice should be given on all of what is mentioned above, appropriate activity levels, the use of ice, always wearing shoes, heel raises and stretching, follow this advice. As a pronated foot is common in children with this problem, a discussion regarding the use of foot orthotics long term may be important. Strapping or tape is sometimes used during activity to limit the ankle joint range of motion. If the symptoms are bad enough and not responding to these measures, medication to help with anti-inflammatory may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal. After the calcaneal apophysitis resolves, prevention with the use of stretching, good supportive shock absorbing shoe and heel raises are important to prevent it happening again.

Recovery

If the child has a pronated foot, a flat or high arch, or another condition that increases the risk of Sever's disease, the doctor might recommend special shoe inserts, called orthotic devices, such as heel pads that cushion the heel as it strikes the ground, heel lifts that reduce strain on the Achilles tendon by raising the heel, arch supports that hold the heel in an ideal position, If a child is overweight or obese, the doctor will probably also recommend weight loss to decrease pressure on the heel. The risk of recurrence goes away on its own when foot growth is complete and the growth plate has fused to the rest of the heel bone, usually around age 15.
Remove all ads

Achilles Tendon Rupture Pain After Surgery

Overview
Achilles Tendon Achilles tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). The tendon can rupture completely or just partially. If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that usually affects your ability to walk properly. Surgery is often the best treatment option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.

Causes
The tendon usually ruptures without any warning. It is most common in men between the ages of 40-50, who play sports intermittently, such as badminton and squash. There was probably some degeneration in the tendon before the rupture which may or may not have been causing symptoms.

Symptoms
Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.

Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone. Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.

Non Surgical Treatment
Non-operative treatment consists of placing the foot in a downward position [equinus] and providing relative immobilization of the foot in this position until the Achilles has healed. This typically involves some type of stable bracing or relative immobilization for 6 weeks, often with limited or no weight bearing. The patient can then be transitioned to a boot with a heel lift and then gradually increase their activity level within the boot. It is very important that the status of the Achilles is monitored throughout non-operative treatment. This can be done by examination or via ultrasound. If there is evidence of gapping or non-healing, surgery may need to be considered. Formal protocols have been developed to help optimize non-operative treatments and excellent results have been reported with these protocols. The focus of these treatments is to ensure that the Achilles rupture is in continuity and is healing in a satisfactory manner. The primary advantage of non-operative treatment is that without an incision in this area, there are no problems with wound healing or infection. Wound infection following Achilles tendon surgery can be a devastating complication and therefore, for many patients, non-operative treatment should be contemplated. The main disadvantage of non-operative treatment is that the recovery is probably slower. On average, the main checkpoints of recovery occur 3-4 weeks quicker with operative treatment than with non-operative treatment. In addition, the re-rupture rate appears to be higher with some non-operative treatments. Re-rupture typically occurs 8-18 months after the original injury. Achilles Tendinitis

Surgical Treatment
Surgery could allow for a quicker healing time. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the tissue, the repair may be reinforced with other tendons. As with any surgery, the main complication is the risk for infection, however, this risk is reduced by using smaller incisions.

Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.

Leg Length Discrepancy Shoe Lift

Overview

Large leg length inequalities can be treated by staged lengthenings or by simultaneous ipsilateral femoral and tibial lengthenings. Additionally, lengthenings can be combined with appropriately timed epiphysiodesis in an effort to produce leg length equality. Staged lengthenings are often used for congenital deficiencies such as fibular hemimelia, in which 15 cm or more may be needed to produce leg length equality. We typically plan for the final lengthening to be completed by age 13 or 14 years, and allow at least 3 years between lengthenings. Lengthening of both the tibia and femur simultaneously requires aggressive therapy and treatment of soft tissue contractures. Curran et al[57] reported the need for surgical release of soft tissue contractures in 3 of 8 patients treated with simultaneous ipsilateral femoral and tibial lengthenings. Lengthening over an IM nail can be done in an effort to decrease the amount of time the fixator needs to be worn and to prevent angular malalignment. This technique requires that the patient be skeletally mature and it carries a higher risk of osteomyelitis (up to 15%). Additionally, if premature consolidation occurs, a repeat corticotomy is more difficult.Leg Length Discrepancy

Causes

Some causes of leg length discrepancy (other than anatomical). Dysfunction of the hip joint itself leading to compensatory alterations by the joint and muscles that impact on the joint. Muscle mass itself, i.e., the vastus lateralis muscle, pushes the iliotibial band laterally, causing femoral compensations to maintain a line of progression during the gait cycle. This is often misdiagnosed as I-T band syndrome and subsequently treated incorrectly. The internal rotators of the lower limb are being chronically short or in a state of contracture. According to Cunningham's Manual of Practical Anatomy these are muscles whose insertion is lateral to the long axis of the femur. The external rotators of the hip joint are evidenced in the hip rotation test. The iliosacral joint displays joint fixations on the superior or inferior transverse, or the sagittal axes. This may result from many causes including joint, muscle, osseous or compensatory considerations. Short hamstring muscles, i.e., the long head of the biceps femoris muscle. In the closed kinetic chain an inability of the fibula to drop inferior will result in sacrotuberous ligament loading failure. The sacroiliac joint dysfunctions along its right or left oblique axis. Failure or incorrect loading of the Back Force Transmission System (the longitudinal-muscle-tendon-fascia sling and the oblique dorsal muscle-fascia-tendon sling). See the proceedings of the first and second Interdisciplinary World Congress on Low Back Pain. Sacral dysfunction (nutation or counternutation) on the respiratory axis. When we consider the above mentioned, and other causes, it should be obvious that unless we look at all of the causes of leg length discrepancy/asymmetry then we will most assuredly reach a diagnosis based on historical dogma or ritual rather than applying the rules of current differential diagnosis.

Symptoms

Patients with significant lower limb length discrepancies may walk with a limp, have the appearance of a curved spine (non-structural scoliosis), and experience back pain or fatigue. In addition, clothes may not fit right.

Diagnosis

Infants, children or adolescents suspected of having a limb-length condition should receive an evaluation at the first sign of difficulty in using their arms or legs. In many cases, signs are subtle and only noticeable in certain situations, such as when buying clothing or playing sports. Proper initial assessments by qualified pediatric orthopedic providers can reduce the likelihood of long-term complications and increase the likelihood that less invasive management will be effective. In most cases, very mild limb length discrepancies require no formal treatment at all.

Non Surgical Treatment

Treatments for limb-length discrepancies and differences vary, depending on the cause and severity of the condition. At Gillette, our orthopedic surgeons are experts in typical and atypical growth and development. Our expertise lets us plan treatments that offer a lifetime of benefits. Treatments might include monitoring growth and development, providing noninvasive treatments or therapy, and providing a combination of orthopedic surgical procedures. To date, alternative treatments (such as chiropractic care or physical therapy) have not measurably altered the progression of or improved limb-length conditions. However, children often have physical or occupational therapy to address related conditions, such as muscle weakness or inflexibility, or to speed recovery following a surgical procedure. In cases where surgical treatment isn?t necessary, our orthopedists may monitor patients and plan noninvasive treatments, such as, occupational therapy, orthoses (braces) and shoe inserts, physical therapy, prostheses (artificial limbs).

Leg Length Discrepancy

Surgical Treatment

In growing children, legs can be made equal or nearly equal in length with a relatively simple surgical procedure. This procedure slows down the growth of the longer leg at one or two growth sites. Your physician can tell you how much equalization can be gained by this procedure. The procedure is performed under X-ray control through very small incisions in the knee area. This procedure will not cause an immediate correction in length. Instead, the limb length discrepancy will gradually decrease as the opposite extremity continues to grow and "catch up." Timing of the procedure is critical. The goal is to reach equal leg length by the time growth normally ends. This is usually in the mid-to-late teenage years. Disadvantages of this option include the possibility of slight over-correction or under-correction of the limb length discrepancy. In addition, the patient's adult height will be less than if the shorter leg had been lengthened. Correction of significant limb length discrepancy by this method may make a patient's body look slightly disproportionate because of the shorter leg. In some cases the longer leg can be shortened, but a major shortening may weaken the muscles of the leg. In the thighbone (femur), a maximum of 3 inches can be shortened. In the shinbone, a maximum of 2 inches can be shortened.
Remove all ads

Acquired Flat Foot Tibialis Posterior Tenosynovitis

Overview
Often considered solely a product of genetics, flatfoot rarely carries with it the stigma of presenting over time. The truth, however, is that flatfoot does not discriminate on the basis of age and can become an issue in the form of adult-acquired flatfoot. Like its congenital cousin, adult-acquired flatfoot deformity is one that, in causing structural damage to the foot (and particularly to the posterior tibial tendon), creates an imbalance that may result in any number of symptoms, including inflammation, pain, stiffness, limited mobility, and even arthritis. Acquired Flat Foot

Causes
The cause of posterior tibial tendon insufficiency is not completely understood. The condition commonly does not start from one acute trauma but is a process of gradual degeneration of the soft tissues supporting the medial (inner) side of the foot. It is most often associated with a foot that started out somewhat flat or pronated (rolled inward). This type of foot places more stress on the medial soft tissue structures, which include the posterior tibial tendon and ligaments on the inner side of the foot. Children nearly fully grown can end up with flat feet, the majority of which are no problem. However, if the deformity is severe enough it can cause significant functional limitations at that age and later on if soft tissue failure occurs. Also, young adults with normally aligned feet can acutely injure their posterior tibial tendon from a trauma and not develop deformity. The degenerative condition in patients beyond their twenties is different from the acute injuries in young patients or adolescent deformities, where progression of deformity is likely to occur.

Symptoms
Not everyone with adult flatfoot has problems with pain. Those who do usually experience it around the ankle or in the heel. The pain is usually worse with activity, like walking or standing for extended periods. Sometimes, if the condition develops from arthritis in the foot, bony spurs along the top and side of the foot develop and make wearing shoes more painful. Diabetic patients need to watch for swelling or large lumps in the feet, as they may not notice any pain. They are also at higher risk for developing significant deformities from their flatfoot.

Diagnosis
Perform a structural assessment of the foot and ankle. Check the ankle for alignment and position. When it comes to patients with severe PTTD, the deltoid has failed, causing an instability of the ankle and possible valgus of the ankle. This is a rare and difficult problem to address. However, if one misses it, it can lead to dire consequences and potential surgical failure. Check the heel alignment and position of the heel both loaded and during varus/valgus stress. Compare range of motion of the heel to the normal contralateral limb. Check alignment of the midtarsal joint for collapse and lateral deviation. Noting the level of lateral deviation in comparison to the contralateral limb is critical for surgical planning. Check midfoot alignment of the naviculocuneiform joints and metatarsocuneiform joints both for sag and hypermobility.

Non surgical Treatment
Conservative treatment is indicated for nearly all patients initially before surgical management is considered. The key factors in determining appropriate treatment are whether acute inflammation and whether the foot deformity is flexible or fixed. However, the ultimate treatment is often determined by the patients, most of whom are women aged 40 or older. Compliance can be a problem, especially in stages I and II. It helps to emphasise to the patients that tibialis posterior dysfunction is a progressive and chronic condition and that several fittings and a trial of several different orthoses or treatments are often needed before a tolerable treatment is found. Acquired Flat Foot

Surgical Treatment
Flatfoot reconstruction (osteotomy). This is often recommended for flexible flatfoot condition. Flatfoot reconstruction involves cutting and shifting the heel bone into a more neutral position, transferring the tendon used to flex the lesser toes (all but the big toe) to strengthen the posterior tibial tendon, and lengthening the calf muscle. Fusion (also known as triple arthrodesis). Fusion involves fusing, or making stiff, three joints in the back of the foot the subtalar, talonavicular, and calcaneocuboid joints, to realign the foot and give it a more natural shape. Pins or screws hold the area in place until it heals. Fusion is often recommended for a rigid flatfoot deformity or evidence of arthritis. Both of these surgeries can provide excellent pain relief and correction.