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Looking At Pes Planus


Adult Acquired Flat Feet

In a normal foot, the tendons in your foot and lower leg work together to form the arch. When the tendons all pull properly, your foot forms a moderate, normal arch. When the tendons do not pull together properly, there is little or no arch, called flat foot or fallen arch. Children are born with flat feet. In infants and toddlers, prior to walking, the longitudinal arch is not developed and flat feet are normal. As children begin standing on their toes, the muscles start to develop and an arch appears. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches. But in some cases the arch doesn?t form completely.


You can have a tendency towards fallen arches from birth. Up through the toddler stage, it is common to have flat feet. Throughout childhood, arches tend to normally develop. For reasons not well understood, however, in some cases the feet stay flat and the arch never forms. In many cases this abnormality does not cause symptoms or require any treatment. In other cases, it is due to a condition called tarsal coalition. This occurs when some of the foot bones fuse.


Fallen arches may induce pain in the heel, the inside of the arch, the ankle, and may even extend up the body into the leg (shin splints), knee, lower back and hip. You may also experience inflammation (swelling, redness, heat and pain) along the inside of the ankle (along the posterior tibial tendon). Additionally, you may notice some changes in the way your foot looks. Your ankle may begin to turn inward (pronate), causing the bottom of your heel to tilt outward. Other secondary symptoms may also show up as the condition progresses, such as hammertoes or bunions. You may also want to check your footprint after you step out of the shower. (It helps if you pretend you?re in a mystery novel, and you?re leaving wet, footprinty clues that will help crack the case.) Normally, you can see a clear imprint of the front of your foot (the ball and the toes) the heel, and the outside edge of your foot. There should be a gap (i.e. no footprinting) along the inside where your arches are. If your foot is flat, it?ll probably leave an imprint of the full bottom of your foot-no gap to be had. Your shoes may also be affected: because the ankle tilts somewhat with this condition, the heel of your shoes may become more worn on one side than another.


Most children and adults with flatfeet do not need to see a physician for diagnosis or treatment. However, it is a good idea to see a doctor if the feet tire easily or are painful after standing, it is difficult to move the foot around or stand on the toes, the foot aches, especially in the heel or arch, and there is swelling on the inner side of the foot, the pain interferes with activity or the person has been diagnosed with rheumatoid arthritis. Most flatfeet are diagnosed during physical examination. During the exam, the foot may be wetted and the patient asked to stand on a piece of paper. An outline of the entire foot will indicate a flattened arch. Also, when looking at the feet from behind, the ankle and heel may appear to lean inward (pronation). The patient may be asked to walk so the doctor can see how much the arch flattens during walking. The doctor may also examine the patient's shoes for signs of uneven wear, ask questions about a family history of flatfeet, and inquire about known neurological or muscular diseases. Imaging tests may be used to help in the diagnosis. If there is pain or the arch does not appear when the foot is flexed, x-rays are taken to determine the cause. If tarsal coalition is suspected, computed tomography (CT scan) may be performed, and if an injury to the tendons is suspected, magnetic resonance imaging (MRI scan) may be performed.

Can you fix a fallen arch?

Non Surgical Treatment

Custom orthotics are specially designed insoles, which are made for your by prescription. This is done by taking a plaster cast of the foot in its neutral position and is then sent to a laboratory, with your prescription to be made to your exact specifications. The insole then correctly aligns your foot and as a result your body. This will relieve abnormal strain of tissues and structures which can cause pain. For less severe mal-alignments or for sports use a wide variety of temporary insoles.

Surgical Treatment

Acquired Flat Foot

A better approach is to strengthen the weakened ligaments with Prolotherapy, supplemented by an arch support if the condition has existed for several years. Chronic pain is most commonly due to tendon and ligament weakness, or cartilage deterioration. The safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing. Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What?s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent.


Going barefoot, particularly over terrain such as a beach where muscles are given a good workout, is good for all but the most extremely flatfooted, or those with certain related conditions such as plantar fasciitis. Ligament laxity is also among the factors known to be associated with flat feet. One medical study in India with a large sample size of children who had grown up wearing shoes and others going barefoot found that the longitudinal arches of the bare footers were generally strongest and highest as a group, and that flat feet were less common in children who had grown up wearing sandals or slippers than among those who had worn closed-toe shoes. Focusing on the influence of footwear on the prevalence of pes planus, the cross-sectional study performed on children noted that wearing shoes throughout early childhood can be detrimental to the development of a normal or a high medial longitudinal arch. The vulnerability for flat foot among shoe-wearing children increases if the child has an associated ligament laxity condition. The results of the study suggest that children be encouraged to play barefooted on various surfaces of terrain and that slippers and sandals are less harmful compared to closed-toe shoes. It appeared that closed-toe shoes greatly inhibited the development of the arch of the foot more so than slippers or sandals. This conclusion may be a result of the notion that intrinsic muscle activity of the arch is required to prevent slippers and sandals from falling off the child?s foot.

After Care

Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.