Painful flatfoot and fallen arches conditions are estimated to affect 5% of US adults, and may limit their desire to exercise. The American College of Foot and Ankle Surgeons (ACFAS) today announced publication of a new clinical practice guideline for this common foot problem. Flatfoot and fallen arches can cause debilitating foot pain in adults.
Flatfoot Disorders Cause Pain and May Limit Exercise
Adult flatfoot often is a complex disorder with a variety of symptoms and varying degrees of deformity and debilitation. "In adults, flat feet can be very painful and limit one's ability to exercise and stay in good cardiovascular health," said Kris DiNucci, DPM, FACFAS, an Omaha-based foot and ankle surgeon. "The guidelines are intended to help clinicians differentiate various types of flatfoot conditions and intercede before the condition progresses to a serious, activity-limiting foot problem."Fallen Arches
In adults, DiNucci said flat feet occur from a partial or complete collapse of the arch, and the condition is commonly called "fallen arches." It usually results from overstretching the tendon that supports the arch or progression of an untreated childhood flatfoot condition. "For many adults, flat feet cause nagging foot pain that gets worse over time. It's tough to be active, shed excess pounds and maintain a healthy lifestyle if your feet hurt constantly," said DiNucci.Flexible Flatfoot
Flexible flatfoot is the most common type in which the foot is flat when standing and returns to a normal arch in non-weight-bearing positions. In most cases, it develops in childhood. When medical treatment is required for adults with flexible flatfoot, the new ACFAS guideline recommends first-line therapy that may include activity modifications or limitations, stretching exercises, custom shoe orthotics and nonsteroidal anti-inflammatory medications. If the patient's response to initial treatment is unsatisfactory, a variety of surgical procedures can be considered to relieve pain and improve foot function.Adult-Acquired Flatfoot
A less frequent but more serious type of flatfoot is called adult-acquired flatfoot. It is caused most frequently by a disorder known as posterior tibial tendon dysfunction (PTTD), in which the tendon that supports the arch progressively weakens from overuse. PTTD can lead to a rigid flatfoot condition in which the arch stays flat even without weight pressure.Adult-acquired flatfoot is common in women ages 45 to 65. As the condition progresses, pain and tenderness in the arch are frequent symptoms, as well as a noticeable flattened arch. When the deformity is more severe, patients lose range of motion in the foot and ankle and are unable to rise up on their toes at all or without pain. At initial stages, the ACFAS guideline recommends that patients with flatfoot caused by PTTD can be treated with custom shoe orthotics, soft casts, walking boots, physical therapy and non- steroidal anti-inflammatory medications.
When initial treatments fail to bring improvement, or if initial improvement deteriorates, surgery may be considered. In cases where the initial evaluation and treatment were provided by a primary care physician, referral to a podiatric foot and ankle surgeon is strongly recommended.
Seeking Help
For further information about adult flatfoot conditions and to locate a foot and ankle surgeon in your area, visit http://www.footphysicians.com/.Source: American College of Foot and Ankle Surgeons
