By Matthew H. Paden, DPM
Remember playing “London Bridge Is Falling Down” when you were little? When the kids forming the bridge drop their arms down, the person in the middle is trapped and brought to “prison.” You might feel trapped, too, when the arches in your feet begin to fall down and you are caught in a life of pain and limited movement. Flat feet can develop when you are older from various causes. Adult-acquired flatfoot can be an aching nuisance that keeps you from enjoying your favorite activities, or a serious painful issue that keeps you from living a normal life. If you are tired of dealing with sore feet, it is time to find out what can be done.
Weakened Arches Falling Down
There are many reasons that your normal arch may collapse later in life. The posterior tibial tendon can become weak from age, obesity, or wear and tear from sports. Arthritis can attack the ligaments that hold the foot joints in place as well as cartilage, and the joints can move out of alignment, changing the shape of your foot and often leading to severe pain. An injury to the ligaments or a fractured or dislocated bone in your foot can be culprits as well, often resulting in flat feet and overpronation problems.
If you have diabetes, your foot is particularly at risk of collapse. Associated nerve problems may mean you cannot feel the pain of a pulled ligament or fractured bone. You keep walking on the damage, making it worse, until the entire foot becomes misshapen and painful.
Setting Your Feet Free
In one verse, the London bridge rhyme asks my fair lady: “What’ll you take to set him free?” There are several conservative measures we can try to set you free from the pain and immobility of flat feet. Here are a few:
- Rest from impact activities, giving the tissues time to heal
- Immobilize the foot with a brace or cast to hold bones in place
- Try shoe inserts to give support to the arch
- Use physical therapy to increase muscle and tendon strength in the feet
Many times these will help you enough so you can resume your activities. When they don’t, surgery may bring the relief you need.
Rebuilding Your Foot Structure
Just as the children sing “build it up with iron and steel,” there are procedures we can use to realign the bones of your feet and hold them in place with pins, bars, or screws. We can also repair tendons and ligaments to help hold the bones in place. Some common procedures to relieve flatfoot pain include the following:
- Part of the heel bone can be cut, slid back into correct position, and held in place.
- Wedges of bone can be inserted in the outer side of the heel bone to correct the outward rotation of the foot.
- If arch collapse on the outer edge forces the inside edge too high, a bone wedge can be inserted in the cuneiform bone to lower it.
- Metatarsal bones can be fused in the correct position and held in place with screws or plates.
- The posterior tibial tendon can be repaired or removed, the Achilles tendon can be lengthened, or another tendon transferred to the bones of the arch to help hold it up.
- With stiffened deformities from arthritis or diabetes, several bones may need to be fused in order to bring relief from pain.
Recovering from Surgery for Flat Feet
The procedures are done with regional or general anesthesia, and you may be in the hospital overnight. You will need to wear a cast and elevate your leg for a couple of weeks. When the stitches are removed, another cast or boot will be applied. You must keep weight off for 6 – 8 weeks after surgery. You will likely need physical therapy to regain function of your feet.
At Rocky Mountain Foot & Ankle Center, our podiatrists do reconstructive foot surgery extremely well. Call us at (303) 423-2520 or use our online form to request an appointment at one of our four Denver-area offices. We can help you decide if surgery is the right step for you.
