COMMON FOOT PROBLEMS

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Foot Deformities and Biomechanical Problems

FLAT FOOT (PES PLANUS)
"Flat Foot" is a term which refers to a foot which pronates(rolls inward) excessively or remains in an excessively pronated position during stance and gait. Flat feet can be considered flexible or rigid. With a flexible flatfoot, there may be a relatively high arch when the foot is not bearing weight. This then collapses with weight bearing. A rigid flatfoot as its name implies, remains flat (pronated) at all times.

In children -
Majority of children between the ages of 1 to 5 have a flat foot. This is a normal part of the development of their feet. Most of these feet correct over the growing years and return to normal foot placement. Very few lead to development of a pediatric flat foot. Pediatric flat foot symptoms show when the child is involved in sports or other physical activities.




In adults -
Most adults loose the elasticity in their longitudinal arches leading to Adult Acquired Flat Foot. It is one of the most common foot deformity affecting adults. In severe conditions this can further lead to severe deformities of the knee and hip. Some causes are wrong placement of foot, posture, the inflammation of the posterior tibial tendon, injury to the foot, rheumatoid arthritis, obesity and diabetic collapse.

High Arched Feet (Pes Cavus)
The opposite of a flat foot is a high arched (Cavus) foot.The cavus foot is one which remains in a supinated, high-arched position. These are often rigid or semi-rigid .While excessive pronation leads to instability, inadequate pronation results in poor shock absorption during gait. This may also cause pain in the knees, hips and lower back. Symptoms commonly occur in the heel and at the ball of the foot (metatarsalgia), areas which bear the most weight. The abnormal shape of the foot may also result in tendon imbalances causing hammertoes.

Bunions (Hallux Abducto Valgus, Hallux Valgus, H.A.V.)

A bunion is an abnormal prominence located on the side of the foot, just behind the big toe. Hallux Abducto Valgus refers to a deformity associated with a bunion in which the big toe (Hallux) is angled excessively toward the 2nd toe. The Hallux Abductus Angle may be used to quantify the amount of Hallux Abducto Valgus deformity.

Hallux Abducto Valgus and Bunions are usually associated with flat feet ( hyper-pronating feet/ pes planus). Excessive pronation (flattening of the foot) leads to instability of the first metatarsal bone which drifts up and out towards the side of the foot. The big toe drifts the opposite direction toward the 2nd toe. The bunion prominence is often caused by some enlargement of the head of the 1st metatarsal bone as well as the position of the 1st metatarsal bone as it protrudes from the side of the foot.

Metatarsalgia
Metatarsalgia refers to pain at the ball of the foot, at the head of one or more metatarsal bones. It is basically a bruise of the bone or an inflammation of the soft tissue around the joint between a metatarsal and a toe bone( a metatarsophalangeal joint). This often occurs as a result of overuse, excessive walking or running without adequate cushioning beneath the bones at the ball of the foot

Heel Pain and Plantar Fasciitis
There are many causes of heel pain. However, plantar fasciitis, also known as heel spur syndrome, is the most common, by far. The pain is usually localized to the bottom of the heel towards the inside of the foot. The arch may also be painful. With this condition, pain is typically most severe with the first few steps after a period of rest. The pain may then subside and then return after extended periods of standing. There is usually no specific traumatic event that is responsible for the condition. It is usually the result of overuse, e.g. too much standing, walking or running. There are several common contributory factors such as weight gain, foot type, shoes. Flat shoes or going barefoot are the worst. The plantar fascia is a fibrous band or ligament that connects the ball of the foot with the heel and helps to support the arch. When this band gets stretched too much or overused, inflammation results, often at the location where it attaches to the heel bone.

Tendonitis
Tendons are the cord-like structures that connect muscles to bones. Tendonitis is a general term describing an inflammation of a tendon. Tendonitis often results from overuse rather than an isolated traumatic event although either case is possible. The most common tendons at risk of tendonitis in the foot are the Achilles tendon at the back of the heel, the posterior tibial tendon on the inner side of the foot, the peroneal tendons on the outer side of the foot and the extensor tendons on the top of the foot.

Calluses and Plantar Keratoses
Increased thickness of the outer layer of skin is referred to as hyperkeratosis. Common examples of hyperkeratotic lesions in the foot are corns and calluses. These conditions are usually the result of increased friction and pressure on a specific location on the foot. The friction and pressure stimulates cells in the skin to produce an increased amount of 'keratin' which makes the skin in that area feel hard. This can be extremely painful. When the hyperkeratosis is spread out over a wide area, it is known as a callus (or tyloma). If the pressure is concentrated in a smaller area on the bottom of the foot, an intractable plantar keratosis (IPK) or plantar heloma is formed. This often has the appearance and feeling of a small pebble buried in the ball of the foot. These are often treated by periodic trimming of the hard dead skin.

Corns (Heloma Durum)
A corn is a form of hyperkeratosis which is found on the top of one of the toe joints. These are usually associated with a hammertoe deformity. A hammertoe deformity is a rigid or flexible contracture of a toe which results in the toe being bent so that one of the toe joints sticks up higher than it should. The corn is formed in response to the toe rubbing against the toe box of the shoe.

Knock Knee Arising From Flat Foot
Genu valgum, commonly called "knock-knee", is a condition in where in the knees move inwards and touch one another while standing. This condition originates from a flat foot. When the foot pronates inside it leads to the twisting of the knee joint leading to inward movement of knees. Individuals with severe knock knees while straightening theirs legs will be unable to touch their feet together.

In children -
Between the time of birth and age of 18months, inward movement of hip, knee and ankle is normal in children. Children are born with a flat foot and hence the movement in ankle, knee and hip. But once they start walking on uneven grounds the arches of their foot develop. Till the age of 5years this inward movements tends to become neutral naturally. If the condition does not correct by the age of 8 then the while could have bone deformity and should be checked.

In adults -
If a person suffers from acquired flat foot, this leads to excessive biomechanical stress on the knee joint thereby leading to angular deformity of the knee. Such patients suffer from osteoarthritis or rheumatoid arthritis. The stress on the knee joint leads to the wear of the knee cartilage leading to osteoarthritis. In severe cases this deformity further moves up and causes hip and back pain.

Bow Leg Arising From High Arch
Genu Varum also known as bow-leggedness, is a physical deformity marked by the outward movement of the knee joint leading to an appearance of an archers bow. This is due to the medial angulations of the femur and tibia of the leg.

In children -
It is normal for children till the age of 3 to 4 to have a degree of genu varum or bow -leggedness. The child sits with the sole of the feet facing one another and the bones in the leg are curved outwards. At this stage the children have a gap between their knee joints. During the growing years the changes in the foot gradually bring this to natural position. If by the age of 3 or 4 the child's foot does not become normal then it could be due to Blount's disease or rickets and should be checked immediately.

In adults -
In adults this deformity is most common in people having a high arch foot. When a person has a high arch, the foot tends to move outward thereby causing stress on the knees and causing the movement outwards. This also leads to the wear in knee cartilage thereby causing osteoarthritis.