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I Have Flat Feet... It's Not Arthritis Is It?

Oct 18, 2007
Having flat feet is a common condition with about 25 percent of the population having this disorder. The medical term for flat foot is "pes planus."

Contrary to popular belief though, having flat feet is a potentially serious problem. It has been associated with plantar fasciitis (inflammation of the soft tissue of the bottom of the heel), Achilles tendonitis, painful shin splints and osteoarthritis of the knee.

While most people with flat feet probably have a genetic predisposition towards this, some people have "acquired" flat feet... in other words, they develop it over time.

The most common cause of acquired flat foot in an adult patient is posterior tibial tendonopathy (tendonitis).

While posterior tibial tendonopathy is a common disorder, it is often overlooked.

So... what are some of the factors that might cause posterior tibial tendonopathy?

Often, a flat foot will develop over time following an injury to the ankle.

Patients may be overweight. A typical scenario is a middle-aged person who suddenly increases their activity level. It is a common disorder in runners and hikers.

Signs and symptoms include:

* Pain and swelling of the inside part of the ankle extending down into the arch of the foot

* The patient may be unable to invert (turn in) their foot or lift up on their heel while standing.

* On examination, there may be pain with palpation (pressure) along the course of the tendon, behind and below the inside bump of the ankle. Pain can be provoked if the patient is asked to turn the foot in against resistance.

While posterior tibial tendonopathy can present in one foot only, about three-quarters of the time it may be present in both feet.

Inflammatory forms of arthritis, particularly rheumatoid arthritis, are a very common cause of posterior tibial tenodonopathy.

While the diagnosis may be suspected on clinical grounds, diagnostic ultrasound or magnetic resonance imaging (MRI) should be done to better assess the condition of the tendon.

Early diagnosis is important to staging treatment and improving prognosis. The danger accompanying posterior tibial tendonopathy is the high probability of tendon rupture occurring over time. Vigilance must be maintained.

Patients should be told about the danger of tendon rupture and the need to remain compliant with therapy
If there is an underlying form of inflammatory arthritis, it must be optimally controlled with medication.

The joint should be stabilized with devices such as orthoses, braces, and casts. Therapeutic taping can also be used with early disease. An orthopedic foot and ankle specialist should be consulted. Steroid injection into the tendon sheath along with bracing can be done if there is severe pain but it should be remembered that steroids may weaken the tendon leading to the possibility of subsequent tendon rupture.

If the problem is diagnosed early, intensive physical therapy can be helpful.

In cases where the tendonopathy is advanced or where there is already rupture, surgical intervention is required. Surgical procedures include debridement of the tendon, tendon transfer, and possibly ankle fusion.

Flat foot is not a benign process and should be investigated sooner rather than later.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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