Flatfoot, or Pes Planus, is a condition where the arches of the feet are lowered or absent, causing the entire sole to make contact with the ground. This condition can often be associated with Posterior Tibial Tendon Dysfunction (PTTD), where the tendon that supports the arch weakens or tears, contributing to the collapse of the arch.
Flatfoot (Pes Planus)
Causes and Risk Factors
Causes and Risk Factors include genetics, foot structure, pregnancy, aging, or injury to the posterior tibial tendon. It can also develop in individuals with certain conditions, such as diabetes or arthritis.
Symptoms
Symptoms may include foot pain, especially in the arch or heel, fatigue in the legs, and difficulty walking or standing for long periods.
Diagnosis
Diagnosis is made through a physical exam, and in some cases, imaging studies such as X-rays or MRIs may be used to assess the degree of the flatfoot.
Treatment
Treatment includes custom orthotics, physical therapy, and in more severe cases, surgical correction to restore the arch or realign the bones.
High Arch Pain (Pes Cavus)
High arch pain, or Pes Cavus, is a condition where the arches of the feet are abnormally high, leading to excessive pressure on the ball and heel of the foot.
Causes and Risk Factors include genetics, foot structure, neurological conditions (such as cerebral palsy or Charcot-Marie-Tooth disease), or injury.
Symptoms may include foot pain, difficulty walking, frequent ankle sprains, and calluses on the ball or heel of the foot.
Diagnosis is made through a physical exam to assess the foot structure and may include X-rays or other imaging to identify structural issues. Additionally, a neuromuscular exam may be conducted to assess tendon imbalances or neurological conditions affecting muscle strength or coordination.
Treatment often involves custom orthotics, supportive footwear, physical therapy, and in some cases, evaluation by neurologist, or surgery to realign the bones or tendons.
Bunion (Hallux Valgus)
A bunion, or Hallux Valgus, is a deformity in which the first metatarsal bone shifts out of alignment, creating a prominent bump at the base of the big toe.
Causes and Risk Factors include foot structure, wearing tight or narrow shoes, genetics, excessive pressure on the feet, and conditions like arthritis or flatfoot.
Symptoms include a visible bump at the joint of the big toe, pain, swelling, and redness, which may worsen when wearing tight shoes or walking.
Diagnosis involves a physical examination to assess the deformity, along with X-rays to determine the degree of misalignment.
Treatment begins with conservative measures such as wearing properly fitted shoes, using bunion pads, and managing inflammation with anti-inflammatory medications. In more severe cases, surgical options such as minimally invasive bunionectomy may be considered to realign the bones, relieve pain, and improve foot function with quicker recovery and less scarring than traditional surgery.
Tailor's Bunions (Bunionette)
A Tailor’s Bunion, or Bunionette, is a bony bump that forms at the base of the little toe, causing the toe to angle outward.
Causes and Risk Factors include foot structure / genetics, wearing narrow shoes, and certain foot deformities like flatfoot or high arches.
Symptoms include a visible bump at the joint of the little toe, pain, swelling, and redness, which can worsen with certain footwear.
Diagnosis is made through a physical exam and X-rays to evaluate the bony prominence and alignment of the toe.
Treatment may include wearing proper footwear, using padding, and in severe cases, surgery to remove the bump and realign the toe.
Hammertoe
Hammertoe is a deformity that causes one or more toes to bend downward at the middle joint, creating a hammer-like appearance. This condition typically affects the second, third, or fourth toe.
Causes and Risk Factors include ill-fitting shoes, muscle imbalances in the foot, and certain genetic factors. Age, arthritis, and conditions like diabetes also increase the risk of developing hammertoe.
Symptoms include bent toe appearance, pain, especially when moving the affected toe or wearing shoes, corns and calluses on the affected joint, and difficulty straightening the toe. Swelling, redness, and burning sensations may also occur.
Diagnosis A physical examination is conducted to assess toe alignment and identify any signs of muscle imbalance. X-rays may be used to evaluate the severity of the deformity.
Treatment initially includes footwear changes, custom orthotics, stretching exercises, and toe pads / sleeves. For more severe cases, I perform an in-office procedure called flexor tenotomy, where the tendon is released to correct the deformity without removing bone. In some cases, surgical options may involve tendon release or bone removal.
Coalition (Tarsal and Calcaneonavicular)
A coalition is an abnormal connection or fusion between two or more bones in the foot. The most common types are tarsal coalitions, which involve the fusion of bones in the rearfoot, and calcaneonavicular coalitions, which connect the calcaneus (heel) and navicular bones.
Causes and Risk Factors
Causes and Risk Factors are typically congenital, meaning the condition is present at birth. It can also develop due to injury or arthritis.
Symptoms
Symptoms include foot pain, stiffness, and limited motion, often worsening with activity.
Diagnosis
Diagnosis involves a physical exam and imaging, such as X-rays or CT scans, to visualize the fused bones and assess the extent of the coalition.
Treatment
Treatment may include rest, physical therapy, custom orthotics, or, in more severe cases, surgery to remove the fused bone or correct the joint alignment.
Ganglion Cysts
A ganglion cyst is a fluid-filled bump that forms on the joints or tendons, often on the top or bottom of the foot or ankle.
Causes and Risk Factors include joint or tendon irritation, previous injury, or repetitive use. These cysts can develop as a result of abnormal fluid accumulation of the tendon sheath.
Symptoms include a visible lump, pain, or tenderness, especially when pressure is applied or with activity.
Diagnosis involves a physical examination, and an ultrasound or MRI may be used to confirm the cyst and rule out other conditions.
Treatment may include observation, aspiration (draining the cyst), or in some cases, surgical removal if the cyst causes persistent symptoms or discomfort.
Metatarsalgia
Metatarsalgia is a condition characterized by pain and inflammation in the ball of the foot, typically affecting the area just behind the toes. It commonly occurs due to excessive pressure on the metatarsal bones.
Causes and Risk Factors include high-impact activities like running or jumping, wearing improper footwear such as high heels or unsupportive shoes, foot deformities like high arches or hammertoes, and conditions like arthritis or excess weight that increase stress on the forefoot.
Symptoms include a burning or aching pain in the ball of the foot, discomfort that worsens with activity or prolonged standing, and a sensation of having a pebble in the shoe.
Diagnosis involves a physical examination to assess pain and foot structure, and imaging tests like X-rays or ultrasound may be used to rule out fractures or other conditions.
Treatment may include wearing supportive footwear with proper cushioning, using custom orthotics to redistribute pressure, applying ice and taking anti-inflammatory medications for pain relief, and modifying activities to reduce stress on the foot. In persistent cases, more advanced treatments like injections or surgery may be considered.
