Starkey Podiatry

23/01/2023

26/09/2022

PES PLANOVALGUS (Flat Foot)

Pes planovalgus (i.e., flatfoot) is a common condition among young children and also is encountered in adults. In children, congenital pes planus typically resolves with age as the foot musculature strengthens. Flexible pes planus is defined as a normal arch during non-weight-bearing activity or tiptoeing, with a flattening arch on standing. In rigid pes planus, the arch remains stiff and collapsed with or without weight bearing. Patients with rigid pes planus should be referred for subspecialist treatment. Patients with flexible pes planus, in the absence of signs of rheumatologic, neuromuscular, genetic, or collagen conditions, should be treated conservatively. Asymptomatic children should be monitored and maintenance of a healthy weight should be encouraged. Surgical intervention for refractory symptomatic pediatric pes planus may be considered but there is little evidence to support it. Several etiologies of acquired pes planus in adults have been identified as posterior tibial tendon dysfunction. Clinical and x-ray evaluation can assist in staging the condition and guiding treatment decisions.

A Podiatrist can reduce the symptoms through conservative treatments; advise appropriate shoes and exercises, he can prescribe custom made orthotics and rest or advise surgery when recommended. The correct foot position will help avoiding the risk of further problems, especially in severe cases and for further deformity especially in children.
The flat foot may impact on quality of life: pain and stiffness may cause disability and limitation at any age. There are many conservative and simple ways to reduce pain and limitation. The Podiatrist will evalute your condition and advice or treat if needed.

References:

1. Foot and Ankle Conditions: Pes Planus
Charlie Michaudet 1, Katherine M Edenfield, Guy W Nicolette, Peter J Carek
Foot and Ankle Conditions: Pes Planus - PubMed (nih.gov), 2018 Feb

2. Flat Foot in a Random Population and its Impact on Quality of Life and Functionality
Salvador Pita-Fernandez 1, Cristina Gonzalez-Martin 2, Francisco Alonso-Tajes 2, Teresa Seoane-Pillado 1, Sonia Pertega-Diaz 1, Sergio Perez-Garcia 2, Rocio Seijo-Bestilleiro 1, Vanesa Balboa-Barreiro 1
Flat Foot in a Random Population and its Impact on Quality of Life and Functionality - PubMed (nih.gov)

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12/09/2022

Plantar digital Neuroma: General Surg/Conser

Morton’s neuralgia

Morton's neuralgia is a painful nerve disease of the foot due to chronic compression, which is caused by swelling and nodular thickening of the interdigital nerves (neuroma) mainly in the area of the metatarsal heads III and IV, more rarely between II and III.
Additional compression can also be generated by an inflammatory altered and enlarged bursa, which is also located between the heads of the metatarsals and can form a conglomerate with the nerve node.

Other foot deformities such as splayfoot and hallux valgus, which can also be caused by wearing unsuitable shoes that are too tight, are particularly conducive to the development of Morton's neuroma.

Symptoms are severe pain in the area of the metatarsus heads up to the toes especially after longer walking distances due to the rolling of the foot and can be detected by the compression of the Metatarsal heads, the “squeeze test”, which is very painful in Morton´s neuralgia.
At the same time, there is usually numbness of the toes in the shoe, requiring patients to remove their shoes and massage their feet. These intermittent paraesthesia and pain in the forefoot are caused by sclerosing thickening of the nerves digitales plantares communes.

Conservative treatment may consist of padding and spreading the anterior transverse arch, also with orthosis, to widen the spaces between and straighten the toes and thereby relieve the neuroma. Also, temporary pain management with local anaesthesia or infiltration of a local anaesthetic may be performed.
Surgical removal of the neuroma may be necessary.


References:
Fleischner, Dr. Gerhard, Der schmerzende Fuß, Monographie, Ein Kompendium der medizinischen Fußpflege Band II, Verlag Neuer Merkur München, ISBN 3-921280-745, 1991 (The aching foot, monograph, A Compendium of Medical Foot Care Volume II)

Grünewald, Klaus, et al GmbH, ISBN 978-3-95409-027-3, 3. Auflage 2015 und ISBN 3-929360-52-7, 1. Auflage 2001 (Theory of medical foot care, Volume 2, Picture Orthosis)

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