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- Dr.Joni Redlich PT,DPT
I am asked about flat feet all the time. I’ve even gotten our OTs in the habit of looking at their client’s feet. Over and over again parents take their child to the orthopedic surgeon and ask about orthotics for their child’s flat feet. Each time the physician says no. The orthotic will not change anything. You are wasting your money. Flat feet don’t cause pain. My orthopedic books all say the same thing.
My response: I’m not looking to change the structure of the foot. I’m not concerned about pain. I am looking at FUNCTION.
I don’t see children who only have flat feet. They don’t wind up in physical or occupational therapy for flat feet alone. If that was the case I would give the same response as the orthopedic surgeon. Don’t worry about it. If I recommend orthotics for flat feet it is because the child’s lack of alignment from their foot on up is affecting their balance and gross motor skills.
Unfortunately, this decision then lands on the parent. Do they listen to the doctor telling them not to waste their money or to their therapist who works with the family on a weekly basis to improve their child’s mobility skills.
I like to use these. I measure them, the family orders them and they are relatively inexpensive.
Orthotics won’t change a child’s feet when they are barefoot. However, to watch a child put orthotics in and for the first time can run and jump with speed and agility, tells me that there are times when it is appropriate.
I am totally with you on this, Joni. Flat feet are an indicator of inactive foot muscles. Support for better skeletal alignment (from an orthotic) prompts more activation of the foot muscles and specifically the intrinsics. In addition to performing more and better gross movements, a child may develop quicker the ability to wiggle their toes – an indicator of controlling balance in the foot.
Good point regarding activating the intrinsic foot muscles! Get ’em turning on.
I am curious about the cause of adult onset flat foot. Over several years, I gradually developed flat foot (left foot). Initially, I dealt with plantar fascittis and then plantar fasciosis for three years. I did have pt. Finally cryo eliminated the pain. About two years later, I was suffering pttd despite trying pt. Over two years, symptoms got worse until finally my ptt had partially ruptured and spring ligament was damaged. I am 20 month post op pttt/spring ligament repairs, cotton/calcaneal osteotomy, tendon transfer and gastroc recession. I am thrilled with the outcome; however my other foot is starting to pronate. Do you have any suggestions to help me avoid the nonsurgical foot from continuing to deteriorate?
Hi Amy. I would suggest searching for the cause of the pronation. Perhaps there is poor alignment higher up in your back, hips, etc, that are causing this new pressure to be created in your feet. One approach I feel is very effective for this is TMR. Check out their website at http://www.totalmotionrelease.com and if you are interested you can find a locally trained physical therapy to evaluate you. Fixing asymmetries higher up could prevent your other foot from the same outcome of the left foot.
Thank you for your response. I have very tight Achilles tendons and always have. I do stretch several times a week. I also have patella femoral syndrome with increased Q angle in both knees. I am bone on bone over about 1/2 of the patella femoral joint in the right knee and not much better in the left knee. About 5 years ago, two different PT’s told me that they were amazed that I was walking as the knee cap was hanging off the edge of the joint, severe lateral tilt, patella alta. I ended up having a soft tissue realignment, lateral release and cleaning of bone spurs to hopefully put off a tkr 8-10 years, until I am closer to 60. The doctor said that I will know when I am ready for a knee replacement. I definitely have flare ups but so I don’t feel that I am reading for TKR’s yet.
Could either the knee issues, tight Achilles tendon be the original source of my foot
problems? Could the tight Achilles be neurologically based? The reason I ask is that even after having the gastroc recession, both tendons are tight.
Have you been seen by a neurologist yet? If you have concerns then you should see one to rule out neurological causes. I would continue to try addressing the overall alignment issues to try to help your other feet and prevent reinjury of the repaired one.
Thank you for your response. I have very tight Achilles tendons and always have. I do stretch several times a week. I also have patella femoral syndrome with increased Q angle in both knees. I am bone on bone over about 1/2 of the patella femoral joint in the right knee and not much better in the left knee. About 5 years ago, two different PT’s told me that they were amazed that I was walking as the knee cap was hanging off the edge of the joint, severe lateral tilt, patella alta. I ended up having a soft tissue realignment, lateral release and cleaning of bone spurs to hopefully put off a tkr 8-10 years, until I am closer to 60. The doctor said that I will know when I am ready for a knee replacement. I definitely have flare ups but so I don’t feel that I am reading for TKR’s yet.
Could either the knee issues, tight Achilles tendon be the original source of my foot
problems? Could the tight Achilles be neurologically based? The reason I ask is that even after having the gastroc recession, both tendons are tight.