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But for those who once had arches, Flatfoot slowly develops from wear and tear (aging) or trauma, causing pain in the arches, heels, ankles, knees or hips, as the leg and foot fall out of alignment. The culprit is usually damage to the posterior tibial tendon which runs along the inside of your ankle - when it weakens, it can no longer support the arch.
We all start with zero arch. We're born with flat feet and slowly our arches develop during childhood, becoming fully developed in adulthood.
The arches and the biomechanics of the lower leg are intimately linked - our arches literally put a "spring" in our step, determine how we walk and distribute our body weight proportionally across our feet and legs. Arches also need to be sturdy and flexible to adapt to various surfaces. When the strength or flexibility of the arch fails, the alignment and balance of the foot and leg suffers.
The most common cause of Adult Acquired Flat Foot Deformity (AAFFD) is damage to the posterior tibial tendon, one of the most important tendons in your leg. Starting at the calf, the posterior tibial tendon travels down the inside of your leg and heel, and attaches to the bones on the inside of your foot. The main function of the tendon is to support your arch and foot. If the tendon suffers chronic damage such as persistent inflammation, it may lose its ability to support your arch, and the arch will slowly collapse. Pain and discomfort from AAFFD can be substantial, occurring anywhere in the foot, heel, ankle, knee, back, or hip.
Inflammatory arthritis, especially rheumatoid arthritis, attacks the cartilage in the joints as well as the ligaments that support the foot. The inflammation causes not only pain, but also may change the shape of the foot and cause the arch to drop.
Ligament injury causes the joints to fall out of alignment. The job of the ligaments is to hold the bones in place and prevent them from moving. When the ligaments are damaged, the bones fall, flattening the arch.
Fractures or dislocations of the bones in the midfoot can lead to Flatfoot deformity.
Charcot Foot Disorder, a complication of diabetes, results from a nerve condition (diabetic peripheral neuropathy) which causes a loss of sensation in the feet. An infection in the foot, unknown to the patient, causes weakness in the ligaments and bones, leading to collapse of the arch and other complications. Complicated surgery is required to correct the problem.
Watch the story of how we alleviated the pain of Flatfoot (and other conditions) for one of our patients.
Heel pain and ankle pain usually appear separately. But sometimes, pain in the heel and ankle can occur together as a result of one injury or multiple, associated injuries.
Runners and other athletes are especially prone to overuse injuries in the heel and ankle. Some, especially those with long legs, are also prone to having a stiff Achilles tendon and stiff calf muscles. As the foot and ankle literally hinge on these mechanisms, inflexibility leaves the tendon, heel and ankle at risk of injury, especially when we play sports. Usually, the injury appears in the form of Achilles tendonitis, calcaneal (heel bone) bursitis, or plantar fasciitis.
If, at the first sign of pain you rest, elevate and ice the sore area until the pain subsides, healing may be achieved without medical intervention. If you ignore the pain and keep training, the injury may become very serious. If pain continues for 4 days or more, see a podiatrist.
A stress fracture in the ankle or foot generally occurs gradually from overuse. Depending on the location and severity of the fracture, pain can radiate through the entire foot, ankle and/or heel. The pain may be accompanied by numbness or tingling, redness, swelling and a feeling of instability.
It's essential that any fracture - whether a small stress fracture or a more serious break - be treated by a podiatrist to insure that it heals correctly. Don't blow it off - ask anybody who's middle aged or older and they'll tell you how much these "minor" stress fractures come back to haunt you later in life.
Tarsal Tunnel Syndrome and peripheral neuropathy can cause considerable pain and discomfort. Tarsal Tunnel is an entrapment of the posterior tibial nerve which passes through your ankle. When the nerve becomes compressed, pain can be felt from the sole of the foot and throughout the ankle. Pain may also radiate to the leg and hip. Peripheral neuropathy, usually a side effect of diabetes, can cause tingling and pain at any point in the foot and lower leg.
Both conditions require the intervention of a podiatrist to relieve symptoms.
In or near the ankle, the Achilles tendon is the most likely tendon to cause pain. But pain may also be felt from injury to the peroneal, posterior tibial or flexor hallucis longus tendons. The area of swelling and tenderness usually indicates which tendon has been damaged.
Treat with rest, ice and anti inflammatories, and see a podiatrist for an evaluation.
Ankle Impingement Syndrome
Anterior Ankle Impingement or Posterior Ankle Impingement Syndrome occurs when soft tissues around the ankle become pinched. When the ankle is bent fully up or down, pain occurs. Runners, footballers and dancers are notorious for developing these syndromes.
Treat as above with tendinitis.
An ankle sprain occurs when the ankle ligaments are subjected to an unnatural twisting, causing stretching or tearing of the ligaments. A sprain can easily cause pain in the entire area around the ankle, including the heel.
Treatment by a podiatrist is necessary to insure that the sprain heals correctly. Damaged ligaments which are not cared for properly become weak and are more likely to be reinjured and cause long-term problems.
Arthritis can occur in any joint in the body. It's especially debilitating when it takes up residence in the ankle. Due to the inflexibility of the arthritic ankle, arthritis patients are prone to plantar fasciitis.
This chronic autoimmune disease attacks joints at any point in the body. RA usually starts in the small joints of the hands and feet, and progresses to the larger joints. More than 90% of Rheumatoid Arthritis patients develop symptoms in their feet and ankles, usually occurring in both feet simultaneously. Difficulty climbing stairs is an early sign that the ankle is beset with RA. Difficulty on uneven ground suggests that the hindfoot - the heel area - is showing signs of the disease. A podiatrist can identify your symptoms and you will be referred to a rheumatologist for treatment.