Over-Pronation
Overview
Pronation is the natural act of the body spreading the impact of walking, jogging or running throughout the foot evenly. As the foot strikes the ground, the ankle naturally rolls inward absorbing the shock of the ground and mobilizing to the terrain. Overpronation is when the ankle of the foot rolls in past its normal 15? of inward rotation. The cause of this could be many things such as foot type, biomechanics, or compensation strategies. People with flat feet often, although not always, overpronate.
Causes
For those not familiar with the term pronation, you might be familiar with terms related to shoes and pronation such as ?motion control?, ?stability,? and ?neutral cushioned.? The terms motion control and stability are typically associated with the word ?over-pronation? or a foot that is supposedly pronating too much and needs correction. According to the running shoe industry, ?over-pronation? is a biomechanical affliction evident when the foot and or ankle rolls inward past the vertical line created by your leg when standing.
Symptoms
People with overpronation may suffer from pain in the knees, hips, and low back. Overpronation itself does not necessarily cause any other symptoms but is a contributing factor of many foot conditions such as Plantar Facsiitis, Heel Spur Syndrome, Posterior Tibialis Tendon Rupture or Tendonitis, Hallux Valgus, Bunion Deformities, Metatarsalgia, Hallux Limitus or Hallux Rigidus, Hammer Toes, and Morton?s Neuroma.
Diagnosis
The best way to discover whether you have a normal gait, or if you overpronate, is to visit a specialty run shop, an exercise physiologist, a podiatrist or a physical therapist who specializes in working with athletes. A professional can analyze your gait, by watching you either walk or run, preferably on a treadmill. Some facilities can videotape your gait, then analyze the movement of your feet in slow-motion. Another (and less costly) way is to look at the bottom of an older pair of run shoes. Check the wear pattern. A person with a normal gait will generally see wear evenly across the heel and front of the shoe. A person who overpronates will likely see more wear on the OUTside of the heel and more wear on the INside of the forefoot (at the ball). A person who supinates will see wear all along the outer edges of the shoe. You can also learn about your gait by looking at your arches. Look at the shape your wet feet leave on a piece of paper or a flat walking surface.
Non Surgical Treatment
Heel counters that make the heel of the shoe stronger to help resist/reduce excessive rearfoot motions. The heel counter is the hard piece in the back of the shoe that controls the foot?s motion from side-to-side. You can quickly test the effectiveness of a shoe?s heel counter by placing the shoe in the palm of your hand and putting your thumb in the mid-portion of the heel, trying to bend the back of the shoe. A heel counter that does not bend very much will provide superior motion control. Appropriate midsole density, the firmer the density, the more it will resist motion (important for a foot that overpronates or is pes planus), and the softer the density, the more it will shock absorb (important for a cavus foot with poor shock absorption) Wide base of support through the midfoot, to provide more support under a foot that is overpronated or the middle of the foot is collapsed inward.
Surgical Treatment
Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.
An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
Pronation is the natural act of the body spreading the impact of walking, jogging or running throughout the foot evenly. As the foot strikes the ground, the ankle naturally rolls inward absorbing the shock of the ground and mobilizing to the terrain. Overpronation is when the ankle of the foot rolls in past its normal 15? of inward rotation. The cause of this could be many things such as foot type, biomechanics, or compensation strategies. People with flat feet often, although not always, overpronate.
Causes
For those not familiar with the term pronation, you might be familiar with terms related to shoes and pronation such as ?motion control?, ?stability,? and ?neutral cushioned.? The terms motion control and stability are typically associated with the word ?over-pronation? or a foot that is supposedly pronating too much and needs correction. According to the running shoe industry, ?over-pronation? is a biomechanical affliction evident when the foot and or ankle rolls inward past the vertical line created by your leg when standing.
Symptoms
People with overpronation may suffer from pain in the knees, hips, and low back. Overpronation itself does not necessarily cause any other symptoms but is a contributing factor of many foot conditions such as Plantar Facsiitis, Heel Spur Syndrome, Posterior Tibialis Tendon Rupture or Tendonitis, Hallux Valgus, Bunion Deformities, Metatarsalgia, Hallux Limitus or Hallux Rigidus, Hammer Toes, and Morton?s Neuroma.
Diagnosis
The best way to discover whether you have a normal gait, or if you overpronate, is to visit a specialty run shop, an exercise physiologist, a podiatrist or a physical therapist who specializes in working with athletes. A professional can analyze your gait, by watching you either walk or run, preferably on a treadmill. Some facilities can videotape your gait, then analyze the movement of your feet in slow-motion. Another (and less costly) way is to look at the bottom of an older pair of run shoes. Check the wear pattern. A person with a normal gait will generally see wear evenly across the heel and front of the shoe. A person who overpronates will likely see more wear on the OUTside of the heel and more wear on the INside of the forefoot (at the ball). A person who supinates will see wear all along the outer edges of the shoe. You can also learn about your gait by looking at your arches. Look at the shape your wet feet leave on a piece of paper or a flat walking surface.
Non Surgical Treatment
Heel counters that make the heel of the shoe stronger to help resist/reduce excessive rearfoot motions. The heel counter is the hard piece in the back of the shoe that controls the foot?s motion from side-to-side. You can quickly test the effectiveness of a shoe?s heel counter by placing the shoe in the palm of your hand and putting your thumb in the mid-portion of the heel, trying to bend the back of the shoe. A heel counter that does not bend very much will provide superior motion control. Appropriate midsole density, the firmer the density, the more it will resist motion (important for a foot that overpronates or is pes planus), and the softer the density, the more it will shock absorb (important for a cavus foot with poor shock absorption) Wide base of support through the midfoot, to provide more support under a foot that is overpronated or the middle of the foot is collapsed inward.
Surgical Treatment
Subtalar Arthroereisis. Primary benefit is that yje surgery is minimally invasive and fully reversible. the primary risk is a high chance of device displacement, generally not tolerated in adults.
An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer.
What Exactly Is Severs Disease?
Overview
Sever?s disease, also known as calcaneal apophysitis, is a common heel problem affecting children. This heel bone disorder is often painful, though it?s usually temporary and causes no long-term health effects. With Sever?s disease, the Achilles tendon repeatedly pulls on the heel?s growth plate, causing microtrauma (i.e. microfractures), inflammation, and swelling in the affected area. Sever?s disease is similar to Osgood-Schlatter disease, which affects the knee. Inappropriate footwear may be a contributing factor in the onset of this condition.
Causes
Sever?s disease is often associated with a growth spurt, when the bones grow but the muscles do not. Therefore the muscles effectively become tighter which results in increased stress at the heel. It may also be related to unusual biomechanics, for instance poor foot posture, muscle tightness or muscle weakness. Overtraining or incorrect training can also play a part. Usually, the cause is a combination of factors.
Symptoms
Pain is reproduced through a gentle squeeze of the back of the heel. Children may present with a limp or ?Bouncy gait?. Pain is worse barefoot and often present in the mornings and post exercise. The pain is located at the back of the heel, with localized swelling of the area.
Diagnosis
Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.
Non Surgical Treatment
Treatment revolves around decreasing activity. Usual treatment has been putting children in a boot in slight equinus, or a cast with the foot in slight equinus, thereby decreasing the tension on the heel cord, which in turn pulls on the growth plate at the heel. As the pain resolves, children are allowed to go back to full activities. Complete resolution may be delayed until growth of the foot is complete (when the growth plate fuses to the rest of the bone of the heel). A soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and increases the shock absorption, so the growth plate is not knocked around as much). The use of an ice pack after activity for 20mins is often useful for calcaneal apophysitis, this should be repeated 2 to 3 times a day. As a pronated foot is common in children with this problem, a discussion regarding the use of long term foot orthotics may be important. If the symptoms are bad enough and are not responding to these measures, medication to help with inflammation may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal.
Exercise
Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The child should do this exercise routine a few times daily.
Sever?s disease, also known as calcaneal apophysitis, is a common heel problem affecting children. This heel bone disorder is often painful, though it?s usually temporary and causes no long-term health effects. With Sever?s disease, the Achilles tendon repeatedly pulls on the heel?s growth plate, causing microtrauma (i.e. microfractures), inflammation, and swelling in the affected area. Sever?s disease is similar to Osgood-Schlatter disease, which affects the knee. Inappropriate footwear may be a contributing factor in the onset of this condition.
Causes
Sever?s disease is often associated with a growth spurt, when the bones grow but the muscles do not. Therefore the muscles effectively become tighter which results in increased stress at the heel. It may also be related to unusual biomechanics, for instance poor foot posture, muscle tightness or muscle weakness. Overtraining or incorrect training can also play a part. Usually, the cause is a combination of factors.
Symptoms
Pain is reproduced through a gentle squeeze of the back of the heel. Children may present with a limp or ?Bouncy gait?. Pain is worse barefoot and often present in the mornings and post exercise. The pain is located at the back of the heel, with localized swelling of the area.
Diagnosis
Children or adolescents who are experiencing pain and discomfort in their feet should be evaluated by a physician. In some cases, no imaging tests are needed to diagnose Sever?s disease. A podiatrist or other healthcare professional may choose to order an x-ray or imaging study, however, to ensure that there is no other cause for the pain, such as a fracture. Sever?s disease will not show any findings on an x-ray because it affects cartilage.
Non Surgical Treatment
Treatment revolves around decreasing activity. Usual treatment has been putting children in a boot in slight equinus, or a cast with the foot in slight equinus, thereby decreasing the tension on the heel cord, which in turn pulls on the growth plate at the heel. As the pain resolves, children are allowed to go back to full activities. Complete resolution may be delayed until growth of the foot is complete (when the growth plate fuses to the rest of the bone of the heel). A soft cushioning heel raise is really important (this reduces the pull from the calf muscles on the growth plate and increases the shock absorption, so the growth plate is not knocked around as much). The use of an ice pack after activity for 20mins is often useful for calcaneal apophysitis, this should be repeated 2 to 3 times a day. As a pronated foot is common in children with this problem, a discussion regarding the use of long term foot orthotics may be important. If the symptoms are bad enough and are not responding to these measures, medication to help with inflammation may be needed. In some cases the lower limb may need to be put in a cast for 2-6 weeks to give it a good chance to heal.
Exercise
Stretching exercises can help. It is important that your child performs exercises to stretch the hamstring and calf muscles, and the tendons on the back of the leg. The child should do these stretches 2 or 3 times a day. Each stretch should be held for about 20 seconds. Both legs should be stretched, even if the pain is only in 1 heel. Your child also needs to do exercises to strengthen the muscles on the front of the shin. To do this, your child should sit on the floor, keeping his or her hurt leg straight. One end of a bungee cord or piece of rubber tubing is hooked around a table leg. The other end is hitched around the child's toes. The child then scoots back just far enough to stretch the cord. Next, the child slowly bends the foot toward his or her body. When the child cannot bend the foot any closer, he or she slowly points the foot in the opposite direction (toward the table). This exercise (15 repetitions of "foot curling") should be done about 3 times. The child should do this exercise routine a few times daily.
Achilles Rupture Facts Not Popular Misconceptions
Overview
The largest tendon in the body, the Achilles tendon is a cord connecting the calf muscles to the heel bone. Also called the ?cord of Achilles,? the tendon gets its name from the hero of Greek myth. According to legend, Achilles was invulnerable everywhere but his heel, where a poisoned arrow eventually felled him. Because the blood supply to the Achilles tendon lessens with age, the tendon becomes vulnerable to inflammation and rupture, a fact which makes it a true ?Achilles heel? for many older patients. Achilles tendon injuries are also common among athletes and those who engage in more physically demanding activity.
Causes
A rupture occurs when a patient overstretches the Achilles tendon, an act which causes it to tear partially or completely. Achilles tendon ruptures can occur during athletic play or any time the tendon is stretched in an unexpected way.
Symptoms
If you rupture your Achilles tendon, you may hear a snapping or popping sound when it happens. You will feel a sudden and sharp pain in your heel or calf (lower leg). It might feel like you have been kicked or hit in the back of your leg. You may also have swelling in your calf. be unable to put your full weight on your ankle, be unable to stand on tiptoe, or climb stairs, have bruising around the area. If you have any of these symptoms and believe you have ruptured your Achilles tendon, go straight to accident and emergency at your local hospital. If you partially rupture your Achilles tendon, the tear may only be small. Symptoms of pain and stiffness may come on quite suddenly like a complete rupture, but may settle over a few days.
Diagnosis
A detailed history, and examination by an appropriately qualified health professional, will allow a diagnosis to be made. An ultrasound or MRI scan can confirm the diagnosis. Other causes of symptoms in the area, such as those referred from the lumbar spine and local infection, should be excluded.
Non Surgical Treatment
There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such as infection. There is a risk the tendon can heal too long and more slowly. 
Surgical Treatment
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient?s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weight bearing. Complications such as incision-healing difficulties re-rupture of the tendon, or nerve pain can arise after surgery.
Functional Leg-Length Discrepancy Pads
Overview
Surgeries to lengthen a leg are generally only performed when there is a difference in leg length of greater than four centimeters. These types of surgeries can be more difficult and have more complications, such as infections, delayed healing, dislocations, and high blood pressure. In a several step process, bone lengthening surgeries involve cutting a bone in two in order to allow new bone growth to occur. After the bone is cut, a special apparatus is worn with pins that will pull the bone apart at approximately one millimeter per day. This causes osteogenesis, or new bone growth, in between the cut bone segments. A cast or brace may be required for several months after surgery to allow the new bone growth to harden and provide extra support..jpg)
Causes
The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.
Symptoms
Faulty feet and ankle structure profoundly affect leg length and pelvic positioning. The most common asymmetrical foot position is the pronated foot. Sensory receptors embedded on the bottom of the foot alert the brain to the slightest weight shift. Since the brain is always trying to maintain pelvic balance, when presented with a long left leg, it attempts to adapt to the altered weight shift by dropping the left medial arch (shortening the long leg) and supinating the right arch to lengthen the short leg.1 Left unchecked, excessive foot pronation will internally rotate the left lower extremity, causing excessive strain to the lateral meniscus and medial collateral knee ligaments. Conversely, excessive supination tends to externally rotate the leg and thigh, creating opposite knee, hip and pelvic distortions.
Diagnosis
The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.
Non Surgical Treatment
In some circumstances, the physician will recommend a non-surgical form of treatment. Non-surgical treatments include orthotics and prosthetics. Orthotics are a special type of lift placed in or on a shoe that can be used in the treatment of leg length discrepancies between two and six centimeters. In pediatric patients who have large discrepancies and are not good candidates for other treatment forms, prosthetics can be helpful.
Surgical Treatment
Epiphysiodesis is a surgical option designed to slow down the growth of the long leg over a period of months to years. It is only used in growing children. The operation involves a general anaesthetic. Small incisions are made around the knee near the growth plates of the thigh bone and the shin bone. The growth plates are prevented from growing by the use of small screws and plates (?8 - plates?). The screws are buried beneath the skin and are not visible. Stitches are buried beneath the skin and do not need to be removed. The child is normally in hospital for 2-3 days. The child can weight bear immediately and return back to normal activity within a few weeks. Long term follow up is required to monitor the effects of the surgery. The timing of the surgery is based on the amount of growth predicted for the child. Therefore, this procedure can under- and over-correct the difference in leg length. Occasionally the screws have to be removed to allow growth to continue. This procedure can be used on one half of the growth plate to correct deformity in a limb e.g. knock-knees or bow legs. This is known as hemiepiphysiodesis.
Surgeries to lengthen a leg are generally only performed when there is a difference in leg length of greater than four centimeters. These types of surgeries can be more difficult and have more complications, such as infections, delayed healing, dislocations, and high blood pressure. In a several step process, bone lengthening surgeries involve cutting a bone in two in order to allow new bone growth to occur. After the bone is cut, a special apparatus is worn with pins that will pull the bone apart at approximately one millimeter per day. This causes osteogenesis, or new bone growth, in between the cut bone segments. A cast or brace may be required for several months after surgery to allow the new bone growth to harden and provide extra support.
Causes
The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.
Symptoms
Faulty feet and ankle structure profoundly affect leg length and pelvic positioning. The most common asymmetrical foot position is the pronated foot. Sensory receptors embedded on the bottom of the foot alert the brain to the slightest weight shift. Since the brain is always trying to maintain pelvic balance, when presented with a long left leg, it attempts to adapt to the altered weight shift by dropping the left medial arch (shortening the long leg) and supinating the right arch to lengthen the short leg.1 Left unchecked, excessive foot pronation will internally rotate the left lower extremity, causing excessive strain to the lateral meniscus and medial collateral knee ligaments. Conversely, excessive supination tends to externally rotate the leg and thigh, creating opposite knee, hip and pelvic distortions.
Diagnosis
The only way to decipher between anatomical and functional leg length inequalities (you can have both) is by a physical measurement and series of biomechanical tests. It is actually a simple process and gets to the true cause of some runner?s chronic foot, knee, hip and back pain. After the muscles are tested and the legs are measured it may be necessary to get a special X-ray that measures both of your thighs (Femurs) and legs (Tibias). The X-ray is read by a medical radiologist who provides a report of the actual difference down to the micrometer leaving zero room for error. Once the difference in leg length is known, the solution becomes clear.
Non Surgical Treatment
In some circumstances, the physician will recommend a non-surgical form of treatment. Non-surgical treatments include orthotics and prosthetics. Orthotics are a special type of lift placed in or on a shoe that can be used in the treatment of leg length discrepancies between two and six centimeters. In pediatric patients who have large discrepancies and are not good candidates for other treatment forms, prosthetics can be helpful.
Surgical Treatment
Epiphysiodesis is a surgical option designed to slow down the growth of the long leg over a period of months to years. It is only used in growing children. The operation involves a general anaesthetic. Small incisions are made around the knee near the growth plates of the thigh bone and the shin bone. The growth plates are prevented from growing by the use of small screws and plates (?8 - plates?). The screws are buried beneath the skin and are not visible. Stitches are buried beneath the skin and do not need to be removed. The child is normally in hospital for 2-3 days. The child can weight bear immediately and return back to normal activity within a few weeks. Long term follow up is required to monitor the effects of the surgery. The timing of the surgery is based on the amount of growth predicted for the child. Therefore, this procedure can under- and over-correct the difference in leg length. Occasionally the screws have to be removed to allow growth to continue. This procedure can be used on one half of the growth plate to correct deformity in a limb e.g. knock-knees or bow legs. This is known as hemiepiphysiodesis.
Will Posterior Tibial Tendon Dysfunction Always Need To Have Surgery Teatment ?
Overview
A painful flat foot, or adult acquired flatfoot deformity, is a progressive collapsing of the arch of the foot that occurs as the posterior tibial tendon becomes insufficient due to various factors. Early stages may present with only pain along the posterior tibial tendon whereas advanced deformity usually results in arthritis and rigidity of the rearfoot and ankle. 
Causes
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle. Symptoms, which may occur in some persons with flexible flatfoot, include. Pain in the heel, arch, ankle, or along the outside of the foot. ?Turned-in? ankle. Pain associated with a shin splint. General weakness / fatigue in the foot or leg.
Diagnosis
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured, you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an initial diagnosis.
Non surgical Treatment
Flatfoot can be treated with a variety of methods, including modified shoes, orthotic devices, a brace or cast, anti-inflammatory medications or limited steroid injections, rest, ice, and physical therapy. In severe cases, surgery may be necessary. 
Surgical Treatment
If conservative treatments don?t work, your doctor may recommend surgery. Several procedures can be used to treat posterior tibial tendon dysfunction; often more than one procedure is performed at the same time. Your doctor will recommend a specific course of treatment based on your individual case. Surgical options include. Tenosynovectomy. In this procedure, the surgeon will clean away (debride) and remove (excise) any inflamed tissue surrounding the tendon. Osteotomy. This procedure changes the alignment of the heel bone (calcaneus). The surgeon may sometimes have to remove a portion of the bone. Tendon transfer: This procedure uses some fibers from another tendon (the flexor digitorum longus, which helps bend the toes) to repair the damaged posterior tibial tendon. Lateral column lengthening, In this procedure, the surgeon places a small wedge-shaped piece of bone into the outside of the calcaneus. This helps realign the bones and recreates the arch. Arthrodesis. This procedure welds (fuses) one or more bones together, eliminating movement in the joint. This stabilizes the hindfoot and prevents the condition from progressing further.
Acquired Flat Foot Syndrome
Overview Have you noticed the arch in your foot collapse over a fairly short period of time as an adult? Or Do you suffer from pain on the inside and sole of your arch? If it does, then you may be suffering from a condition known as adult acquired flat foot. As one of the main support structures of the foot?s arch, the tibilais posterior tendon, along with other muscles, tendons and ligaments, play a very important role in its mechanical function. 
Causes Adult flatfoot typically occurs very gradually. If often develops in an obese person who already has somewhat flat feet. As the person ages, the tendons and ligaments that support the foot begin to lose their strength and elasticity. Symptoms Symptoms are minor and may go unnoticed, Pain dominates, rather than deformity. Minor swelling may be visible along the course of the tendon. Pain and swelling along the course of the tendon. Visible decrease in arch height. Aduction of the forefoot on rearfoot. Subluxed tali and navicular joints. Deformation at this point is still flexible. Considerable deformity and weakness. Significant pain. Arthritic changes in the tarsal joints. Deformation at this point is rigid. Diagnosis The diagnosis of tibialis posterior dysfunction is essentially clinical. However, plain radiographs of the foot and ankle are useful for assessing the degree of deformity and to confirm the presence or absence of degenerative changes in the subtalar and ankle articulations. The radiographs are also useful to exclude other causes of an acquired flatfoot deformity. The most useful radiographs are bilateral anteroposterior and lateral radiographs of the foot and a mortise (true anteroposterior) view of the ankle. All radiographs should be done with the patient standing. In most cases we see no role for magnetic resonance imaging or ultrasonography, as the diagnosis can be made clinically. Non surgical Treatment The following is a summary of conservative treatments for acquired flatfoot. Stage 1, NSAIDs and short-leg walking cast or walker boot for 6-8 weeks; full-length semirigid custom molded orthosis, physical therapy. Stage 2, UCBL orthosis or short articulated ankle orthosis. Stage 3, Molded AFO, double-upright brace, or patellar tendon-bearing brace. Stage 4, Molded AFO, double-upright brace, or patellar tendon-bearing brace. 
Surgical Treatment In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.
