Flat Feet

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

During childhood, usually between the ages of 3 and 10, we develop a space (arch) on the inner side of our feet where the bottom of the foot is off the ground. People with a low arch or who have no arch are classified as having flat feet, sometimes referred to as having "fallen arches".

Causes

Flat feet can run in families, and both feet are usually affected. Occasionally, flat feet are due to a problem in the way the foot forms in the womb, in this situation, the feet are stiff and flat and the problem is usually noticeable during childhood.

Another form of the problem is when the foot has a tendency to roll inwards too much while standing or walking. This can be due to weak ligaments in the heel joint or at the base of the big toe. "Pronation" or "over-pronated foot" is a term for excessive rolling of the feet. 

While over-pronated feet usually develop in childhood it can sometimes develop in adulthood. Flat feet may develop due to a ruptured tendon (which is rare), tear of the spring ligament (also rare), arthritis, nerve damage due to diabetes, or injury which leads to stiffness and distortion of the joints of the feet. Conditions of the nervous system or muscles including cerebral palsy, spina bifida or muscular dystrophy can cause flat feet as they can cause muscle weakness or lack of movement in the muscles. These conditions lead to the feet becoming stiff which get worse as the condition develops. Other contributing factors can include shoes which limit toe movement such as high heels (walking barefoot may have a protective effect). Tight achilles tendon or calf muscles can also make a person more prone to flat feet. Obesity also can contribute to flat feet.

 When is treatment needed?

Most flat feet do not cause any problem so no treatment is needed. Reasons to look for treatment include pain (not eased by any type of foot wear). Pain from flat feet can occur in a number of areas including inside the ankle, at arch of the foot, the outer-side of the foot, calf, knee, hip or back. Other reasons for seeking treatment include wearing out shoes quickly, feet appear to be getting flatter, feet tire easily, swelling on the inside bottom of feet, feet are stiff and lack of feeling in the feet or weakness.

 Treatment

No treatment is required if flat feet do not cause problems. Well-fitted shoes, especially extra-broad fitting types of shoes can help. For people suffering from over-pronated feet, a special insole, which prevents feet rolling over too much, can ease the problems. These specialised insoles can be advised on by a chiropodist or a physiotherapist. These insoles are also called orthotics and are available in pharmacies. A more permanent solution is a customized orthotic, whereby an orthotic is specifically designed for your foot. Measurements for this type of insole are taken, by your chartered physiotherapist, from a plaster cast of your foot or by stepping into a foam box. These are then sent on to a lab where the custom insole will be created.

 If pain occurs, rest, ice and over-the-counter non-steroidal anti-inflammatories, or NSAIDS (eg. ibuprofen) can give temporary relief. Children with an abnormal foot that has not developed properly may require an operation to straighten the foot or to separate bones that have fused. Luckily operations are rarely needed as these are rare causes of flat feet in children. Other actions that can help include wearing footwear with lower heels and wide toes, losing weight if appropriate and doing appropriate exercises that strengthen muscles in the feet which can include walking barefoot, exercises called toe curls (flexing the toes) and heel raises (standing on tiptoes).

Heel cord stretching exercises

These stretch and lengthen the achilles tendon and posterior calf muscles. Your physiotherapist is best for advising on appropriate exercises.

How to do:

Stand facing a wall with your hands on the wall at about eye level. Put the leg needing stretching about a step behind the other leg. Keeping the back heel on the floor, bend the front knee until you can feel a stretch in the back leg. Hold the stretch for 15 to 30 seconds. Repeat 2 to 4 times. You should aim to do this exercise 3 to 4 times a day.

Physiotherapy

Whelehans physiotherapy service is with Chartered Physiotherapist Sinead Brogan. Reduced rates for over 60’s and affiliated sport clubs. Book a physiotherapy appointment by calling Sinead at 083 1722171. Sinead can also treat flat feet. Physiotherapists can perform a detailed investigation to assess foot and lower limb function. Specific patient related treatment can then be implemented to accurately treat and manage health and exercise issues pertaining to this condition. This exercise program addresses identified muscle weaknesses and imbalances and is often sufficient to alleviate pain and restore normal function. If the exercise regime or temporary insole or orthotic is not sufficient to relieve the problem, Sinead can measure you for a more permanent customized orthotic (as described above). Our Chiropodist James Pedley can also advise on flat feet in adults and children; to book his clinic for adults or children call 04493 34591 and he also has reduced rates for over 60’s.

This article is shortened for this health blog. More detailed information and leaflets is available in Whelehans or www.whelehans.ie

Osteoarthritis

Osteoarthritis is by far the most common form of arthritis. Unlike rheumatoid arthritis which is caused by inflammation, osteoarthritis is caused by long-term wear-and-tear in the joints. After years of use, the cartilage that cushions the joints can break down, until bone rubs against bone. Osteoarthritis is rarely as crippling as rheumatoid arthritis, but it can have a big impact on a person's life. It can make it hard to do every day activities like getting dressed and walking up the stairs. It most commonly affects the knees, hands, hips and spine. It does not affect both sides equally and symmetrically as commonly as rheumatoid arthritis. Osteoarthritis is the cause of knee pain in over half of people over 55. It is not to be confused with osteoporosis which is “brittle bone disease” and not related to osteoarthritis.

 Who is affected?

Osteoarthritis is the number one reason for joint-replacement surgery.  It can take decades for enough cartilage to wear down to cause osteoarthritis. It occurs mostly in men after the age of 50 and in women after the age of 40. After menopause, women are twice as likely as men of the same age to develop the condition. Being overweight and a family history of arthritis makes you more prone to the condition. However, it has less of a tendency to run in families than rheumatoid arthritis. Playing a lot of high impact sport (eg. Gaelic football and rugby) and having an injury or an operation on a joint can make you more likely to have problems later on.

Symptoms

The main symptoms of osteoarthritis are pain and stiffness of the joints. The joints may also become swollen although this is less common than in rheumatoid arthritis. Unlike rheumatoid arthritis, where pain and stiffness tends to be worse in the morning, the pain of osteoarthritis tends to get worse throughout the day. The joints may not be able to move as easily as before. There may be a crunching feeling in the joints. Joints may make creaking sounds called crepitations. Joints may become misshapen and knobbly, and they may become unstable (but generally not as severe as with rheumatoid arthritis).

Diagnosis             

Unlike other forms of arthritis, there is no single test that can check for osteoarthritis. Outgrowths, swelling, creaking, instability and reduced movement of the joint can be signs. X-rays only give limited information and in the early stages of osteoarthritis, joints may look normal.

Treatment

Certain actions can prevent and reduce the symptoms of osteoarthritis including losing any excess weight, wearing shock-absorbent shoes, using a walking stick and wearing a knee brace. Taking regular exercise is important as it keeps weight down and strengthens muscles which support the joints.

Medicines

There is no cure for osteoarthritis however certain medication will relieve symptoms.

Paracetamol- Over-the-counter painkillers such as paracetamol can help. Paracetamol is safe for most patients once taken within the recommended dosage limits.

NSAIDs- If the pain is more severe, the doctor may prescribe anti-inflammatory medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammation. These are helpful in reducing pain, swelling and stiffness. Examples include diclofenic (Difene^®, Diclac^®), naproxen (Naprosyn^®) or etoricoxib (Arcoxia^®). Ibuprofen is an NSAID available over the counter in pharmacies. NSAIDs should be avoided or used in caution with asthma and heart problems and can cause stomach ulcers if over used.

Topical preparations- Many NSAIDs are available in topical forms such as creams or gels which can be rubbed on to give a local effect (eg) Difene Gel^®, Fastum Gel^®. These topical forms have fewer side effects than NSAIDs taken orally. However they are likely to be less effective as less of the drug is absorbed.

Opioid Analgesics- Opioid analgesics such as tramadol are prescription only painkiller which may be considered in cases where NSAIDs are not tolerated or ineffective. However, opioids can become additive. Side effects include drowsiness, nausea and constipation.

Steroid Injections- Steroid injections into the affected joints may be a treatment option. It should only be considered where there is inflammation in the joint. However, the effects of steroid injections only last up to four weeks (often only a week) so it is not a long term solution.

Surgery

Surgery should only be considered when all other options have been tried. Surgical options available have advanced recently. Some options such as realignment and hip resurfacing are available even if you have only mild osteoarthritis. Hip resurfacing is an alternate to hip replacement and is more often used in younger patients.

It involves replacing the socket where the top of leg attaches to the pelvis with a “metal socket”. The advantages of this compared to hip replacement is that it is very durable for young and active patients. It allows the patient to maintain full mobility and even return to active sports in many cases. Some research shows that there is less pain and stiffness after hip resurfacing compared to hip replacement. However more research is needed to confirm this. Patients normally can resume normal daily activities a few weeks after hip resurfacing. Hip resurfacing lasts for 10 to 15 years on average.

If you have a particularly painful joint you may need an operation to replace it. This is most commonly done for the hip and knee joints and both of these have high rates of success in improving mobility and reducing pain. With proper selection of patients, 95% of hip and knee replacements have excellent results with 95% of replacement joints lasting 15 years. 85% of hip and knee replacements are due to osteoarthritis.

Whelehan’s physiotherapy service

Whelehans physiotherapy service is available on Wednesdays and on Saturday mornings. Book a physiotherapist appointment by calling Sinead at 083 1722171.

 Osteoarthritis information event

Whelehans Pharmacy in conjunction with the Westmeath Branch of the Arthritis Ireland are hosting an Osteoarthritis Information evening on Wednesday November 20^th in the Annebrook Hotel, Mullingar at 7:30pm. The guest speaker for the evening is orthopaedic surgeon from Midland Hospital Tullamore, Eoin C Sheehan, MD FRCS (Ortho). Book your free place by calling Whelehans at 044 93 34591.

 This article is shortened to fit within this Health Blog. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie