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Overview<br>A fallen arch or flatfoot is known medically as pes planus. The foot loses the gently curving arch on the inner side of the sole, just in front of the heel. If this arch is flattened only when standing and returns when the foot is lifted off the ground, the condition is called flexible pes planus or flexible flatfoot. If the arch disappears in both foot positions, standing and elevated, the condition is called rigid pes planus or rigid flatfoot.<br><br><br>Causes<br>Conditions that affect the nervous system (brain and spinal cord) can also cause the arches to fall. Over time, the muscles gradually become stiffer and weaker and lose their flexibility. Conditions where this can occur include cerebral palsy, spina bifida and muscular dystrophy. Adult-acquired flat feet often affect women over 40 years of age. It often goes undiagnosed and develops when the tendon that supports the foot arch gradually stretches over time. It's not fully understood what causes the tendon to become stretched, but some experts believe that [http://antoniocawley.myblog.de/ wearing high heels] and standing or walking for long periods may play a part. Obesity, high blood pressure (hypertension) and diabetes are all risk factors.<br><br>Symptoms<br>Repetitive exertive activity arch pain is usually sharp, and localized to a specific area, rather than the entire arch. Usually the pain occurs in the area just in front of the heel. It is present when first standing on the foot in the morning, but may decrease once you start walking around, but will, gradually becomes worse with continued walking or running. Swelling may be present. The pain subsides with rest, but stretching the arch while resting may cause the pain to return. Injury pain is constantly present, but worse when standing on the foot. This pain is localized to a specific area, but may radiate out from this area to the entire foot. The pain is sharp, and usually accompanied by swelling and occasionally "black and blue" discolorations. The pain due to the natural aging process is usually dull and aching, or stiff, and can be felt throughout the entire arch area, rather then in just one spot. This pain is present whenever weight bearing, and usually becomes worse with continued walking. The pain gradually subsides when resting, and usually does not return with stretching. Biomechanical defect pain is usually localized to a section of the arch, such as the inner, middle, outer, front, or back of the arch. This pain may be sharp or dull, but is always worse with continued walking.<br><br>Diagnosis<br>To come to a correct diagnosis, your podiatrist will examine your foot by using his or her fingers to look for a lump or stone bruise in the ball of your foot. He or she will examine your foot to look for deformities such as high or low arches, or to see if you have hammertoes. He or she may use x-rays, MRIs (magnetic resource imaging), and CT scans to rule out fractures and damage to ligaments, tendons, and other surrounding tissues. Your doctor will also inquire about your daily activities, symptoms, medical history, and family history. If you spend a lot of time running or jumping, you may be at a higher risk for pain in the bottom of your foot. These diagnostic tests will help your doctor come to a proper diagnosis and create an appropriate treatment plan.<br><br>Non Surgical Treatment<br>Treatment must be directed to supporting the individual bones and joints which make up the arch, and to aid the arch in its job as a shock absorber. This in turn alleviates the arch pain, and prevents the further collapse of the arch. This is accomplished through the use of either a high quality arch support or custom-made orthotics. These devices support not only the arch, but each individual bone and joint which makes up the arch; and because of the space-age materials used in their construction, allow the arch to become a much more efficient shock absorber. This not only relieves the arch pain, but also prevents it from returning, and keeps the arch from collapsing further.<br><br><br>Surgical Treatment<br>If you have pain that has not been responsive to other treatments, there is a new non-surgical treatment that was recently approved by the FDA. ESWT (extracorporeal shockwave therapy) uses strong electrohydraulic acoustic (sound) energy that triggers the body?s natural repair mechanism. This treatment method is safe, effective and requires a very short recovery period compared to older surgical techniques.<br><br><br>Prevention<br>The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise, walk a lot, or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Maintain a healthy weight. Stretch when you feel a tightening of the ligament that runs along the bottom of your foot. Stop impact sports when symptoms first occur.<br><br>Stretching Exercises<br>Start in an L-Sit position. (If you?re hips and hamstrings are tight sit up on a box or phone book to be able to achieve a tall back position. You can even sit on a box with your back supported against a wall!) Keeping the legs straight, but not locked, reach both heels out away from your body to ?Flex? the ankles. Try to avoid pulling back with the toes to flex. Keep the toes relaxed and lead from the heel to hinge the foot into the flexed position. Hold the flexed foot and breathe. Take 3-5 breaths and see if you can reach farther through the heel to deepen the flex on each exhale. To transition to the pointed position, begin by pointing the foot to move the ankles as far as possible in the other direction. Once the ankles have reached their endpoint, use the muscles along the sole of the foot to point the toes. Inhale to continue lengthening out through the top of the foot, exhale to deepen the contraction under the sole of the foot to point the toes. Take 3-5 breaths. Then release the toes, and begin reaching out through the heel to hinge the ankle into the flexed position to repeat the exercise. Continue to flex and the point for 5-10 repetitions.