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Tuesday, October 17, 2017

Painful Flat Feet: Email Advice

Thanks so much for your blog--I've learned a lot.

I'm a 60-year-old, 5' 8" guy.  I have had overpronation and "flattish" feet--if not exactly flat feet--all my life. Both my feet have problems, the right foot being worse.  (My right leg is a little longer and the right foot is more overpronated than the left.)  I have tried orthotics, but the only one that I liked is the "Dr Roberts Orthotics," which was discontinued 25 years ago.  (It corrected the overpronation by re-aligning the gait by putting pressure just behind the arch on the outside of the foot.)  If I had been able to wear these orthotics for the past 15 years, I might not be having these foot problems.

Seven years ago, I went for a series of day-long hikes and injured my feet.  I weighed 250 pounds back then; I'm under 220 now. Both my ankles were swollen at the end of the day.  

Now, seven years later, my right foot still hurts after I start walking a bit.  The throbbing pain is below the ankle on the inside and across the flat of the foot.  At first, an orthopedist thought that I had partially torn the post tibial tendon. He gave me a diagnosis of PTTD/flatfoot and thought that surgery would be required.  But the MRI shows that the tendon is "intact."   There is "mild tenosynovitis" of that tendon and others, as well as some beginning arthritis in the foot.   I'm attaching the radiologist's report and the X-rays in the following email.

My left foot isn't as bad but has pain in the ball of the foot. I suppose it could be the post-tib tendon here too.  I don't have any imaging of this foot.

Walking is one of my favorite activities, but long walks are no longer possible with the pain I experience from both feet.  I have tried physical therapy at a local place but didn't gain much benefit from that.  I also tried three rounds of shock-wave therapy for the sore tendon (in Canada) but didn't notice any improvement.  In addition to a few physical therapists, I have also seen: one podiatrist, a chiropractor, an acupuncturist, a chiropodist (in Canada) and a naturopath for my feet.  (The only thing that really helped me was a supplement from the naturopath, Ligaplex II by Standard Process.  This contains VERY high amounts of manganese, so I'm not sure how suitable it would be for general use.)  

From reading your blog, it seems that I need better orthotics and appropriate physical therapy to strengthen the tendon.  I'm in the Raleigh-Durham area of North Carolina and am not sure where to turn.  It's not difficult for me to get orthotics made (again) or find a physical therapist (again), but it's hard for me to know whether I chose the right people.  Is it possible that you know someone in my area who could help me?  Or perhaps it would be better to get the proper orthotics and do the tendon strengthening exercises that you've posted about?


Dr Blake's comment: Thank you so very much for emailing. Please first look for Dr Doug Milch in the North Carolina area. Also, contact the Root Functional Orthotic Laboratory and Richey and Company and see if these labs can give you recommendations of places and doctors that will design the Inverted Orthotic Technique for flat feet. 
     You have to make your feet better for the next 30 year stretch of life. That program should include foot strengthening, orthotics, taping at times, soft tissue work, flexibility work, and stable shoes when your activity demands. This is the program you need to work on the next year. The MRI and X-rays show nothing that serious, although minor things can be a bigger problem at times. Good luck. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.