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?

Thanks!

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

Flat Feet with Marked Heel Eversion: Inverted Technique

This patient has pronated flat feet with marked eversion of the heels. The Inverted Orthotic Technique will be utilized to attempt to place the heel bisection line close to vertical. You can measure the angle, and use a 5 degree cast correction for 1 degree of foot correction ratio. If the line is over 7 degrees everted, I stop at 35 degrees to get the patient used to this amount of support. A good starting point. 

Inverted Technique for Flat Foot Children

Hello Dr.

my daughter has severe overpronation and has been using a sole with your inverted technique for 2 and a half years and she has improved a lot.

her feet is bigger now and need a new sole.

I read somewhere in your blog 3 years ago you have a very good friend in fort Lauderdale fl.

I would like to take my daughter to see someone that know very well your technique, could you please provide his clinic phone number, address and web page, is any? please.

he probably can do a good assessment of my daughter, because the dr in Miami just took her cast and that's it.

in case you know another Dr.  in Miami that know very well your technique please let me know also.

thank you very much for your work and dedication, its really  making a very good difference in my daughter.

regards,

Dr Blake's response:

Pronation noted in the back of the heel of the right foot. Ruler denoting vertical, and the heel bisection line shows marked eversion which flattens the arch.

This same right heel in the Inverted Technique attempting to center the heel. 

http://www.aapsm.org/members-south.html

Mari, above is the members in Florida of the AAPSM. I looked at the list and 5 names popped up. They are not in any order:

Matthew Werd

James Losito

Russell Rowan

Brian Fullem

Joseph Agostinelli

You would have to call their offices and inquire. 

You can also get the names of who uses the Inverted Technique alot by calling the 4 Labs I know use it alot:

Root Functional Orthotic Laboratory

http://www.root-lab.com/

Richey and Company

http://www.richeylab.com/

Allied OSI Lab

http://www.aolabs.com/

ProLab USA

http://www.prolaborthotics.com/

The labs would have the doctors names in your area. Please let me know what you found out and thank you for your kind words. I am very happy to hear that the technique is helping your daughter. Rich

Flat Feet and Obesity: Blog Post from Dr Lance Silverman

I hope this post is an eye opener for many. This has been common knowledge to many, but some scientific evidence is wonderful. Many podiatrists make orthotic devices for flat feet that can help with the development of some arches if caught early enough. Both my boys had flat feet and out grew the need for their orthotic devices as teenagers. In the early 1980's, I invented one such orthotic device technique called the Inverted Orthotic Technique or the Blake Inverted Orthosis. This blog has many references to that technique. The key is the recognition of the child that is flat footed and inactive. Children may not complain about their feet, but even at a young age, can ask to be carried too much, or not want to do the activities right for their age. Dr Rich Blake

New post on Silverman Ankle & Foot - Edina Orthopedic Surgeon

Obesity Linked To Flat Feet in Children by Lance Silverman, MD A new study out of King George's Medical University suggests that over 90 percent of overweight or obese children express symptoms of flat feet. The study based out of India examined nearly 400 children under the age of 12. 386 children were divided into two groups based on their body-mass index. Researchers uncovered that flat feet weren't isolated to children with elevated body mass indexes, but the condition was much more common in overweight children. "In kids with normal BMI, about 30 percent had flat foot," said Professor Ajai Singh, head of the pediatric orthopaedic department at King George's Medical University, who helped lead the study. "But in the abnormal BMI category, 90 percent of kids had flat foot." Grades of Flat Feet For the study, researchers broke down cases of flat feet into three different grades. The first grade involved an arch of the sole that was smaller than the normal height, while a second grade involved cases of flat feet where no arch was present. A grade three flat foot involved situations where the arch of the foot was reversed and the bottom of the foot was actually convex, bending outward slightly. "We found that 45 percent of kids had Grade 2 flat feet, while 43 percent had Grade 1 flat feet," said Professor Singh. "The remaining 12 percent belonged to Grade 3." Previous studies have uncovered a connection between obesity and flat-footedness, but they've also noted that the problem can be reversed if it is identified at an early stage in life. "In most of the cases, flat foot is reversible, while in the remaining, it is manageable," the authors wrote. "If kids come to us by the time they are five or six, we can help them with exercises and interventions like silica pads to be worn inside their shoes." So if you notice that your child has flat feet, or if the pediatrician has suggested that your child has an elevated BMI, consider some lifestyle interventions to help alleviate the condition. Help them get regular exercise and make an effort to provide them with healthy meals. A flat arch can put abnormal pressure on a person's foot, which can predispose them to other foot conditions. Like the authors said, take steps at an early stage to prevent it from becoming a bigger problem down the road. Lance Silverman, MD | November 16, 2016 at 1:29 am | Tags: flat feet in kids, flat feet obesity, flat footedness | URL: http://wp.me/p6p9tP-3aY

Flat Feet Got U Down: Read This Story on Running Legend Darryl Beardall

At 75, local running legend hardly slowing down
Santa Rosa Press Democrat
To run 300000 miles on flat feet? I'd have an easier time of it if you tried explaining a Bassett hound playing Angry Birds on my computer. Bewildered, I looked for some perspective. I went to Dr. Peter Redko of the North Bay Foot and Ankle Center.
See all stories on this topic »

Dr Blake's son's wedding in Kona Hawaii: See Steve and Clare Blake in the center

Can you pick out the flatfoot?

So many generalizations surround feet that just are not true from a medical prespective. The general rule that all patients with flatfeet have very weak feet is totally insane. Flat Feet can be strong, weak, or somewhere in between. Flatfeet can be very stable, and very unstable. Flatfeet can run marathons and not walk across the street comfortably. One of the fastest woman runners I ever treated had the flattest foot I had ever seen. The foot is too complex to use these general rules, but it did get a lot of people out of the military in World War II. The shape of the foot should not be used to generalize treatment programs or success in athletics since there are just as many exceptions to the rule as people who fit the rule. And some generalizations actually only apply to less than 30% of the population. Sorry. Treatments are started with general rules and it is up to the practitioner to see if the general rule actually applies in followup visits.