New Clinical Practice Guideline Published to Treat Flat Feet in Adults

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New Clinical Practice Guideline Published to Treat Flat Feet in Adults

14 Mar 2005 Medical News Today

News From The 2005 Annual Scientific Conference of the American

College of Foot And Ankle Surgeons -

To help physicians and patients better understand ways to diagnose

and treat painful flatfoot conditions in adults, the American College

of Foot and Ankle Surgeons (ACFAS) today announced publication of a

new clinical practice guideline for this common foot problem.

According to a study noted in the ACFAS guideline, the incidence of

flatfoot is estimated at 5 percent of the U.S. population.

The new guideline was announced by ACFAS at its annual scientific

conference held here and attended by some 1,000 U.S. foot and ankle

surgeons.

Several oral presentations at the meeting covered diagnosis and

treatment of flatfoot conditions. An overriding concern is that

flatfoot can cause debilitating foot pain in adults and should be

diagnosed early and treated appropriately.

In one presentation, Kris DiNucci, DPM, FACFAS, an Omaha-based foot

and ankle surgeon, said that adult flatfoot often is a complex

disorder with diverse symptoms and varying degrees of deformity and

debilitation. " In adults, flat feet can be very painful and limit

one's ability to exercise and stay in good cardiovascular health, "

said DiNucci. " So the guidelines are intended to help clinicians

differentiate various types of flatfoot conditions and intercede

before the condition progresses to a serious, activity-limiting foot

problem. "

The adult flatfoot clinical practice guideline is published in the

March/April issue of the Journal of Foot & Ankle Surgery, and

provides diagnostic and treatment pathways to follow when evaluating

flatfoot patients.

In adults, DiNucci said flat feet occur from a partial or complete

collapse of the arch, hence the condition is commonly called " fallen

arches. "

It usually results from overstretching the tendon that supports the

arch or progression of an untreated childhood flatfoot

condition. " For many adults, flat feet cause nagging foot pain that

gets worse over time. It's tough to be active, shed excess pounds and

maintain a healthy lifestyle if your feet hurt constantly, " said

DiNucci.

Flexible flatfoot is the most common type in which the foot is flat

when standing and returns to a normal arch in non-weight-bearing

positions. In most cases, it develops in childhood. When medical

treatment is required for adults with flexible flatfoot, the new

ACFAS guideline recommends first-line therapy that may include

activity modifications or limitations, stretching exercises, custom

shoe orthotics and nonsteroidal anti-inflammatory medications. If the

patient's response to initial treatment is unsatisfactory, a variety

of surgical procedures can be considered to relieve pain and improve

foot function.

A less frequent but more serious type of flatfoot is called adult-

acquired flatfoot. It is caused most frequently by a disorder known

as posterior tibial tendon dysfunction (PTTD), in which the tendon

that supports the arch progressively weakens from overuse. PTTD can

lead to a rigid flatfoot condition in which the arch stays flat even

without weight pressure.

Adult-acquired flatfoot is common in women ages 45 to 65. As the

condition progresses, pain and tenderness in the arch are frequent

symptoms, as well as a noticeable flattened arch. When the deformity

is more severe, patients lose range of motion in the foot and ankle

and are unable to rise up on their toes at all or without pain. At

initial stages, the ACFAS guideline recommends that patients with

flatfoot caused by PTTD can be treated with custom shoe orthotics,

soft casts, walking boots, physical therapy and non- steroidal anti-

inflammatory medications.

When initial treatments fail to bring improvement, or if initial

improvement deteriorates, surgery may be considered. In cases where

the initial evaluation and treatment were provided by a primary care

physician, referral to a podiatric foot and ankle surgeon is strongly

recommended. For further information about adult flatfoot conditions

and to locate a foot and ankle surgeon in your area, visit

http://www.FootPhysicians.com.

American College of Foot and Ankle Surgeons

FootPhysicians.com