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June 01 2015

boringdad2889

Does Overpronation Of The Foot Require Surgical Procedures

Overview

Over-pronation is very common and affects millions of Australians. To better understand this condition, we'll take a closer look at the 3 most common foot types. An estimated 70% of the population has fallen arches (or a low arch). Only 20% have a normal arch. And 10% have abnormal feet, in other words they either have flat feet or the opposite, a high arched foot. Most of us have a low arch. The foot actually appears quite normal and a clear (but low) arch is present under the foot, especially when sitting down. The situation changes with weight-bearing: when we get up the arch lowers. When we start walking the arches collapse and the ankles roll inwards. This is called over-pronation or fallen arches. Over-pronation is not the same as flat feet as often noted.Over Pronation

Causes

There may be several possible causes of over pronation. The condition may begin as early as birth. However, there are several more common explanations for the condition. First, wear and tear on the muscles throughout the foot, either from aging or repetitive strain, causes the muscles to weaken, thereby causing the foot to turn excessively inward. Also, standing or walking on high heels for an extended period of time also places strain and pressure on the foot which can weaken the tissue. Lastly, shoes play a very common factor in the development of over pronation. Shoes that fail to provide adequate support through the arch commonly lead to over pronation.

Symptoms

Symptoms can manifest in many different ways. Here is a list of some of the common conditions associated with over-pronation in children. Achilles Pain. Ankle pain. Arch Pain. Low back pain. Heel Pain. Knee Pain (Runner's knee and Chondromalecia of the patella) Osgood Schlatter Disease (pain below the knee) Shin Splints (pain in the front of the lower leg) Over-pronation does not necessarily mean your child has "flat feet." Even though children's arches may be relatively high when they lie down or sit, over-pronation may not be seen until your child is standing. A certain amount of pronation is normal. During normal walking or running ("gait cycle"), the heel strikes the ground and the foot rolls inward to absorb shock and adapt to the surface. This gait cycle is even more important if the running surface is uneven.

Diagnosis

Do the wet foot test. Get your feet wet and walk along a paved surface or sand and look at the footprints you leave. If you have neutral feet you will see a print of the heel with a thin strip connecting to your forefoot, but if you're overpronating your foot print will look a bit like a giant blob with toes.Over Pronation

Non Surgical Treatment

If pronation is diagnosed before the age of five it can usually be treated in such a manner that the bones and joints will be aligned properly as growth continues. This may prevent the arch from collapsing, as well as allowing the muscles of the leg to enter the foot without twisting. With proper and early treatment, the foot will not turn out at the ankle, and the child?s gait will improve. Treatment for pronation in children may include: night braces, custom-made orthotics, and exercises. These treatments usually continue until growth is complete, and then the adult may need to wear custom-made orthotics to prevent the pronation from returning (the foot, as every other part of our body, tends to return to its original form if preventive measures are not taken). One side note: frequently, pediatricians will wait too long, hoping that the child will ?outgrow? the problem. By the time they realize that the child?s feet will not improve, it is too late to change the foot. In these cases, custom-made orthotics is used to prevent the pronation from becoming worse.

Surgical Treatment

Hyperpronation can only be properly corrected by internally stabilizing the ankle bone on the hindfoot bones. Several options are available. Extra-Osseous TaloTarsal Stabilization (EOTTS) There are two types of EOTTS procedures. Both are minimally invasive with no cutting or screwing into bone, and therefore have relatively short recovery times. Both are fully reversible should complications arise, such as intolerance to the correction or prolonged pain. However, the risks/benefits and potential candidates vary. Subtalar Arthroereisis. An implant is pushed into the foot to block the excessive motion of the ankle bone. Generally only used in pediatric patients and in combination with other procedures, such as tendon lengthening. Reported removal rates vary from 38% - 100%, depending on manufacturer. HyProCure Implant. A stent is placed into a naturally occurring space between the ankle bone and the heel bone/midfoot bone. The stent realigns the surfaces of the bones, allowing normal joint function. Generally tolerated in both pediatric and adult patients, with or without adjunct soft tissue procedures. Reported removal rates, published in scientific journals vary from 1%-6%.

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