Dr. Usman Ansari

Excessive and persistent pain in the feet as well as the ankle joints could point at the existence of a condition known as flat foot pain. This happens due to the difference between a normal foot and a flat foot. While a normal foot will have an upward arch under the foot, right in the middle, the flat foot does not have such a support. This arch is usually formed by the tendons and ligaments that help in rendering support to the foot as well as stabilising the rest of the body. When these tendons and ligaments become weak, the arch begins to diminish before finally disappearing, which leaves the patient with a flat foot.

This can be a painful condition. Let us look at the ways in which it may be cured.

1. Foot Wear: When you are suffering from this condition, it is important to wear comfortable and supportive foot wear like shoes, sandals and slippers which can support the arch and help in giving stability to the rest of the body. Besides looking for shoes that will provide the right amount of comfort, one can also use additional support like insoles that will help in giving comfort while you are walking, standing or running.
2. Orthotics: These are tools that can be recommended by your doctor in order to help in minimising the pressure that one feels in the foot. The orthotics usually distributes this pressure by giving much needed additional support to the arch of the foot. These tools also help in realigning the foot’s ankle with its bones as well as the joints, which can help in successfully treating this condition to a great extent. They are usually customised as per your exact foot shape and size, as well as the problem you are facing, so that you have plenty of support when you are using your feet for varied activities.
3. Arch inserts and wraps: If your normal shoes are lacking the arch support that you require for flat feet, then you can also invest in arch inserts and wraps which will reduce the pain and prevent it from reoccurring. Also, these will help you to remain standing or walking for longer periods of time, as they add that extra bit of support to your feet for normal functioning.
4. Surgery: If the various non surgical treatments do not help you over a period of a few months, then it may be time to speak with your podiatrist or orthopaedic specialist so that you can go in for a surgery that will fix this problem. This kind of surgery will help in stabilising the feet and ankle bones by applying corrective foot support.

What is arthritis of the knee?

The knee acts as hinge joint and allows flexion (bending) and extension (straightening). The knee is formed by the tibiofemoral joints, where end of the femur (thigh bone) glides over the top of the tibia (shin bone) and the patellofemoral joint where the kneecap glides over the end part of the femur. The gliding surfaces of the knee are covered with articular cartilage which helps the joint to glide smoothly. Over time the articular cartilage can become damaged or 'worn away' and this is known as osteoarthritis.

What is medial compartment arthritis?

Most people with knee arthritis have predominantly pain in the inner aspect of the knee, which is due to medial compartment arthritis. Patients who are born with varus knees (bow legs) are more likely to get medial compartment osteoarthritis. This is because the weight of their body mainly passes through the medial compartment of the knee rather than spreading the load evenly between the whole gliding surface of the knee. 

How do you diagnose medial compartment arthritis?

ClinicaFeatures, examination findings and standing X-rays of the knee joint and the patello-femoral joint are needed to diagnose medial compartment arthritis. The X-ray will often show narrowing of the joint space in the medial compartment of the knee which suggest that a patient has medial compartment osteoarthritis. Long Leg standing X-ray of the whole of both of both legs from the hip joints to the ankle joints ( Fig 2), allows us to carefully examine the overall alignment of your legs. They help to calculate the weight bearing axis of your leg and find out where most of the force is passing through your knee joint. MRI would be done too, to assess degree of cartilage damage. It is imperative to know status of other structures in the knee like meniscus and ligaments.

Non-operative treatment

Some patients are advised for a type of knee brace known as a medial offloading brace to trial. To a certain extent this mimics the result of osteotomy surgery by pushing the leg into a more normal alignment and taking the pressure of the damaged medial compartment. This is usually only a temporary solution whilst waiting for surgery. Patients who are overweight often find their knee pain is significantly improved when they lose weight. Simple analgesia such as paracetamol together with etodolac can help with pain and sleep disturbance form the pain.

Who requires surgery?

People suffering from growing cartilage lesions resulting in pain and activity restriction with proved mechanical axis deviation as the cause, would benefit from surgery. Age and extent of cartilage wear determine the nature of surgery. Younger individuals with smaller lesions are good candidates for a joint preservation surgery in the form of a High Tibial Osteotomy. With advancing age and extent of disease, Arthroplasty would be a
more beneficial option.