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Foot Collapse
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Foot Collapse

For years my left foot has been flexible and flat. I wore prescription orthotics for several years, but stopped a couple years back. Now, the same foot practically collapsed inwardly, such that I have no push-off. Both calves and my left hip/thigh are painful, as is my lumbar spine. I recently had a emg/ncv (nerve tests), which were normal. I got new prescription orthotics a couple months back, but symptoms continue. My foot feels like it still is not being supported at the arch. Any suggestions?
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Avatar_n_tn
Hi,
How are you feeling now?
What was the orthotics you used to use before? Is the new orthotics some as what you used to use before or are they different? Do you feel the old orthotics were better able to handle your arch than the new one? Has the doctor prescribed any new custom made insoles for you?
I think the pain is due to some nerve irritation along the course of nerve distribution.
Nerve Root Pain - nerve root pinching / irritation / compression / trapping is always associated with signs of nerve dysfunction (not working properly) such as pain, tingling, numbness, and weakness. The causes of the irritation are: - within the spine Annular Tear (small disc tear), Disc Prolapse (herniation), Spinal Stenosis (narrowing of the internal diameter of the spinal canal) among others. Spinal Nerve Root Pain (Radiculopathy) can arise when nerves become pinched or trapped within the bony spinal canal or vertebral column:-
L4 to S1 nerves in the lower back cause Sciatica in the hips and leg.
EMG/NCV could be normal.
Are you on pain meds?
I think you should consult a pain medicine specialist and physiotherapist for your current problem.
Hope this helps.
Bye.
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Avatar_n_tn
They sent me for a lumbar MRI which showed mild diffuse disc bulge with small herniation at L1-L2 and mild diffuse disc bulge at L4-L5. The Dr. doesn't think that the disc bulge is causing the arch problem. He also said no operation is needed. I noticed that when the arch collapses (with every step), I must contract my entire leg (especially calf) just to be able to walk, which is exacerbating the thigh pain. The arch is like totally collapsed even standing (if I have weight on it). He gave me meds, which don't really help that much. The orthotics that I have now seem to be of a higher quality than before, but my condition and ability to walk is deteriorating. At this point, I don't know if my foot is causing the back pain or vice-versa or whether it is two unrelated things. I do know that it is getting very difficult to walk. I go back the podiatrist tomorrow for evaluation on the orthotics. Frustrating. Neuro says no problem, spine specialist says no surgery, podiatrist said wear these orthotics. The spine guy just gave me the name of a pain specialist.  
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Avatar_n_tn
Hi Staley,
Flatfoot, is a deformity of the foot in which the normal medial longitudinal arch of the foot has been lost. What type of flat foot have you been diagnosed with? Is it a rigid or flexible variety?
I think it is flexible flatfoot for you (as per your description), which lacks an arch only when patient is weight bearing, not when non weight bearing or toe-standing.
Since when are you having this flat foot deformity as you have mentioned in your earlier post that you wore prescription orthotics for several years? Do several years suggest that you have been wearing it from birth? Does this also suggest that your deformity is a congenital one and not acquired one? Does any other family member have similar deformity?
I was curious as the causes for acquired deformity is different from congenital deformity.
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Avatar_n_tn
The podiatrist, who I saw again today, says he believes it to be a weak posterior tibial tendon. I don't know if it is rigid or flexible, but there is not much of an arch on either foot without weight, and with weight there is a total collapse.  I can recall in my late teens my mom telling me to stop turning my left ankle inward.  I told her I wasn't doing anything intentional. Prior to that, when I was 15, I jumped up to catch a ball and landed on the outside of my left foot, breaking the fifth metatarsal. After posterior splint/crutches for 2 or 3 weeks, it never felt the same. Maybe I was favoring the right side of my left foot, I don't know. Anyway, I wore prescription orthotics in beginning in about 1992. Around 2004, I stopped wearing them and went with an over the counter type. Since it was getting worse, I got the prescription ones that I now have. The podiatrist put a wedge under the heel portion today. Still lack of push off, almost a toe drag, but there is no foot drop and I can walk on my heels and toes without difficulty. Other family members are normal (at least their feet). Btw, I am in my early forties. He wants me to see neuro and if all checks out, my recommend surgery on foot/ankle.
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Avatar_n_tn
In the last line, I meant "may" not "my". Sorry.
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Avatar_n_tn
Hi Staley,
Lot of your post suggests that it is not congenital, it is an acquired one. First is that no family member is affected and they are fine. It was around your teens when the problem actually started. You said it right that it might be you r weak posterior tibial tendon (PTT).
PTT deficiency is the most common cause of acquired flatfoot in adults, although its precise incidence is not known.
Do you have hypertension? Are you been tested for Diabetes? Did you suffer trauma to your foot any time?
The risk factors for acquired flexible flatfoot secondary to PTT synovitis or rupture are Hypertension, diabetes, and a history of trauma.
There are lots of other conditions which can lead to flat foot.
Other conditions that can lead to flatfoot are:
Tight Achilles tendon, Neurologic diseases (e.g., poliomyelitis, spina bifida, myelodysplasia, NF, stroke), Osteoarthritis, posttraumatic arthritis, or inflammatory arthritis.
Charcot arthropathy secondary to diabetes or other peripheral neuropathy is also a cause for acquired deformity.
The doctor is right in thinking and right in sending a referral for neurologist to rule out any pathological disorder.
What management has the doctor planned for you? Is he considering surgery for you? If yes, what type surgery is he planning? What is the risk factor involved in doing surgery?
Keep me informed about your visit to neurologist. If he wants some test to be done like NCV/EMG, it is always prudent to get it done before thinking of major intervention like surgery.
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Avatar_n_tn
I don't seem to have hypertension, blood pressure is normal. A fasting blood test taken during my physical in the summer came back at 104 mg/dl with an A1C of 6%.  The nurse said it wouldn't be considered diabetes or pre-diabetes.  To rule out inflammatory processes, i just had blood tests (sed rate c-reactive protein, ana, rf, etc.) which were all normal. I'd probably know if I had had stroke, right? Otherwise, I don't think that I have any of the other neuros you mentioned.  As far as prior ankle trauma, I severely sprained it in my early 20s while jumping over a split rail fence while on vacation (showing off). The podiatrist, said surgery would be a last resort and that if the nerve is damaged, then it wouldn't help anyway. Like I said before, a prior emg/ncv was normal, and i remain confused as to whether my lumbar pain (burning/pain) is causing the foot problem or vice-versa. as for the last resort of surgery, he said something about suring up the tibial tendon, lengthening the achilles, and building up something in the foot, with a 2 1/2 month no weight bearing recovery. he said he has done a bunch of them.
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Avatar_n_tn
HI Staley.
Your doctor sounds pretty confident about, what he wants to operate. His line of management appears to clear.
EMG/NCV prior to surgery would be required to understand the neuromuscular state.
Good that most of the tests are already been done, but if any of them are few months old, then they need to be repeated.
His line of management is similar to ones which are practiced worldwide like for Flatfoot secondary to a tight Achilles tendon:
Tendon lengthening to be done which involves a Z-lengthening procedure or partial sectioning of the tendon and for acquired flatfoot secondary to PTT synovitis:
In early stages of the disease, synovectomy may be sufficient.
Patient monitoring is of prime importance post-surgery.
Patients should be followed at 3-month intervals to monitor their discomfort and function and to check whether their deformity is stable or progressive.
Keep me informed about when is the surgery planned.
Happy Holidays to you.
Bye.
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