Case Study: Managing Severe, Painful Flat Feet (Ankle & Leg Pain)

MEET LISA

65-year-old active retiree

Lives on a rural QLD farm with her husband

Struggling to walk – excruciating pain at her left ankle

We first met Lisa in early 2019, when she was struggling to walk because of excruciating ankle and lower leg pain. She felt that it was having a large impact on her independence, and she needed to find a solution before the pain worsened.

Lisa already had some orthotics made years ago to help support her flat feet, but they were worn down and no longer providing any supportive benefits.

LISA’S EXAM

During her exam, Lisa felt pain and heat on the inside of her left ankle, along her posterior tibial tendon. Her pain ran down the inside of the leg, below the bony bump on the inside of her ankle, and beneath her arch.

Lisa felt pain when turning her foot inwards while we resisted it, and her feet were severely rolled-in (pronated), with the left foot more so than the right. She was unable to go up onto her tiptoes because of the pain.

When assessing her walking, Lisa would change the way she walked to avoid pain (defensive gait) and had a limp with a shorter left stride.

DIAGNOSIS: PTTD

We diagnosed Lisa with Posterior Tibial Tendon Dysfunction (PTTD), also known as adult acquired flatfoot. The posterior tibial tendon is the most important muscle supporting the arch. When it is overused to the point that damage or a tear develops, this is known as PTTD. At this stage, it can no longer properly perform its job of supporting the foot and arch, leading to the flattening of the arch. As the tendon is still being activated with every step, walking becomes extremely painful, and inflammation can develop. This is why it is referred to as ‘acquired flatfoot’.

TREATMENT

Given the severity of Lisa’s pain and how her foot function was contributing to her PTTD, we determined that a Richie Brace was the best treatment for her condition. We also recommended compression socks and rock tape to further support her healing tendon, and taught her a series of gentle strengthening exercises to assist with her rehab. Finally, we taught Lisa about heat/ice therapy and massage to help manage her symptoms when they flared up.

THE RICHIE BRACE

• Given the severity of Lisa’s pain and how her foot function was contributing to her PTTD, we determined that a Richie Brace was the best treatment for her condition. We also recommended compression socks and rock tape to further support her healing tendon, and taught her a series of gentle strengthening exercises to assist with her rehab. Finally, we taught Lisa about heat/ice therapy and massage to help manage her symptoms when they flared up.

RESULTS

Lisa has seen significant improvement in her quality of life after starting treatment. After 4 weeks, her pain had significantly reduced. At her 3 month review, Lisa was walking in the brace completely pain-free. Her pain would return if she spent too much time out of her brace, as the tendon had not completely healed yet, but she was making great progress and feeling stoked.

The long-term prognosis for Lisa is very good, provided she continues to complete her exercise program alongside the brace. Once the tendon has sufficiently healed, we expect to move Lisa into a traditional orthotic inside her shoe.