Adult Acquired Flat Foot

[ezmacncheese]

I have it in my left foot.

Currently recovering from PTTD.

Once this has healed, is there a general recommendation as to training? Should I wear an orthotic? Is there a way to restore my arch?

It has, in my observation, caused some pelvic compensation which has tilted and twisted my pelvis. BB training in just my lifting shoes, in short, has not been good for my body.

[Derek Miles]

If you are are still going through a tendon loading protocol for posterior tib tendon disorder, the loading program should assist with this. There is not much in terms of history here so it is hard to give any general recommendations regarding training. Orthotics lack evidence for assisting with arch training and it gets into a discussion of compensation versus correct. Your arch doesn't get any stronger from wearing an orthotic.

Last, your hips don't rotate or twist. Sometimes, having an injury makes you hyperaware of things that are perfectly normal and some things that are not really even there. I would recommend giving this a read.

https://thelogicofrehab.com/2018/07/...ously-stop-it/

[ezmacncheese]

If you are are still going through a tendon loading protocol for posterior tib tendon disorder, the loading program should assist with this.

Not aware of a protocol for this. I was in a boot full time for three weeks with an orthotic per the orthopedic doctor's instructions. I'm beginning to transition slowly out of the boot, also in line with doctor's orders.

There is not much in terms of history here so it is hard to give any general recommendations regarding training.

I've had trouble with a tight calf and ankle dorsiflexion for about a year and a half. Left leg wants to collapse in when squatting/deadlifting. Left calf gets exceptionally tight after squatting and deadlifting. I did a dumb thing and taped my left foot to assist the arch then played a soccer game. I played a great game, then had some serious arch pain and hallux varus the next day. This was last August. The hallux varus went away after a month but the arch pain has persisted at a low level which increases with activity or sitting for long periods.

Orthotics lack evidence for assisting with arch training and it gets into a discussion of compensation versus correct. Your arch doesn't get any stronger from wearing an orthotic.

If I can somehow restore the arch then I will not wear an orthotic. If I cannot restore the arch then I will need to wear the orthotic to maintain activity. Squatting and deadlifting with one normal arch and one collapsed has for sure not been working. I did not think it necessary to tell the long story about my symptoms but I'm happy to provide if it helps you understand. If you do not believe this this the nature of my issue then I am all ears however this is the most plausible hypothesis I can come up with. The symptoms however are quite real and not in my head I assure you.

Last, your hips don't rotate or twist. Sometimes, having an injury makes you hyperaware of things that are perfectly normal and some things that are not really even there. I would recommend giving this a read.

This confuses me. The hips certainly do rotate and twist. This can be plainly observed through diagnostic imaging. You can literally google "twisted pelvis xray" to view hundreds of pelvises that are in fact twisted. I'd be happy to post my own CT scanogram if it will make you a believer. I don't understand where you are coming from in that blog post. It seems you think that people are saying the SI joint is the point of rotation. I think you may be misunderstanding what people are referring to when they say the pelvis is twisted.

[Derek Miles]

The protocol for posterior tib tendon loading is very similar to what is used for most tendinopathies focused on heavy slow resistance training. For posterior tib (and it would sound like some possible plantar fasciopathy with your complaint of arch pain) this involves working slow, weighted calf raises starting at 4 sets of 12 for 2 weeks at RPE 8, then 4 sets of 10 at RPE 8 for two weeks, decreasing reps by 2 until you're at 4 sets of 6 at RPE 8 from week 7 on. If you want the primary sources for this you can check Beyer https://www.ncbi.nlm.nih.gov/pubmed/26018970) or Kongsgaard https://www.ncbi.nlm.nih.gov/pubmed/20154324

If the primary complaint is a tight calf and limited dorsiflexion it would be hard to diagnostically narrow that down to PTTD. Your left leg collapsing in when squatting or deadlifting is not indicative of PTTD either and could be a few different things, most of which can be worked on with technical cues and some training variations. The arch pain would likely bias the heavy slow protocol towards a plantar fasciopathy in which most of the time we work on the calf raises by placing a towel rolled up under the toes to bias the exercise towards the arch more.

Orthotics in general enters into a conversation regarding compensation versus correction. Using an orthotic typically elicits another adaptation and doesn't necessarily fix any problem. The better solution tends to be working on means with which to train your arch to better withstand the forces to which it is exposed.

Last, you are more than welcome to share your scan but that does not offer evidence that pelvic obliquity is a thing, or one that can be corrected. The innominate rotate far below a palpable position. I'm curious as to what you believe are twisting. I did take the time to google "twisted pelvis xray" and there was nothing in the literature and what I did see on google runs contrary to everything in the peer reviewed literature. The studies by Goode and Nagamoto cited in my blog allude to the fact that any rotation that does occur is well below a detectable threshold.

[JustinW]

Derek Miles

thanks for sharing this information. I’m in a similar situation as original poster. My question is can it make sense to use orthotics AND do the suggested slow weighted calf raises?

My thoughts are an orthotic could help to continue some training with load without a collapsing arch while separately dedicating time and exercise to strengthening arch/calf, using the orthotic only as an interim measure and not permanently