Science |
Home
| Archives | About | Media Links |
| January 2000 Do you feel hurt? Flat-footedness a common disorder in Hong Kong By Wong Heung Wing After half an hour of walking, Alice Chau, a teenage girl, felt tired. It was no big deal until her mother took her to the doctor. The doctor told them that she was suffering from a kind of foot deformity called flat-footedness, meaning that she didn’t have the arches in her feet. “My knees and ankles were a little painful after walking. But people could not tell I had this kind of deformity,” said Alice. She is very lucky that she got medical attention so early. Many people, however, are not so lucky because they don’t even know they have such a deformity. According to Dr. Samson Chan of the Department of Orthopedic Surgery at the University of Hong Kong, flat-footedness or pes planus in Latin, is quite common in Hong Kong. “This is because it runs in the family. Some of my patients’ parents also have flat-footedness,” said Dr. Chan. “As a result, some of the patients take their children to see a doctor when they observe signs of flat-footedness.” In order to know more about flat-footedness, one has to know the structure of the feet. Each foot has 26 bones. The bones are connected by tough bands of tissue called ligaments. The feet are moved by muscles and tendons, as are the hands. The areas on the inside of the feet that curl up a little are called arches. However, flat-footed patients don’t have arches. The arches are very important to the human body, because they facilitate walking. “The human walking mechanism is that first one of our heels touches the ground, then the sole, and the toes then push the body forward. This process repeats itself, and this is walking,” said Dr. Chan. “This mechanism is less effective without the arches.” This mechanism of walking is called the windlass mechanism and it is very technical and complicated. The reason why Alice got tired so easily, however, is quite simple. This is because her strides are shorter than normal; she has to spend more energy than other people to cover the same distance. People suffer from flat-footedness because they are born without the arches. “Their foot bones just touch the ground as opposed to curling up a little,” said Dr. Chan. “They inherit this deformity from their parents.” For these patients, there is no problem in their teens or early 20s, as their muscles and tendons are still strong. These muscles and tendons combined can “pull” the bones back up to form arches. As a result, patients may not be aware of having such a deformity. “Their feet will automatically form arches even if they don’t have the normal ones because we need them to walk,” said Dr. Chan. “Just like a bus’ suspension system will move up when the driver steps on the accelerator.” When patients grow older, say, to their 30s, symptoms of flat-footedness may surface. First is tiredness. Like Alice, these patients get tired easily when walking or even standing. Second is that they can feel the deformity. They know that their whole soles are touching the ground. Or they find it out from the footprints they leave after a bath. Third is that their feet may move to face outward like the letter “V”. This will fundamentally affect their appearance, making them walk rather like a duck. The youngest of Dr. Chan’s patients was 15. He, like Alice, had his signs of flat-footedness discovered by his mom. Most of his patients, however, range in age from their early 40s to 50s. Everyone is susceptible to flat-footedness, but Dr. Chan observed that males are more likely to have it. “Most of these middle-aged patients are slightly obese, partly because their abnormal feet have to support a lot more weight than others,” said Dr. Chan. Flat-footedness is “programmed” to appear in people’s early 30s because muscles and tendons suffer from fatigue and degeneration after decades and will not be as strong as they were. The result of this is that they can no longer hold the bones, so the bones drop to the ground. The whole foots without an arch is flat. That is where the term “flat-footedness” comes from. Not only will the patients feel tired easily, their feet will hurt or swell. “I cannot walk for long; I cannot stand for long,” are common complaints from Dr. Chan’s patients when he asks how his patients feel. Also, people who have to stand or walk all day long are the main victims. Waiters and policemen are susceptible. For more seriously affected patients, their naviculars, the bones right above the arch area, may protrude, causing great suffering and inconvenience. Measures against flat-footedness are twofold: prevention and cure. Prevention is suitable for teenage patients like Alice since the deformity has not yet fully developed. The doctors often give the patients supports to put inside their shoes. Each of these supports has a bump in the arch area. This reduces the workload of the muscles and the tendons, as the bumps help to keep the feet in a normal stage even when the muscles and tendons relax. By Dr. Chan’s observation, this kind of prevention is effective. In fact, Alice’s doctor told her to buy a pair of supports. But for the middle-aged patients, prevention just seems to be too late. Their pains may not only be a result of tiredness, but also of inflammation. The synovium, which helps lubricate the action of the joints, may thicken as a result of rubbing, since flat-footed patients pound the pavement harder. A kind of inflammation, called synovitis, then follows. “We then administer anti-inflammation medication to them,” said Dr. Chan. “However, this only postpones the pain. The fundamental problem is not addressed.” In some extreme cases, the patients’ tendons may be old and broken. “Tendons have been white and ‘crisp’ when I opened feet during operations, different from the heavy ones we see in chicken legs,” said Dr. Chan. “All we can do is to cut a tendon from a part which is dispensable, usually one of the toes other than the big ones, to transfer it to the arches.” Another cure of flat-footedness is called bone fusion, which means fixing the bones together. However, its main drawback is that the recipients of this operation cannot turn their feet left or right. Flat-footedness can be quite a serious problem, but not everyone in Hong Kong is aware of its seriousness. “I don’t know how people can bear it. Their feet hurt, their way of walking is strange, but they still do not see a doctor as long as no serious problems occur,” said Dr. Chan, describing the attitude of Hong Kong citizens towards flat-footedness. Precaution does help, though. Alice, after using the supports for four months, has stopped using them, because she doesn’t need them anymore. There may be something to learn here. |
|
|
Home | Archives | About | Media Links |
