Knee Injuries: How to treat and manage meniscus tear?

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Having a meniscus tear is very common, especially for athletes. Menisci act as shock absorbers between the thighbone and shinbone. When this cartilage is torn in the knee, this is referred to as a meniscus tear. When having this injury, there are several things that you want to avoid in order to promote healing. Here are a few things to consider when having a torn meniscus.
1) See an Orthopaedic Specialist

It is important to see an orthopaedic surgeon who can analyse the problem and its severity. Different types of tears require different treatments, so you should see someone who gives a clear diagnosis and advice on how to properly treat it. Continuing to use the knee without due care can result in permanent damage. Without proper treatment, a piece of meniscus can actually come loose and obstruct the joint, causing the knee to slip, lock, or pop.

2) Avoid Forcing Your Knee into Extremes of Motion or Squat

A torn meniscus can prevent a knee from having its normal full range of motion. If it is torn, it should not be forced into a position that is painful or feels like it adds extra strain to the knee. This could cause further tears to occur.

3) When injury occurs, initiate RICE immediately

Do not forget to treat a meniscus tear or any other knee injury with the common RICE treatment. This comprises of rest, ice, compression, and elevation. This will increase blood flow to the area and decrease swelling, which promotes healing.
4) Knee Arthroscopic “Key-hole” Surgery

Knee arthroscopy is a very common surgical procedure to treat meniscus tear and it is also minimally invasive. During this surgery, a very small camera is inserted through a small incision in the knee, providing the orthopaedic surgeon with a clear view of the internal knee. Miniature surgical instruments are inserted through other parts of the knee to repair the tear.  It is advisable to have knee arthroscopy done if the meniscus injury is affecting your walking or daily activities.

5) Do Not Skip Rehab

A knee brace may be applied after the surgery. Crutches are important to use for about a month in order to keep weight off of the knee.

Rehabilitation exercises should be done after initial healing is complete. Regular exercise is necessary in order to restore the mobility and strength of the knee. Starting with exercises to improve the range of motion, strengthening exercises will be added into the program to fully complete healing. Rehab or physical therapy will take up to three months and it is advised to do it regularly.

Avoiding Knee Dislocations With Exercise Works!

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Knee dislocations can occur for a myriad of reasons; motor vehicle accidents or severe torsion injuries while playing sports. Due to the extreme severity of injury, immediate medical attention and proper treatment with aggressive rehabilitation is required to preserve neurovascular integrity and joint function.

Mechanism of Injury

Dislocation of the knee occurs when the tibia and fibula or patella(knee cap) moves out of position in relation to the femur. These bones are held together by stabilizing ligaments. These ligaments are responsible for supporting the knee in a specific position. Dislocations occur when there is a tear in the ligaments. If there is only a partial dislocation, it’s called a subluxation.

Overview

Patellar dislocations are caused by traumatic injury, underdeveloped leg musculature or alignment issues. Patella dislocations can cause bone, ligament and cartilage injuries. Knee dislocations can occur for various reasons such as engaging in high-risk activities such as skiing, as well as playing certain types of sports where there is the possibility of a torsion injury. Knee dislocations can result in injury to the nerves and vessels to the lower leg, as well as ligament and cartilage injuries.

Prevention

There are many types of exercises to strengthen the musculature around the patella to prevent injury from recurring. These fundamental exercises will strengthen the hamstrings, quadriceps and inner and outer thigh muscles.

1) Doing Squats

How does it help: Knee dislocation treatment like this involves exercises that strengthen the muscles and ligaments that support the knee. Squats are an optimal strengthening exercise since they work all muscles of the thigh.

How to do it: Squats involves lowering down in a squatting position until your knees and thighs create a 90-degree angle. Form is very important while performing squats as you don’t want to place too much stress on the knee joint. Weight should be centred as you push up from your heels. A good starting point would be to perform two to three sets of 15 repetitions.

2) Isometrics 

How does it help: Strengthening of the inner and outer thigh musculature is imperative to prevent recurrence of knee subluxation.

How to do it: Begin by lying on your back with an exercise ball in between your thighs. Gently squeeze your inner thighs together and hold for the count of five. To work outer thighs, again lie on your back and place a resistance band around the outside of your legs. With legs together, gently push against the resistance bands and then bring your legs back together. Begin with three sets of 10 of each exercise with a 30-second between each set.

5 Tips for Coming Back Strong After a Sports Injury

 

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Getting physically injured is a nightmare, especially for active people and athletes. Injuries mean lost time at the gym, sitting out of games, and feeling defeated. But believe it or not, the challenges that come from recovery can actually inspire improvement. Follow these five tips and return to workouts physically and mentally strong.

1. Get diagnosed. Know the difference between being hurt and suffering an injury. “We like to ‘man up’ and walk it off when we get hurt. But you know you are injured when the pain you sustained has not gone away or perhaps has gotten worse.” says Aaron Wexler, NASM CPT. “Pain is the first sign that something in your body’s kinetic chain is not right.” You can walk off being sore, but you should not walk off real pain.

2. Understand what happened. How did you get injured? Understanding what happened will be key to your rehab plan so you can avoid further injury. Knowing what went wrong will also help you mentally, as getting injured can really impact your confidence level.

3. Seek supervision. Work with your doctor on an exercise-based rehab program. A physical therapist or personal trainer can also help correct bad movement patterns and muscle imbalances in order to prevent further injuries.

4. Fuel your body. A nutrient-packed diet and adequate hydration are key during recovery. Adding a supplement like glutamine or MSM and chondroitin may also help rebuild joints. Stay away from alcohol, sugar, and white flour.

5. Keep going. Continue your prescribed rehab plan for a few weeks after you feel back to normal. This will help you continue to build strength. Focus on stabilization, core, and flexibility exercises after rehab. You’ll also want to warm up your injured muscle with a foam roller

Adapted from mensfitness.com

How to Avoid Runner’s Knee

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Your knees are put under a lot of stress, whether you’re running, playing basketball, dancing, or simply cleaning your house. Just using the stairs can put pressure on each knee equal to four times your body weight.

Functioning simultaneously as a hinge, lever, and shock absorber, the knee is the key to your ability to stand up, walk, climb, and kick. Yet it depends almost entirely on soft tissue—ligaments, tendons, and muscles—for stability. Because of its complexity and the great forces to which it is routinely subjected, the knee is susceptible to a host of injuries.

Of all chronic knee injuries caused by overuse, runner’s knee—more accurately called patellofemoral pain syndrome, or PFPS—is the most common.

Prevention is the key

PFPS typically occurs when a misaligned kneecap (patella) irritates the connective tissue supporting the knee. Characterized by dull pain in or around the kneecap, it is most noticeable when you go down stairs, run, or squat.

Nearly 30 percent of runners eventually develop this disorder. Skiers, cyclists, soccer players and people who participate in any high-impact activities are also prone to it.

Research has shed light on a variety of underlying factors that can contribute to PFPS. These include biomechanical problems such as a kneecap sitting too high or tilted in the groove in which it rests on the thighbone (femur); knees that turn in too much; feet that are very flat or very highly arched; and various muscle-related issues that affect how the kneecap moves. Genetics may predispose you to some of these factors.

Women are at greater risk for PFPS than men for anatomical reasons. For instance, they have a wider pelvis, which increases the angle of the quadriceps (the large four-part muscle group on the front of the thigh) to the knee. They also have smaller knees with less restraining tissue and weaker supporting muscle.

The best way to prevent runner’s knee is to strengthen and stretch the muscles that power knee movement, especially the quadriceps and hamstrings, which are located in the back of the thigh. (The exercises below will get you started.) A weakness or imbalance in the quads, hamstrings, and/or hip muscles can contribute to improper tracking of the kneecap.

If you’re a runner, your quadriceps are probably weaker than your hamstrings, so it’s a good idea to alternate cycling (a good way to strengthen the quads) with running. Walking up stairs or hills also helps strengthen the quadriceps.

To protect your knees, avoid the following:

  • Deep lunges or full squats
  • Downhill running
  • Cycling with the seat too low or in too high a gear
  • Taking large steps on the stairs or a stair-climbing machine
  • Full leg extensions with heavy weights and locked knees

In addition, do not exercise in worn-out shoes; don’t suddenly increase the intensity or length of your workouts; and don’t run on very hard, very soft, or hilly terrain. Don’t wear high heels, except on special occasions.

Treatment: what’s right for you?

If you have knee pain for more than a week or two, see your doctor. If you have PFPS, you should be referred to a physical therapist. There has been much debate about which treatments are best for PFPS.

Taping: One rehab technique for correcting a kneecap that doesn’t track properly is called McConnell taping, in which special tape is used to pull the cap into the correct position, thus reducing pain and allowing people to engage in rehab exercises. However, there is a need for large studies on taping techniques, and not all the findings have been positive. In addition, many people have trouble applying the tape properly.

Braces: There are special knee braces or sleeves that are supposed to correct knee biomechanics. The compression also stimulates skin and muscle receptors, thereby improving proprioception—that is, how you perceive the position of your knee in space. Improved proprioception may allow you to modify your movement in a way that puts less stress on the knee joint. A review in the American Family Physicianconcluded, however, that it’s not clear how effective the braces are.

Bottom line: If you have PFPS, it’s crucial to determine what’s causing it and get a personalized treatment plan. A skilled physical therapist—especially one who works with athletes and dancers—can then develop an exercise program to address your specific muscle weaknesses or imbalances and/or biomechanical problems.

Not everyone with PFPS has weak quads, hamstrings or hip muscles, for example. If it’s a biomechanical problem in the feet, you may need special shoe inserts. In rare cases, if nothing else helps, surgery may be an option.

(Originally published on Berkeley Wellness in November 2010. Updated April 2013.)

5 Myths About Dislocated Shoulders and the Real Truth

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Being hit from behind in a lively sports game or falling onto an outstretched arm can both result in a dislocated shoulder. The movies portray actors who treat their shoulders by ramming it against a wall to pop it back into place before running back into action. Unfortunately, there are many myths surrounding this injury, which is common seen by an orthopaedic surgeon. Here are the myths & facts in order to heal properly after a shoulder dislocation.

Myth 1: Dislocated and separated shoulders are the same thing.

Though they sound similar, they are actually very different things. A shoulder that has been dislocated has been popped out of its socket. This condition can cause the tissue and nerves that surround the joint to be damaged. A separated shoulder doesn’t affect the actual shoulder joint; instead the ligaments that attach the collarbone to the shoulder blade become torn as a result of an injury, which causes pressure on the skin near the shoulder.

Myth 2: You can pop your shoulder back into place by pushing against a hard surface.

Though this move is commonly seen in sitcoms, it’s almost impossible to relocate a shoulder by oneself. In most cases, emergency help should be sought. However, in a situation where waiting for help can lead to more damage (i.e. a bad fall while hiking), having a friend relocate a shoulder before seeing an orthopaedic surgeon is preferable. Always place the arm that has been dislocated in a sling, apply ice and take painkillers to reduce pain and inflammation. Because fractures sometimes occur when the shoulder is dislocated, it’s important to keep the arm still until a visit to the orthopaedic surgeon can take place. Sometimes these fractures occur because of prior attempts to relocate the shoulder, so always have the relocation done by an experienced professional.

Myth 3: A shoulder that has been dislocated won’t dislocate again.

Unfortunately, almost 50% of people who dislocate their shoulder once have a recurrence. Over 90% have a recurrence if dislocated twice. In males who dislocate their shoulder between the ages of 14 to 20, almost all have a recurrence of the injury. If the shoulder has been dislocated a few times, it will be necessary to have surgery in order to repair the damaged nerves and tissue. It would be best to have preventive surgery done before this scenario occurs.

Myth 4: The main symptom of a shoulder that has been dislocated is a floppy arm.

The main symptom is actually pain. Even the slightest movement in a shoulder that has been dislocated from its joint will result in severe pain. The arm will also be extremely difficult to move and may become numb or tingly. When touched from the side, the shoulder will feel soft, as though the underlying bone has gone.

Myth 5:Most people dislocate their shoulders sometime during their life.

In reality, only one to two percent of people dislocate their shoulders in their life. Most of these cases occur in males aged 20 to 30. Though contact sports are often the cause, elderly women are also prone to dislocating their shoulders as a result of falling.

Getting professional care and applying basic first aid are the first things to do when a dislocated shoulder is suspected. Though relatively rare, it’s a good idea to always be prepared when playing sports in case an injury does occur.

Weight Lifting Tips for Women

Women are hitting the weight room in record numbers, and a new study found that weight-training injuries among women have jumped a whopping 63 percent. Here are the most common slipups and how to fix them, so you leave the gym strutting—not limping.

Skipping Your Warm-up
You wouldn’t launch into an all-out sprint the second you stepped onto a treadmill, so you shouldn’t jump right into deadlifts the instant you hit the weight room. “Working cold, stiff muscles can lead to sprains and tears,” says Morey Kolber, Ph.D., a professor of physical therapy at Nova Southeastern University in Florida. “Warming up increases circulation and improves range of motion, which preps your muscles and joints for action.”

The fix: “While opinions about static stretching may differ, a dynamic warm-up can decrease your risk for injury,” says exercise physiologist Marco Borges, author of Power Moves. After five to 10 minutes of walking or jogging, do 10 to 12 lunges and pushups (the bent-knee version is fine) before starting your routine.

Using Sloppy Form
Experts agree that proper form is the single most important factor in injury prevention, yet many women don’t give it a lot of thought—especially when they’re in a rush. And women, thanks to their naturally wider hips, are more at risk for form-related injuries than men are: One study found that women had nearly twice as many leg and foot injuries as guys did.

The fix: Before you begin any exercise, think S.E.A.K., says trainer Robbi Shveyd, owner of Advanced Wellness in San Francisco: Stand straight (head over shoulders; shoulders over hips; hips over feet), eyes on the horizon (looking down encourages your shoulders to round and your chest to lean forward), abs tight (as if you were about to be punched in the gut, but without holding your breath; this helps stabilize your pelvis), and knees over your second toe (women’s knees have a tendency to turn in because of the angle created by wider hips, says Joan Pagano, author of Strength Training for Women).

Stressing Out Your Shoulders
As crazy as it sounds, women who lift weights tend to have less-stable shoulder joints than women who don’t lift at all, found a recent study. The reason: Doing too many exercises in which your elbows are pulled behind your body (think chest flies and rows) can overstretch the connective tissue in the front of the joints. If the backs of your shoulders are tight, you’re even more likely to overstretch the front, increasing the imbalance at the joint, says Kolber.

The fix: Modify your moves. First, don’t allow your elbows to extend more than two inches behind your body. In the lowering phase of a bench press, for example, stop when your elbows are just behind you. Second, avoid positioning a bar behind your head. Bring the lat-pulldown bar in front of your shoulders, and when you’re doing an overhead press, use dumbbells instead of a bar and keep the weights in your line of vision (meaning just slightly in front of your head).

Neglecting Opposing Muscle Groups
“Many women have strength imbalances, which can make them more prone to injury,” says Shveyd. Sometimes they’re the result of your lifestyle (hovering over a desk all day, for example, tightens and weakens your hip flexors while your glutes become overstretched and inactive). Other times they’re caused by not working both sides of the body equally (say, focusing on moves that rely on your quads but not your hamstrings).

The fix: For every exercise that works the front of the body (chest, biceps, quads), be sure to do an exercise that targets the rear (back, triceps, hamstrings). For instance, pair stability-ball chest presses with dumbbell rows, or step-ups with deadlifts.

Doing Too Much Too Soon
A lot of people think that more is better—more reps, more sets, more weight. But if you increase any of these things too quickly, your body may not be able to handle the extra workload. “Gradual conditioning prevents injuries such as torn ligaments and tendinitis, because your muscles and connective tissues have time to adapt,” says Pagano.

The fix: Practice a three-step progression. First, learn to do a move using only your body weight. “When you can do 15 reps with proper form, add weight,” says Pagano. Second, stick to one set with light weights for two weeks or until you feel comfortable with the move. And finally, when you can complete nearly all of your reps with proper form, add another set or more weight (increase weight by roughly 10 percent each time).

(Article originally from Women’s Health Magazine)

Ways to Treat Knee Pain Conservatively

Knees

Many individuals suffer from pain in their knees as a result of arthritis, over exertion or knee malalignment. Although a visit to a physician can be costly, there are several over the counter treatments that can bring relief. Using one or several of the following products can reduce the pain and discomfort of knee ailments.

Analgesic/anti-inflammatory: The knee is held in place by a series of strong ligaments. When these ligaments become torn or stretched, it can result in extreme discomfort. Analgesics can help ease the pain, while anti-inflammatories can reduce the swelling of the ligaments.

Brace: It can be tricky to determine which is the best brace for knee pain, as this is determined largely upon what has caused the pain. When ligaments in the knee become strained, they may need to be immobilized to give them a chance to heal. There are many braces available that will immobilize the joint to prevent it from bending while the healing process takes place.

For those who suffer from pain due to excessive physical exertion, a hinged knee brace may be of benefit. These hinged knee braces help to stabilise lax ligaments around the knee while allowing flexibility.

Supplement: Glucosamine is a chemical compound naturally found in the body. Its main purpose is to keep cartilage in the joints healthy. As we age, this compound begins to decrease, which can lead to pain in the knees. Taking glucosamine supplements for knee degeneration helps to rebuild this cartilage, providing more cushioning within the joints.

Medicated cream: Many athletes, gardeners and labourers suffer from pain in or around the knee as a result of over worked muscles or ligaments. There are many medicated creams for knee pain that contain anti-inflammatories and pain relief ingredients to help increase blood flow to the area where it is applied, which in turn releases tension around the knee area.

Pain doesn’t have to keep you immobilized.  It is still advisable to see an Orthopaedic Surgeon for a proper diagnosis and recommended treatment.

 

 

Why We Are Prone to Patella Dislocation?

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Central Importance of the Patella

Leg bones carry the weight of the body. The thigh bone (aka the “femur”), shinbone (aka the “tibia”), and calf bone (aka the “fibula”) convey the body’s weight with each step we take with the help of the kneecap (aka “patella”).

An Interlocking System

Our skeletal system of individual bones is linked by ligaments, muscles, and cartilage. When we walk, our body weight is transferred through the thigh bone, also known as longest bone in the body and strongest bone in the leg. When this bone fails, it often has no effect on the function of lower leg bones. Femoral fractures most often occur in the central portion of the thigh bone called the “femoral shaft”, and do not directly impact the kneecap. The kneecap “facilitates” the weight transfer from the thigh bone to the shinbone and calf bone, the second strongest bone in the weight-bearing leg’s structure and the thinnest bone in the mechanism, respectively. They transfer weight to the ankle. Tibial shaft fractures are the body’s most common broken bones, perhaps related to their weight-bearing in the lower leg. Less common fibular fractures do not transfer weight in walking.

Kneecap Function

The kneecap covers and protects the front of the knee joint. It approximates the bottom of the thigh bone in a shallow trough and the shinbone at the “tibial plateau” at the top end of the shinbone. Both bones are protected by flexible cartilaginous tissue in the trough and plateau areas, permitting the bending motion at the knee. The three bones are held in place and ligament alignment by the “collaterals” (lateral and medial) and the “cruciates” (anterior and posterior). The kneecap position is maintained by additional tendons, the “quadriceps” and “patellar”. With injury at the bone insertions of the patellar and tibial tendons or with kneecap dislocation, walking will be compromised or limited. Unfortunately, injuries to these structures are common with contact athletics.

Patella Dislocation

When the tendon support structures fail to hold the kneecap in place, the knee joint fails. The medical term is “patellar dislocation”. The etiology is rather specific, either trauma directly to the knee from body or sports equipment contact or from a twisting motion occurring at the knee level (accompanied by inability to stand on the involved leg). The kneecap may be visibly in the wrong place, e.g., the side of the leg instead of the front, or there may be a lack of mobility. Pain may radiate from the front of the knee with activity or be present even at rest. Stiffness, joint noise like creaking and crackling, may be present and accompanied by swelling.

Troubleshooting a bad knee will require physical examination with x-ray and MRI imaging to define the problem and differentiate ligament tears from stretches or bone damage, visit Orthopaedic Specialist to get immediate treatment. Ligament damage may require surgical or arthroscopic reconstruction. Rehabilitation of repaired structures or for strengthening minimally damaged dislocations may be indicated. Even flaccid tissues anchoring the kneecap may benefit from physical therapy.

 

What Happens When You have an Anterior Cruciate Ligament (ACL) Tear and What are the Proper Methods to Treat it?

 

What is the ACL?

The anterior cruciate ligament (ACL) is just one of four main ligaments that are located in the knee. This ligament prevents movement of the shin bone forward relative to the thigh bone, but unfortunately is a common knee injury among athletes and active individuals.

An ACL tear or sprain will occur when direction of the body suddenly changes and the knee is locked in place. Typically, a pop sound will occur and then swelling and pain begins almost immediately. A complete ACL tear usually requires surgery while other times it can recover on its own if it is a minor or partial tear.

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What Are the Non-Surgical Options? 

If a partial tear or sprain has occurred, it can be helped with rest, use of knee braces and physiotherapy. Sometimes if the problem persists, surgeries such as ACL repair or reconstruction can help with this condition. Depending on the age of the patient and their level of activity, this will determine whether or not orthopaedic surgery is necessary.

What are the Orthopaedic Surgical Options?

If there is a complete tear of the ACL, a surgical option such as ACL arthroscopic reconstruction should be considered. While surgery is not always necessary for an ACL Tear, most injuries will require surgical intervention. The purpose of an ACL reconstruction procedure is to restore stability of the knee. Without long-term stability of the knee, it can lead to weakening of other muscles in the knee and leg. It may cause arthritis and meniscus tears due to misusing the knee and putting weight on the wrong areas of the knee joint.

ACL Repair versus Reconstruction-

ACL Repair: When a repair of the ACL takes place this involves a surgeon suturing the torn ends of the ligament back together again.

ACL Reconstruction: ACL Reconstruction has become a far more popular procedure as it is more effective for complete tears. Part of the hamstring tendon will be harvested from either the patient or a donor and is then used to replace the torn ACL.

While there are different options available when it comes to an injury of the anterior cruciate ligament, it is often recommended that some sort of treatment takes place in order to bring back stability in this region. This is especially true in active individuals and athletes as this could result in further damage to the knee if this injury is not taken care of properly. For most patients who receive treatment, activity and normal life can begin again approximately six to nine months after reconstruction or treatment.

Do you have flat foot?

Flat foot

Flat foot is a.k.a fallen arches or pes planus. Most adults have an upward curve on the inside sole of their feet. This is called an arch. However, if you place your feet on a flat surface and you see a complete imprint of your feet, then you most likely have flat feet.

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Common Causes

Flat feet arise from many causes. Some common factors are abnormality from birth, stretched or torn tendons, broken or dislocated bones and rheumatoid arthritis. Other factors that can increase your risks are obesity, aging and pregnancy. People with flat feet tend to notice that their shoes wear out unevenly.

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Symptoms

Most people with flat feet do not have any symptoms. However some might complain of

  • Tired feet
  • Pain over the heel, big toes and/or the arches after long distance walking
  • Lower back pain
  • Swelling along the inside of the ankle

Those usually occur when the connecting ligaments and muscles of the ankles are strained.

Why pain?

The reason why people get pain from running and walking long distances is mainly due to over-pronation. Over-pronation is when the feet roll inwards too much and go past the point for shock absorption. This places stress and causes pain on the ankle, lower leg muscle, knee joints, hips and sometimes the back.

Prevention

Good running shoes are important for people with flat feet. Good running shoes prevent over-pronation and provide stability and motion control while a good insole provides firm support to prevent undue stress to the body. Run on flat terrain to reduce over-pronation. Avoid running shoes with excessive cushioning and little support.

Exercises

  • Sit in a chair with your knees 90 degree to the ground. Lay a towel on the floor. Place your bare feet flat on the towel, curl your toes, gather a ridge of the towel under your toes and pull the towel towards you. Repeat 10 times. Reverse the motion by grabbing the ridges in the towel with your toes and push them away from you. Repeat 10 times.
  • Sit on the ground with your knees bent and your feet positioned flat on the floor. Keep your toes facing forward. Pull your toes slowly toward your ankles while keeping your heels on the ground. This movement raises the middle portion of your foot. Hold in this position for 10 seconds. Relax and repeat 10 times.
  • Sit in a chair with your knees 90 degree to the ground. Place a tennis ball below the soles of your feet and roll it for 10 minutes.

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Treatment

The common treatment will normally be using an orthotic device either over-the-counter or custom made insoles to provide support for the feet. Stretching exercises on the Achilles tendon and posterior calf muscles with proper footwear can help alleviate the symptoms from a flat foot.

In rare cases, surgery is required to alleviate the symptoms of flat feet.