Prolotherapy: A Great Alternative Treatment for Flat Foot Pain and Posterior Tibial Tendon Injuries
Ross A. Hauser, M.D.

There are many causes of flat feet. Two of the more common are genetic - you were born with it. Acquired flat footedness, on the other hand, usually means your posterior tibial tendon is worn out and not supporting your arch. Often, but not always, a flat foot can be painful and achy. Usually, but not always, posterior tibial tendon injuries, can be painful. Very painful!

The posterior tibial muscle lies within the calf and goes behind the inside ankle (medial malleolus) and attaches to a bone in the foot called the navicular bone. When the navicular bone starts to move from its normal position, toward the ground a person’s arch begins to collapse. The main tendon that keeps the navicular bone in the proper position to maintain the medial arch of the foot is the posterior tibial tendon. If the posterior tibial tendon is torn, stretched, or loses strength, the navicular bone drops and a flat foot starts to develop. This can cause not only pain at the navicular bone where the posterior tibial tendon attaches, but also along the whole arch, especially with walking or running. Realize just a lot of standing, walking or running, especially if a person is overweight, can cause the posterior tibial tendon to degenerate. It just gets tired and worn out. You don’t need a major trauma for the tendon to get injured and for flat feet to develop.

Standing on one foot and then standing on just the toes of the one foot without pain is a normal phenomenon. If this is difficult or painful on one side, especially along the arch or navicular area, this is a sign that the posterior tibial tendon is in trouble. You know I like palpation. Where is the foot tender? If it is tender where the posterior tibial tendon attaches then we suspect the patient has a posterior tibial tendon injury. If the whole arch is painful, then the whole arch is weakened. This begs the question - What is a person to do if their flat foot is painful or the posterior tibial tendon is injured?

Most traditionally-minded physicians give the patient an anti-inflammatory medication, tell them to ice the area, limit activities, and perhaps try some physical therapy or an orthotic inside their shoe. You know as well as I do, all of these treatments (perhaps besides exercises) do nothing to strengthen anything. At best, they give temporary relief. Why not strengthen the posterior tibial tendon and medial arch? Isn’t the pain caused by the arch and posterior tibial tendon becoming weakened? What is the best treatment to strengthen a connective tissue such as a ligament, tendon or fascia? Yes – you know it! Prolotherapy.

Prolotherapy, in my opinion, is the best alternative treatment for a painful flat foot! Let me say it another way: Prolotherapy, in my opinion, is the best alternative treatment for a genetic painful flat foot or one that is flat because the posterior tibial tendon is injured. Prolotherapy to the weakened tissues will stimulate them to repair. Prolotherapy is a treatment that stimulates the body to repair painful areas. It involves the injections of substances that stimulate the immune system to come to the area to repair the injured tissue and start the natural healing inflammatory reaction. The goal and end result is stronger collagen which makes up ligaments and tendons. This is what the person with a painful arch needs. Typically three to eight treatments are needed.
More good news! The patient can exercise while getting Prolotherapy. We typically encourage patients to purchase Yogi Toes (available at www.benuts.com) and do exercises with them. Yogi Toes are worn between the toes and the person is asked to contract and extend the toes for about 10 minutes each day. This helps strengthen some of the muscles of the foot. Also instead of orthotics, we typically recommend strengthening the arch by walking on a Bosu ball, in sandals, or in bare feet. Yes, initially this may hurt, so only do it for a few minutes at a time. Eventually the foot will be so strong that many can do this for an hour without pain! While I can not guarantee that, success with Prolotherapy for posterior tibial tendon injuries and painful flat feet is the norm at Caring Medical!

Prolotherapy can make the foot stronger and provide you with stronger soft tissue. Stronger collagen. Stronger posterior tibial tendon tissue. So the next time your foot hurts, consider getting Prolotherapy. For most people with a painful flat foot it is the right choice!