Adult acquired flat foot
was first described in the late 1960s as something that occurred after trauma, as a result
of a tear to the tibial posterior tendon. However, by 1969 two doctors called Kettlekamp and Alexander described cases in which no trauma had taken place. They referred to the condition as "tibial
posterior tendon dysfunction" and this became known as the most common type of adult acquired flat foot.
Many health conditions can create a painful flatfoot, an injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from
moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In
addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially
develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may
still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more
and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also
develop in the ankle.
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon,
the tendon which is primarily responsible for supporting the arch structure of the foot.
Non surgical Treatment
Non-surgical treatment includes rest and reducing your activity until the pain improves. Orthotics or bracing help support the tendon to reduce its pull along the arch, thus reducing pain. In
moderate to severe cases, a below knee cast or walking boot may be needed to allow the tendon to rest completely and heal. Physical therapy is an integral part of the non-surgical treatment regimen
to reduce inflammation and pain. Anti-inflammatory medication is often used as well. Many times evaluation of your current shoes is necessary to ensure you are wearing appropriate shoe gear to
In cases where cast immobilization, orthoses and shoe therapy have failed, surgery is the next alternative. The goal of surgery and non-surgical treatment is to eliminate pain, stop progression of
the deformity and improve mobility of the patient. Opinions vary as to the best surgical treatment for adult acquired flatfoot. Procedures commonly used to correct the condition include tendon
debridement, tendon transfers, osteotomies (cutting and repositioning of bone) and joint fusions. (See surgical correction of adult acquired flatfoot). Patients with adult acquired flatfoot are
advised to discuss thoroughly the benefits vs. risks of all surgical options. Most procedures have long-term recovery mandating that the correct procedure be utilized to give the best long-term
benefit. Most flatfoot surgical procedures require six to twelve weeks of cast immobilization. Joint fusion procedures require eight weeks of non-weightbearing on the operated foot - meaning you will
be on crutches for two months. The bottom line is, Make sure all of your non-surgical options have been covered before considering surgery. Your primary goals with any treatment are to eliminate pain
and improve mobility. In many cases, with the properly designed foot orthosis or ankle brace, these goals can be achieved without surgical intervention.