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.
There are numerous causes of acquired adult flatfoot, including fracture or dislocation, tendon laceration, tarsal coalition, arthritis, neuroarthropathy, neurologic weakness, and iatrogenic causes.
The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction.
At first you may notice pain and swelling along the medial (big toe) side of the foot. This is where the posterior tibialis tendon travels from the back of the leg under the medial ankle bone to the
foot. As the condition gets worse, tendon failure occurs and the pain gets worse. Some patients experience pain along the lateral (outside) edge of the foot, too. You may find that your feet hurt at
the end of the day or after long periods of standing. Some people with this condition have trouble rising up on their toes. They may be unable to participate fully in sports or other recreational
Perform a structural assessment of the foot and ankle. Check the ankle for alignment and position. When it comes to patients with severe PTTD, the deltoid has failed, causing an instability of the
ankle and possible valgus of the ankle. This is a rare and difficult problem to address. However, if one misses it, it can lead to dire consequences and potential surgical failure. Check the heel
alignment and position of the heel both loaded and during varus/valgus stress. Compare range of motion of the heel to the normal contralateral limb. Check alignment of the midtarsal joint for
collapse and lateral deviation. Noting the level of lateral deviation in comparison to the contralateral limb is critical for surgical planning. Check midfoot alignment of the naviculocuneiform
joints and metatarsocuneiform joints both for sag and hypermobility.
Non surgical Treatment
Treatment will vary depending on the degree of your symptoms. Generally, we would use a combination of rest, immobilization, orthotics, braces, and physical therapy to start. The goal is to keep
swelling and inflammation under control and limit the stress on the tendon while it heals. Avoidance of activities that stress the tendon will be necessary. Once the tendon heals and you resume
activity, physical therapy will further strengthen the injured tendon and help restore flexibility. Surgery may be necessary if the tendon is torn or does not respond to these conservative treatment
methods. Your posterior tibial tendon is vital for normal walking. When it is injured in any way, you risk losing independence and mobility. Keep your foot health a top priority and address any pain
or problems quickly. Even minor symptoms could progress into chronic problems, so don?t ignore your foot pain.
For patients with a more severe deformity, or significant symptoms that do not respond to conservative treatment, surgery may be necessary. There are several procedures available depending on the
nature of your condition. Ligament and muscle lengthening, removal of inflamed tendon lining, transferring of a nearby tendon to re-establish an arch, and bone realignment and fusion are examples of
surgical options to help with a painful flatfoot condition. Surgery can be avoided when symptoms are addressed early. If you are feeling ankle pain or notice any warmth, redness or swelling in your
foot, contact us immediately. We can create a tailored treatment plan to resolve your symptoms and prevent future problems.