Adult Acquired Flatfoot
(Posterior Tibial Tendon Dysfunction) is a painful, progressive
deformity in adults. It results from a gradual stretch (attenuation) of the tibialis posterior tendon and the ligaments that support your foot's arch. This stretching causes the tendon to lose
strength and function. Many people have flat feet and do not experience pain. However, pain occurs with Adult Acquired Flatfoot because the tendons and ligaments have been torn. Once the vital
ligaments and posterior tibial tendon are lost, there is no longer anything holding the arch of the foot in place.
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of
the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse
completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension
can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms here. Pain along the course of the posterior tibial tendon which lies on the inside of the foot
and ankle. This can be associated with swelling on the inside of the ankle. Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some
patients can have difficulty walking or even standing for long periods of time. When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can
cause pain on the outside of the ankle. Arthritis in the heel also causes this same type of pain. Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on
the top and inside of the foot. These make shoewear very difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the
foot and into the toes. Diabetics may only notice swelling or a large bump on the bottom of the foot. Because their sensation is affected, people with diabetes may not have any pain. The large bump
can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoewear is not used.
Although you can do the "wet test" at home, a thorough examination by a doctor will be needed to identify why the flatfoot developed. Possible causes include a congenital abnormality, a bone fracture
or dislocation, a torn or stretched tendon, arthritis or neurologic weakness. For example, an inability to rise up on your toes while standing on the affected foot may indicate damage to the
posterior tibial tendon (PTT), which supports the heel and forms the arch. If "too many toes" show on the outside of your foot when the doctor views you from the rear, your shinbone (tibia) may be
sliding off the anklebone (talus), another indicator of damage to the PTT. Be sure to wear your regular shoes to the examination. An irregular wear pattern on the bottom of the shoe is another
indicator of acquired adult flatfoot. Your physician may request X-rays to see how the bones of your feet are aligned. Muscle and tendon strength are tested by asking you to move the foot while the
doctor holds it.
Non surgical Treatment
Depending on the stage of the deformity and patient?s functional goals, various treatment options are available. Some patients improve with conservative care which includes rest and immobilization,
shoe modifications, orthoses and bracing, or physical therapy. Surgery might be warranted for advanced stages of the condition. Often a combination of procedures including tendon and muscle
augmentation, tendon transfers, realigning of bones or fusion of certain joints might be necessary in more advanced cases. Your doctor will evaluate and recommend an individualized plan of care with
your specific needs in mind.
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot
and ankle surgeon will determine the best approach for you.