Adult acquired flatfoot
deformity (AAFD) is a painful, chronic condition found most often in women between
the ages of 40 and 60. AAFD occurs when the soft tissues of the foot are overstretched and torn, causing the arch to collapse. Flatfoot deformities may also be caused by a foot fracture, or may
result from long-term arthritis. Once the posterior tibial tendon-the tendon unit that holds up the arch-loses its function, the foot becomes flat as the bones spread out of position during weight
bearing. Without an AAFD repair, the condition may progress until the affected foot becomes entirely rigid and quite painful.
There are multiple factors contributing to the development of this problem. Damage to the nerves, ligaments, and/or tendons of the foot can cause subluxation (partial dislocation) of the subtalar or
talonavicular joints. Bone fracture is a possible cause. The resulting joint deformity from any of these problems can lead to adult-acquired flatfoot deformity. Dysfunction of the posterior tibial
tendon has always been linked with adult-acquired flatfoot deformity (AAFD). The loss of active and passive pull of the tendon alters the normal biomechanics of the foot and ankle. The reasons for
this can be many and varied as well. Diabetes, high blood pressure, and prolonged use of steroids are some of the more common causes of adult-acquired flatfoot deformity (AAFD) brought on by
impairment of the posterior tibialis tendon. Overstretching or rupture of the tendon results in tendon and muscle imbalance in the foot leading to adult-acquired flatfoot deformity (AAFD). Rheumatoid
arthritis is one of the more common causes. About half of all adults with this type of arthritis will develop adult flatfoot deformity over time. In such cases, the condition is gradual and
progressive. Obesity has been linked with this condition. Loss of blood supply for any reason in the area of the posterior tibialis tendon is another factor. Other possible causes include bone
fracture or dislocation, a torn or stretched tendon, or a neurologic condition causing weakness.
Initially, flatfoot deformity may not present with any symptoms. However, overtime as the tendon continues to function in an abnormal position, people with fallen arches will begin to have throbbing
or sharp pain along the inside of the arch. Once the tendon and soft tissue around it elongates, there is no strengthening exercises or mechanism to shorten the tendon back to a normal position.
Flatfoot can also occur in one or both feet. If the arch starts to slowly collapse in one foot and not the other, posterior tibial dysfunction (PTTD) is the most likely cause. People with flatfoot
may only have pain with certain activities such as running or exercise in the early phase of PTTD. Pain may start from the arch and continue towards the inside part of the foot and ankle where the
tendon courses from the leg. Redness, swelling and increased warmth may also occur. Later signs of PTTD include pain on the outside of the foot from the arch collapsing and impinging other joints.
Arthritic symptoms such as painful, swollen joints in the foot and ankle may occur later as well due to the increased stress on the joints from working in an abnormal position for a long period of
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the
most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a
single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured,
you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic
tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a
complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an
Non surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be
arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities. In
many cases of PTTD, treatment can begin with non-surgical approaches that may include. Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you
with an ankle brace or a custom orthotic device that fits into the shoe. Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may
need to completely avoid all weight-bearing for a while. Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization. Medications.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation. Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and
may provide special inserts designed to improve arch support.
Flatfoot reconstruction (osteotomy). This is often recommended for flexible flatfoot condition. Flatfoot reconstruction involves cutting and shifting the heel bone into a more neutral position,
transferring the tendon used to flex the lesser toes (all but the big toe) to strengthen the posterior tibial tendon, and lengthening the calf muscle. Fusion (also known as triple arthrodesis).
Fusion involves fusing, or making stiff, three joints in the back of the foot the subtalar, talonavicular, and calcaneocuboid joints, to realign the foot and give it a more natural shape. Pins or
screws hold the area in place until it heals. Fusion is often recommended for a rigid flatfoot deformity or evidence of arthritis. Both of these surgeries can provide excellent pain relief and