Acquired Flatfoot in Adults

Recently, more and more individuals have been presenting to centers of foot and ankle care with the major complaint of pain and swelling in their medial ankle. This is mostly due to a condition known as posterior tibial tendon dysfunction (PTTD) which is the leading cause for acquired flatfoot in adults. The posterior tibial tendon provides stability to the medial side of the ankle joint by supporting the arch and providing support during walking. Impairment of this tendon is a progressive condition and results in PTTD. Methods of treatment vary within different stages of PTTD. If left untreated, partial and complete ruptures of the tendon may result.

Activities such as walking, running, hiking, climbing stairs, where the function of the tendon is required, as well as conditions such as hypertension, smoking, obesity, arthritis, diabetes and peripheral neuropathy can lead to the progressive dysfunction of the tendon. A condition known as equinus which may result from the tightness of the calf muscles of the leg may also contribute to the development of PTTD. Equinus results in the over working of the posterior tibial tendon during the gait cycle and therefore the weakening of the tendon over time.

Symptoms of PTTD include pain, stiffness, and swelling in the medial ankle. The pain is worst when the individual is weight-bearing or during activity. Progressive flattening of the foot and the outward turning of the forefoot in comparison to the rearfoot are also conditions associated with the tendon dysfunction.

Treatment methods vary within the different stages of the tendon dysfunction. At early stages where minimal amount of pain with activity is present, anti-inflammatory medications (NSAIDS), orthotics, and shoe modifications with arch support are appropriate and beneficial. Treatment for later stages of PTTD includes ankle braces, immobilization, walking casts, physical therapy, and finally surgical correction to prevent further damage to the tendon. If left untreated, fusion of the subtalar joint and other primary joints along the medial arch and the foot become necessary and lead to long term disability.

Presenting to a foot and ankle surgeon once symptoms begin to occur is of major importance in order to prevent further dysfunction, disability and the need for complicated surgical procedures.