Adult acquired flatfoot is often a complex disorder, with diverse symptoms and varying degrees of deformity and disability. There are several types of flatfoot, all of which have one characteristic in common-partial or total collapse (loss) of the arch. Other characteristics shared by most types of flatfoot include Toe drift, where the toes and front part of the foot point outward. The heel tilts toward the outside and the ankle appears to turn in. A short Achilles tendon or calf muscle, which causes the heel to lift off the ground earlier when walking and may act as a deforming force. In addition, other deformities such bunions and hammertoes can occur and cause pain in people with flexible flatfoot. Health problems such as rheumatoid arthritis, diabetes and obesity can increase the risk of developing flatfoot and may (or may not) make it more difficult to treat. This article provides a brief overview of the problems that can result in AAFD. Further details regarding the most common conditions that cause an acquired flatfoot and their treatment options are provided in separate articles. Links to those articles are provided.
There are numerous causes of acquired Adult Flatfoot, including, trauma, fracture, dislocation, tendon rupture/partial rupture or inflammation of the tendons, tarsal coalition, arthritis, neuroarthropathy and neurologic weakness. The most common cause of acquired Adult Flatfoot is due to overuse of a tendon on the inside of the ankle called the posterior tibial tendon. This is classed as - posterior tibial tendon dysfunction. What are the causes of Adult Acquired flat foot? Trauma, Fracture or dislocation. Tendon rupture, partial tear or inflammation. Tarsal Coalition. Arthritis. Neuroarthropathy. Neurological weakness.
Symptoms of pain may have developed gradually as result of overuse or they may be traced to one minor injury. Typically, the pain localizes to the inside (medial) aspect of the ankle, under the medial malleolus. However, some patients will also experience pain over the outside (lateral) aspect of the hindfoot because of the displacement of the calcaneus impinging with the lateral malleolus. This usually occurs later in the course of the condition. Patients may walk with a limp or in advanced cases be disabled due to pain. They may also have noticed worsening of their flatfoot deformity.
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.
Non surgical Treatment
Icing and anti-inflammatory medications can reduce inflammation and physical therapy can strengthen the tibial tendon. Orthotic inserts that go inside your shoes are a common way to treat and prevent flatfoot pain. Orthotics control the position of the foot and alleviate areas of pressure. In some cases immobilization in a cast or walking boot is necessary to relieve symptoms, and in severe cases surgery may be required to repair tendon damage.
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. Surgical treatment may include repairing the tendon, tendon transfers, realigning the bones of the foot, joint fusions, or both. Dr. Piccarelli will determine the best approach for your specific case. A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, or insertion of implant devices. Whether you have flexible flatfoot or PTTD, to select the procedure or combination of procedures for your particular case, Dr. Piccarelli will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.