Adult acquired flatfoot is a progressive disorder that involves a compromise of soft tissue supports of the medial arch. The condition most commonly affects middle aged women and is characterized by
lowering of the arch, turning out of the forefoot, and a sideways angulation of the heel. There are five stages of the disorder that becomes progressively disabling. The end stage can potentially
compromise the ankle joint along with the joints in the hindfoot.
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing
Most people will notice mild to extreme pain in their feet. Below outlines some signs and symptoms of AAFD. Trouble walking or standing for any duration. Pain and swelling on the inside of the ankle.
Bump on the bottom of the foot. Ulcer or wound developing on the outer aspects of foot.
Observe forefoot to hindfoot alignment. Do this with the patient sitting and the heel in neutral, and also with the patient standing. I like to put blocks under the forefoot with the heel in neutral
to see how much forefoot correction is necessary to help hold the hindfoot position. One last note is to check all joints for stiffness. In cases of prolonged PTTD or coalition, rigid deformity is
present and one must carefully check the joints of the midfoot and hindfoot for stiffness and arthritis in the surgical pre-planning.
Non surgical Treatment
Options range from shoe inserts, orthotics, bracing and physical therapy for elderly and/or inactive patients to reconstructive surgical procedures in those wishing to remain more active. These
treatments restore proper function and alignment of the foot by replacing the damaged muscle tendon unit with an undamaged, available and expendable one, lengthening the contracted Achilles tendon
and realigning the Os Calcis, or heel bone, while preserving the joints of the hindfoot. If this condition is not recognized before it reaches advanced stages, a fusion of the hindfoot or even the
ankle is necessary. Typically this is necessary in elderly individuals with advanced cases that cannot be improved with bracing.
If conservative treatments don?t work, your doctor may recommend surgery. Several procedures can be used to treat posterior tibial tendon dysfunction; often more than one procedure is performed at
the same time. Your doctor will recommend a specific course of treatment based on your individual case. Surgical options include. Tenosynovectomy. In this procedure, the surgeon will clean away
(debride) and remove (excise) any inflamed tissue surrounding the tendon. Osteotomy. This procedure changes the alignment of the heel bone (calcaneus). The surgeon may sometimes have to remove a
portion of the bone. Tendon transfer: This procedure uses some fibers from another tendon (the flexor digitorum longus, which helps bend the toes) to repair the damaged posterior tibial tendon.
Lateral column lengthening, In this procedure, the surgeon places a small wedge-shaped piece of bone into the outside of the calcaneus. This helps realign the bones and recreates the arch.
Arthrodesis. This procedure welds (fuses) one or more bones together, eliminating movement in the joint. This stabilizes the hindfoot and prevents the condition from progressing further.