Adult acquired flatfoot deformity
, primarily posterior tibial tendon dysfunction, in many cases can be successfully managed
with conservative treatment modalities including early immobilization, long-term bracing, physi?cal therapy, and anti-inflam?matory medications. Adult acquired flatfoot deformity (AAFD), the painful
flatfoot deformity in adults, is a major cause of disability for a patient and can be a challenge for foot and ankle specialists.
The most common cause of acquired adult flatfoot is posterior tibial tendon dysfunction. What causes adult acquired flat foot? Fracture or dislocation. Tendon laceration. Tarsal Coalition. Arthritis.
Neuroarthropathy. Neurological weakness.
Symptoms shift around a bit, depending on what stage of PTTD you?re in. For instance, you?re likely to start off with tendonitis, or inflammation of the posterior tibial tendon. This will make the
area around the inside of your ankle and possibly into your arch swollen, reddened, warm to the touch, and painful. Inflammation may actually last throughout the stages of PTTD. The ankle will also
begin to roll towards the inside of the foot (pronate), your heel may tilt, and you may experience some pain in your leg (e.g. shin splints). As the condition progresses, the toes and foot begin to
turn outward, so that when you look at your foot from the back (or have a friend look for you, because-hey-that can be kind of a difficult
maneuver to pull off) more toes than usual will be visible on the outside (i.e. the side with the pinky toe). At this stage, the foot?s still going to be flexible, although it will likely have
flattened somewhat due to the lack of support from the posterior tibial tendon. You may also find it difficult to stand on your toes. Finally, you may reach a stage in which your feet are inflexibly
flat. At this point, you may experience pain below your ankle on the outside of your foot, and you might even develop arthritis in the ankle.
In diagnosing flatfoot, the foot & Ankle surgeon examines the foot and observes how it looks when you stand and sit. Weight bearing x-rays are used to determine the severity of the disorder.
Advanced imaging, such as magnetic resonance imaging (MRI) and computed tomography (CAT or CT) scans may be used to assess different ligaments, tendons and joint/cartilage damage. The foot &
Ankle Institute has three extremity MRI?s on site at our Des Plaines, Highland Park, and Lincoln Park locations. These extremity MRI?s only take about 30 minutes for the study and only requires the
patient put their foot into a painless machine avoiding the uncomfortable Claustrophobia that some MRI devices create.
Non surgical Treatment
Nonoperative therapy for posterior tibial tendon dysfunction has been shown to yield 67% good-to-excellent results in 49 patients with stage 2 and 3 deformities. A rigid UCBL orthosis with a medial
forefoot post was used in nonobese patients with flexible heel deformities correctible to neutral and less than 10? of forefoot varus. A molded ankle foot orthosis was used in obese patients with
fixed deformity and forefoot varus greater than 10?. Average length of orthotic use was 15 months. Four patients ultimately elected to have surgery. The authors concluded that orthotic management is
successful in older low-demand patients and that surgical treatment can be reserved for those patients who fail nonoperative treatment.
Good to excellent results for more than 80% of patients have been reported at five years' follow up for the surgical interventions recommended below. However, the postoperative recovery is a lengthy
process, and most surgical procedures require patients to wear a plaster cast for two to three months. Although many patients report that their function is well improved by six months, in our
experience a year is required to recover truly and gain full functional improvement after the surgery. Clearly, some patients are not candidates for such major reconstructive surgery.