deformity caused by dysfunction of the posterior tibial tendon is a common clinical
problem. Treatment, which depends on the severity of the symptoms and the stage of the disease, includes non-operative options, such as rest, administration of anti-inflammatory medication, and
immobilization, as well as operative options, such as tendon transfer, calcaneal osteotomy, and several methods of arthrodesis.
As the name suggests, adult-acquired flatfoot occurs once musculoskeletal maturity is reached, and it can present for a number of reasons, though one stands out among the others. While fractures,
dislocations, tendon lacerations, and other such traumatic events do contribute to adult-acquired flatfoot as a significant lower extremity disorder, as mentioned above, damage to the posterior
tibial tendon is most often at the heart of adult-acquired flatfoot. One study further elaborates on the matter by concluding that ?60% of patients [presenting with posterior tibial tendon damage and
adult-acquired flatfoot] were obese or had diabetes mellitus, hypertension, previous surgery or trauma to the medial foot, or treatment with steroids?.
Symptoms are minor and may go unnoticed, Pain dominates, rather than deformity. Minor swelling may be visible along the course of the tendon. Pain and swelling along the course of the tendon. Visible
decrease in arch height. Aduction of the forefoot on rearfoot. Subluxed tali and navicular joints. Deformation at this point is still flexible. Considerable deformity and weakness. Significant pain.
Arthritic changes in the tarsal joints. Deformation at this point is rigid.
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon,
the tendon which is primarily responsible for supporting the arch structure of the foot.
Non surgical Treatment
Nonoperative treatment of stage 1 and 2 acquired adult flatfoot deformity can be successful. General components of the treatment include the use of comfort shoes. Activity modification to avoid
exacerbating activities. Weight loss if indicated. Specific components of treatment that over time can lead to marked improvement in symptoms include a high repetition, low resistance strengthening
program. Appropriate bracing or a medial longitudinal arch support. If the posterior tibial tendon is intact, a series of exercises aimed at strengthening the elongated and dysfunctional tendon
complex can be successful. In stage 2 deformities, this is combined with an ankle brace for a period of 2-3 months until the symptoms resolve. At this point, the patient is transitioned to an
orthotic insert which may help to support the arch. In patients with stage 1 deformity it may be possible to use an arch support immediately.
Although non-surgical treatments can successfully manage the symptoms, they do not correct the underlying problem. It can require a life-long commitment to wearing the brace during periods of
increased pain or activity demands. This will lead a majority of patients to choose surgical correction of the deformity, through Reconstructive Surgery. All of the considerations that were extremely
important during the evaluation stage become even more important when creating a surgical plan. Generally, a combination of procedures are utilized in the same setting, to allow full correction of
the deformity. Many times, this can be performed as a same-day surgery, without need for an overnight hospital stay. However, one or two day hospital admissions can be utilized to help manage the
post-operative pain. Although the recovery process can require a significant investment of time, the subsequent decades of improved function and activity level, as well as decreased pain, leads to a
substantial return on your investment.