One in four adults in the U.S. has adult acquired flatfoot
deformity, which may begin during
childhood or be acquired with age. The foot may be flat all the time or may lose its arch when the person stands. The most common and serious cause of flat foot is Posterior Tibial Tendon
Dysfunction, in which the main tendon that supports the arch gradually weakens.
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 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
Initial treatment for most patients consists of rest and anti-inflammatory medications. This will help reduce the swelling and pain associated with the condition. The long term treatment for the
problem usually involves custom made orthotics and supportive shoe gear to prevent further breakdown of the foot. ESWT(extracorporeal shock wave therapy) is a novel treatment which uses sound wave
technology to stimulate blood flow to the tendon to accelerate the healing process. This can help lead to a more rapid return to normal activities for most patients. If treatment is initiated early
in the process, most patients can experience a return to normal activities without the need for surgery.
If conservative treatment fails to provide relief of pain and disability then surgery is considered. Numerous factors determine whether a patient is a surgical candidate. They include age, obesity,
diabetes, vascular status, and the ability to be compliant with post-operative care. Surgery usually requires a prolonged period of nonweightbearing immobilization. Total recovery ranges from 3
months to one year. Clinical, x-ray, and MRI examination are all used to select the appropriate surgical procedure.