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.
Women are affected by Adult Acquired Flatfoot four times more frequently than men. Adult Flatfoot generally occurs in middle to older age people. Most people who acquire the condition already have
flat feet. One arch begins to flatten more, then pain and swelling develop on the inside of the ankle. This condition generally affects only one foot. It is unclear why women are affected more often
than men. But factors that may increase your risk of Adult Flatfoot include diabetes, hypertension, and obesity.
At first you may notice pain and swelling along the medial (big toe) side of the foot. This is where the posterior tibialis tendon travels from the back of the leg under the medial ankle bone to the
foot. As the condition gets worse, tendon failure occurs and the pain gets worse. Some patients experience pain along the lateral (outside) edge of the foot, too. You may find that your feet hurt at
the end of the day or after long periods of standing. Some people with this condition have trouble rising up on their toes. They may be unable to participate fully in sports or other recreational
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
Patients can be treated non-surgically with in-shoe devices and braces to hold their feet in the correct position. This can reduce pain and damage and assist with walking. Physical therapy is also
given to improve muscle strength and help prevent injury to the foot. Surgery can be performed if the patient doesn?t find any relief.
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.