A more serious condition, according to ACFAS, is adult-acquired flatfoot
, often cause
by posterior tibial tendon dysfunction (PTTD). In this case, the tendon that supports the arch weakens and fails, leading to a rigid flatfoot where the arch stays flat even when you aren't standing.
It can lead to a loss of range of motion in the foot and ankle and pain in the arch. The ACFAS clinical guideline recommends that flatfoot caused by PTTD can be treated with custom shoe orthotics,
soft casts, walking boots, physical therapy and non-steroidal anti-inflammatory medications. If there is no relief or the condition worsens, then the patient may be referred to surgery.
Causes of an adult acquired flatfoot may include Neuropathic foot (Charcot foot) secondary to Diabetes mellitus, Leprosy, Profound peripheral neuritis of any cause. Degenerative changes in the ankle,
talonavicular or tarsometatarsal joints, or both, secondary to Inflammatory arthropathy, Osteoarthropathy, Fractures, Acquired flatfoot resulting from loss of the supporting structures of the medial
longitudinal arch. Dysfunction of the tibialis posterior tendon Tear of the spring (calcaneoanvicular) ligament (rare). Tibialis anterior rupture (rare). Painful flatfoot can have other causes, such
as tarsal coalition, but as such a patient will not present with a change in the shape of the foot these are not included here.
Not everyone with adult flatfoot has problems with pain. Those who do usually experience it around the ankle or in the heel. The pain is usually worse with activity, like walking or standing for
extended periods. Sometimes, if the condition develops from arthritis in the foot, bony spurs along the top and side of the foot develop and make wearing shoes more painful. Diabetic patients need to
watch for swelling or large lumps in the feet, as they may not notice any pain. They are also at higher risk for developing significant deformities from their flatfoot.
Perform a structural assessment of the foot and ankle. Check the ankle for alignment and position. When it comes to patients with severe PTTD, the deltoid has failed, causing an instability of the
ankle and possible valgus of the ankle. This is a rare and difficult problem to address. However, if one misses it, it can lead to dire consequences and potential surgical failure. Check the heel
alignment and position of the heel both loaded and during varus/valgus stress. Compare range of motion of the heel to the normal contralateral limb. Check alignment of the midtarsal joint for
collapse and lateral deviation. Noting the level of lateral deviation in comparison to the contralateral limb is critical for surgical planning. Check midfoot alignment of the naviculocuneiform
joints and metatarsocuneiform joints both for sag and hypermobility.
Non surgical Treatment
Orthoses (insoles, functional orthoses, ankle supports, braces, ankle foot orthoses (AFOs)) - are usually custom-made to increase the functional stability of the foot and improve the mechanical
properties of the tendon as well as reducing the actual degree of strain on the tendon. This reduces pain and inflammation. Physiotherapy - exercises and physiotherapy are often used to increase
mobility, strengthen the tendon itself, stretch your Achilles tendon as well as reduce pain. Once the tendon has been stretched (stage one), the heel starts rolling outwards. Total immobilisation in
a cast may help the symptoms to subside and prevent progression of the deformity in a smaller percentage of patients. Long-term use of orthoses may help stop progression of the deformity and reduce
pain without surgery. Non-surgical treatment is unlikely to prevent progression to stage three and four but may be chosen by some patients who either are unsuitable for surgery or prefer not to have
For more chronic flatfoot pain, surgical intervention may be the best option. Barring other serious medical ailments, surgery is a good alternative for patients with a serious problem. There are two
surgical options depending on a person?s physical condition, age and lifestyle. The first type of surgery involves repair of the PTT by transferring of a nearby tendon to help re-establish an arch
and straighten out the foot. After this surgery, patients wear a non-weight bearing support boot for four to six weeks. The other surgery involves fusing of two or three bones in the hind foot below
the ankle. While providing significant pain relief, this option does take away some hind foot side-to-side motion. Following surgery, patients are in a cast for three months. Surgery is an effective
treatment to address adult-acquired flatfoot, but it can sometimes be avoided if foot issues are resolved early. That is why it is so important to seek help right away if you are feeling ankle pain.
But perhaps the best way to keep from becoming flatfooted is to avoid the risk factors altogether. This means keeping your blood pressure, weight and diabetes in check.