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.
Flat footedness, most people who develop the condition already have flat feet. With overuse or continuous loading, a change occurs where the arch begins to flatten more than before, with pain and
swelling developing on the inside of the ankle. Inadequate support from footwear may occasionally be a contributing factor. Trauma or injury, occasionally this condition may be due to fracture,
sprain or direct blow to the tendon. Age, the risk of developing Posterior Tibial Tendon Dysfunction increases with age and research has suggested that middle aged women are more commonly affected.
Other possible contributing factors - being overweight and inflammatory arthritis.
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
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the
gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may
consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course.
Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is
available. Check the anterior tibial tendon for size and strength.
Non surgical Treatment
Options range from shoe inserts, orthotics, bracing and physical therapy for elderly and/or inactive patients to reconstructive surgical procedures in those wishing to remain more active. These
treatments restore proper function and alignment of the foot by replacing the damaged muscle tendon unit with an undamaged, available and expendable one, lengthening the contracted Achilles tendon
and realigning the Os Calcis, or heel bone, while preserving the joints of the hindfoot. If this condition is not recognized before it reaches advanced stages, a fusion of the hindfoot or even the
ankle is necessary. Typically this is necessary in elderly individuals with advanced cases that cannot be improved with bracing.
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.