Flatfoot may sound like a characteristic of a certain water animal rather than a human problem. Flatfoot
is a condition in which the
arch of the foot is fallen and the foot is pointed outward. In contrast to a flatfoot condition that has always been present, this type develops after the skeleton has reached maturity. There are
several situations that can result in fallen arches, including fracture, dislocation, tendon laceration, tarsal coalition, and arthritis. One of the most common conditions that can lead to this foot
problem is posterior tibial tendon dysfunction. The posterior tibial tendon attaches the calf muscle to the bones on the inside of the foot and is crucial in holding up and supporting the arch. An
acute injury or overuse can cause this tendon to become inflamed or even torn, and the arch of the foot will slowly fall over time.
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.
Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms here. Pain along the course of the posterior tibial tendon which lies on the inside of the foot
and ankle. This can be associated with swelling on the inside of the ankle. Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some
patients can have difficulty walking or even standing for long periods of time. When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can
cause pain on the outside of the ankle. Arthritis in the heel also causes this same type of pain. Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on
the top and inside of the foot. These make shoewear very difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the
foot and into the toes. Diabetics may only notice swelling or a large bump on the bottom of the foot. Because their sensation is affected, people with diabetes may not have any pain. The large bump
can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoewear is not used.
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
A patient who has acute tenosynovitis has pain and swelling along the medial aspect of the ankle. The patient is able to perform a single-limb heel-rise test but has pain when doing so. Inversion of
the foot against resistance is painful but still strong. The patient should be managed with rest, the administration of appropriate anti-inflammatory medication, and immobilization. The injection of
corticosteroids is not recommended. Immobilization with either a rigid below-the-knee cast or a removable cast or boot may be used to prevent overuse and subsequent rupture of the tendon. A removable
stirrup-brace is not initially sufficient as it does not limit motion in the sagittal plane, a component of the pathological process. The patient should be permitted to walk while wearing the cast or
boot during the six to eight-week period of immobilization. At the end of that time, a decision must be made regarding the need for additional treatment. If there has been marked improvement, the
patient may begin wearing a stiff-soled shoe with a medial heel-and-sole wedge to invert the hindfoot. If there has been only mild or moderate improvement, a longer period in the cast or boot may be
If conservative treatments don?t work, your doctor may recommend surgery. Several procedures can be used to treat posterior tibial tendon dysfunction; often more than one procedure is performed at
the same time. Your doctor will recommend a specific course of treatment based on your individual case. Surgical options include. Tenosynovectomy. In this procedure, the surgeon will clean away
(debride) and remove (excise) any inflamed tissue surrounding the tendon. Osteotomy. This procedure changes the alignment of the heel bone (calcaneus). The surgeon may sometimes have to remove a
portion of the bone. Tendon transfer: This procedure uses some fibers from another tendon (the flexor digitorum longus, which helps bend the toes) to repair the damaged posterior tibial tendon.
Lateral column lengthening, In this procedure, the surgeon places a small wedge-shaped piece of bone into the outside of the calcaneus. This helps realign the bones and recreates the arch.
Arthrodesis. This procedure welds (fuses) one or more bones together, eliminating movement in the joint. This stabilizes the hindfoot and prevents the condition from progressing further.