Adult flatfoot (adult acquired flatfoot) or posterior tibial tendon dysfunction (PTTD) is a common pathology presented to foot and ankle specialists. PTTD is characterized by a valgus (everted)
hindfoot, flattening of the longitudinal arch of the foot (collapse) and abduction of the forefoot. This is a progressive deformity that begins flexible and can become rigid over time. The posterior
tibial tendon (PT) is one of the main supporting structures of the foot arch. Changes within this tendon cause flattening of the foot. There are four stages of this deformity that begins flexible and
progressives, with no treatment, to a rigid deformity and with time may involve the ankle joint. Patients usually present with pain in the foot or ankle stating the ?ankle? is rolling. It?s also
common for patients to state they have difficulty walking barefoot. Pain is exacerbated after physical activities. Pain is usually isolated to the inside of the foot along the course of the PT
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.
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.
Diagnostic testing is often used to diagnose the condition and help determine the stage of the disease. The most common test done in the office setting are weightbearing X-rays of the foot and ankle.
These assess joint alignment and osteoarthritis. If tendon tearing or rupture is suspected, the gold standard test would be MRI. The MRI is used to check the tendon, surrounding ligament structures
and the midfoot and hindfoot joints. An MRI is essential if surgery is being considered.
Non surgical Treatment
What are the treatment options? In early stages an orthotic that caters for a medially deviated subtalar joint ac-cess. Examples of these are the RX skive, Medafeet MOSI device. Customised de-vices
with a Kirby skive or MOSI adaptation will provide greater control than a prefabricated device. If the condition develops further a UCBL orthotic or an AFO (ankle foot orthotic) could be necessary
for greater control. Various different forms of surgery are available depending upon the root cause of the issue and severity.
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.