Acquired Flatfoot Deformity
Acquired adult flatfoot deformity (AAFD) is a condition that results in
the gradual flattening of the arch of the foot. While AAFD can be caused
by a number of factors, it most commonly results from dysfunction of the
posterior tibialis tendon, the main tendon supporting the arch in the
foot. Other causes can include laceration of the tendon, fractures or
dislocation, tarsal coalition, neurologic weakness, and iatrogenic causes.
Risk factors can include obesity, hypertension, previous trauma or surgery
involving the foot, and treatment with steroids.
Patients with posterior tibialis tendon dysfunction may initially experience
pain and swelling of the ankle and midfoot when bearing weight. As the
condition progresses, patients may notice fallen arches and a tendency
to walk on the inner border of the foot.
Many adults with acquired flatfoot deformity do not experience pain or
difficulties when walking, and so do not require specialized treatment.
For those who do suffer from pain or problems wearing shoes and bearing
weight, nonsurgical and surgical treatment approaches can be taken. This includes:
- Nonsteroidal anti-inflammatory medications
- Rest and protection of sore tendon, including immobilization in a boot
or firm arch support to alleviate tendon pressure.
- Physical therapy to strengthen the tendon, and ultrasound therapy, heat,
and ice to control swelling and pain.
- Cortisone / steroid injections in the posterior tibialis tendon is not
advised due to risks of rupture.
Surgical management of acquired flatfoot deformity may be an option for
patients who experience pain despite months of nonsurgical treatment.
Surgery to address flatfoot consists of repairing the tendon through a
tendon transfer to the posterior tibialis tendon, as well as manipulation
and reshaping of the bones in the foot. Research indicates that tendon
transfers without bone reshaping have limited success in treating flatfoot.
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Torrance Memorial Physician Network provides patient-centered care and
treatment tailored to your unique needs and goals. If you have questions
about acquired flatfoot deformity, treatment options, and how our board-certified
physicians can help, call today to request an appointment.