Adult-Acquired Flat Foot Deformity (AAFFD) is most commonly caused by a progressive degeneration of the tendon (tibialis posterior) that supports the arch of the foot. As the tendon ages or is
subjected to repetitive trauma, it stretches out over time, the natural arch of the foot becomes less pronounced and the foot gradually flattens out. Although it is uncertain why this occurs, the
problem is seen equally among men and women - at an increasing frequency with age. Occasionally, a patient will experience a traumatic form of the condition as a result of a fall from a height or
abnormal landing during aerial sports such as gymnastics or basketball.
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of
muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due
to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation
and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down
from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot
literally dislocates outward from under the ankle joint.
Most people will notice mild to extreme pain in their feet. Below outlines some signs and symptoms of AAFD. Trouble walking or standing for any duration. Pain and swelling on the inside of the ankle.
Bump on the bottom of the foot. Ulcer or wound developing on the outer aspects of foot.
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal"
treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of
your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.
Non surgical Treatment
Flatfoot can be treated with a variety of methods, including modified shoes, orthotic devices, a brace or cast, anti-inflammatory medications or limited steroid injections, rest, ice, and physical
therapy. In severe cases, surgery may be necessary.
Good to excellent results for more than 80% of patients have been reported at five years' follow up for the surgical interventions recommended below. However, the postoperative recovery is a lengthy
process, and most surgical procedures require patients to wear a plaster cast for two to three months. Although many patients report that their function is well improved by six months, in our
experience a year is required to recover truly and gain full functional improvement after the surgery. Clearly, some patients are not candidates for such major reconstructive surgery.