Adult Acquired Flatfoot Deformity is one of the most common acquired pathologies of the adult foot. Most often it results due to dysfunction of the tibialis posterior tendon. Other causes include inflammatory arthritis, trauma, neuromuscular causes and charcotarthropathy.
Why Is The Posterior Tibial Important
- The PTT converts a flexible valgus hindfoot at heel strike to a rigid varus alignment at toe off phase of the gait cycle.so now the entire length of the foot acts as a rigid lever that lifts and propels the body during the last phase of the gait cycle.
- With progressive dysfunction of the posterior tibial tendon-
The medial longitudinal arch collapses,
The subtalar joint everts,
The heel bends in an outward direction
Initially there is pain & swelling on the inner or medial aspect of the foot accompanied with swelling
As the deformity progresses there is pain on the outer spect of the foot due to sub fibular impingement
Increasing difficulty in wearing shoes and worsening of pain on activity or even prolonged standing
Too many toes’ sign – with advanced deformity and outward rotation of the forefoot, more of the lateral toes become visible when viewed from behind
Stretching and strengthening exercises
Stage and progression of the flatfoot deformity determines the degree and duration of the conservative treatment. The patient should be encouraged to lose weight, modify repetitive loading activities, and use supportive shoes.
Flexor Digitorum Longus (FDL) transfer or side to side tenodesis with the PTT.
Lateral Column Lengthening
Indications are severe flatfoot deformity not responding to conservative management or with concomitant arthritis of the foot joints.
Medialising calcaneal osteotomy