Becoming flatfooted can be a real health issue for people. The advice from healthcare experts is to pay attention to foot pain, and when it happens, to seek help right away. In the last 20 years, adult-acquired flatfoot has become a more commonly recognized health issue. The cause is a dysfunction of the ankle tendon that attaches to the bones on the inside of your foot. The function of this posterior tibial tendon (PTT) is to maintain the foot arch and provide strength during push-off when you walk. When the PTT is not functioning correctly, you tend to lose your arch, or become more flatfooted. This problem occurs about three times more often in women than in men, especially after the age of 40. Initially, PTT dysfunction is associated with pain on the inside of the ankle, swelling and sometimes a limp. If left unchecked, the arch appears to collapse and the pain on the inside of the ankle worsens. Eventually, if left unchecked, patients will begin to feel pain on the outside of the ankle, too.
Adult acquired flatfoot is caused by inflammation and progressive weakening of the major tendon that it is responsible for supporting the arch of the foot. This condition will commonly be accompanied by swelling and pain on the inner portion of the foot and ankle. Adult acquired flatfoot is more common in women and overweight individuals. It can also be seen after an injury to the foot and ankle. If left untreated the problem may result in a vicious cycle, as the foot becomes flatter the tendon supporting the arch structure becomes weaker and more and more stretched out. As the tendon becomes weaker, the foot structure becomes progressively flatter. Early detection and treatment is key, as this condition can lead to chronic swelling and pain.
Often, this condition is only present in one foot, but it can affect both. Adult acquired flatfoot symptoms vary, but can swelling of the foot's inner side and aching heel and arch pain. Some patients experience no pain, but others may experience severe pain. Symptoms may increase during long periods of standing, resulting in fatigue. Symptoms may change over time as the condition worsens. The pain may move to the foot's outer side, and some patients may develop arthritis in the ankle and foot.
Examination by your foot and ankle specialist can confirm the diagnosis for most patients. An ultrasound exam performed in the office setting can evaluate the status of the posterior tibial tendon, the tendon which is primarily responsible for supporting the arch structure of the foot.
Non surgical Treatment
Stage one deformities usually respond to conservative or non-surgical therapy such as anti-inflammatory medication, casting, functional orthotics or a foot ankle orthosis called a Richie Brace. If these modalities are unsuccessful surgery is warranted.
If surgery is necessary, a number of different procedures may be considered. The specifics of the planned surgery depend upon the stage of the disorder and the patient?s specific goals. Procedures may include ligament and muscle lengthening, removal of the inflamed tendon lining, tendon transfers, cutting and realigning bones, placement of implants to realign the foot and joint fusions. In general, early stage disease may be treated with tendon and ligament (soft-tissue) procedures with the addition of osteotomies to realign the foot. Later stage disease with either a rigidly fixed deformity or with arthritis is often treated with fusion procedures. If you are considering surgery, your doctor will speak with about the specifics of the planned procedure.