What is an Adult Acquired Flat Foot?

Adult acquired flatfoot (AAF), also known as posterior tibial tendon dysfunction (PTTD), is a condition that affects the foot and ankle, leading to a progressive flattening of the arch and inward rolling of the foot. It is a common condition in adults, and it typically develops over time due to the weakening or degeneration of the posterior tibial tendon.

Causes of Adult Acquired Flatfoot: The posterior tibial tendon is responsible for supporting the arch of the foot and providing stability during walking and other weight-bearing activities. When this tendon becomes damaged or inflamed, it can lead to adult acquired flatfoot. Several factors can contribute to the development of AAF, including:

  1. Overuse or Repetitive Stress: Activities that involve repetitive motions or overuse of the foot can strain the posterior tibial tendon, leading to its dysfunction.
  2. Trauma: An injury or trauma to the foot or ankle can damage the posterior tibial tendon.
  3. Age and Degeneration: As people age, the tendons in the body may weaken and degenerate, including the posterior tibial tendon.
  4. Obesity: Excess weight puts additional stress on the feet and can contribute to the development of flatfoot.
  5. Systemic Diseases: Certain conditions such as diabetes or rheumatoid arthritis can affect the health of tendons, including the posterior tibial tendon.

Symptoms of Adult Acquired Flatfoot: The symptoms of adult acquired flatfoot can vary in severity and may develop gradually over time. Common signs and symptoms include:

  1. Flattening of the Arch: The arch of the foot progressively lowers, leading to a flattened appearance.
  2. Pain and Swelling: Pain and swelling may occur along the inside of the foot and ankle, especially after physical activity.
  3. Overpronation: The foot may roll inward excessively (overpronate) when walking or standing.
  4. Tired or Aching Feet: Individuals with AAF may experience fatigue or aching in the feet, especially with prolonged activity.
  5. Difficulty with Balance: The altered foot structure may affect balance and stability.
  6. Foot Deformity: In more advanced cases, the foot may develop a characteristic “too many toes” sign, where more of the toes are visible from the back of the foot.

Treatment of Adult Acquired Flatfoot: Treatment for adult acquired flatfoot depends on the severity of the condition. Conservative treatments are often the first line of management and may include:

  1. Rest and Immobilization: Resting the foot and limiting activities that worsen symptoms can help reduce inflammation and allow the tendon to heal.
  2. Supportive Footwear: Shoes with proper arch support and stability can help alleviate discomfort.
  3. Orthotic Devices: Custom orthotic inserts may be used to support the arch and control foot motion.
  4. Physical Therapy: Specific exercises can help strengthen the muscles and tendons in the foot and ankle.
  5. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs may help reduce pain and inflammation.

In cases where conservative measures are not effective or the condition is severe, surgical intervention may be considered. Surgery aims to repair or reconstruct the damaged tendon and restore the arch of the foot.

If you suspect you have adult acquired flatfoot or are experiencing persistent foot pain or deformity, it’s essential to consult with a healthcare professional or a foot and ankle specialist for proper evaluation and personalized treatment recommendations. Early diagnosis and intervention can lead to better outcomes and improved foot function.