What is Adult Flatfoot?
Adult Acquired Flatfoot (Posterior Tibial Tendon Dysfunction) is a painful, progressive deformity in adults. It results from a gradual stretch (attenuation) of the tibialis posterior tendon and the ligaments that support your foot’s arch. This stretching causes the tendon to lose strength and function.
Many people have flat feet and do not experience pain. However, pain occurs with Adult Acquired Flatfoot because the tendons and ligaments have been torn. Once the vital ligaments and posterior tibial tendon are lost, there is no longer anything holding the arch of the foot in place.
Who Gets Adult Flatfoot?
Women are affected by Adult Acquired Flatfoot four times more frequently than men. Adult Flatfoot generally occurs in middle to older age people. Most people who acquire the condition already have flat feet. One arch begins to flatten more, then pain and swelling develop on the inside of the ankle. This condition generally affects only one foot. It is unclear why women are affected more often than men. But factors that may increase your risk of Adult Flatfoot include diabetes, hypertension, and obesity.
How Does Adult Flatfoot Develop?
Below is a set of events that is thought to cause Adult Acquired Flatfoot.
Flat feet causes greater pressure on the posterior tibial tendon than normal. As the person with flat feet ages, the muscles, tendons and ligaments weaken. Blood supplies diminish as arteries narrow. These conditions are magnified for obese patients because of their increased weight and atherosclerosis. Finally, the tendon gives out or tears. Most of the time, this is a slow process. Once the posterior tibial tendon and ligaments stretch, body weight causes the bones of the arch to move out of position. The foot rotates inward (pronation), the heel bone is tilted to the inside, and the arch appears collapsed. In some cases, the deformity progresses until the foot dislocates outward from the ankle joint.
What Are the 3 Stages of Adult Acquired Flatfoot?
Stage I: Inflammation and swelling is present around the inside of the ankle.
Stage II: S Visible deformity occurs, such as, the foot becoming flatter. The deformity is still correctable in this stage.
Stage III: The foot becomes a rigid, non-movable flat foot deformity that is painful.
How do Podiatrists Diagnosis Adult Acquired Flatfoot?
Dallas Podiatrists use a number of ways to diagnose Adult Acquired Flatfoot. However, no single test has been proven to be totally reliable.
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies.
During a single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured, you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally.
X-rays are not always helpful as a diagnostic tool for Adult Flatfoot because both feet will generally demonstrate a deformity.
MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can’t always be relied on for a complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury.
An ultrasound may also be used to confirm the deformity, but is usually not required for an initial diagnosis.
What is the Treatment for Adult Acquired Flatfoot?
Get treated early. There is no recommended home treatment. While in stage one of the deformity, rest, a cast, and anti-inflammatory therapy can help you find relief. This treatment is followed by creating custom-molded foot orthoses and orthopedic footwear. These customized items are critical in maintaining the stability of the foot and ankle.
Once the tendon has stretched and deformity is visible, the chances of success for non-surgical treatment are significantly lower. In a small percentage of patients, total immobilization may arrest the progression of the deformity. A long-term brace known as an ankle foot orthosis is required to keep the deformity from progressing.
What Types of Foot Orthosis Are Used for Adult Flatfoot?
The Richie Brace, a type of ankle foot orthosis, shows significant success as a treatment for stage two posterior tibial dysfunction. It is a sport-style brace connected to a custom corrected foot orthodic that fits into most lace-up footwear (including athletic shoes). It is also light weight and more cosmetically appealing than traditionally prescribed ankle foot orthosis. The Arizona Brace, California Brace or Gauntlet Brace may also be recommended depending on your needs.
Surgery as a Treatment for Adult Acquired Flatfoot
If cast immobilization fails, surgery is the next alternative. Treatment goals include:
1) eliminating pain;
2) halting deformity progression;
3) and improving mobility.
Subtalar Arthroereisis, 15 minute outpatient procedure, may correct flexible flatfoot deformity (hyperpronation). The procedure involves placing an implant under the ankle joint (sinus tarsi) to prevent abnormal motion. Very little recovery time is required and it is completely reversible if necessary. Ask your Dallas foot doctor for more information about this exciting treatment possibility!
If you are experiencing these symptoms, request an appointment with us.
Metroplex Foot and Ankle is a progressive group of physicians and surgeons who are committed to helping our patients to achieve their full wellness potential. Contact our Dallas Podiatrist, Garland Podiatrist, or Richardson Podiatrist offices to schedule an appointment today.