Adult Acquired Flat Foot

Adult acquired flat foot (PTTD)

Adult acquired flat foot is exactly as it is named, a progressive flattening of the medial longitudinal arch of the foot developed during adulthood. The most common cause of this is posterior tibialis tendon dysfunction (PTTD). The posterior tibialis tendon is one of the major supporting structures of the foot and ankle. When injury and damage occur in the tendon, it is no longer sufficiently able to support the arch of the foot.

This can result in limited ability to participate in sports, run and walk distances, and can lead to reduced balance and stability when on your feet. The most common cause is repetitive loading causing micro trauma and progressive failure of the tendon. Other possible causes include but are not limited to; osteoarthritis associated degenerative changes, pre-existing flat foot, abnormal anatomy of the talus (another bone in the foot).

Adult acquired flat foot most commonly affects middle aged people. It is more prevalent in women and people with obesity. Other risk factors include diabetes, previous trauma, hypertension & steroid exposure.

What are the signs and symptoms of PTTD?

The main symptom of adult acquired flat foot is pain. This can be felt at the inside ankle bone (medial malleolus) and along the course of the posterior tibialis tendon including where it connects into the foot, the navicular bone (known as an insertion).

You may also observe:

• swelling
• tenderness along the tendon
• progressive flattening of the foot
• pain of the peroneal tendons on the outside of the foot and ankle
• heel pain
• the arch becoming a weight-baring area of the foot when it previous wasn’t

How do our podiatrists assess adult acquired flat foot (PTTD)?

Diagnosis can be made based on multiple forms of clinical assessment including:

• observation of the foot in static and dynamic positions
• gait analysis
• palpation and manual assessment of the foot
• resisted muscle testing
• function muscle testing
• thorough history taking

Further to this, x-rays can be useful for imaging the bone structure and joint degeneration of the arch area (midfoot). Ultrasound can assess the level of damage in the tendon. CT and MRI can provide further depth to imaging if required.

Imaging won’t always be required. However, often when it is, it is to either confirm the diagnosis or assess the severity of injury when higher grade injury is suspected.

What are the treatment options for adult acquired flat foot (PTTD)?

Thankfully there are a lot of treatment options for adult acquired flat foot deformity. When early intervention occurs, conservative podiatry treatment can be highly successful, although it can take time, from weeks to several months in some cases. Treatment & recovery time will depend on the stages and severity of the injury. Following assessment with a podiatrist, a treatment plan can be formulated.

Treatment can include any of the following:

• rest & immobilisation (CAM walker, crutches)
• footwear changes (often recommended/required)
• short term use of NSAIDs (anti-inflammatories)
• orthotics (can be extremely useful for this injury)
• ankle braces
• stretches
• exercises
• steroid injections
• ankle & foot orthosis (AFO)
• surgery

A patient’s lifestyle, exercise habits, employment, foot type and severity of injury all play a role in determining the optimum treatment plan so treatment is often patient specific.

When should I see a podiatrist?

Not all cases of posterior tibialis tendon injury will result in dysfunction and result in an adult acquired flat foot deformity. Early diagnosis and treatment by one of our Melbourne podiatrists will help significantly in picking up the red flags and reduce risk of the injury progressing.

If you or someone you know starts to notice their foot progressively changing, becoming flatter and more painful along the inside of the ankle and arch, especially when they previously have not had a low or flat arch, then they should make an appointment at Melbourne Podiatrists & Orthotics for thorough podiatric diagnosis and treatment. The podiatrists at our Melbourne foot clinic are highly experienced in prescribing custom foot orthoses to help reduce symptoms associated with flat feet.

Do you have a flat foot that needs support?

At our Melbourne foot clinic our podiatrists are experts in diagnosis and treatment of flat foot deformities including posterior tibial tendon dysfunction.

So if you suffer from painful flat feet which need support, book an appointment with one of our friendly podiatrists today!