Adult acquired flatfoot is a very common condition that affects the feet and ankles of adult males and females. In people with adult acquired flatfoot, the arch of the foot falls or collapses. It can be a painful, sometimes debilitating condition. However, a painful flatfoot can usually be helped with braces or orthotics and other non-surgical treatments.
Adult acquired flatfoot is different than flatfoot in children. Children will usually outgrow flatfoot on their own, often without treatment. In adults, flat feet usually remain permanently flat. Treatment usually addresses the symptoms rather than a cure.
Posterior tibial tendon dysfunction is the most common cause of AAFD. Often there is no specific event or injury that starts the problem. More commonly, the tendon is injured from “wear and tear” over time. Posterior tibial tendon dysfunction occurs more commonly in patients who are born with a flat foot or who develop the condition for other reasons. With a relatively flat arch, more stress is placed on the posterior tibial tendon and also on the ligaments on the inside of the foot and ankle. The result is a progressive disorder. Weight also plays a role in the progression of this disorder.
Injuries to the back of the foot and fractures of the bones in the foot can also cause flatfoot to develop.
Another cause of flatfoot is arthritis. Arthritis that attacks and inflames the cartilage in the joints of the foot can cause the foot to lose its arch and flatten.
In people with diabetes, a condition called Charcot foot may cause flatfoot to develop. This condition may also cause the foot to deform. People with diabetes often have less feeling in their feet or neuropathy, so they do not initially notice as their foot collapses. This can lead to a more severe flattening before diagnosis.
Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms below:
- Pain along the course of the posterior tibial tendon which lies on the inside of the foot and ankle. This can be associated with swelling on the inside of the ankle.
- Pain that is worse with activity. High intensity or impact activities, such as running, can be very difficult. Some patients can have difficulty walking or even standing for long periods of time.
- When the foot collapses, the heel bone may shift position and put pressure on the outside ankle bone (fibula). This can cause pain on the outside of the ankle. Arthritis in the heel also causes this same type of pain.
- Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot. These make shoe wear very difficult. Occasionally, the bony spurs are so large that they pinch the nerves which can result in numbness and tingling on the top of the foot and into the toes.
- Diabetics may only notice swelling or a large bump on the bottom of the foot. Because their sensation is affected, people with diabetes may not have any pain. The large bump can cause skin problems and an ulcer (a sore that does not heal) may develop if proper diabetic shoe wear is not used.
At certain stages of this disorder, pain may shift from the inside to the outside of the ankle as the heel shifts outward and structures are pinched on the outside of the ankle.
The diagnosis of posterior tibial tendon dysfunction and AAFD usually is made from a combination of symptoms, physical exam and X-rays. Your foot and ankle orthopedic surgeon, Dr. Ishrat Khan, DHCC, Dubai will look at the location of the pain, shape of your foot, flexibility of the hindfoot joints, and how you walk to make the diagnosis and assess how advanced the problem is.
Treatment depends very much upon a patient’s symptoms, goals, severity of deformity, and the presence of arthritis. Some patients get better without surgery. Rest and immobilization, orthotics, braces, and physical therapy all may be appropriate.
With early-stage disease that involves pain along the tendon, immobilization with a boot for a period of time can relieve stress on the tendon and reduce the inflammation and pain. Once these symptoms have resolved, patients may transition to using an arch support or orthotic that supports the inside of the hindfoot.
If surgery is needed, a number of different procedures may be considered. 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 usually can be treated with tendon and ligament procedures with the addition of osteotomies (cutting/shortening of bone) to realign the foot.
Later stage disease with either a rigidly fixed deformity or arthritis usually is treated with joint fusion procedures. Fusions involve removing the joint that connects two bones, so that they become fixed together. These procedures allow powerful correction of bad deformities, leading to increased stability and pain relief; however, they also lead to a stiffer foot and loss of motion.
Should you require additional information or would like to make an appointment with our Consultant Orthopedic Surgeon Dr. Ishrat Khan OR Physical Therapists, Anil Daniel, OR Hadel Radwan please call us or e-mail us at firstname.lastname@example.org
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