Adult Acquired Flatfoot
occurs when the arch of your foot collapses after your skeleton has stopped growing, usually resulting in
the foot falling inward with the toes pointing out. This allows your entire sole to touch the ground when you stand, instead of just the outside area. Arches fall for many reasons, including
arthritis, injury to the supporting tendons or bones, nerve problems, diabetic collapse, pregnancy, aging, and obesity. A fallen arch doesn?t have to be painful-though as it develops and worsens, it
can lead to strain and weakness in the feet that could allow for more uncomfortable foot problems later. Diabetics can develop serious complications from their fallen arches, and need to have their
condition evaluated and treated.
There are a number of theories as to why the tendon becomes inflamed and stops working. It may be related to the poor blood supply within the tendon. Increasing age, inflammatory arthritis, diabetes
and obesity have been found to be causes.
Depending on the cause of the flatfoot, a patient may experience one or more of the different symptoms here. 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 shoewear 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 shoewear is not used.
The history and physical examination are probably the most important tools the physician uses to diagnose this problem. The wear pattern on your shoes can offer some helpful clues. Muscle testing
helps identify any areas of weakness or muscle impairment. This should be done in both the weight bearing and nonweight bearing positions. A very effective test is the single heel raise. You will be
asked to stand on one foot and rise up on your toes. You should be able to lift your heel off the ground easily while keeping the calcaneus (heel bone) in the middle with slight inversion (turned
inward). X-rays are often used to study the position, shape, and alignment of the bones in the feet and ankles. Magnetic resonance (MR) imaging is the imaging modality of choice for evaluating the
posterior tibial tendon and spring ligament complex.
Non surgical Treatment
Treatment of Adult Acquired Flatfoot Deformity depends on the stage of progression, as mentioned above paragraphs. Below we will outline a variety of different treatment options available. Orthotics
or bracing. To give your foot the arch the support it needs, your podiatrist or foot specialist may provide you with over the counter brace or a custom orthotic device that fits your shoe. Casting.
In some cases, a cast or boot is worn to stabilize the foot and to give the tendon time to heal. Physiotherapy. Ultrasound treatments and exercises may help rehab the tendon and muscles. Medications.
Over-the-counter (NSAIDS) such as ibuprofen can help reduce pain, inflammation and swelling associated with AAFD. Shoe Gear. Your podiatrist may suggest changes with your shoes you are wearing and
inserts you need in your shoe to help support your arch.
Although non-surgical treatments can successfully manage the symptoms, they do not correct the underlying problem. It can require a life-long commitment to wearing the brace during periods of
increased pain or activity demands. This will lead a majority of patients to choose surgical correction of the deformity, through Reconstructive Surgery. All of the considerations that were extremely
important during the evaluation stage become even more important when creating a surgical plan. Generally, a combination of procedures are utilized in the same setting, to allow full correction of
the deformity. Many times, this can be performed as a same-day surgery, without need for an overnight hospital stay. However, one or two day hospital admissions can be utilized to help manage the
post-operative pain. Although the recovery process can require a significant investment of time, the subsequent decades of improved function and activity level, as well as decreased pain, leads to a
substantial return on your investment.