Adult-acquired flatfoot or collapsed arch
occurs because the large
tendon on the inside of the ankle - the posterior tibial tendon - becomes stretched out and no longer supports the foot's arch. In many cases, the condition worsens and and the tendon thickens,
becoming painful, especially during activities. Flatfoot or collapsed arch is also known as posterior tibial tendon dysfunction. This condition is different than having flat feet since birth (known
as congenital flatfoot
), although sometimes these patients develop similar symptoms and require similar treatments.
As discussed above, many different problems can create a painful flatfoot. Damage to the posterior tibial tendon is the most common cause of AAFD. The posterior tibial tendon is one of the most
important tendons of the leg. It starts at a muscle in the calf, travels down the inside of the lower leg and attaches to the bones on the inside of the foot. The main function of this tendon is to
support the arch of your foot when you walk. If the tendon becomes inflamed or torn, the arch will slowly collapse. Women and people over 40 are more likely to develop problems with the posterior
tibial tendon. Other risk factors include obesity, diabetes, and hypertension. Having flat feet since childhood increases the risk of developing a tear in the posterior tibial tendon. In addition,
people who are involved in high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Inflammatory arthritis, such as rheumatoid arthritis, can cause
a painful flatfoot. This type of arthritis attacks not only the cartilage in the joints, but also the ligaments that support the foot. Inflammatory arthritis not only causes pain, but also causes the
foot to change shape and become flat. The arthritis can affect the back of the foot or the middle of foot, both of which can result in a fallen arch. An injury to the tendons or ligaments in the foot
can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly
occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. Injuries to tendons of the foot can occur either in one instance (traumatically) or with repeated use
over time (overuse injury). Regardless of the cause, if tendon function is altered, the forces that are transmitted across joints in the foot are changed and this can lead to increased stress on
joint cartilage and ligaments. In addition to tendon and ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity. People with diabetes or with
nerve problems that limits normal feeling in the feet, can have collapse of the arch or of the entire foot. This type of arch collapse is typically more severe than that seen in patients with normal
feeling in their feet. In addition to the ligaments not holding the bones in place, the bones themselves can sometimes fracture and disintegrate without the patient feeling any pain. This may result
in a severely deformed foot that is very challenging to correct with surgery. Special shoes or braces are the best method for dealing with this problem.
Your feet tire easily or become painful with prolonged standing. It's difficult to move your heel or midfoot around, or to stand on your toes. Your foot aches, particularly in the heel or arch area,
with swelling along the inner side. Pain in your feet reduces your ability to participate in sports. You've been diagnosed with rheumatoid arthritis; about half of all people with rheumatoid
arthritis will develop a progressive flatfoot deformity.
Your podiatrist is very familiar with tendons that have just about had enough, and will likely be able to diagnose this condition by performing a physical exam of your foot. He or she will probably
examine the area visually and by feel, will inquire about your medical history (including past pain or injuries), and may also observe your feet as you walk. You may also be asked to attempt standing
on your toes. This may be done by having you lift your ?good? foot (the one without the complaining tendon) off the ground, standing only on your problem foot. (You may be instructed to place your
hands against the wall to help with balance.) Then, your podiatrist will ask you to try to go up on your toes on the bad foot. If you have difficulty doing so, it may indicate a problem with your
posterior tibial tendon. Some imaging technology may be used to diagnose this condition, although it?s more likely the doctor will rely primarily on a physical exam. However, he or she may order
scans such as an MRI or CT scan to look at your foot?s interior, and X-rays might also be helpful in a diagnosis.
Non surgical Treatment
It is imperative that you seek treatment should you notice any symptoms of a falling arch or PTTD. Due to the progressive nature of this condition, your foot will have a much higher chance of staying
strong and healthy with early treatment. When pain first appears, your doctor will evaluate your foot to confirm a flatfoot diagnosis and begin an appropriate treatment plan. This may involve rest,
anti-inflammatory medications, shoe modifications, physical therapy, orthotics and a possible boot or brace. When treatment can be applied at the beginning, symptoms can most often be resolved
without the need for surgery.
Types of surgery your orthopaedist may discuss with you include arthrodesis, or welding (fusing) one or more of the bones in the foot/ankle together. Osteotomy, or cutting and reshaping a bone to
correct alignment. Excision, or removing a bone or bone spur. Synovectomy, or cleaning the sheath covering a tendon. Tendon transfer, or using a piece of one tendon to lengthen or replace another.
Having flat feet is a serious matter. If you are experiencing foot pain and think it may be related to flat feet, talk to your orthopaedist.