The majority of people will experience a flattening of the arch
of the feet as we age. This is a natural part of the aging process for
most, as the years of abuse we put on our feet causes weakening of the soft tissue structures that support the arch of the foot and gravity dictates that the feet tend to flatten out. When flattening
of one of the feet occurs rapidly over a relatively short period of time this may signal a more serious problem.
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.
The types of symptoms that may indicate Adult-Acquired Flat Foot Deformity include foot pain that worsens over time, loss of the arch, abnormal shoe wear (excessive wearing on the inner side of shoe
from walking on the inner side of the foot) and an awkward appearance of the foot and ankle (when viewed from behind, heel and toes appear to go out to the side). It is important that we help
individuals recognize the early symptoms of this condition, as there are many treatment options, depending upon the severity, the age of the patient, and the desired activity levels.
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
A painless flatfoot that does not hinder your ability to walk or wear shoes requires no special treatment or orthotic device. Other treatment options depend on the cause and progression of the
flatfoot. Conservative treatment options include making shoe modifications. Using orthotic devices such as arch supports and custom-made orthoses. Taking nonsteroidal anti-inflammatory drugs such as
ibuprofen to relieve pain. Using a short-leg walking cast or wearing a brace. Injecting a corticosteroid into the joint to relieve pain. Rest and ice. Physical therapy. In some cases, surgery may be
needed to correct the problem. Surgical procedures can help reduce pain and improve bone alignment.
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available
to the surgeon and it may take several to correct a flatfoot deformity. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon
transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the
lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder
of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.