Adult acquired flat foot
was first described in the late 1960s as something that occurred after trauma, as a
result of a tear to the tibial posterior tendon. However, by 1969 two doctors called Kettlekamp and Alexander described cases in which no trauma had taken place. They referred to the condition as
"tibial posterior tendon dysfunction" and this became known as the most common type of adult acquired flat foot.
Obesity - Overtime if your body is carrying those extra pounds, you can potentially injure your feet. The extra weight puts pressure on the ligaments that support your feet. Also being over weight
can lead to type two diabetes which also can attribute to AAFD. Diabetes - Diabetes can also play a role in Adult Acquired Flatfoot Deformity. Diabetes can cause damage to ligaments, which support
your feet and other bones in your body. In addition to damaged ligaments, uncontrolled diabetes can lead to ulcers on your feet. When the arches fall in the feet, the front of the foot is wider, and
outer aspects of the foot can start to rub in your shoe wear. Patients with uncontrolled diabetes may not notice or have symptoms of pain due to nerve damage. Diabetic patient don?t see they have a
problem, and other complications occur in the feet such as ulcers and wounds. Hypertension - High blood pressure cause arteries narrow overtime, which could decrease blood flow to ligaments. The
blood flow to the ligaments is what keeps the foot arches healthy, and supportive. Arthritis - Arthritis can form in an old injury overtime this can lead to flatfeet as well. Arthritis is painful as
well which contributes to the increased pain of AAFD. Injury - Injuries are a common reason as well for AAFD. Stress from impact sports. Ligament damage from injury can cause the bones of the foot to
fallout of ailment. Overtime the ligaments will tear and result in complete flattening of feet.
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially
develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may
still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more
and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also
develop in the ankle.
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
PTTD is a progressive condition. Early treatment is needed to prevent relentless progression to a more advanced disease which can lead to more problems for that affected foot. In general, the
treatments include rest. Reducing or even stopping activities that worsen the pain is the initial step. Switching to low-impact exercise such as cycling, elliptical trainers, or swimming is helpful.
These activities do not put a large impact load on the foot. Ice. Apply cold packs on the most painful area of the posterior tibial tendon frequently to keep down the swelling. Placing ice over the
tendon immediately after completing an exercise helps to decrease the inflammation around the tendon.
Nonsteroidal Anti-inflammatory Medication (NSAIDS). Drugs, such as arcoxia, voltaren and celebrex help to reduce pain and inflammation. Taking such medications prior to an exercise activity helps to
limit inflammation around the tendon. However, long term use of these drugs can be harmful to you with side effects including peptic ulcer disease and renal impairment or failure. Casting. A short
leg cast or walking boot may be used for 6 to 8 weeks in the acutely painful foot. This allows the tendon to rest and the swelling to go down. However, a cast causes the other muscles of the leg to
atrophy (decrease in strength) and thus is only used if no other conservative treatment works. Most people can be helped with orthotics and braces. An orthotic is a shoe insert. It is the most common
non-surgical treatment for a flatfoot and it is very safe to use. A custom orthotic is required in patients who have moderate to severe changes in the shape of the foot. Physiotherapy helps to
strengthen the injured tendon and it can help patients with mild to moderate disease of the posterior tibial tendon.
If surgery is necessary, a number of different procedures may be considered. The specifics of the planned surgery depend upon the stage of the disorder and the patient?s specific goals. 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 may be treated with tendon and ligament (soft-tissue) procedures with the addition of osteotomies to realign the foot. Later stage disease with either a rigidly fixed
deformity or with arthritis is often treated with fusion procedures. If you are considering surgery, your doctor will speak with about the specifics of the planned procedure.