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 Understanding Adult Acquired Flat Foot: Diagnosis and Treatment Options

Adult acquired flat foot, also known as posterior tibial tendon dysfunction (PTTD), is a common condition characterized by the progressive weakening or degeneration of the posterior tibial tendon, which supports the arch of the foot. As the tendon weakens the strands of collagen tear contributing to an overall lengthening much like a frayed rope. This condition can lead to the collapse of the arch and the development of flat feet, causing pain, instability, and difficulty with walking or standing. Early proper diagnosis and treatment are essential for managing adult acquired flat foot to limit tendon damage and prevent further complications.

Diagnosis: Diagnosing adult acquired flat foot typically involves a thorough evaluation by a healthcare professional, such as a podiatrist. During the evaluation, the healthcare provider will assess the patient's medical history, symptoms, and perform a physical examination of the feet and ankles. Diagnostic tests such as X-rays, MRI scans, or ultrasound imaging may be ordered to evaluate the structure of the foot and assess the integrity of the posterior tibial tendon. Additionally, a gait analysis may be conducted to evaluate the patient's walking pattern and biomechanics. In advanced cases of Adult Acquired Flat Foot the foot becomes arthritis and rigid. Often times the provider will asses the patient's ability to to stand on one or both of their toes. This helps the provider evaluate the severity of the tendon damage and flexibility of the foot ultimately assisting in staging the patient's condition.

Conservative Treatment: Conservative treatment options are often recommended as the first line of management for adult acquired flat foot, particularly in the early stages of the condition. These may include:

  • Orthotic Devices: Custom foot orthotics or arch supports are often prescribed to provide support and alignment to the feet, reduce excessive pronation, and alleviate pain or discomfort associated with flat feet.

  • Bracing or Splinting: Wearing a brace or splint that supports the ankle and arch of the foot can help reduce strain on the posterior tibial tendon and promote healing.

  • Physical Therapy: Stretching and strengthening exercises may be prescribed to improve foot and ankle strength, flexibility, and range of motion, as well as to correct biomechanical imbalances and improve gait mechanics.

  • Activity Modification: Avoiding high-impact activities or prolonged standing may help reduce symptoms and prevent further progression of the condition.

Surgical Treatment: In cases where conservative measures fail to provide adequate relief or if the posterior tibial tendon dysfunction is severe, surgical intervention may be considered. Surgical procedures for adult acquired flat foot aim to repair or reconstruct the posterior tibial tendon, restore the arch of the foot, and improve overall foot function. Common surgical interventions for PTTD include:

  • Tendon Lengthening: Tendon lengthening is often required to help balance the forces across the mid foot and hind foot.

  • Tendon Transfer: Transferring tendons from other areas of the foot or ankle to reinforce the weakened posterior tibial tendon and provide additional support to the arch.

  • Osteotomy: Surgical cutting or realignment of the bones in the foot or ankle may be performed to correct structural abnormalities and improve foot alignment.

  • Tendon Repair: Repairing or augmenting the damaged posterior tibial tendon with sutures or grafts to restore its function and stability.

  • Arthrodesis: Joint fusions can be an important tool to remove arthritis from the patient's foot and restore its proper alignment.

It's important for individuals with adult acquired flat foot to consult with a podiatrist to determine the most appropriate treatment approach based on their specific needs, symptoms, and lifestyle factors. With proper diagnosis and treatment, most individuals with adult acquired flat foot can experience significant improvement in symptoms and maintain an active and healthy lifestyle.

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