What Is Adult Acquired Flat Foot AKA Posterior Tibial Tendon Dysfunction?
Adult acquired flat foot, also known as posterior tibial tendon dysfunction (PTTD), is a common condition that affects the arch of the foot, leading to pain, instability, and difficulty walking.
What is Adult Acquired Flat Foot?
Adult acquired flat foot occurs when the posterior tibial tendon, which runs along the inside of the ankle and supports the arch of the foot, becomes inflamed, stretched, or torn. This can cause the arch to collapse, resulting in a flattening of the foot and altered gait mechanics. PTTD can be progressive and as the foot starts to change, other areas of the lower limb can become painful including the lateral ankle, midfoot and heel.
Causes of Adult Acquired Flat Foot
Several factors contribute to the development of adult acquired flat foot, including:
Overuse: Repetitive stress or overuse of the posterior tibial tendon, often due to activities such as running, walking long distances, or standing for prolonged periods.
Age-related Changes: As we age, the posterior tibial tendon may weaken or degenerate, increasing the risk of dysfunction and flat foot deformity.
Obesity: Excess body weight places increased strain on the feet and ankles, leading to greater stress on the posterior tibial tendon and a higher likelihood of developing flat foot.
Footwear: Wearing shoes with inadequate support or stability, such as thongs or worn-out sneakers, can contribute to the development of PTTD.
Foot Deformities: Structural abnormalities such as bunions, tight calves or arthritis can alter foot mechanics and increase the risk of posterior tibial tendon dysfunction.
Symptoms of Adult Acquired Flat Foot
Adult acquired flat foot typically presents with the following symptoms:
Pain: Persistent pain along the inside of the ankle or arch of the foot, which may worsen with activity or prolonged standing. This may co-exist with others areas of pain including on top of the foot, on the outside ankle or in the middle of the foot.
Swelling: Swelling and tenderness along the inside of the ankle or arch area, particularly after physical activity.
Weakness: Weakness or fatigue in the foot and ankle, especially when walking or standing for extended periods.
Flattening of the Arch: Visible flattening of the arch of the foot, which may become more pronounced over time.
Diagnosis and Treatment
Diagnosing adult acquired flat foot involves a thorough physical examination and may include imaging studies such as X-rays, ultrasound, or MRI to assess the extent of tendon damage and rule out other underlying conditions. Treatment options for PTTD aim to alleviate pain, improve foot mechanics, and prevent further progression of the deformity. These may include:
Rest and Activity Modification: Modifying activities that exacerbate symptoms and allowing the affected foot to rest can help reduce inflammation and promote healing.
Orthotic Devices: Custom orthoses or foot padding can provide support to the arch of the foot and reduce load to the posterior tibial tendon
Bracing: Ankle braces or supportive boots may be recommended to stabilize the foot and ankle and prevent further collapse of the arch.
Physical Therapy: Stretching and strengthening exercises therapist can improve flexibility, strength, and stability in the foot and ankle.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be prescribed to alleviate pain and reduce inflammation.
Corticosteroid Injections: In cases of severe pain or inflammation, corticosteroid injections may be administered to the affected area to provide temporary relief.
Surgical Intervention: In advanced cases of PTTD where conservative treatments fail to provide relief, surgical intervention such as tendon repair, tendon transfer, or fusion procedures may be considered to restore foot function and stability.
Prevention
Preventing adult acquired flat foot involves taking proactive steps to minimize risk factors and promote foot health. These may include:
Wearing Supportive Footwear: Choosing shoes with adequate support, cushioning, and stability can help prevent excessive strain on the posterior tibial tendon.
Gradual Progression: Gradually increasing the intensity, duration, and frequency of physical activities can allow the foot and ankle to adapt and avoid overuse injuries.
Foot Care: Practicing good foot hygiene, inspecting the feet regularly for signs of irritation or injury, and addressing any foot deformities promptly can help maintain foot health and prevent complications.
In conclusion, adult acquired flat foot, or posterior tibial tendon dysfunction, is a common condition characterized by pain, weakness, and flattening of the arch of the foot. By understanding the causes, symptoms, and treatment options for PTTD, individuals can take proactive steps towards managing this condition effectively and maintaining optimal foot health. If you’re experiencing persistent symptoms of adult acquired flat foot, consult with a healthcare professional or podiatrist for a comprehensive evaluation and personalized treatment plan tailored to your needs.