Flatfoot Deformity in Adult


What is a flatfoot?

A flatfoot condition is where the arch of the patient is decreased and painful.  This condition can occur in early life and also as an adult.  Females have a higher incidence of this condition especially with excessive weight.  Children commonly have a flat foot which is asymptomatic and often times will outgrow the condition .

What causes a flatfoot? 

There are multiple reasons that people develop a flatfoot.  The simplest cause is abnormal motion of the foot.  If the patient has a foot that has a collapsed arch then that means that the posterior tibial tendon is compromised.  The posterior tibial tendon (PTT) is a very important structure that holds the arch of the foot up when weight bearing.  If there is a problem with this tendon, pain can occur on the inside of the arch and the foot will take on a flat appearance.  This condition is called posterior tibial tendon dysfunction or PTTD. 
 
Obesity is a major cause of PTTD and therefore should be mentioned.  When patients gain excess weight the body begins to change the way its joints, muscles and tendons function.  Specifically in the foot, the posterior tibial tendon starts to work harder and will recruit other muscles to help lift the arch up.  Not only does the weight affect the posterior tibial tendon, but also all the tendons that are responsible in supporting the foot throughout the walking cycle.   
 
Another cause of a flatfoot is a tarsal coalition.  A tarsal coalition is when two or more bones fuse together to cause the foot to be flat.  Typically this is seen at a young age but it tends not be symptomatic until adulthood.  Tarsal coalitions are not very common and can require more aggressive treatment plans depending on the extent of the coalitions. 
 

Adult Flatfoot adult flatfoot flatfoot symptoms

How do we diagnose adult flatfoot?

Adult flatfoot is diagnosed primarily by clinical exam.  The doctor will perform a physical exam to assess the overall structure of the foot.  Your doctor will determine the overall shape of the flat foot and will determine what treatment plan would be most beneficial.  MRIimaging can be used in conjunction with standard x-rays to assess both the soft tissue abnormalities and also boney deformities.  When the doctor evaluates the imaging he/she is looking for causes of the flatfoot such as a torn ligament/tendon or even a bone deformity that occurred at birth was never diagnosed.  It is important that the doctor checks the range of motion of the joints when examining the foot in order to rule out any tarsal coalitions (abnormal fusion of bones) in the foot.  These abnormal fusions can causes a severe flatfoot which is very painful especially in adulthood.  
 

What are the surgical options for flatfoot correction?

Surgery is saved as a last resort and is typically proposed for patients who are in chronic pain and can no longer perform their daily activities of life.  Flatfoot reconstructions is a surgical procedure that moves the bones back into a proper shape.  This is accomplished by performing a variety of bone cuts and fusion of the foot bones.  In simple terms the doctor will use pins and screws to reconstruct the arch of the foot so that the patient’s foot is no longer flat.  Surgeries are lengthy and require six months to a year for a full recovery.  Soft tissue correction may also be utilized if there are ligamentous or tendinous issues.  The doctor will review the MRI imaging so that a proper surgical plan can be carried out.  
 

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