Acquired adult flatfoot deformity (AAFD) is a foot condition that occurs as a result of the flattening of the longitudinal arch of the foot. It is also referred to as posterior tibial tendon dysfunction.
The bones of the foot contain many ligaments that hold it together. One of them is the spring ligament complex.. It works with the posterior tibial tendon and the plantar fascia to provide support for the longitudinal arch of the foot. When these ligaments are injured or weakened, they can lose their ability to support the arch, leading to flatfoot deformity.
As the name implies, acquired adult flatfoot deformity is a condition that is common to adults who have fully matured skeleton. It is especially common among women between the ages of 40 and 60.
Causes of acquired adult flatfoot deformity
Several factors can contribute to the development of Acquired adult flatfoot deformity. The first one is an injury to the nerves, ligaments, and tendons of the foot. This can cause partial dislocation of the subtalar joints.
Dysfunction of the posterior tibial tendon can also lead to adult acquired flatfoot deformity. This can happen when there is a loss or impairment of both active and passive pull of the tendons, through factors such as high blood pressure, diabetes, steroid use etc.
Acquired adult flatfoot deformity can also occur as a result of rheumatoid arthritis. More than 50% of individuals with this disorder will develop adult flatfoot deformity.
Other factors include obesity, loss of blood in the posterior tibial tendon, bone fracture, and overstretching or ruptured tendons.
Symptoms of Acquired flatfoot deformity
The condition causes pain and swelling on the big-toe side of the foot. Without prompt treatment, the condition will worsen and the tendon will fail, leading to an increase in pain. Pain is more pronounced during prolonged periods of standing. It can also be painful to get up on your toes.
Treatment of acquired flatfoot deformity
Acquired adult flatfoot deformity can be treated by:
- Wearing shoes with a good arch support
- Using orthotics, or prefabricated shoe inserts, to reduce the symptoms
- Taking over the counter pain relievers or anti-inflammatory drugs such as ibuprofen
- Using a removable boot to support and stabilize the foot and ankle
- Using a customized brace to limit the ankle motion
- Using a physical therapy program of exercise to strengthen the muscles of the foot and leg.
If all the above treatments fail to reduce the symptoms, surgery may be required. The procedure depends on the affected area and severity. However, it can include a combination of treatments, such as reconstruction of torn tendons or ligaments, tendon transfer (moving other tendons to assist in load-bearing function), and lengthening of the tendons.
Recovery from surgery occurs in phases. A patient may be in a cast or brace for approximately six weeks to allow healing. From there, rehabilitation and physical therapy will be recommended for 4-6 months. While failure rates for long-term improvement as high as 50% have been reported, it is important to note that the complex nature of the surgery, the specific procedure performed and adherence to recovery protocols are critical factors in each case.
If you have experienced inflammation to the big toe side of the foot and noticed that your arches have collapsed, schedule an appointment at Houston Foot and Ankle Care. Dr. Maislos will provide a thorough evaluation, and clearly present treatment options based on your needs. Call (713) 541-3199 today for an appointment.