Adult-Acquired Flatfoot Deformity

Abstract

➢ Adult-acquired flatfoot deformity is a complex process attributed mainly to posterior tibial tendon insufficiency.➢ Thorough physical examination and radiographs of the foot and ankle are usually adequate to achieve diagnosis.➢ Nonoperative management is the first line of treatment and has a reported success rate ranging from 67% to 90%.➢ A multitude of surgical options are available, particularly for stage II, with no consensus on the best options.➢ Fusions are associated with poor outcomes; hence, there is a trend toward earlier reconstruction before arthritis ensues.

Adult flatfoot

“…Most cases of adult flatfoot are caused by posterior tibial tendon pathology, which is associated with tenderness 6. Palpate the tibialis posterior tendon to elicit tenderness along its distal course: starting from navicular tubercle (tendon insertion), going proximally posterior to the medial malleolus of the ankle, to the medial distal leg (fig 3).…”

“…With Jack’s test the clinician passively dorsiflexes the great toe, which will recreate the medial arch in a flexible foot (via the windlass mechanism), but not with rigid flatfoot 6…”

“…• For patients with severe symptoms, using a resting ankle splint over four to six weeks to reduce movement while at rest can alleviate the symptoms. A previous study showed that the success rate of this option ranged from 67% to 90% 6…”

“…Causes of flatfoot include posterior tibial tendon dysfunction, trauma, inflammatory arthritis, Charcot arthropathy, and congenital causes such as tarsal coalition 5. The most common cause in adults is posterior tibial tendon dysfunction 6. It is associated with obesity, diabetes mellitus, hypertension, trauma, and corticosteroid injections 7.…”

Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

“…The tibialis posterior tendon (TPT) insufficiency represents the most common cause of AAFD but several other causes are described in the literature (rheumatoid arthritis, trauma, secondary Charcot foot, peripheral neuropathies and tumors) [2][3][4].…”