Approach and treatment of the adult acquired flatfoot deformity

Abstract

Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.

Surgery for adult acquired flatfoot due to posterior tibial tendon dysfunction reduces pain, improves function and health related quality of life

“…Methods: We evaluated 21 patients with a median age of 60 (range 37-72) years who underwent different surgical reconstructions due to stage II AAFD before and 6 and 24 months after surgery by the validated Self-Reported Foot and Ankle Score (SEFAS), Short Form 36 (SF-36) and Euroquol 5 Dimensions (EQ-5D). Results: The improvement from before to 24 months after surgery was in SEFAS mean 12 (95% confidence interval 8-15), SF-36 physical function 21 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), SF-36 bodily pain 28 , EQ-5D 0.2 (0.1-0.3) and EQ-VAS 11 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Conclusion: Surgery for AFFD due to PTTD results in reduced pain and improved function and health related quality of life.…”

“…Adult acquired flatfoot deformity (AAFD) could result in a painful progressive plano-valgus deformity characterized by collapsed medial arch, hindfoot valgus, midfoot varus and forefoot abduction [1][2][3]. The most common cause of AAFD is posterior tibial tendon dysfunction (PTTD), which involves pathology of the posterior tibial tendon (PTT) and the spring ligament [1].…”

Adult Acguired Flatfoot Deformity (Review)

“…В частности, не исключена возможность ослабления эверзии стопы, хотя в данном исследовании это было отмечено только в одном случае из 14. В насто-ящее время некоторые хирурги используют ал-лотрансплантат ахиллова сухожилия, исполь-зуя технику фиксации трансплантата в канале, сформированном в пяточной кости с хорошими клиническими результатами [20,90].…”

“…здесь очень важно не соз-дать гиперкоррекцию, которая может вызвать значительные биомеханические нарушения ста-тики и ходьбы. Также необходимо отметить, что при поднятой І плюсневой кости чаще выпол-няется ее проксимальная остеотомия либо кор-ригирующий артродез І плюсне-клиновидного сустава [90].…”

Ultrasound evaluation of adult‐acquired flatfoot deformity: Emphasis on the involvement of spring ligament

“…2,4 Tibialis posterior tendon (TPT) dysfunction is the commonest cause of AAFD, but is not a sole pathological entity. [6][7][8][9] Misdiagnosis or failure to recognise the condition may increase patient morbidity and lead to adverse clinical outcomes. A spectrum of abnormalities may contribute to AAFD including isolated tears of the TPT, TPT tears in association with spring ligament failure or isolated spring ligament rupture.…”