It is important to note that the tendons are responsible for connecting muscles to the bones as well as stretching over the joints, thus allowing bending of these joints. A vital tendon within the inferior leg is no other than the posterior tibial tendon which originates in the calf area, expands behind the interior of the ankle and connects to the bones within the central region of the foot. The posterior tibial tendon supports the arch and provides support as the individual steps off on the toes while walking. Once this tendon swells, torn or overstretched, pain is triggered on the interior ankle and the inner arch at the base of the foot gradually disappears, resulting to flatfoot.
Indications of progressive flatfoot
- There is swelling and pain on the interior of the ankle
- Loss of arch and development of flat foot
- Gradual development of pain on the exterior side of the foot or ankle
- Tenderness over the middle foot particularly when under stress during activity
- Weakness and inability to stand on the toes
Causes of progressive flatfoot
Progressive flat foot often occurs among women over 50 years old and can be caused by an inherent abnormality of the tendon. There are also other several risk factors which includes the following:
- Inflammatory diseases such as rheumatoid arthritis, Reiter’s syndrome, psoriasis and spondylosing arthropathy
- Use of local steroid injections
- Previous trauma or surgery such as an ankle fracture on the interior side of the foot
- Individuals involved in certain sports such as tennis, basketball, hockey or soccer can rip the posterior tibial tendon. The tendon can swell if extreme force is applied over the foot particularly running over road or banked track.
Treatment options for progressive flatfoot
Without treatment, flatfoot that is caused by dysfunction of the posterior tibial tendon eventually turns stiff. Arthritis can develop in the hind foot. As for the pain, it increases and radiates to the exterior side of the ankle. The manner on how the individual walks can be affected and wearing shoes can be difficult.
The treatment recommended by the doctor depends on how far the condition has progressed. During the initial stages, progressive flatfoot can be managed with rest, immobilization of the foot for 6-8 weeks using a boot or below-knee cast and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. Once the cast is taken out, shoe inserts such as a arch support or heel wedge is beneficial. In case the condition is in the advanced stage, the doctor might recommend the use of a custom-made ankle-foot support or orthotic.
In case conservative treatments do not work, the doctor will recommend surgery. Various measures can be utilized to manage progressive flatfoot but more than one procedure is performed at the same time in most cases. The doctor will recommend a specific course of treatment based on the case of the individual.