What is acquired adult flatfoot deformity?

Acquired adult flatfoot deformity involves progressive flattening of the foot arch that develops as the posterior tibial tendon becomes inadequate. This condition might progress in the initial phases with pain or discomfort throughout the posterior tibial tendon to evident deformity and arthritis throughout the ankle and hindfoot.


There is pain and/or deformity at the hindfoot or ankle. Once the posterior tibial tendon ceases to function normally, there are several changes to the foot and ankle.

During the initial phases, the symptoms often include pain or discomfort and tenderness throughout the posterior tibial tendon behind the interior of the ankle.


There is pain and/or deformity at the hindfoot or ankle.

As the tendon fails progressively, the deformity of the foot and ankle becomes evident. Take note that this deformity might include the following:

  • Progressing flattening of the arch
  • Shifting of the heel where it is not aligned beneath the entire leg
  • Rotation and distortion of the forefoot
  • Tautness of the heel cord
  • Deformity of the ankle joint
  • Formation of arthritis

At certain phases of this condition, the pain might shift from the interior to the outside aspect of the ankle as the heel moves exteriorly and the structures are laterally pinched.

What are the causes?

The dysfunction of the posterior tibial tendon is the usual reason for the formation of acquired adult flatfoot. Generally, there is frequently no precise event that instigates the condition such as an abrupt tendon injury.

Generally, the tendon is damaged from cumulative wear and tear. The dysfunction arises more commonly among individuals who already have flatfoot for other causes. As the arch is flattened, increased stress is placed on the posterior tibial tendon as well as the ligaments on the interior of the foot and ankle.

Management of acquired adult flatfoot

The treatment for this form of deformity is based on the symptoms that develop, functional needs, degree of deformity and if arthritis is present.

Some individuals do not require surgery. In most cases, the treatment includes adequate rest and immobilization, braces, orthotics and physical therapy.

During the initial phase of the condition, there is pain throughout the tendon. Immobilization using a boot for a certain period can alleviate the strain from the tendon and minimize the pain and inflammation. Once the symptoms settle, the individual is given an orthotic that provides support to the interior aspect of the hindfoot. As for cases involving evident deformity, a bigger ankle brace might be required.

If surgery is needed, various procedures might be considered. This is based on the phase of the condition and the specific goals of the individual.


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