Arch height is variable in the general population and is not related to always being painful. A person having a low arched foot is not always pathologic; there is a wide variation among each individual. To be correct Flatfoot should refer to an abnormal loss of the arch WITH PAIN. PTTD is the most common cause of a painful flatfoot, the posterior tibial tendon is the structure that is the primary support to the arch of the foot. When this tendon is not supportive the arch becomes flat. PTTD is often called “adult acquired flatfoot” because this type of flatfoot develops during adulthood usually affecting one foot however some individuals may have both feet affected.
Causes:
Flatfeet can be “congenital/inherited” or “acquired” caused secondarily from trauma, inflammatory arthropathies, and/or neuropathic deformity commonly seen in diabetics. PTTD occurs due to overstress on the tendon due to biomechanical factors, a traumatic injury to the foot, or diabetes. PTTD is more accurately called Posterior Tibial Tendon Disease which is a progressive condition that affects the tendon’s ability to support arch.
Symptoms:
Initial symptoms include pain on the inside of the foot and ankle as well as swelling along the inside of the ankle area, as the disease progresses, flattening of the arch occurs
In the later stages of the disease the arches are completely flattened and the ankle may begin to roll inward causing instability.
Degenerative arthritis is also noted on the x-ray films.
Diagnosis:
The foot and ankle surgeon will obtain a history and physical. Diagnosis is determined on clinical examination and radiographic evaluation.
Treatment:
Conservative Treatments consist of:
- Orthotic devices * as well as custom bracing to give the foot and posterior tibial tendon proper support.
Physical therapy
- Advanced laser therapy * to help with rehabilitation and inflammation.
Anti-inflammatory medication
Operative Treatment consist of:
If all conservative treatment options fail and your stage of disease has progressed to an advance stage, surgery may be an option. Our foot and ankle surgeons will be glad to recommend the best treatment plan for you.