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Adult-Acquired Flatfoot
Adult-acquired flatfoot (AAFD), previously known as posterior tibial tendon dysfunction (PTTD), is a debilitating condition characterized by the collapse of the medial longitudinal arch of the foot, leading to progressive deformity of the foot and ankle. This condition affects up to 5 million people in the United States. The posterior tibial tendon and surrounding ligaments play a crucial role in the development of AAFD. Proper evaluation, diagnosis, and management are essential for improving patient outcomes, often requiring a team-based interprofessional approach.
Symptoms
Patients with adult-acquired flatfoot often experience pain, swelling, and visible deformity of the foot. Key symptoms include difficulty in performing a single-leg heel rise, excessive abduction of the forefoot (noted by the “too many toes” sign), and pain along the posterior tibial tendon. As the condition progresses, patients may also develop stiffness, limited range of motion, and valgus deformity of the ankle, especially in advanced stages.
Treatment Options
Patients with adult-acquired flatfoot often experience pain, swelling, and visible deformity of the foot. Key symptoms include difficulty in performing a single-leg heel rise, excessive abduction of the forefoot (noted by the “too many toes” sign), and pain along the posterior tibial tendon. As the condition progresses, patients may also develop stiffness, limited range of motion, and valgus deformity of the ankle, especially in advanced stages.
Causes
The development of adult-acquired flatfoot is multifactorial. It can result from a preexisting flatfoot condition, obesity, trauma, corticosteroid injections, arthritis, neuromuscular conditions, and diabetes. The posterior tibial tendon is particularly susceptible to damage due to its relative lack of blood supply and its anatomical path around the medial malleolus. Chronic conditions such as diabetes and hypertension also increase the risk of developing AAFD, highlighting the importance of managing these comorbidities to prevent disease progression.