Dr. Sonam Ruit of Martin Foot and Ankle of York, Lancaster, Hanover and Shrewsbury, PA  has written an article on the following subject:

Adult Acquired Flat Foot Deformity (or Posterior Tibial Tendon Dysfunction)

by Sonam Ruit, D.P.M.

This is a flat foot deformity seen on adults due to progressive weakening of the tendon overlying the inside of the ankle known as posterior tibial tendon. This is an extremely important tendon of the foot and ankle, arising from the back of the leg and attaches to multiple sites in the foot, primarily at the inside hindfoot bone known as Navicular. It acts as a stirrup to hold the arch up and provides good inside ankle stability as well as restores our normal arch height. As this tendon weakens, the arch slowly starts to collapse, initially easily controlled with good custom orthotics and proper rehab of the weakened tendon. However as the tendon weakens and is left untreated for a long period of time, the foot then takes a more rigid form of flat foot along with associated arthritic changes due to malposition of the joints. This will lead to abnormal gait, increased pain, inflammation, fatigue, swelling along the tendon, as well as, along the arch, and joints of the ankle, hindfoot and mid foot.

Adult acquired flat foot deformity or PTTD has no single causation, rather it is multifactorial. Of many, the two primary causes are trauma (or acute rupture) of the posterior tibial tendon and chronic degeneration or progressive untreated childhood flatfoot and tight calf muscles. This then leads to chronic weakening (or slow loss) of tendon strength giving rise to complete rigid flat foot deformity at later ages. There are different stages of flat foot deformity, stage I, II, III and IV.  Stage I being mild and Stage IV being severe with degenerative arthritis and ankle involvement.

Early detection and treatment of posterior tibial tendon dysfunction can keep the deformity from progressing to further stages in the adult flat foot scheme. Conservative treatment is often able to decrease pain and the progression of flat foot deformity. Conservative treatments range from anti-inflammatory meds, biomechanical stabilization with proper custom molded orthotics, PTTD bracing, rehab to strengthen the posterior tibial tendon and calf stretching regimen. Slightly more symptomatic patients will also need temporary immobilization in a boot or casts and then will resume rehab and transition into regular shoes with orthotics. However, complex flat foot deformities that fail all conservative measures will require surgical intervention. There are a wide variety of surgical procedures and will depend on the severity of the deformity. Surgical procedures range from simple tendon augmentation, transfer, bone realignment to corrective fusion procedures along with release of the calf muscle. Therefore seeing the proper physician, getting early diagnosis and early treatment can make a huge impact in the quality of your life in the later years.

Sonam Ruit, D.P.M.