Adult-acquired Flatfoot

Deformity
• adult-acquired flatfoot deformity
encompasses a wide range of deformities.

• These deformities vary in location, severity,

and rate of progression.
• Anatomy
• Two arches held by
tendons & ligaments
• Allow foot to support
weight of the body: ball
of foot – 40% weight.
Heel – 60% weight

• Leverage for walking

• Fully developed by age
13
• Longitudinal arch:
medial and lateral parts
• Transverse arch
Two longitudinal arches
Medial longitudinal
arch - extends from
calcaneus bone to
talus, navicular, 3
cuneiforms, and
proximal ends of 3
medial metatarsals

Lateral longitudinal
arch - extends from
calcaneus to cuboid
and proximal ends of
4th & 5th metatarsals
Transverse arch
extends across foot
from 1st metatarsal to
the 5th metatarsal
• The 3 most important static contributors to
arch stability:
• plantar fascia, the long and short plantar
ligaments, and the spring ligament
(calcaneonavicular ligament)
• Dynamic (interinsic ,exterinsic)
• The major dynamic stabilizer for the arch is
the posterior tibial tendon.
Contraction of the posterior tibial
tendon causes inversion of the
midfoot and elevation of the medial
longitudinal arch through its broad
insertion on the navicular,
cuneiforms, medial 3 metatarsal
bases, and cuboid.
 Adult-acquired Flatfoot
Deformity
• Etiology
-Fracture or dislocation
-Tarsal coalition
-Tendon laceration
- Artheritis
- Neuroarthropathy
-Neurologic weakness
- Iatrogenic causes
-Posterior tibial tendon
dysfunction
 Adult-acquired Flatfoot
Deformity
• Originally known as posterior tibial tendon
dysfunction or insufficiency
• first described as tendon failure.
• However, failure of the ligaments that support
the arch also occurs,
 Adult-acquired Flatfoot
Deformity
• Etiology
• The etiology of the condition is multifactorial
attributed to degenerative, inflammatory, and
traumatic causes
obesity , preexisting flatfoot
• Pathology
- PT tendon deg.
- tendon failure most common (1-1.5 cm)
distal to MM (hypovascular)
- ligaments failure (spring )
- talonavi. Subluxation  medioplantar
migration talar head  further deformity
- hind foot valgus
• Diagnosis
Patient History
Clinical examination
Standing Radiograph of foot and ankle
 Adult-acquired Flatfoot
Deformity
• Presentation
- Pain and swelling medial side
(ankle-midfoot)
- loss of the arch
- Tendency to walk on the inner
border of the
foot.
- Loss of push-off strength during
gait
- limping
- latral ankle pain
- shoes wear.
• Clinical Examination
-
• Radiological:
Stages:
- Described by
Johnson and
Strom, 4 stages
Stage 3
 Treatment

• Nonsurgical
- Recommended first because it may be helpful in
alleviating symptoms.
- NSAD
- Removable boot or cast is most often helpful.
- Support with customized brace (articulated
ankle-foot orthosis)
- Foot orthosis e (medial arch+ medial heel wedg)
- Physiotherapy
• Nonsurgical
• No study has been done to document
whether these devices slow or prevent the
progression of deformity. ( Jonathan T. AAOS 2008 ,)
 Treatment

• Surgical
- Failed nonsurgical Rx in alleviate symptoms.
- Increasing deformity.
-When the deformities become more severe
and fixed, the results of treatment are more
limited.
- Controversies persist regarding how to treat
 • Surgical

Surgical
 Surgical treatment

• Tendone transfer FHL ,FDL

• medial side
• osteotomy
 Surgical treatment

• In all stages, there are benefits to achieve

proper alignment and maintaining as much
flexibility as possible.