What Is The Treatment And Cause For Adult Aquired FlatFoot
OverviewAcquired flatfoot deformity caused by dysfunction of the posterior tibial tendon is a common clinical problem. Treatment, which depends on the severity of the symptoms and the stage of the disease, includes non-operative options, such as rest, administration of anti-inflammatory medication, and immobilization, as well as operative options, such as tendon transfer, calcaneal osteotomy, and several methods of arthrodesis.CausesMany health conditions can create a painful flatfoot, an injury to the ligaments in the foot can cause the joints to fall out of alignment. The ligaments support the bones and prevent them from moving. If the ligaments are torn, the foot will become flat and painful. This more commonly occurs in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot. In addition to ligament injuries, fractures and dislocations of the bones in the midfoot can also lead to a flatfoot deformity.SymptomsSymptoms of pain may have developed gradually as result of overuse or they may be traced to one minor injury. Typically, the pain localizes to the inside (medial) aspect of the ankle, under the medial malleolus. However, some patients will also experience pain over the outside (lateral) aspect of the hindfoot because of the displacement of the calcaneus impinging with the lateral malleolus. This usually occurs later in the course of the condition. Patients may walk with a limp or in advanced cases be disabled due to pain. They may also have noticed worsening of their flatfoot deformity.DiagnosisPerform a structural assessment of the foot and ankle. Check the ankle for alignment and position. When it comes to patients with severe PTTD, the deltoid has failed, causing an instability of the ankle and possible valgus of the ankle. This is a rare and difficult problem to address. However, if one misses it, it can lead to dire consequences and potential surgical failure. Check the heel alignment and position of the heel both loaded and during varus/valgus stress. Compare range of motion of the heel to the normal contralateral limb. Check alignment of the midtarsal joint for collapse and lateral deviation. Noting the level of lateral deviation in comparison to the contralateral limb is critical for surgical planning. Check midfoot alignment of the naviculocuneiform joints and metatarsocuneiform joints both for sag and hypermobility.Non surgical TreatmentNonoperative treatment of stage 1 and 2 acquired adult flatfoot deformity can be successful. General components of the treatment include the use of comfort shoes. Activity modification to avoid exacerbating activities. Weight loss if indicated. Specific components of treatment that over time can lead to marked improvement in symptoms include a high repetition, low resistance strengthening program. Appropriate bracing or a medial longitudinal arch support. If the posterior tibial tendon is intact, a series of exercises aimed at strengthening the elongated and dysfunctional tendon complex can be successful. In stage 2 deformities, this is combined with an ankle brace for a period of 2-3 months until the symptoms resolve. At this point, the patient is transitioned to an orthotic insert which may help to support the arch. In patients with stage 1 deformity it may be possible to use an arch support immediately.Surgical TreatmentIn cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, tendon transfers, realigning the bones of the foot, joint fusions, or both. Dr. Piccarelli will determine the best approach for your specific case. A variety of surgical techniques is available to correct flexible flatfoot. Your case may require one procedure or a combination of procedures. All of these surgical techniques are aimed at relieving the symptoms and improving foot function. Among these procedures are tendon transfers or tendon lengthening procedures, realignment of one or more bones, or insertion of implant devices. Whether you have flexible flatfoot or PTTD, to select the procedure or combination of procedures for your particular case, Dr. Piccarelli will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.