Adult Acquired Flatfoot

This is a gradual, progressive flattening of the foot with loss of the medial arch. This problem occurs most commonly in women older than 50 years. It is thought to be due to dysfunction of the tibialis posterior tendon which runs behind the ankle joint into the foot on the medial or inside of the foot and ankle. It is often not associated with a traumatic event, but related more to a soft tissue imbalance and degeneration.

  • Imaging

    Weight-bearing X-rays of the foot and ankle are required. At times CT or MRI scans are required.
    Flatfoot due to failure of the tibialis-posterior tendon cannot be reversed with surgery, but many patients can manage their symptoms with non-operative measures. These measures do not modify the course of the disease.

  • Non-operative Measures:
    • Topical pain creams e.g. NSAIDS
    • Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
    • Ankle brace: cross ankle brace e.g. Arizona Brace
    • Shoe insert: over the counter or orthotic which is semi-rigid or rigid to provide medial arch
    • Footwear modification: lace up ankle boots, stiffer-soled shoe with rocker bottom modification
    • Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling,
      swimming. Avoid axial loading exercises e.g. running
    • Weight loss management
    • Joint injections
    • Use of steroid injections for the tibialis posterior tendon are NOT recommended as they increase risk of rupture of the tendon and can precipitate further collapse
  • Surgery:
    Considered if symptoms are progressing and function is decreasing after a trial of non surgical treatment.
    Depending on the extent of disease, surgical options may include:

    • Bone realignment osteotomy: cutting the heel bone and fixing with a screw
    • Bone realignment osteotomy: cutting the medial cuneiform bone and inserting a wedge.
    • Fusion of the first TMTJ may be required
    • Debridement and repair of the tibialis posterior tendon with its adjacent tendon (Flexor Digitorum Longus) or performing a transfer
    • Spring ligament repair or reconstruction.

    Please find more information in the post-operative protocol section for your specific surgical procedure.
    All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

    • Infection: superficial wounds or deep infections
    • Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
    • Nerve damage: tingling, numbness or burning
    • Ongoing pain
    • Stiffness
    • Non union: in a fusion the bones may not heal together adequately
    • General or anaesthetic risks including to the heart and lung
    • Drug reactions/allergy
    • Hardware complications
    • Revision surgery
    • Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
  • Expected recovery period:
    Non weight-bearing in a plaster cast for 2 weeks.
    Partial weight-bearing or non-weight-bearing in a CAM boot between 2 to 6 weeks (depends on nature of surgery).
    Commence physiotherapy at 6 weeks.
    Return to most activities around 6 months.
    A full recovery may take up to 12 months.

Post Operative Guide Further Reading

General info: