Becoming flatfooted can be a real health issue for people. The advice from healthcare experts is to pay attention to foot pain, and when it happens, to seek help right away. In the last 20 years,
has become a more commonly recognized health issue. The cause is a dysfunction of
the ankle tendon that attaches to the bones on the inside of your foot. The function of this posterior tibial tendon (PTT) is to maintain the foot arch and provide strength during push-off when you
walk. When the PTT is not functioning correctly, you tend to lose your arch, or become more flatfooted. This problem occurs about three times more often in women than in men, especially after the age
of 40. Initially, PTT dysfunction is associated with pain on the inside of the ankle, swelling and sometimes a limp. If left unchecked, the arch appears to collapse and the pain on the inside of the
ankle worsens. Eventually, if left unchecked, patients will begin to feel pain on the outside of the ankle, too.
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing
Your feet tire easily or become painful with prolonged standing. It's difficult to move your heel or midfoot around, or to stand on your toes. Your foot aches, particularly in the heel or arch area,
with swelling along the inner side. Pain in your feet reduces your ability to participate in sports. You've been diagnosed with rheumatoid arthritis; about half of all people with rheumatoid
arthritis will develop a progressive flatfoot deformity.
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the
gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may
consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course.
Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is
available. Check the anterior tibial tendon for size and strength.
Non surgical Treatment
Footwear has an important role, and patients should be encouraged to wear flat lace-up shoes, or even lace-up boots, which accommodate orthoses. Stage I patients may be able to manage with an off the
shelf orthosis (such as an Orthaheel or Formthotics). They can try a laced canvas ankle brace before moving to a casted orthosis. The various casted, semirigid orthoses support the medial
longitudinal arch of the foot and either hold the heel in a neutral alignment (stage I) or correct the outward bent heel to a neutral alignment (stage II). This approach is meant to serve several
functions: to alleviate stress on the tibialis posterior; to make gait more efficient by holding the hindfoot fixed; and thirdly, to prevent progression of deformity. Devices available to do this are
the orthosis of the University of California Biomechanics Laboratory, an ankle foot orthosis, or a removable boot. When this approach has been used, two thirds of patients have good to excellent
In 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. Your foot
and ankle surgeon will determine the best approach for you.