Adult acquired flatfoot deformity (AAFD) is a condition in which the arch of the foot collapses, resulting in a flatfoot deformity that develops during adulthood.
Symptoms of AAFD can include pain and swelling along the inside of the foot and ankle, in the area of the posterior tibial tendon. Collapse of the arch of the foot leads to visible flattening which can result in wider changes in foot shape; the heel may also turn outward (hindfoot valgus), and toes may bend or curl downward (hammer toes).
More generally, patients with AAFD can experience stiffness and loss of flexibility in the affected foot.
AAFD occurs when the arch of the foot collapses, often due to dysfunction or weakening of the structures that support the foot. This weakening can be the result of:
Posterior tibial tendon dysfunction (PTTD): inflammation stretching or tearing of the PTTD which can significantly undermine the ability of the tendon to support the arch of the foot. Older age, overweight and obesity, hypertension and diabetes are all factors which increase the risk of PTTD problems.
Trauma: damage to the foot or ankle impacting the structural integrity of the foot and disrupt ligament and tendon function.
Arthritis: chronic inflammation of joints, tendons and surrounding soft tissue of the foot.
Diabetes: nerve damage (neuropathy) and poor circulation contributing to weakening of the tendons and ligaments of the foot. Charcot foot, a condition in which the bones and joints gradually breakdown due to neuropathy, can result in a more severe form of AAFD.
Non-surgical treatment options aim to relieve pain, improve foot function, and prevent further progression of the condition. These treatments are most effective in the early stages of the condition, particularly when the deformity is flexible and the arch can still be corrected. These include:
Bracing and orthotics: can help to redistribute weight more evenly across the foot, reducing stress on the PTTD and providing support to the arch.
Physiotherapy: can be used to strengthen the muscles and tendons which support the arch of the foot. Gait training can also help to correct abnormal walking patterns that may aggravate the condition.
Anti-inflammatory medication: NSAIDs can be used to reduce inflammation and pain in the affected foot; corticosteroid injections can also be used to reduce inflammation in the PTTD, although repeated injections may weaken the tendon.
Surgical treatment is typically considered when non-surgical treatments are ineffective or when the deformity has progressed to an advanced stage resulting in significant pain and loss of function. These include:
Tendon repair and reconstruction: repair of the damaged part of the PTTD may be possible at an early stage of the condition. Where repair is not possible, a tendon from another part of the foot may be transferred to assume the role of the PTTD.
Osteotomy: involves the cutting and repositioning of the bones to correct deformity and improve foot alignment. A Medialising calcaneal osteotomy repositions the heel bone closer to the midline of the body to relieve stress on the PTTD and restore proper alignment. Lateral column lengthening can be completed in conjuction with osteotomy, whereby a bone graft is added to lengthen the lateral side and improve the shape of the arch.
Arthrodesis (joint fusion): involves the permanent joining of joints in the foot in order to improve stability and relieve pain.
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Professor Dr Munjed Al Muderis is an orthopaedic surgeon specialising in osseointegration, hip, knee and trauma surgery. He is a clinical professor at Macquarie University and The Australian School Of Advanced Medicine, a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group.