Posterior tibial tendon insufficiency
(also called posterior tibial tendon dysfunction or adult
acquired flatfoot) has been named literally after failure of the posterior tibial tendon. However, the condition is caused not only by the progressive failure of the posterior tibial tendon; it is
also failure of associated ligaments and joints on the inner side of the ankle and foot. This results in collapse of the arch of the foot, along with the deformity which most often becomes the
debilitating problem in its later stages. While at the beginning the common symptom is pain over the tendon in the inner part of the hindfoot and midfoot, later on it is the deformity that can
threaten a person's ability to walk. Just as the tendon degenerates and loses its function, other soft tissue on the same inner side of the foot - namely the ligaments - degenerate and fail.
Ligaments are responsible for holding bones in place, and when they fail, bones shift to places where they shouldn?t; deformity is the result. The deformity causes malalignment, leading to more
stress and failure of the ligaments.
There are numerous causes of acquired Adult Flatfoot, including, trauma, fracture, dislocation, tendon rupture/partial rupture or inflammation of the tendons, tarsal coalition, arthritis,
neuroarthropathy and neurologic weakness. The most common cause of acquired Adult Flatfoot is due to overuse of a tendon on the inside of the ankle called the posterior tibial tendon. This is classed
as - posterior tibial tendon dysfunction. What are the causes of Adult Acquired flat foot? Trauma, Fracture or dislocation. Tendon rupture, partial tear or inflammation. Tarsal Coalition. Arthritis.
Neuroarthropathy. Neurological weakness.
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact
activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may
shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on
the affected side.
There are four stages of adult-acquired flatfoot deformity (AAFD). The severity of the deformity determines your stage. For example, Stage I means there is a flatfoot position but without deformity.
Pain and swelling from tendinitis is common in this stage. Stage II there is a change in the foot alignment. This means a deformity is starting to develop. The physician can still move the bones back
into place manually (passively). Stage III adult-acquired flatfoot deformity (AAFD) tells us there is a fixed deformity. This means the ankle is stiff or rigid and doesn???t move beyond a neutral
(midline) position. Stage IV is characterized by deformity in the foot and the ankle. The deformity may be flexible or fixed. The joints often show signs of degenerative joint disease
Non surgical Treatment
The adult acquired flatfoot is best treated early. Accurate assessment by your doctor will determine which treatment is suitable for you. Reduce your level of activity and follow the RICE regime. R -
rest as often as you are able. Refrain from activity that will worsen your condition, such as sports and walking. I - ice, apply to the affected area, ensure you protect the area from frostbite by
applying a towel over the foot before using the ice pack. C - compression, a Tubigrip or elasticated support bandage may be
applied to relieve symptoms and ease pain and discomfort. E - elevate the affected foot to reduce painful swelling. You will be prescribed pain relief in the form of non-steroidal antiinflammatory
medications (if you do not suffer with allergies or are asthmatic). Immobilisation of your affected foot - this will involve you having a below the knee cast for four to eight weeks. In certain
circumstances it is possible for you to have a removable boot instead of a cast. A member of the foot and ankle team will advise as to whether this option is suitable for you. Footwear is important -
it is advisable to wear flat sturdy lace-up shoes, for example, trainers or boots. This will not only support your foot, but will also accommodate orthoses (shoe inserts).
For more chronic flatfoot pain, surgical intervention may be the best option. Barring other serious medical ailments, surgery is a good alternative for patients with a serious problem. There are two
surgical options depending on a person?s physical condition, age and lifestyle. The first type of surgery involves repair of the PTT by transferring of a nearby tendon to help re-establish an arch
and straighten out the foot. After this surgery, patients wear a non-weight bearing support boot for four to six weeks. The other surgery involves fusing of two or three bones in the hind foot below
the ankle. While providing significant pain relief, this option does take away some hind foot side-to-side motion. Following surgery, patients are in a cast for three months. Surgery is an effective
treatment to address adult-acquired flatfoot, but it can sometimes be avoided if foot issues are resolved early. That is why it is so important to seek help right away if you are feeling ankle pain.
But perhaps the best way to keep from becoming flatfooted is to avoid the risk factors altogether. This means keeping your blood pressure, weight and diabetes in check.