Occassionally I will get questions which are profound, as they give me insight into what people want to know as a whole. So whenever I get a good question I will try and answer it on this blog. This information may answer many of your questions that you did not know you had at the time, and may make for some intelligent reading as well.
The adult acquired flatfoot (AAF) is a progressive, symptomatic (painful) deformity resulting from gradual stretch of the tibialis posterior tendon as well as the ligaments that support the arch of the foot.
Most flat feet are not painful, particularly those flat feet seen in children. In the adult acquired flatfoot, pain occurs because soft tissues (tendons and ligaments) have been torn. The deformity progresses or worsens because once the vital ligaments and posterior tibial tendon are lost, nothing can take their place to hold up the arch of the foot.
The painful, progressive adult acquired flatfoot affects women four times as frequently as men. It occurs in middle to older age people with a mean age of 60 years. Most people who develop the condition already have flat feet. A change occurs in one foot where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Why this event occurs in some people (female more than male) and only in one foot remains poorly understood. Contributing factors increasing the risk of adult acquired flatfoot are diabetes, hypertension, and obesity.
The following scheme of events is thought to cause the adult acquired flatfoot:
1) A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot.
2) Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow.
3) Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon.
4) Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
Treatment varies based on the stage of the disease, and each patient is treated differently based on findings. Arthritis, age, comorbidities, and whether it's flexible or rigid greatly influence the the foot and ankle surgeon's modalities. Surgery and bracing are key elements to reconstruction and palliative symptom control.
In this section, I encourage readers to submit questions/comments/personal stories/etc and I will definetly respond on this forum. I enjoy informing people about their conditions and the reasons why we do what we do for them. I do not have all the answers, as nobody can say they do, but I will strive to report the latest information available and keep you up to date as I go through these many topics.
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Hi Dr Tim, we have an active 13 yr old boy who has been diagnosed with flat feet. Treatment was orthodics which he wears diligently. After standing all day, hiking or running, he experiences pain in his ankles.
ReplyDeleteWe he was diagnosed he did not expience (or report) he has ankle pain, but now it is quite frequent.
How can we treat this, what can we expect from treatment and how can we relieve our sons pain.
Sincerely,
Ken