What is an Adult Acquired Flatfoot Deformity?
Adult Flatfoot Deformity is a condition of the foot where the arch on the inside of the foot collapses to the ground after previously being normal. This is also known as “fallen arches” or medically as Pes (Foot) Planus (Flat).
Should I have my Flatfoot corrected?
If you have tried physiotherapy, anti-inflammatories and arch supports and your flatfoot has constant pain and restricts your everyday activities you should seek a surgical opinion.
Who gets Flatfoot?
Not all flatfeet are the same. The most common type is usually present from birth and normal. Approximately 30% of the general population have a form of this flatfoot with the majority affecting both feet and remaining pain free.
A painful flatfoot usually occurs in adults who have had a previously normal arch and acquire the deformity over time. This usually occurs in females and is more prevalent during middle age however can also happen in men and younger patients.
What are causes of Adult Acquired Flatfoot Deformity?
The most common cause of Adult Acquired Flatfoot Deformity is a torn or degenerate posterior tibial tendon. This tendon goes down the inside of the leg and is important in maintaining the arch while walking. However, as it fails, pain develops along the tendon and with repetitive load the arch of the foot begins to fall and the severity of the deformity begins to increase.
The exact cause of tendon failure is unknown however previous trauma, obesity, high blood pressure, diabetes, increasing age, corticosteroid use, and rheumatoid arthritis increase your risk of developing the condition.
What are the symptoms of Adult Acquired Flatfoot Deformity?
What other Conditions are associated with a Flatfoot?
Tarsal Coalition – abnormal connection between bones in the foot.
Ligamentous Laxity – condition in which the ligaments of the body are loose.
How do you Diagnose Adult Acquired Flatfoot Deformity?
Dr. Chow will take a thorough medical history to delineate the nature of the pain, evaluate the degree of functional impairment and assess the deformity. Risk factors such as Rheumatoid Arthritis, diabetes and any other significant medical history will be considered. Diabetes and cigarette smoking greatly reduce the healing capability of any surgery and increase the risk of infection.
A physical examination will be undertaken to evaluate the flexibility of the foot and isolate any other areas of pain and tenderness in the foot and ankle.
Imaging is essential to evaluate the severity of the deformity and associated degeneration. Weight bearing x-rays of the foot and ankle are reviewed for evidence of osteoarthritis and the bony alignment of the foot. An MRI is also required to assess the quality of the tendon and surrounding soft tissue.
What happens if Adult Acquired Flatfoot Deformity is left untreated?
Unfortunately, Adult Acquired Flatfoot Deformity is progressive and generally gets worse with time. As the deformity progresses arthritis and stiffness will develop in the many joints of the foot and ankle. Early recognition, diagnosis, and treatment is essential to prevent the progression and allows patients to remain active and pain free.
What are the non-operative treatments for Flatfoot?
Patients with early evidence of posterior tibial tendon insufficiency leading to adult acquired flatfoot deformity and minimal pain are encouraged to attempt non-surgical treatments. This usually involves activity modification, orthotic arch supports, physical therapy to
encourage stretching and muscle rebalancing and anti-inflammatory medications.
What are the surgical treatments for Flatfoot?
Surgery is offered to patients with persistent pain and symptoms despite all attempts at non-operative treatments. The goal of surgery is to correct the deformity by restoring the bony alignment and balancing the soft tissues of the foot and ankle. This will relieve the associated pain and prevent progression or re-occurrence.
Every flatfoot is different, and a detailed pre-operative assessment by Dr. Chow will ensure the appropriate operation can be tailored to the individual patient. Dr. Chow has extensive experience locally and internally on the various procedures that are required to address these factors and will offer you the best procedure to fit the needs of your foot.
Flatfoot Surgery may involve:
What to expect after Flatfoot surgery
You should expect to stay 3-4 days in hospital with your leg elevated. This will allow for adequate pain control and a thorough physiotherapy assessment. You will be placed in a post-operative boot and advised not to weight bear on the foot. Depending on the operation performed on your foot the weight bearing status will vary along with the duration of blood thinners required to prevent clots.
Dressings are to remain dry and intact until your first post-operative appointment. Your sutures will be removed after 2 weeks and scar massage, desensitization and early ROM will commence with a physiotherapist. A repeat x-ray will be undertaken at 6 weeks, however expect to be in the boot for at least 12 weeks.
At 3 months the boot will be removed and transition into normal shoes along with physiotherapy for strengthening, range of motion and balance retraining. The ongoing recovery usually lasts for up to 6-9 months.
Potential complications of Flatfoot surgery
All surgical procedures involve inherent risk of complications. However, these risks are generally uncommon and quite infrequent. These include anesthetic complications, wound infections, nerve injuries, tendon injuries, bleeding, fracture, failure of bone to heal, ongoing pain, stiffness, chronic regional pain syndrome, blood clots, recurrence of the deformity and development of arthritis.
Patients can minimize the risk of complications by carefully following post-operative instructions.