Review of the Acquired Adult Flatfoot Deformity

Vol 32| Issue 2 | July – Dec 2019 | page: 62-68| Dennis P Jose, Rajesh Simon, Gautam Kumar

Authors: Dennis P Jose[1], Rajesh Simon[1], Gautam Kumar[1]

[1]Department Of Orthopedics, VPS Lakeshore hospital, Kochi, Kerala, India.

Address of Correspondence
Dr. Rajesh Simon,
VPS Lakeshore hospital, Kochi, Kerala, India.


Acquired adult flatfoot deformity is a common disorder commonly seen in the middle-aged and elderly female that is responsible for foot pain, misalignment, and difficulty to walk. The progressive involvement of dynamic and static stabilizers results in flattening of medial arch, subtalar subluxation, and forefoot abduction. Posterior tibial tendon (PTT) dysfunction is the most common associated pathology though it has been linked to multiple factors including trauma, neuromuscular disorders, and inflammatory pathologies. The PTT is the primary dynamic stabilizer and spring ligament is the primary static stabilizer of the medial arch of the foot. Tendon degeneration involves several stages that include synovitis, peritendinous inflammation to partial, and complete tear with overlapping stages present at the same time. The clinical examination is the cornerstone of diagnosis. Staging is based on clinical examination with objective findings such as the presence or absence of deformity; the deformity is correctable or not, and the presence or absence of osteoarthritis rather than the severity of symptoms. Acquired flat foot deformity (AFFD) is a progressive disorder starting from PTT dysfunction. As the disease progresses the damage to other supporting structure lead to worsening of the disease culminating in misalignment, gait abnormality, and osteoarthritis. The four-tier staging of AFFD by Johnson and Storm weighs the clinical examination findings and level of misalignment. Initial stages can be managed conservatively, but as severity increases, soft tissue and bones get involved warranting surgical procedures directed toward correcting the pathophysiology.
Keywords: Acquired adult flatfeet, Posterior tibial tendon dysfunction, Flattened arch, Too many toes sign.


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How to Cite this Article: Jose D P, Simon R, Kumar G | Review of the Acquired Adult Flatfoot Deformity | Kerala Journal of Orthopaedics| July – Dec 2019; 32(2): 62-68 .

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