Adult flatfoot

Flatfoot deformity in adults is a type of postural deformity of the foot in which the arch collapses. This condition includes a wide spectrum of clinical situations, ranging from asymptomatic to progressive and disabling pathology. The common causes of adult-acquired flatfoot deformity are sustained flexible flatfoot from childhood, posterior tibial tendon insufficiency, tarsal coalition, generalized inflammatory diseases, neuropathic arthropathy, and posttraumatic deformities. The treatment of adult acquired flatfoot deformity should be individualized in each case, depending on the causes, symptoms, severity of deformity, and flexibility of the deformity. Therefore, it is mandatory for physicians to be acquainted with the basic pathomechanics of flatfoot deformity as well as the diagnostic procedures and treatments for each condition. The treatment usually begins with conservative methods and variable surgical procedures could be selectively performed. This article reviews the basic pathoanatomy, the diagnostic procedures for various causes and the treatment of flatfoot deformity in adult.

Acquired Adult Flatfoot: Pathophysiology, Diagnosis, and Nonoperative Treatment / 대한족부족관절학회지

Acquired adult flatfoot is a deformity characterized by a decreased medial longitudinal arch and a hindfoot valgus with or without forefoot abduction. The etiologies of this deformity include posterior tibial tendon dysfunction, rheumatoid arthritis, trauma, Charcot's joint, neurologic deficit, and damage to the medial spring ligament complex or plantar fascia. Among these, posterior tibial tendon dysfunction is the most well-known cause. Although posterior tibial tendon dysfunction has been regarded as a synonym of acquired adult acquired flatfoot, failure of the ligaments supporting the arch can also result in progressive deformity even without a posterior tibial tendon problem. The authors describe the pathophysiology, diagnosis, and nonoperative treatment of acquired adult flatfoot, focusing on posterior tibial tendon dysfunction.

Operative Treatment of Acquired Adult Flatfoot / 대한족부족관절학회지

Acquired adult flatfoot deformity is characterized by flattening of the medial longitudinal arch and dysfunction of the posteromedial soft tissues, including the posterior tibial tendon. When the non-operative treatment fails to result in improvement of symptoms, surgery should be considered. Operative techniques include flexor digitorum longus tendon transfer, calcaneal medial slide osteotomy, lateral column lengthening, and arthrodesis of the hindfoot. The principle of correcting the deformity while avoiding overcorrection and excessive stiffness is important in achievement of good outcomes in these patients.