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Adult Aquired Flatfoot

What is the Adult aquired flatfoot?

Adult aquired flat foot is commonly referred to as posterior tibialis tendon dysfunction.

What is the Posterior Tibialis Tendon?

  • The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. 

  • Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot. PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. PTTD is usually progressive, which means it will keep getting worse, especially if it is not treated early.

How is it commonly injured

  • Histological examination has shown that, rather than tendinitis (tendon inflammation), the process is one of tendinosis (tendon degeneration), and the tibialis posterior tendon becomes fibrotic through a process of repeated microtrauma.

  • A poor blood supply to the tendon has been identified as it courses posterior to the medial malleolus. Mechanical factors must be at play that predispose the tendon to progressive fibrosis. A growing body of research proposes that abnormal forces arise from even mild flatfootedness, resulting in lifelong greater mechanical demands on the tibialis posterior than in a normal foot

Classification and Signs and Symptoms of this injury

  • Pain and/or swelling behind the medial malleolus and along the instep, Change in foot shape, Decrease in walking ability and balance, Ache on walking long distance

​There are 4 stages of PTTD:

  • Tendon is inflamed

  • Tendon becomes elongated

  • The deformity becomes more rigid and degenerative changes are noted in sub taller joint

  • Fixed deformity with degeneration in subtalar and ankle joints

Currently management techniques

  • In early stages techniques used include a combination of resting the injured area and then beginning gradually strengthening exercises to re-strengthen the tibailis posterior muscle

  • Footwear  / Orthotics are normally recommended to help reduce work on the tibias posterior 

  • Failure of conservative treatment can mean surgical intervention is necessary 

Global Rehabilitation Network

  • We provide a complete online program of 12 consecutive weeks of instructions on how to conservatively manage this injury

  • We provide a global network of therapists that can chat remotely via our Telehealth services to guide you through the process week by week for minimal cost.

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