This document discusses adult-acquired flatfoot deformity, including its anatomy, causes, presentation, diagnosis, and treatment options. It notes that the deformity encompasses a wide range of conditions that vary in location and severity. The posterior tibial tendon is a major dynamic stabilizer of the arch, and its dysfunction or failure is a common cause of the deformity. Treatment progresses from nonsurgical options like orthotics to surgical procedures like tendon transfers or osteotomies when symptoms increase or the deformity worsens. The goal of any treatment is to relieve pain while maintaining foot flexibility and proper alignment.

1. Adult-acquired Flatfoot
Deformity

2. • adult-acquired flatfoot deformity
encompasses a wide range of deformities.
• These deformities vary in location, severity,
and rate of progression.

3. • Anatomy

4. • Two arches held by
tendons & ligaments
• Allow foot to support
weight of the body: ball
of foot – 40% weight.
Heel – 60% weight
• Leverage for walking
• Fully developed by age
13
• Longitudinal arch:
medial and lateral parts
• Transverse arch

5. Two longitudinal
arches
Medial longitudinal
arch - extends from
calcaneus bone to
talus, navicular, 3
cuneiforms, and
proximal ends of 3
medial metatarsals
Lateral longitudinal
arch - extends from
calcaneus to cuboid
and proximal ends of
4th & 5th metatarsals
Transverse arch
extends across foot
from 1st metatarsal to
the 5th metatarsal

6. • The 3 most important static contributors to
arch stability:
• plantar fascia, the long and short plantar
ligaments, and the spring ligament
(calcaneonavicular ligament)

8. • Dynamic (interinsic ,exterinsic)
• The major dynamic stabilizer for the arch is
the posterior tibial tendon.
Contraction of the posterior tibial
tendon causes inversion of the
midfoot and elevation of the medial
longitudinal arch through its broad
insertion on the navicular,
cuneiforms, medial 3 metatarsal
bases, and cuboid.

9. Adult-acquired Flatfoot
Deformity
• Etiology
-Fracture or dislocation
-Tarsal coalition
-Tendon laceration
- Artheritis
- Neuroarthropathy
-Neurologic weakness
- Iatrogenic causes
-Posterior tibial tendon
dysfunction

10. Adult-acquired Flatfoot
Deformity
• Originally known as posterior tibial tendon
dysfunction or insufficiency
• first described as tendon failure.
• However, failure of the ligaments that support
the arch also occurs,

11. Adult-acquired Flatfoot
Deformity
• Etiology
• The etiology of the condition is multifactorial
attributed to degenerative, inflammatory, and
traumatic causes
obesity , preexisting flatfoot

12. • Pathology
- PT tendon deg.
- tendon failure most common (1-1.5 cm)
distal to MM (hypovascular)
- ligaments failure (spring )
- talonavi. Subluxation  medioplantar
migration talar head  further deformity
- hind foot valgus

14. • Diagnosis
Patient History
Clinical examination
Standing Radiograph of foot and ankle

15. Adult-acquired Flatfoot
Deformity
• Presentation
- Pain and swelling medial side
(ankle-midfoot)
- loss of the arch
- Tendency to walk on the inner
border of the
foot.
- Loss of push-off strength during
gait
- limping
- latral ankle pain
- shoes wear.

16. • Clinical Examination
-

18. • Radiological:

20. Stages:
- Described by
Johnson and
Strom, 4 stages

21. Stage 3

22. Treatment
• Nonsurgical
- Recommended first because it may be helpful in
alleviating symptoms.
- NSAD
- Removable boot or cast is most often helpful.
- Support with customized brace (articulated
ankle-foot orthosis)
- Foot orthosis e (medial arch+ medial heel wedg)
- Physiotherapy

23. • Nonsurgical
• No study has been done to document whether
these devices slow or prevent the progression
of deformity. ( Jonathan T. AAOS 2008 ,)

24. Treatment
• Surgical
- Failed nonsurgical Rx in alleviate symptoms.
- Increasing deformity.
-When the deformities become more severe
and fixed, the results of treatment are more
limited.
- Controversies persist regarding how to treat

25. • Surgical
Surgical

26. Surgical treatment
• Tendone transfer FHL ,FDL
• medial side
• osteotomy

27. Surgical treatment
• In all stages, there are benefits to achieve
proper alignment and maintaining as much
flexibility as possible.