Originally known as posterior tibial tendon dysfunction or insufficiency, adult-acquired
deformity encompasses a wide range of deformities. These deformities vary in location, severity, and rate of progression. Establishing a diagnosis as early as possible is one of the most
important factors in treatment. Prompt early, aggressive nonsurgical management is important. A patient in whom such treatment fails should strongly consider surgical correction to avoid worsening of
the deformity. In all four stages of deformity, the goal of surgery is to achieve proper alignment and maintain as much flexibility as possible in the foot and ankle complex. However, controversy
remains as to how to manage flexible deformities, especially those that are severe.
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing
The symptom most often associated with AAF is PTTD, but it is important to see this only as a single step along a broader continuum. The most important function of the PT tendon is to work in synergy
with the peroneus longus to stabilize the midtarsal joint (MTJ). When the PT muscle contracts and acts concentrically, it inverts the foot, thereby raising the medial arch. When stretched under
tension, acting eccentrically, its function can be seen as a pronation retarder. The integrity of the PT tendon and muscle is crucial to the proper function of the foot, but it is far from the lone
actor in maintaining the arch. There is a vital codependence on a host of other muscles and ligaments that when disrupted leads to an almost predictable loss in foot architecture and subsequent
It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal"
treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of
your foot, through an extensive evaluation. X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.
Non surgical Treatment
Options range from shoe inserts, orthotics, bracing and physical therapy for elderly and/or inactive patients to reconstructive surgical procedures in those wishing to remain more active. These
treatments restore proper function and alignment of the foot by replacing the damaged muscle tendon unit with an undamaged, available and expendable one, lengthening the contracted Achilles tendon
and realigning the Os Calcis, or heel bone, while preserving the joints of the hindfoot. If this condition is not recognized before it reaches advanced stages, a fusion of the hindfoot or even the
ankle is necessary. Typically this is necessary in elderly individuals with advanced cases that cannot be improved with bracing.
If cast immobilization fails, surgery is the next alternative. Treatment goals include eliminating pain, halting deformity progression and improving mobility. Subtalar Arthroereisis, 15 minute
outpatient procedure, may correct flexible flatfoot deformity (hyperpronation). The procedure involves placing an implant under the ankle joint (sinus tarsi) to prevent abnormal motion. Very little
recovery time is required and it is completely reversible if necessary. Ask your Dallas foot doctor for more information about this exciting treatment possibility.