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Adult (Acquired) Flatfoot

Last updated March 21, 2018

Adult Acquired Flatfoot (AAF) is a painful condition that results in the progressive flattening of the arch of the foot, which is noticeable when an individual stands up.


What are the other Names for this Condition? (Also known as/Synonyms)

  • AAF (Adult Acquired Flatfoot)
  • Adult Acquired Flatfoot Deformity (AAFD)
  • Fallen Arches

What is Acquired Flatfoot in Adults? (Definition/Background Information)

  • Adult Acquired Flatfoot (AAF) is a painful condition that results in the progressive flattening of the arch of the foot, which is noticeable when an individual stands up
  • Individuals with flatfoot have no arch on the inside of their feet, allowing the entire foot to touch the floor while standing
  • Many contributing factors that can cause Adult Acquired Flatfoot include damage to the nerves, ligaments, and surrounding tendons of the foot, causing a partial dislocation (subluxation) of the subtalar or talonavicular joints. Another possible cause may be a bone fracture, which results in deformity of the joint, causing the disorder
  • For a majority of the individuals with Adult Acquired Flatfoot, the treatment methods include specialized orthotics and braces. However, if nonsurgical methods do not help relieve the pain, surgery may be used in treating the deformity and symptoms associated with flatfoot
  • The prognosis of individuals with Adult Acquired Flatfoot is usually good, if detected and properly treated early

Adult Acquired Flatfoot can be classified into four stages:

  • Stage I: There is a noticeable flatfoot position without any deformity. Pain, inflammation, and swelling of the posterior tibial tendon around the inside of the ankle are common during this stage
  • Stage II: There are visible abnormalities in the foot position when compared to the other foot, indicating that the deformity is beginning to occur. During this stage, the deformity is still treatable non-surgically
  • Stage III: The foot condition progresses to a rigid, non-movable flat foot deformity that is painful, primarily on the outside of the ankle
  • Stage IV: This stage denotes that there is a deformity in the foot and ankle. The abnormality can be moveable or fixed. Frequently, the joints in the foot and ankle show signs of degenerative joint disease (osteoarthritis)

Who gets Acquired Flatfoot in Adults? (Age and Sex Distribution)

  • Generally, women over the age of 60 years have the highest risk of developing symptoms of Adult Acquired Flatfoot
  • Also, females are more likely to develop the condition than males
  • No ethnic or racial preference is seen

What are the Risk Factors for Acquired Flatfoot in Adults? (Predisposing Factors)

Risk Factors of Adult Acquired Flatfoot include:

  • Advancing age
  • Abnormal pressure on the foot or ankle, due to excessive body weight (obesity)
  • Women have a higher incidence of the condition than men
  • Any traumatic injury to the posterior tibial tendon may result in Adult Acquired Flatfoot
  • An inflammatory or autoimmune disorder, such as rheumatoid arthritis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Acquired Flatfoot in Adults? (Etiology)

Common causes of Adult Acquired Flatfoot include:

  • Injury to the posterior tibial tendon is the most common cause of Adult Acquired Flatfoot
  • An inflammatory or autoimmune disorder such as rheumatoid arthritis: Rheumatoid arthritis not only damages the cartilage within the joints, but also the ligaments that support the foot
  • Individuals with diabetes or nerve damage, which may reduce sensation within the feet, causing a collapse of the arch

What are the Signs and Symptoms of Acquired Flatfoot in Adults?

Signs and symptoms of Adult Acquired Flatfoot include:

  • Pain around the heel or arch of the foot
  • Difficulty standing on one’s toes (difficulty tiptoeing)
  • Noticeable swelling on the inside of the ankle

How is Acquired Flatfoot in Adults Diagnosed?

Adult Acquired Flatfoot is diagnosed using the following tools:

  • Physical examination: During a thorough physical examination for Adult Acquired Flatfoot, a physician will examine the individual while walking, and test the range of motion with the foot and ankle joints. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
  • X-ray of the foot: A physician may order an x-ray to help determine the severity of the flatfoot
  • Magnetic resonance imaging (MRI) of the foot: An MRI is a more detailed scan that uses a magnetic field to generate thorough images of the interior bones and soft tissues, which helps confirm a diagnosis
  • Computerized tomography (CT) scan of the foot: A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the foot. This then allows the physician to examine the foot and surrounding structures to confirm a diagnosis
  • General ultrasound imaging of the foot: If the physician believes that there may be a damaged tendon, an ultrasound of the foot may be ordered. Ultrasounds are high-frequency sound waves that generate a detailed image of the tendons in the body

What are the possible Complications of Acquired Flatfoot in Adults?

Complications are rare for individuals with Adult Acquired Flatfoot. However, some complications that may arise after surgical treatments include:

  • Fused bones do not heal
  • Permanent deformity of the foot
  • Infection of the foot
  • Decreased range of motion of the ankle
  • Permanent pain in the foot or ankle

How is Acquired Flatfoot in Adults Treated?

Adult Acquired Flatfoot does not hinder an individual's ability to walk or wear shoes. Treatment may include nonsurgical and surgical methods that depend on severity of the condition: 

Nonsurgical treatments for Adult Acquired Flatfoot include:

  • Oral medications, such as ibuprofen and naproxen, can help decrease pain and swelling in the foot
  • If an individual is experiencing any pain in the foot, ankle, or leg caused by any physical activity, the physician may recommend exercises to stretch the heel cord
  • A well-padded custom-made shoe insert may be used to relieve pain
  • A physician may recommend physical therapy if the affected individual has tight heel cords

If conservative methods are not successful in controlling the symptoms, the physician may recommend a surgery. 

Surgical treatments for Adult Acquired Flatfoot include:

  • Triple arthrodesis: Triple arthrodesis is a surgical procedure that involves fusing three joints within the back of the foot. These joints include the talonavicular joints, the subtalar joints, and the calcaneocuboid joints
  • Calcaneal osteotomy: Calcaneal osteotomy is an open reduction procedure that involves a controlled surgical break of the calcaneus (heel bone). This procedure is performed to correct a deformity of the foot and ankle
  • Lateral column lengthening: Lateral column lengthening is a surgical procedure that involves removing a small piece of bone from the hip and places it on the outside of the calcaneus (heel bone). This procedure helps in restoring the arch of the foot
  • Tendon transfer: A Tendon transfer is a procedure that uses another tendon from a different part of the body to repair the injured posterior tibial tendon. A combination of surgical treatments may be required to restore normal movement in the foot and ankle. The prognosis may depend on the individual’s age, stage, and severity of the condition, and also their preferred daily activity levels

How can Acquired Flatfoot in Adults be Prevented?

Currently, there are no specific methods or guidelines to prevent Adult Acquired Flatfoot. However, there are certain measures that may help in preventing abnormal pressure on the foot or ankle joint. These measures include:

  • Maintaining a healthy body weight can help prevent abnormal pressure on the foot or ankle joints
  • Individuals are advised to take appropriate measures to prevent an injury or trauma to the posterior tibial tendon

Active research is currently being performed to identify tissue abnormalities and potential causes responsible for Adult Acquired Flatfoot. This has the possibility to lead to improved treatment methods and preventative techniques. 

What is the Prognosis of Acquired Flatfoot in Adults? (Outcomes/Resolutions)

  • The majority of cases involving Adult Acquired Flatfoot are painless, and complications are also rare
  • Some adults with this condition may experience pain that can be treated with nonsurgical methods
  • If conservative methods are unsuccessful in treating the foot deformity, then surgery may be required to relieve the pain in the foot

Additional and Relevant Useful Information for Acquired Flatfoot in Adults:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 27, 2015
Last updated: March 21, 2018

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