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Bone, Muscle & Joint Health
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Pay Attention to Pain, Avoid Adult-acquired Flatfoot

Learn who is susceptible to becoming flatfooted, symptoms and treatments

Contributor: James Sferra, MD

Becoming flatfooted can be a real health issue for people. The advice from healthcare experts is to pay attention to foot pain, and when it happens, to seek help right away.

Flatfoot is more common

In the last 20 years, adult-acquired flatfoot has become a more commonly recognized health issue. The cause is a dysfunction of the ankle tendon that attaches to the bones on the inside of your foot. The function of this posterior tibial tendon (PTT) is to maintain the foot arch and provide strength during push-off when you walk.

When the PTT is not functioning correctly, you tend to lose your arch, or become more flatfooted. This problem occurs about three times more often in women than in men, especially after the age of 40.

Initially, PTT dysfunction is associated with pain on the inside of the ankle, swelling and sometimes a limp. If left unchecked, the arch appears to collapse and the pain on the inside of the ankle worsens. Eventually, if left unchecked, patients will begin to feel pain on the outside of the ankle, too.

Risk factors

Several risk factors are associated with PTT dysfunction, including high blood pressure, obesity, diabetes, previous ankle surgery or trauma and exposure to steroids.

A person who suspects that they are suffering from PTT dysfunction should seek medical attention earlier rather than later. It is much easier to treat early and avoid a collapsed arch than it is to repair one. When the pain first happens and there is no significant flatfoot deformity, initial treatments include rest, oral anti-inflammatory medications and, depending on the severity, a special boot or brace.

A cast boot will stop the ankle from going up and down and allow the tendon to rest. The boot can be taken on and off and is worn from four to six weeks to help resolve symptoms. If the boot is effective, your physician can prescribe shoe inserts, or orthotics, to take the strain off the PTT and help you maintain an arch in everyday shoes. If the boot is not effective, a custom-made brace can be designed for long-time daily use. The brace is made to conform to a person’s foot and ankle and it fits inside a person’s shoe to provide continuous arch support.

Surgical treatments

For more chronic flatfoot pain, surgical intervention may be the best option. Barring other serious medical ailments, surgery is a good alternative for patients with a serious problem. There are two surgical options depending on a person’s physical condition, age and lifestyle.  

The first type of surgery involves repair of the PTT by transferring of a nearby tendon to help re-establish an arch and straighten out the foot. After this surgery, patients wear a non-weight bearing support boot for four to six weeks. The other surgery involves fusing of two or three bones in the hind foot below the ankle. While providing significant pain relief, this option does take away some hind foot side-to-side motion. Following surgery, patients are in a cast for three months.

Surgery is an effective treatment to address adult-acquired flatfoot, but it can sometimes be avoided if foot issues are resolved early. That is why it is so important to seek help right away if you are feeling ankle pain. But perhaps the best way to keep from becoming flatfooted is to avoid the risk factors altogether. This means keeping your blood pressure, weight and diabetes in check.

To make an appointment with Dr. Sferra or any of our foot and ankle specialists, please call 440.312.6242.

Tags: flatfoot, inmotion, posterior tibial tendon, PTT
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  • Bhawana Sahu

    I feel I have got PTT coz i have swelling in my foot since last 2 months, and all the rheumats and physicians can say is its coz of flat food. But arch support footwear isnt helping much what to do?

    • Health Hub Team

      Hello Bhawana Sahu,
      Probably best to try a cast boot for 4-6 weeks to see if the pain subsides. If it does, then get orthotics. If not, then get an MRI to assess the tendon. Feel free to make an appointment with our department.
      Sincerely,
      Dr. Sferra