ADULT ACQUIRED FLATFOOT

POSTERIOR TIBIAL TENDON DYSFUNCTION

When children are born their feet always have a flat appearance. This is normal. When children start to walk their bodies undergo changes, one of those changes is the formation of an arch in the foot that is designed to soften the pressure on the legs when walking. There are many occasions when arches do not form properly. We call this a flatfoot ( Pes Planus is the medical terminology ).

There are two kids of flatfoot - flatfoot from childhood and there is one other type- the flatfoot that appears later in life. We commonly call this adult acquired flatfoot. This can be caused by a few different situations- one of those is an injury to a structure called the posterior tibial tendon. This tendon and muscles job is to help hold up the arch against the force of the body weight, injuries to this tendon can be chronic (meaning happen over time) or acute (like a tear). If you want to read about children’s (pediatric flatfoot CLICK HERE, otherwise keep reading for adult flatfoot below.)

HOW DOES A DOCTOR DIAGNOSE IT?

A history of the foot as told by the patient is the most important way for a doctor to figure out if there is damage to the posterior tibial tendon. Recent injury or sprains can give us a clue as well as a change in the shape of the foot. Thats a very common problem people notice when they try to put on their regular shoes. During the physical examination we look for swelling and tenderness over the area where the posterior tibial tendon lies just on the inside of the ankle joint.

Then we do a common and simple test - the single leg raise. The doctor will ask you to get up on your toes with both feet at once, after that you will be asked to get up pn toes one foot at a time. Usually in cases of PTTD the patient will not be able to get up on the toes on the effected side.

Also as part of the exam having the patient isolate and use the posterior tibial tendon