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Abstract
Acquired adult flatfoot is a deformity characterized by a decreased medial longitudinal arch and a hindfoot valgus with or without forefoot abduction. The etiologies of this deformity include posterior tibial tendon dysfunction, rheumatoid arthritis, trauma, Charcot’s joint, neurologic deficit, and damage to the medial spring ligament complex or plantar fascia. Among these, posterior tibial tendon dysfunction is the most well-known cause. Although posterior tibial tendon dysfunction has been regarded as a synonym of acquired adult acquired flatfoot, failure of the ligaments supporting the arch can also result in progressive deformity even without a posterior tibial tendon problem. The authors describe the pathophysiology, diagnosis, and nonoperative treatment of acquired adult flatfoot, focusing on posterior tibial tendon dysfunction.
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Figure 1.
Medial longitudinal arch is reestablished when an examiner extends the great toe while the patient is standing in the case of flexible flat foot.
Figure 2.
This figure shows ‘too many toes sign’ in right side. When looking at the heel from the back of the patient, usually only the fifth toe and half of the fourth toe are seen. In a flatfoot deformity (right foot), more of the little toe can be seen.
Figure 3.
During the double-limb heel-rise test, the right heel shows a failed restoration of inversion.
Figure 4.
On standing foot anteroposterior view, talo-calcaneal angle (A) and talo-navicular coverage angle (B) can be measured. α: talocalcaneal angle is the angle between the long axis of talus and the long axis of calcaneus. β: talo-navicular coverage angle is formed between the line through base of distal articular cap of talus and the line through proximal articular cap of navicula.
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