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Managing Adult Flatfoot: From Orthotics to Surgery

Flatfoot - also called pes planus - is a condition where the arch on the inside of the foot flattens, causing the entire sole to touch the ground when standing.

While some people are born with flat feet, others develop the condition later in life, a condition known as Adult Acquired Flatfoot Deformity (AAFD).

This condition can gradually cause pain, imbalance, difficulty walking, and even deformity if not addressed early.

Understanding the symptoms, treatment options, and when surgery may be necessary can help you make informed decisions about your foot health.

In this blog, Dr. Sukesh Rao Sankineani, widely regarded as the Best Orthopedic Doctor in Secunderabad, explains what adult acquired flatfoot is, why it happens, and how it can be treated effectively.

What Is an Adult Acquired Flatfoot?

Adult acquired flatfoot develops when the posterior tibial tendon - the primary structure that supports the arch - becomes weakened, stretched, or torn over time.

This tendon runs from the calf down to the inside of the ankle and into the foot, helping maintain the arch and providing stability during walking.

When this tendon becomes dysfunctional, it leads to a progressive flattening of the arch, inward rolling of the ankle, and gradual deformity of the foot.

Causes of Adult Acquired Flatfoot

Several underlying conditions or risk factors can lead to the development of adult acquired flatfoot, including:

Posterior Tibial Tendon Dysfunction (PTTD): The most common cause. Chronic overuse or degeneration of the tendon leads to its inability to support the arch.
Obesity: Increased body weight puts extra strain on the foot tendons and ligaments.
Arthritis: Inflammatory arthritis (such as rheumatoid arthritis) can damage the joints and soft tissues, altering foot structure.
Injury or Trauma: Fractures, dislocations, or sprains in the foot or ankle can damage the tendon or supporting structures.
Diabetes or Hypertension: These conditions can weaken tendons over time due to poor blood supply.
Age-Related Degeneration: Tendons naturally lose elasticity and strength with age, making older adults more prone to flatfoot.

Symptoms of Adult Acquired Flatfoot

The symptoms of adult acquired flatfoot can range from mild discomfort to severe deformity and pain that interferes with daily activities. Early recognition is key to preventing progression.

Common symptoms include:

Pain and swelling along the inside of the ankle or arch.
Loss of arch height - the foot appears flatter when standing.
Difficulty standing on tiptoes or performing calf raises.
Outward tilt of the heel (foot rolls inward).
Pain on the outside of the ankle, due to shifting of the foot bones.
Fatigue or aching in the foot or lower leg after prolonged standing or walking.
Uneven wear on shoes, indicating altered foot mechanics.

If you experience persistent foot pain or notice your foot shape changing, it’s important to consult an orthopedic specialist.

A detailed examination and imaging can confirm the stage and severity of flatfoot.

Stages of Adult Acquired Flatfoot

Orthopaedic surgeons classify AAFD into four progressive stages based on severity:

Stage I: Inflammation or mild degeneration of the posterior tibial tendon without foot deformity.
Stage II: Partial tendon tear with a flexible flatfoot deformity (foot can still be corrected manually).
Stage III: Advanced tendon damage with rigid flatfoot deformity that cannot be corrected manually.
Stage IV: Severe deformity involving the ankle joint as well.

Understanding the stage helps the Best Orthopedic Surgeon in Secunderabad, like Dr. Sukesh Rao Sankineani, design the most effective treatment plan - from conservative management to surgical reconstruction.

Diagnosis

A thorough clinical examination is the cornerstone of diagnosis. Dr. Sukesh Rao assesses:

Foot alignment and flexibility
Range of motion of the ankle and hindfoot
Tenderness along the tendon path
Ability to perform a single-leg heel raise

Imaging studies like X-rays, ultrasound, or MRI help confirm the diagnosis, showing the degree of tendon degeneration and bone alignment.

Non-Surgical Management: Orthotics and Rehabilitation

In the early stages, adult acquired flatfoot can often be managed without surgery. The goal is to reduce pain, control inflammation, and prevent progression of deformity.

1. Activity Modification

Avoid high-impact activities like running or jumping that strain the tendon. Opt for low-impact exercises such as swimming or cycling.

2. Footwear and Orthotics

Wearing supportive footwear and using custom orthotic insoles can significantly improve comfort and stability. Orthotics are designed to:

Support the medial arch,
Prevent excessive inward rolling (pronation),
Redistribute body weight evenly,
Reduce strain on the posterior tibial tendon.

For flexible deformities, a medial arch support or ankle-foot orthosis (AFO) can help restore alignment and reduce pain.

3. Physiotherapy

A structured rehabilitation program focuses on:

Strengthening the posterior tibial tendon and calf muscles,
Improving ankle flexibility and balance,
Correcting gait mechanics.

Therapies such as ultrasound therapy, manual mobilization, and resistance exercisesenhance healing and prevent recurrence.

4. Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve pain and swelling. In select cases, corticosteroid injections may be considered for short-term relief.

When conservative treatment fails to provide adequate improvement, surgical options may be discussed.

When Is Surgical Correction Indicated?

Surgery becomes necessary when:

Pain persists despite 3 - 6 months of conservative treatment,
The deformity becomes rigid or progressively worse,
The patient is unable to perform normal daily or recreational activities,
There is associated arthritis or tendon rupture.

Surgical Options

The type of surgery depends on the severity (stage) of the deformity:

2. Osteotomy (Bone Realignment): If the foot alignment is significantly altered, bone cuts are made to reposition the heel or forefoot, restoring normal mechanics.

3. Arthrodesis (Joint Fusion): In advanced, rigid deformities or arthritic joints, fusion may be done to correct alignment and relieve pain.

4. Combination Procedures: Surgeons may combine tendon reconstruction with osteotomy or fusion for optimal long-term outcomes.

Dr. Sukesh Rao Sankineani, known as the Best Orthopedic Surgeon in Secunderabad, uses minimally invasive and arthroscopic techniqueswherever possible to ensure faster recovery, smaller scars, and less postoperative pain.

Recovery and Rehabilitation

Postoperative recovery varies depending on the procedure but generally includes:

Immobilization: The foot is kept in a cast or boot for 6 - 8 weeks to allow proper healing.
Gradual Weight Bearing: You will transition from non-weight-bearing to partial, and finally full weight-bearing under your surgeon’s guidance.
Physiotherapy: Essential to restore strength, mobility, and balance.
Return to Activities: Most patients resume normal daily activities within 3 - 4 months, though complete recovery may take up to a year for complex reconstructions.

With advanced surgical expertise and structured rehabilitation, patients can expect excellent long-term outcomes and return to active lifestyles without pain or instability.

Prevention Tips

Maintain a healthy body weight to reduce stress on the feet.
Wear supportive shoes with good arch support, especially during exercise.
Perform foot and ankle strengthening exercises regularly.
Avoid prolonged standing on hard surfaces.
Seek early evaluation if you notice arch collapse, ankle swelling, or persistent foot pain.

Final Thoughts

Adult acquired flatfoot is a progressive condition, but with timely diagnosis and individualized care, it can be effectively managed - often without surgery in early stages.

However, when conservative measures fail, surgical correction offers durable pain relief and restores normal alignment and function.

If you are experiencing foot pain or arch collapse, consulting an expert like Dr. Sukesh Rao Sankineani,the Best Orthopedic Doctor in Secunderabad, can make all the difference.

His extensive training, advanced surgical expertise, and patient-centered approach ensure that every treatment is personalized for the best possible outcome.