Flatfoot, acquired:

Acquired flatfoot deformity (AFD) is a reformist straightening of the curve of the foot that happens as the back tibial ligament wears out. It has numerous different names, for example, back tibial ligament brokenness, back tibial ligament deficiency, and dorsolateral peritalar subluxation. This issue may advance from beginning phases with pain and growing along the back tibial ligament to finish curve breakdown and arthritis all through the hindfoot (back of the foot) and lower leg.


Patients with AFD frequently experience pain, deformity, or potentially growing at the lower leg or hindfoot. At the point when the back tibial ligament doesn't work appropriately, various changes can happen to the foot and lower leg. In beginning phases, symptoms regularly incorporate pain and expanding along the back tibial ligament behind within the lower leg.

As the ligament fizzles over the long haul, deformity of the foot and lower leg may happen. This deformity can include:

  • reformist straightening of the curve
  • outward movement of the heel so it never again is adjusted under the rest of the leg
  • rotational deformity of the forefoot
  • fixing of the heel cord
  • arthritis development
  • deformity of the lower leg joint

At specific phases of this issue, pain may move from within to the outside of the lower leg as the heel moves outward and structures are squeezed outwardly of the lower leg.

Treatment Of Acquired Flatfoot

Treatment relies particularly on a patient's symptoms, objectives, seriousness of deformity, and the presence of arthritis. A few patients improve without surgery. Rest and immobilization, orthotics, supports, and active recuperation all might be proper.

With beginning phase illness that includes pain along the ligament, immobilization with a boot for a while can mitigate weight on the ligament and decrease the aggravation and pain. When these symptoms have settled, patients may progress to utilizing an arch help or orthotic that bolsters within the hindfoot. For patients with a more critical deformity, a bigger lower leg support might be essential. Non-careful medicines for further developed phases of AFD may moderate the movement of the problem and breaking point symptoms, yet they won't fix the deformity

In the event that surgery is required, various techniques might be thought of. The points of interest of the arranged surgery rely upon the phase of the problem and the patient's particular objectives.

Flatfoot, acquired

Adult acquired flatfoot is a very common condition that affects the feet and ankles of adult males and females. In people with adult acquired flatfoot, the arch of the foot falls or collapses. It can be a painful, sometimes debilitating condition. However, a painful flatfoot can usually be helped with braces or orthotics and other non-surgical treatments.

Adult acquired flatfoot is different from flatfoot in children. Children will usually outgrow flatfoot on their own, often without treatment. In adults, flat feet usually remain permanently flat. Treatment usually addresses the symptoms rather than a cure.

In adults the condition is called "acquired" flatfoot because it affects feet that at one point in time had a normal longitudinal arch. The deformity may worsen over time as one ages.

Types of flat feet

Flexible flat foot

Flexible flat foot is the most common type. The arches in your feet appear only when you lift them off the ground, and your soles touch the ground fully when you place your feet on the ground. This type starts in childhood and usually doesn’t cause pain.

Tight Achilles tendon

Your Achilles tendon connects your heel bone to your calf muscle. If it’s too tight, you might experience pain when walking and running. This condition causes the heel to lift prematurely when you’re walking or running.

Posterior tibial tendon dysfunction

This type of flat foot is acquired in adulthood when the tendon that connects your calf muscle to the inside of your ankle is injured, swollen, or torn. If your arch doesn’t receive the support it needs, you’ll have pain on the inside of your foot and ankle, as well as on the outside of the ankle.

Depending on the cause, you might have the condition in one or both feet.


There are myriad causes of acquired flatfoot, including posterior tibialis tendon (PTT) degeneration, trauma, neuroarthropathy, neuromuscular disease, and inflammatory arthritis. Of these, PTT degeneration is, by far, the most common


Patients with acquired flatfoot often experience pain, deformity, and/or swelling at the ankle or hindfoot. When the posterior tibial tendon does not work properly, a number of changes can occur to the foot and ankle. In early stages, symptoms often include pain and swelling along the posterior tibial tendon behind the inside of the ankle.

As the tendon fails over time, deformity of the foot and ankle may occur. This deformity can include:

  • progressive flattening of the arch
  • outward shifting of the heel so that it no longer is aligned underneath the rest of the leg
  • rotational deformity of the forefoot
  • tightening of the heel cord
  • development of arthritis
  • deformity of the ankle joint


At certain stages of this disorder, pain may shift from the inside to the outside of the ankle as the heel shifts outward and structures are pinched on the outside of the ankle.


While flat feet can usually be self-diagnosed, the underlying cause may require investigation by a foot specialist known as a podiatrist. This may involve a visual exam as well as imaging tests to evaluate the structure of the foot.

Visual Examination

A podiatrist can usually diagnose flat feet by looking at your feet while standing. Among some of the visual tests used:

The wet footprint test is performed by wetting the feet and standing on a smooth, level surface. The thicker the print between the heel and ball of the foot, the flatter the foot. By contrast, a high-arch foot would leave only a narrow print of the outer foot.

The shoe inspection test can provide evidence of faulty foot mechanics. If you have flat feet, there will be more wear on the inside of your sole, especially in the heel area. The shoe's upper will also tend to lean inward over the sole.

The "too many toes" test is performed as the healthcare provider stands behind you and counts the number of toes peeking out to the sides. While only the pinky toe would be seen in people with normal pronation, three or four may be seen in those who overpronate.

The tiptoe test is used to see if you have flexible or rigid flat feet. If a visible arch forms when you stand on your toes, you have flexible flat feet. If not, your healthcare provider would likely recommend treatment for a rigid flat foot.

Imaging Tests

If you are experiencing a lot of foot pain, your healthcare provider may order imaging tests to help pinpoint the underlying cause. Among the imaging tests used:

X-rays and computed tomography (CT) scans are ideal for diagnosing arthritis and evaluating irregularities in the angle and/or alignment of the foot bones.

Ultrasound can be used to produce detailed images of soft tissue damage, such as a ruptured tendon.

Magnetic resonance imaging (MRI) can provide detailed images of bone and soft tissue damage, ideal for people with rheumatoid arthritis, tendonitis, or an Achilles heel injury.

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