Adult acquired flatfoot is a progressive collapse of the arch in a previously normal foot, usually caused by degeneration of the posterior tibial tendon. It starts as pain and swelling behind the inner ankle, progresses to a visibly flattening foot with an outward-tilting heel, and is one of the few flatfoot presentations where early treatment genuinely changes the outcome.
Stages I and II are managed first with immobilisation or a custom orthosis, eccentric strengthening of the tibialis posterior, and weight optimisation. Persistent stage II deformity is reconstructed with tendon transfer combined with a medialising calcaneal osteotomy, lateral column lengthening, and gastrocnemius recession as required. Stage III and IV disease usually needs selective fusion or ankle reconstruction.
Childhood flexible flatfoot is a developmental shape that is usually stable and painless. Adult acquired flatfoot is a new, progressive deformity in a foot that used to have an arch, and it is a tendon disease first and a bone deformity second.
Yes, with modification. Swimming, cycling and controlled strengthening are encouraged; prolonged standing, running on hard surfaces and unsupported footwear aggravate the tendon.
Dr. Mutasem Aldhoon is a leading Pediatric Orthopedic Consultant specializing in complex lower extremity deformities. With extensive experience in advanced joint-sparing and reconstructive techniques, he is the trusted authority for severe pediatric flatfoot and neurological foot reconstructions.
