Acquired Flatfoot

The flatfoot can be congenital or can appear after skeletal maturity.

The acquired flatfoot can appear because of arthritis, a fracture, neurologic weakness, or when a dislocation occurred. Statistics show that one of the most common causes of the appearance of flatfoot is when the posterior tibial tendon is not working properly.

When a patient suffers from tibial tendon dysfunction, he will present swelling of the ankle and he may be tempted to walk on the inner part of the foot. In order to evaluate the condition, the examination will start when the patient is standing because this way the doctor may compare between the normal foot and the one where has been located a problem. The first step in the treatment of posterior tibial tendon dysfunction is getting rid of the pain and resolves the shoes issue. Some doctors may consider surgery in this situation but there are some cases when surgery is better to be avoided. If the patient has open ulceration or chronic infection or vascular disease surgery is not recommended.

There are also some risk factors that may influence the appearance of this condition like: previous injuries to that part of the foot, diabetes mellitus, hypertension, obesity.

Before setting the diagnose, the doctor may require a magnetic resonance imaging, because a MRI can help in this situation but is not compulsory. After a MRI, the tibial tendon dysfunction may be divided into three groups: complete rupture or 2 types of partial tendon dysfunction. Not very successful but still used in some situation is the tenography. The radiography is also used and the tendon is pictured from different position : from standing to abduction (lateral movement).

 

The treatment depends a lot on the stage of the illness. At the beginning of the illness the tendon’s length is not affected, and the patient experience pain and swelling. In stage 2, a deformity appears, but this problem may be resolved. After a rather long period of time, the condition evolves and the deformity is more severe . The final stage is severe and the ligament is not useful anymore.

 

This illness can be treated both with surgery or without. The treatment that exclude surgery includes immobilization, rest, anti-inflammatory drugs that do not include steroids, and physical therapy. Surgery is not recommended to patients over 40 years old which have had prior health problems. Also if the tendon is not used a lot surgery is better to be avoided.

If the first type of treatment does not solve the problem, then surgery is needed. Before surgery the doctor has to know the stage of the illness, and the possible health problems of the patient. The recovery is quite a long period, it may be more than three months. Also after surgery, the foot may swell for some months. It is true that the outcome of a surgery is rather positive but there still remain some, annoyance at the foot level.

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