When many of us were born, our feet were flat and mostly arch-less. We don’t really need that structural component until we start walking, and as we grew and matured, our arches formed as well to support us as we moved. This childhood flatfoot likely never caused us any problems, but it’s a different matter entirely if our arches start disappearing on us as adults.
Adult-acquired flatfoot often shows itself as a gradual but continuing flattening of the arch over time. As opposed to the normally painless flatfoot of childhood, this condition often begins with pain or tenderness felt along the inside of the foot and ankle, sometimes accompanied by swelling or redness. As it progresses and the arch continues to flatten, the toes and foot may begin to pivot outward as the ankle rolls inward. In more advanced stages, pain will tend to shift to the outside of the foot. Arthritis may also begin to develop in the foot or ankle.
The most common cause of the arch sinking in this manner is a weakening or wearing down of the posterior tibial tendon. This tendon is one of the main supporting structures of the foot, and the foot’s stability begins to suffer along with a deterioration in the tendon’s own stability. The tendon doesn’t seem to get affected by a sudden injury as much as it does regular overuse—“wear and tear.” This usually happens in only one foot, but it is not unheard of for both feet to have the same problem.
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The best treatment for adult-acquired flatfoot is that which begins early and right away. Since the condition becomes continuously worse over time, an early intervention might take care of it before the condition reaches a degree that surgery may be required.
However, most cases of flat feet are discovered early enough that more conservative, non-surgical measures can be taken to try and relieve the condition. Custom orthotic devices, shoe modifications, or bracing can return support to the foot and the arch, relieving much discomfort.
It is also possible that the posterior tibial tendon can recover, but this might require the foot to be immobilized in a cast or boot for a period of time. Physical therapy and exercises would then be recommended to restore strength, flexibility, and mobility to the area.
If non-surgical treatments don’t provide enough relief, or the condition has just progressed so much that they would be ineffective, surgery might become the best or only option. The procedure will depend on each specific case, but might involve realigning the bones, lengthening the muscles and ligaments, or joint fusion.
If you or a loved one has foot pain that might be caused by a deteriorating arch, this is not a problem to wait on in hopes of improvement. The sooner a suspected case of adult-acquired flatfoot is verified and treatment begins, the higher the rate of success through conservative means. Dr. Sanjay Patel and the staff of Family Foot Care & Surgery are here to get to the source of foot and ankle problems in the ways that best benefit the needs of patients. Take the first step toward relief by calling either of our offices: (203) 876-7736 for Milford or (203) 288-4055 for Hamden.