flat feet

Posterior tibial tendon dysfunction is one of several terms to describe a painful, progressive flatfoot deformity in adults.

This is a progressive, symptomatic deformity resulting from gradual stretch of the tibialis posterior tendon as well as the ligaments that support the arch of the foot.

Most flat feet are not painful, particularly those in children. In adults there can be pain because soft tissues have been torn. The deformity progresses or worsens because once the ligaments and tendon are lost, nothing can take their place to hold up the arch of the foot.

A person with flat feet has a greater load placed on the posterior tibial tendon which is the main tendon supporting the arch of the foot. With aging it leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons as arteries narrow. Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to artherosclerosis. In some people the posterior tibial tendon finally gives out or tears.

This is a slow, gradual stretching followed by inflammation and degeneration of the tendon. Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside.

The most accurate diagnosis is made by a podiatrist by observing the foot while the patient is walking. The affected foot appears more pronated and deformed compared to the unaffected foot. Muscle testing will show a strength deficit.

An MRI can show tendon injury and inflammation but cannot be relied on with 100% accuracy.

The inflammation and tendon injury will respond to rest, protected ambulation in a cast, as well as anti-inflammatory therapy. Follow-up with custom-molded orthotics are critical to maintain stability of the foot after initial symptoms have been calmed.

Long-term use of a foot brace is required to stop progression of the deformity without surgery.

In cases where orthotics and braces have failed surgery is the next alternative. The goal of surgery is to eliminate pain, stop progression of the deformity and improve mobility of the patient. Procedures commonly used to correct the condition include tendon debridement, tendon transfers and joint fusions.

If you think you may have flat feet, give Dr.T. F. Vail's office a call at 419-423-1888 to set up an appointment to see what can best benefit your feet.