Skip to main content

Advertisement

Log in

Adult-acquired flatfoot deformity

  • General Review • ANKLE - FOOT
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Trnka HJ (2004) Dysfunction of the tendon of tibialis posterior. J Bone Joint Surg Br 86:939–946

    Article  CAS  PubMed  Google Scholar 

  2. Kohls-Gatzoulis J, Woods B, Angel JC, Singh D (2009) The prevalence of symptomatic posterior tibial tendon dysfunction in women over the age of 40 in England. Foot Ankle Surg 15(2):75–81

    Article  CAS  PubMed  Google Scholar 

  3. Myerson MS (1996) Adult acquired flatfoot deformity. J Bone Joint Surg Am 78:780–792

    Article  Google Scholar 

  4. Holmes GB Jr, Mann RA (1992) Possible epidemiological factors associated with rupture of the posterior tibial tendon. Foot Ankle 13(2):70–79

    Article  PubMed  Google Scholar 

  5. Hambright D, Guss D, Smith JT (2016) Unique case of posterior tibial tendon dysfunction after stingray strike. Foot Ankle Spec 9(3):275–278

    Article  PubMed  Google Scholar 

  6. Brodsky JW (2004) Preliminary gait analysis results after posterior tibial tendon reconstruction: a prospective study. Foot Ankle Int 25:96–100

    Article  PubMed  Google Scholar 

  7. Deland JT (2001) The adult acquired flatfoot and spring ligament complex. Pathology and implications for treatment. Foot Ankle Clin 6:129–135

    Article  CAS  PubMed  Google Scholar 

  8. Orr JD, Nunley JA II (2013) Isolated spring ligament failure as a cause of adult-acquired flatfoot deformity. Foot Ankle Int 34(6):818–823

    Article  PubMed  Google Scholar 

  9. Resnick RB, Jahss MH, Choueka J, Kummer F, Hersch JC et al (1995) Deltoid ligament forces after tibialis posterior tendon rupture: effects of triple arthrodesis and calcaneal displacement osteotomies. Foot Ankle Int 16:14–20

    Article  CAS  PubMed  Google Scholar 

  10. Bluman EM, Myerson MS (2007) Stage IV posterior tibial tendon rupture. Foot Ankle Clin 12:341–362

    Article  PubMed  Google Scholar 

  11. Giza E, Cush G, Schon LC (2007) The flexible flatfoot in the adult. Foot Ankle Clin 12:251–271

    Article  PubMed  Google Scholar 

  12. Johnson KA, Strom DE (1989) Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 239:196–206

    Google Scholar 

  13. Myerson MS (1997) Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. Instr Course Lect 46:393–405

    CAS  PubMed  Google Scholar 

  14. Rosenberg ZS, Beltran J, Bencardino JT (2000) Radiological Society of North America: MR imaging of the ankle and foot. Radiographics 20:S153–S179

    Article  PubMed  Google Scholar 

  15. Kong A, Van Der Vliet A (2008) Imaging of tibialis posterior dysfunction. Br J Radiol 81(970):826–836

    Article  CAS  PubMed  Google Scholar 

  16. Alvarez RG, Marini A, Schmitt C, Saltzman CL (2006) Stage I and II posterior tibial tendon dysfunction treated by a structured non operative management protocol: an orthosis and exercise program. Foot Ankle Int 27:2–8

    Article  PubMed  Google Scholar 

  17. Wapner KL, Chao W (1999) Nonoperative treatment of posterior tibial tendon dysfunction. Clin Orthop Relat Res 365:39–45

    Article  Google Scholar 

  18. Augustin JF, Lin SS, Berberian WS, Johnson JE (2003) Nonoperative treatment of adult acquired flat foot with the Arizona brace. Foot Ankle Clin 8:491–502

    Article  PubMed  Google Scholar 

  19. Teasdall RD, Johnson KA (1994) Surgical treatment of stage I posterior tibial tendon dysfunction. Foot Ankle Int 15:646–648

    Article  CAS  PubMed  Google Scholar 

  20. Khazen G, Khazen C (2012) Tendoscopy in stage I posterior tibial tendon dysfunction. Foot Ankle Clin 17(3):399–406

    Article  PubMed  Google Scholar 

  21. Roussignol X, Lagrave B, Berthiaux S, Duparc F, Dujardin F (2013) Posterior tibial tendoscopy: description of an accessory portal and assessment of tendon vascularization lesion according to portal. Foot Ankle Surg 19(1):22–26

    Article  CAS  PubMed  Google Scholar 

  22. Gianakos AL, Ross KA, Hannon CP, Duke GL, Prado MP, Kennedy JG (2015) Functional outcomes of tibialis posterior tendoscopy with comparison to magnetic resonance imaging. Foot Ankle Int 36(7):812–819

    Article  PubMed  Google Scholar 

  23. Deland JT (2008) Adult-acquired flatfoot deformity. J Am Acad Orthop Surg 16(7):399–406

    Article  PubMed  Google Scholar 

  24. Mann RA (1983) Acquired flat foot in adults. Clin Orthop Relat Res 181:46–51

    Google Scholar 

  25. Mann RA, Thompson FM (1985) Rupture of the posterior tibial tendon causing flat foot. J Bone Joint Surg Am 67(556):561

    Google Scholar 

  26. Mann RA (2001) Posterior tibial tendon dysfunction: treatment by flexor digitorum longus transfer. Foot Ankle Clin 6:77–87

    Article  CAS  PubMed  Google Scholar 

  27. Myerson MS, Badekas A, Schon LC (2004) Treatment of stage II posterior tibial tendon deficiency with flexor digitorumlongus tendon transfer and calcaneal osteotomy. Foot Ankle Int 25:445–450

    Article  PubMed  Google Scholar 

  28. Otis JC, Deland JT, Kenneally S, Chang V (1999) Medial arch strain after medial displacement calcaneal osteotomy: an in vitro study. Foot Ankle Int 20:222–226

    Article  CAS  PubMed  Google Scholar 

  29. Zaw H, Calder JD (2010) Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review. Knee Surg Sports Traumatol Arthrosc 18(2):135–142

    Article  PubMed  Google Scholar 

  30. Evans D (1975) Calcaneovalgus deformity. J Bone Joint Surg Br 57:270–278

    CAS  PubMed  Google Scholar 

  31. Sands AK, Tansey JP (2007) Lateral column lengthening. Foot Ankle Clin 12:301–308

    Article  PubMed  Google Scholar 

  32. Hintermann B, Valderrabano V, Kundert HP (1999) Lengthening of the lateral column and reconstruction of the medial soft tissue for the treatment of acquired flat foot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int 20:622–629

    Article  CAS  PubMed  Google Scholar 

  33. Chan JY, Greenfield ST, Soukup DS, Do HT, Deland JT, Ellis SJ (2015) Contribution of lateral column lengthening to correction of forefoot abduction in stage IIb acquired flatfoot deformity reconstruction. Foot Ankle Int 36(12):1400–1411

    Article  PubMed  Google Scholar 

  34. Cooper P, Nowak M, Shaer J (1997) Calcaneocuboid joint pressures with lateral column lengthening (Evans) procedure. Foot Ankle Int 18:199–205

    Article  CAS  PubMed  Google Scholar 

  35. Phillips GE (1983) A review of elongation of os calcis for flat feet. J Bone Joint Surg Br 65:15–18

    CAS  PubMed  Google Scholar 

  36. Momberger N, Morgan J, Bachus K, West J (2000) Calcaneocuboid pressure after lateral column lengthening in a cadaveric planovalgus deformity model. Foot Ankle Int 21:730–735

    Article  CAS  PubMed  Google Scholar 

  37. Vander GriendR (2008) Lateral column lengthening using a “Z” osteotomy of the calcaneus. Tech Foot Ankle Surg 7(4):257–263

    Article  Google Scholar 

  38. Demetracopoulos CA, Nair P, Malzberg A, Deland JT (2015) Outcomes of a stepcut lengthening calcaneal osteotomy for adult-acquired flatfoot deformity. Foot Ankle Int 36(7):749–755

    Article  PubMed  Google Scholar 

  39. Thompson IM, Bohay DR, Anderson JG (2005) Fusion rate of first tarsometatarsal arthrodesis in the modified Lapidus procedure and flatfoot reconstruction. Foot Ankle Int 26:698–703

    Article  PubMed  Google Scholar 

  40. Younger A, Wing K (2003) Medial column fusion for type 2 posterior tibial tendon deficiency: the navicular cuneiform fusion to correct forefoot varus. J Foot Ankle Surg 2:74–83

    Article  Google Scholar 

  41. Aiyer A, Dall GF, Shub J, Myerson MS (2016) Radiographic correction following reconstruction of adult acquired flat foot deformity using the cotton medial cuneiform osteotomy. Foot Ankle Int 37(5):508–513

    Article  PubMed  Google Scholar 

  42. Ling JS, Ross KA, Hannon CP, Egan C, Smyth NA, Hogan MV, Kennedy JG (2013) A plantar closing wedge osteotomy of the medial cuneiform for residual forefoot supination in flatfoot reconstruction. Foot Ankle Int 34(9):1221–1226

    Article  PubMed  Google Scholar 

  43. Kraus JC, McKeon KE, Johnson JE, McCormick JJ, Klein SE (2014) Intraosseous and extraosseous blood supply to the medial cuneiform: implications for dorsal opening wedge plantarflexion osteotomy. Foot Ankle Int 35(4):394–400

    Article  PubMed  Google Scholar 

  44. Taniguchi A, Tanaka Y, Takakura Y, Kadono K, Maeda M, Yamamoto H (2003) Anatomy of the spring ligament. J Bone Joint Surg 85-A:2174–2179

    Article  PubMed  Google Scholar 

  45. Mengiardi B, Zanetti M, Schottle PB et al (2005) Spring ligament complex: MRI-anatomic correlation and findings in asymptomatic patients. Radiology 237(1):242–249

    Article  PubMed  Google Scholar 

  46. Deland JT, de Asla RJ, Sung I-H, Emberg LA, Potter HG (2005) Posterior tibial tendon insufficiency: which ligaments are involved? Foot Ankle Int 26(6):427–435

    Article  PubMed  Google Scholar 

  47. Acevedo J, Vora A (2013) Anatomical reconstruction of the spring ligament complex: “internal brace” augmentation. Foot Ankle Spec 6(6):441–445

    Article  PubMed  Google Scholar 

  48. Lee WC, Yi Y (2014) Spring ligament reconstruction using the autogenous flexor halluces longus tendon. Orthopedics 37(7):467–471

    Article  PubMed  Google Scholar 

  49. Baxter JR, LaMothe JM, Walls RJ, Prado MP, Gilbert SL, Deland JT (2015) Reconstruction of the medial talonavicular joint in simulated flatfoot deformity. Foot Ankle Int 36(4):424–429

    Article  PubMed  Google Scholar 

  50. Brilhault J (2009) Single medial approach to modified double arthrodesis in rigid flatfoot with lateral deficient skin. Foot Ankle Int 30(1):21–26

    Article  PubMed  Google Scholar 

  51. Rohm J, Zwicky L, Horn Lang T, Salentiny Y, Hintermann B, Knupp M (2015) Mid- to long-term corrective hindfoot fusions in 84 patients with rigid flatfoot dofermity. Bone Joint J 97-B(5):668–674

    Article  CAS  PubMed  Google Scholar 

  52. Jagodzinski NA, Parsons AM, Parsons SW (2015) Arthroscopic triple and modified double hindfoot arthrodesis. Foot Ankle Surg 21(2):97–102

    Article  CAS  PubMed  Google Scholar 

  53. Deland JT, Page A, Sung I-H, O’Malley MJ, Inda D, Choung S (2006) Posterior tibial tendon insufficiency results at different stages. HSS J 2:157–160

    Article  PubMed  PubMed Central  Google Scholar 

  54. Pell RF IV, Myerson MS, Schon LC (2000) Clinical outcomes after primary triple arthrodesis. J Bone Joint Surg Am 82(1):47–57

    Article  PubMed  Google Scholar 

  55. Hutchinson ID, Baxter JR, Gilbert S, Hogan MV, Ling J, Saunders SM, Wang H, Kennedy JG (2016) How do hindfoot fusions affect ankle biomechanics: a cadaver model. Clin Orthop Relat Res 474(4):1008–1016

    Article  PubMed  Google Scholar 

  56. Smith JT, Bluman EM (2012) Update on stage IV acquired adult flatfoot disorder: when the deltoid ligament becomes dysfunctional. Foot Ankle Clin 17(2):351–360

    Article  PubMed  Google Scholar 

  57. Deland JT, de Asla RJ, Segal A (2004) Reconstruction of the chronically failed deltoid ligament: a new technique. Foot Ankle Int 25(22):795–799

    Article  PubMed  Google Scholar 

  58. Ellis SJ, Williams BR, Wagshul AD, Pavlov H, Deland JT (2010) Deltoid ligament reconstruction with peroneus longus autograft in flatfoot deformity. Foot Ankle Int 31(9):781–789

    Article  PubMed  Google Scholar 

  59. Jeng CL, Bluman EM, Myerson MS (2011) Minimally invasive deltoid ligament reconstruction for stage IV flatfoot deformity. Foot Ankle Int 32(1):21–30

    Article  PubMed  Google Scholar 

  60. Herscovici D, Sammarco GJ, Sammarco VJ, Scaduto JM (2011) Pantalar arthrodesis for post-truamatic arthritis and diabetic neuropathy. Foot Ankle Int 32(6):581–588

    Article  PubMed  Google Scholar 

  61. Papa JA, Myerson MS (1992) Pantalar tibiocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot. J Bone Joint Surg Am 74:1042–1049

    Article  CAS  PubMed  Google Scholar 

  62. Gross CE, Lewis JS, Adams SB, Easley M, DeOrio JK, Nunley JA II (2016) Secondary arthrodesis after total ankle arthroplasty. Foot Ankle Int 37(7):709–714

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anish R. Kadakia.

Ethics declarations

Conflict of interest

ARK has received royalties and speaking fees from Accumed, royalties from Depuy, and consulting fees from Arthrex. JRK and AAA have received consulting fees from Paragon 28 and Medline. NAS and CAC have no conflicts of interest to report.

Funding

There was no funding involved in this study.

Ethical approval

This article does not contain any studies with human or animal participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smyth, N.A., Aiyer, A.A., Kaplan, J.R. et al. Adult-acquired flatfoot deformity. Eur J Orthop Surg Traumatol 27, 433–439 (2017). https://doi.org/10.1007/s00590-017-1945-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-017-1945-5

Keywords

Navigation