Acquired Adult Flatfoot Deformity

  • Joseph S. Park
  • Lew C. SchonEmail author


Acquired adult flatfoot deformity (AAFD), also referred to as posterior tibialis insufficiency, is a clinical entity which has only been recently recognized in the literature. First described in 19531, the progression of dysfunction and eventual deformity has only recently been better understood by physicians treating this complex disorder. Early recognition and treatment of this disorder enable surgeons to utilize techniques which can maximize foot function and preserve joint range of motion.


Tendon Transfer Lateral Column Posterior Tibialis Tendon Posterior Tibialis Deltoid Ligament 
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  1. 1.
    Key JA. Partial rupture of the tendon of the posterior tibial muscle. J Bone Joint Surg Am. 1953;35-A(4):1006-8.PubMedGoogle Scholar
  2. 2.
    Pell RF, Myerson MS, Schon LC. Clinical outcome after primary triple arthrodesis. J Bone Joint Surg Am. 2000;82(1):47-57.PubMedGoogle Scholar
  3. 3.
    Coetzee JC, Hansen ST. Surgical management of severe deformity resulting from posterior tibial tendon dysfunction. Foot Ankle Int. 2001;22(12):944-9.PubMedGoogle Scholar
  4. 4.
    Saltzman CL, Fehrle MJ, Cooper RR, Spencer EC, Ponseti IV. Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients. J Bone Joint Surg Am. 1999;81(10):1391-402.PubMedGoogle Scholar
  5. 5.
    Deland J, de Asla R, Sung I-H, Ernberg L, Potter H. Posterior tibial tendon insufficiency: which ligaments are involved? Foot Ankle Int. 2005;26(6):427-35.PubMedGoogle Scholar
  6. 6.
    Niki H, Ching RP, Kiser P, Sangeorzan BJ. The effect of posterior tibial tendon dysfunction on hindfoot kinematics. Foot Ankle Int. 2001;22(4):292-300.PubMedGoogle Scholar
  7. 7.
    Van Boerum D, Sangeorzan B. Biomechanics and pathophysiology of flat foot. Foot Ankle Clin. 2003;8(3):419-30.PubMedCrossRefGoogle Scholar
  8. 8.
    Supple KM, Hanft JR, Murphy BJ, Janecki CJ, Kogler GF. Posterior tibial tendon dysfunction. Semin Arthritis Rheum. 1992;22(2):106-13.PubMedCrossRefGoogle Scholar
  9. 9.
    Petersen W, Hohmann G. Collagenous fibril texture of the gliding zone of the human tibialis posterior tendon. Foot Ankle Int. 2001;22(2):126-32.PubMedGoogle Scholar
  10. 10.
    Petersen W, Hohmann G, Stein V, Tillmann B. The blood supply of the posterior tibial tendon. J Bone Joint Surg Br. 2002;84(1):141-4.PubMedCrossRefGoogle Scholar
  11. 11.
    Han S, Lee J, Guyton G, Parks B, Courneya J-P, Schon L. J. Leonard Goldner Award 2008. Effect of extracorporeal shock wave therapy on cultured tenocytes. Foot Ankle Int. 2009;30(2):93-8.CrossRefGoogle Scholar
  12. 12.
    Sullivan JA. Pediatric flatfoot: evaluation and management. J Am Acad Orthop Surg. 1999;7(1):44-53.PubMedGoogle Scholar
  13. 13.
    Myerson M, Solomon G, Shereff M. Posterior tibial tendon dysfunction: its association with seronegative inflammatory disease. Foot Ankle. 1989;9(5):219-25.PubMedGoogle Scholar
  14. 14.
    Holmes GB, Mann RA. Possible epidemiological factors associated with rupture of the ­posterior tibial tendon. Foot Ankle. 1992;13(2):70-9.PubMedGoogle Scholar
  15. 15.
    Beals TC, Pomeroy GC, Manoli A. Posterior tibial tendon insufficiency: diagnosis and ­treatment. J Am Acad Orthop Surg. 1999;7(2):112-8.PubMedGoogle Scholar
  16. 16.
    Pinney S, Lin S. Current concept review: acquired adult flatfoot deformity. Foot Ankle Int. 2006;27(1):66-75.PubMedGoogle Scholar
  17. 17.
    Johnson K, Strom D. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res. 1989;239:196-206.PubMedGoogle Scholar
  18. 18.
    Deland J. Adult-acquired flatfoot deformity. J Am Acad Orthop Surg. 2008;16(7):399-406.PubMedGoogle Scholar
  19. 19.
    Bluman E, Title C, Myerson M. Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin. 2007;12(2):233-49, v.PubMedCrossRefGoogle Scholar
  20. 20.
    Myerson M. Adult acquired flatfoot deformity. J Bone Joint Surg Am. 1996;78:780-90.Google Scholar
  21. 21.
    Chao W, Wapner K, Lee T, Adams J, Hecht P. Nonoperative management of posterior tibial tendon dysfunction. Foot Ankle Int. 1996;17(12):736-41.PubMedGoogle Scholar
  22. 22.
    Augustin J, Lin S, Berberian W, Johnson J. Nonoperative treatment of adult acquired flat foot with the Arizona brace. Foot Ankle Clin. 2003;8(3):491-502.PubMedCrossRefGoogle Scholar
  23. 23.
    Alvarez R, Marini A, Schmitt C, Saltzman C. Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot Ankle Int. 2006;27(1):2-8.PubMedGoogle Scholar
  24. 24.
    Lin J, Balbas J, Richardson EG. Results of non-surgical treatment of stage II posterior tibial tendon dysfunction: a 7–10-year followup. Foot Ankle Int. 2008;29(8):781-6.PubMedCrossRefGoogle Scholar
  25. 25.
    Teasdall RD, Johnson KA. Surgical treatment of stage I posterior tibial tendon dysfunction. Foot Ankle Int. 1994;15(12):646-8.PubMedGoogle Scholar
  26. 26.
    Schon LC. Crush-plasty of the calcaneus. Tech Orthop. 1996;11(3):222-3.CrossRefGoogle Scholar
  27. 27.
    Sammarco GJ, Hockenbury RT. Treatment of stage II posterior tibial tendon dysfunction with flexor hallucis longus transfer and medial displacement calcaneal osteotomy. Foot Ankle Int. 2001;22(4):305-12.PubMedGoogle Scholar
  28. 28.
    Song SJ, Deland JT. Outcome following addition of peroneus brevis tendon transfer to treatment of acquired posterior tibial tendon insufficiency. Foot Ankle Int. 2001;22(4):301-4.PubMedGoogle Scholar
  29. 29.
    Tien T, Parks B, Guyton G. Plantar pressures in the forefoot after lateral column lengthening: a cadaver study comparing the Evans osteotomy and calcaneocuboid fusion. Foot Ankle Int. 2005;26(7):520-5.PubMedGoogle Scholar
  30. 30.
    Hintermann B, Valderrabano V, Kundert HP. Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon. Foot Ankle Int. 1999;20(10):622-9.PubMedGoogle Scholar
  31. 31.
    Evans D. Calcaneo-valgus deformity. J Bone Joint Surg Br. 1975;57(3):270-8.PubMedGoogle Scholar
  32. 32.
    Vora A, Tien T, Parks B, Schon L. Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer. J Bone Joint Surg Am. 2006;88(8):1726-34.PubMedCrossRefGoogle Scholar
  33. 33.
    Viladot R, Pons M, Alvarez F, Omaa J. Subtalar arthroereisis for posterior tibial tendon ­dysfunction: a preliminary report. Foot Ankle Int. 2003;24(8):600-6.PubMedGoogle Scholar
  34. 34.
    Needleman R. A surgical approach for flexible flatfeet in adults including a subtalar ­arthroereisis with the MBA sinus tarsi implant. Foot Ankle Int. 2006;27(1):9-18.PubMedGoogle Scholar
  35. 35.
    Myerson M, Badekas A, Schon L. Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int. 2004;25(7):445-50.PubMedGoogle Scholar
  36. 36.
    Brodsky J. Preliminary gait analysis results after posterior tibial tendon reconstruction: a ­prospective study. Foot Ankle Int. 2004;25(2):96-100.PubMedGoogle Scholar
  37. 37.
    Fayazi A, Nguyen H-V, Juliano P. Intermediate term follow-up of calcaneal osteotomy and flexor digitorum longus transfer for treatment of posterior tibial tendon dysfunction. Foot Ankle Int. 2002;23(12):1107-11.PubMedGoogle Scholar
  38. 38.
    Guyton GP, Jeng C, Krieger LE, Mann RA. Flexor digitorum longus transfer and medial ­displacement calcaneal osteotomy for posterior tibial tendon dysfunction: a middle-term ­clinical follow-up. Foot Ankle Int. 2001;22(8):627-32.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUnion Memorial HospitalBaltimoreUSA
  2. 2.Department of OrthopaedicsUnion Memorial HospitalBaltimoreUSA

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