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Todd Borenstein MD

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Flatfeet in Adults

What is adult acquired flatfoot deformity?

Flatfeet are a common condition, often beginning in childhood or adolescence. 20-25% of all adults have a flatfoot deformity. It is often associated with calf tightness.

What causes adult acquired flatfoot deformity?

The most common cause of adult acquire flatfoot deformity is posterior tibial tendon dysfunction. This occurs when the tendon that supports the arch becomes inflamed and weakened. Posterior tibial tendon dysfunction is the result of a repetitive injury to the posterior tibial tendon during standing, walking, or climbing stairs. Often patients have tight calf muscles which can increase the stress on the posterior tibial tendon, rendering the tendon more prone to injury.

What are the symptoms of adult acquired flatfoot deformity?

Many patients with adult acquired flatfoot deformity have no symptoms. However, the flatfoot deformity can worsen over time, especially in patients with obesity and calf tightness. When symptomatic, patients often have pain, swelling, a painful limp, and heel pain. With time, the joints of the foot may become arthritis, and the foot can be come stiff as a result. Shoe wear may become painful and difficult

How is adult acquired flatfoot deformity diagnosed?

Adult acquired flatfoot deformity is diagnosed with a thorough medical history and physical examination. X-rays of the foot and ankle will be ordered. Magnetic resonance imaging (MRI) may also be ordered to assess the joint surfaces, tendons and bones.

How is adult acquired flatfoot deformity treated?

Nonsurgical treatment

Adult acquired flatfoot deformity can be treated successfully with shoe changes, orthotics, and anti-inflammatory medications. Physical therapy to strengthen the tendons and muscles that support the arch of the foot, immobilization with a walking boot or ankle brace, ice, rest, and activity modifications may also be prescribed.


Surgery may be necessary for adult acquired flatfoot deformity when conservative measures fail to bring relief. Surgery includes removing inflamed tissue around the tendon, replacing the damaged tendon with another tendon of the foot, realigning the structure of the foot by cutting bones, and fusing bones when arthritis has developed in order to remove the arthritis and realign the foot