Adult acquired flatfoot or collapsed arch is a condition that occurs when the large tendon inside the ankle (known as posterior tibial tendon) is overstretched and cannot support the foot’s arch. This common condition is also called posterior tibial tendon dysfunction.

The condition can worsen especially during physical activities as the tendon thickens and becomes painful. Adult acquired flatfoot is different from flatfoot in children. This is due to the fact that children outgrow flatfoot on their own, most of the times without any treatment. But in adults, the flat feet often remain permanently flat and the treatment mainly addresses the symptoms rather than a cure.

This condition is called ‘acquired’ flatfoot as it affects the feet which were normal at one point and can worsen with age.

Individuals who are at risk of developing adult acquired flatfoot include:

• Women over the age of 40 years
• Pregnant women
• Adults that had flatfeet when they were children
• Adults with certain medical conditions such as diabetes, uncontrolled hypertension, obesity and rheumatoid arthritis (RA).

Causes of Adult Acquired Flatfoot

There are several causes of flatfoot in adults and they include:

• Posterior tibial tendon dysfunction (PTTD): The main function of the posterior tibial tendon is to support the arch of the foot during walking. If the tendon is torn, injured or becomes swollen and overused it can lead to the arch collapsing. This mostly occurs in rheumatoid arthritis patients and overweight individuals.
• Tear or injury to the ligaments of the foot: An injury known as Lisfranc injury which can happen to the middle of the foot can cause flatfoot. Injuries or fractures in the back of the foot can also cause development of flatfoot.
• Arthritis: Arthritis can cause the foot to flatten if it attacks the cartilage in the joints of the foot.

Symptoms of Adult Acquired Flatfoot

The symptoms of flatfoot include:

• Inward turned ankle
• The whole foot touches the floor
• Pain and/or swelling inside and outside the ankle
• Cannot stand on tiptoes

Diagnosis of Adult Acquired Flatfoot

Your doctor will be able to diagnose if you have flatfoot through a physical examination. He/she will look for areas of discomforts and may ask you to stand with your full weight on your feet, or for you to tip toe or even on your heels to see if an arch appears.

An x-ray may also be done to evaluate your bone alignment. If need be, an ultrasound or MRI may be done to assess the tendon further.

If you are diagnosed with flatfoot, your doctor will try and determine the cause of the condition as this will determine the treatment plan.

Treatment of Adult Acquired Flatfoot

The severity of your symptoms as well as your other medical conditions will determine your treatment plan. Treatment for adult acquired flatfoot include:

• Boot immobilization: This supports the tendon allowing it to heal.
• Ankle brace/ Orthotic: Shoe inserts position the foot and relieve pain. Ankle brace also helps in easing the tendon pain and tension.
• Anti-inflammatory medications: These may be given to decrease the symptoms.
• Activity modifications: You may be advised to limit high-impact activities such as jumping, running or court sports for a period of time.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses and physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.

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