There are a few other things that can weaken the tendon (and thus move that quitting time a little closer). Women are much more likely than men to develop this condition, and it often takes place around the same time as menopause (around age 60 or so). Steroid use (not always illegal-this may come from having cortisone shots in the area) and smoking may also increase the likelihood for developing PTTD, since steroids tend to weaken tendons. A history of injury in the area, arthritis, or an already flat foot may also serve to push the tendon to declare, ?That?s the last straw!? (Silly tendon. As if it even knows what straw is.)
The posterior tibial tendon, which connects the bones inside the foot to the calf, is responsible for supporting the foot during movement and holding up the arch. Gradual stretching and tearing of the posterior tibial tendon can cause failure of the ligaments in the arch. Without support, the bones in the feet fall out of normal position, rolling the foot inward. The foot's arch will collapse completely over time, resulting in adult acquired flatfoot. The ligaments and tendons holding up the arch can lose elasticity and strength as a result of aging. Obesity, diabetes, and hypertension can increase the risk of developing this condition. Adult acquired flatfoot is seen more often in women than in men and in those 40 or older.
The types of symptoms that may indicate Adult-Acquired Flat Foot Deformity include foot pain that worsens over time, loss of the arch, abnormal shoe wear (excessive wearing on the inner side of shoe from walking on the inner side of the foot) and an awkward appearance of the foot and ankle (when viewed from behind, heel and toes appear to go out to the side). It is important that we help individuals recognize the early symptoms of this condition, as there are many treatment options, depending upon the severity, the age of the patient, and the desired activity levels.
Starting from the knee down, check for any bowing of the tibia. A tibial varum will cause increased medial stress on the foot and ankle. This is essential to consider in surgical planning. Check the gastrocnemius muscle and Achilles complex via a straight and bent knee check for equinus. If the range of motion improves to at least neutral with bent knee testing of the Achilles complex, one may consider a gastrocnemius recession. If the Achilles complex is still tight with bent knee testing, an Achilles lengthening may be necessary. Check the posterior tibial muscle along its entire course. Palpate the muscle and observe the tendon for strength with a plantarflexion and inversion stress test. Check the flexor muscles for strength in order to see if an adequate transfer tendon is available. Check the anterior tibial tendon for size and strength.
Non surgical Treatment
Get treated early. There is no recommended home treatment. While in stage one of the deformity, rest, a cast, and anti-inflammatory therapy can help you find relief. This treatment is followed by creating custom-molded foot orthoses and orthopedic footwear. These customized items are critical in maintaining the stability of the foot and ankle. Once the tendon has stretched and deformity is visible, the chances of success for non-surgical treatment are significantly lower. In a small percentage of patients, total immobilization may arrest the progression of the deformity. A long-term brace known as an ankle foot orthosis is required to keep the deformity from progressing. The Richie Brace, a type of ankle foot orthosis, shows significant success as a treatment for stage two posterior tibial dysfunction. It is a sport-style brace connected to a custom corrected foot orthodic that fits into most lace-up footwear (including athletic shoes). It is also light weight and more cosmetically appealing than traditionally prescribed ankle foot orthosis. The Arizona Brace, California Brace or Gauntlet Brace may also be recommended depending on your needs.
Surgical correction is dependent on the severity of symptoms and the stage of deformity. The goals of surgery are to create a more functional and stable foot. There are multiple procedures available to the surgeon and it may take several to correct a flatfoot deformity. Usually surgical treatment begins with removal of inflammatory tissue and repair of the posterior tibial tendon. A tendon transfer is performed if the posterior tibial muscle is weak or the tendon is badly damaged. The most commonly used tendon is the flexor digitorum longus tendon. This tendon flexes or moves the lesser toes downward. The flexor digitorum longus tendon is utilized due to its close proximity to the posterior tibial tendon and because there are minimal side effects with its loss. The remainder of the tendon is sutured to the flexor hallucis longus tendon that flexes the big toe so that little function is loss.