Acorn Article
January 2001
PTD or Adult Flatfoot
Almost every week an adult patient comes into the office with a complaint
that their feet have flattened. Sometimes called fallen arches, adult flatfoot
is surprisingly common. An adult flat foot hurts to walk with pain in the arch
and inside of the ankle without recollection of any damage or trauma.
The cause is usually traced to the posterior tibial (PT) tendon that has
“given out.” I would say it runs in families, but with this problem there is
very little running possible. The tendon starts as a strong muscle attached to
the tibia, the big bone in the lower leg. The tendon of this muscle travels down
behind the inside ankle bone and inserts into no fewer than five bones on the
bottom of the foot. When this tendon fails it becomes very difficult to rise up
onto your tiptoes. Often there is visible swelling on the inside of the ankle
and running your finger long the course of this tendon causes considerable pain.
If this tendon is ruptured in an accident suffered by an otherwise
healthy adult, the tendon is easily and successfully repaired with surgery. When
it dies a slow death a simple tendon surgery is not very successful. Surgery for
PT dysfunction (PTD) is long and complicated and involves the fusion of several
of the foot joints with screws. It requires several weeks of wearing a cast and
being non-weight bearing with crutches or a wheel chair. Because surgery for
adult PTD is so difficult many people opt to try a course of conservative
therapy first.
Conservative care involves bracing or supporting the foot to keep it from
flattening, or at least flattening too much. Conservative care has spared many
people from surgery.
The first level of conservative care is wearing good, strong and
supportive shoes. Avoid sandals, thongs, bare feet, wearing socks-only and
slippers around the house. The closer to a hiking boot you wear the more support
you get. Interestingly, a high-heeled shoe adds support to an adult flat foot
and many people find relief with high-heeled pumps and cowboy boots.
Many people try to add an over-the-counter arch support to their shoes.
If this helps, you are lucky. Most people, however, find PTD too strong a force
for flimsy nd inexpensive support.
In the office I will try to make any of three levels of arch supports.
The first is the standard orthotic made from a cast taken of the foot. This
device fits into many of the commonly worn shoes. The next is a stronger nd
bigger device but one that still fits in some shoes and is not visible to
others. This one is often called by the initials UCBL (University of California
Biomechanics Laboratory).
The final level of support is a device that attaches to the leg but
passes under the foot. This device, called an ankle-foot orthosis (AFO) provides
considerable support but at the expense of being visible to others.
If you have or develop PTD you will unfortunately get to know foot pain.
Early treatment with the proper support, however, can give you tremendous relief
and stave off surgery.
Dr. Michael Zapf is a podiatrist in private practice in
Agoura and Thousand Oaks. For more information call his office at (818) 707-3668
or visit his web site: www.zfootdoc.com.
