Clinical Research on Foot & Ankle
Open Access

Adult Flat Foot Syndrome; adult flatfoot deformity; tibial tendon; diagnostic modalities

Introduction

Adult Flat Foot Syndrome (AFFS), also referred to as acquired adult flatfoot deformity or posterior tibial tendon dysfunction, is a prevalent musculoskeletal condition characterized by the collapse of the medial longitudinal arch of the foot. This disorder primarily affects adults and can significantly impact the biomechanics, stability, and overall functionality of the foot. The complex interplay of structural, biomechanical, and degenerative factors contributes to the development of AFFS, making it a multifaceted and often underdiagnosed condition [1,2].

Description

The arch of the foot plays a crucial role in supporting body weight, absorbing shock during locomotion, and facilitating efficient gait. When the posterior tibial tendon, a key stabilizing structure of the foot, becomes dysfunctional, it can lead to the gradual collapse of the arch, resulting in the characteristic flatfoot deformity. This deformity can manifest with a spectrum of symptoms, ranging from mild discomfort to severe pain, swelling, and functional limitations [3]. The etiology of AFFS is diverse and may include factors such as posterior tibial tendon insufficiency, ligament laxity, trauma, and degenerative changes associated with aging. Individuals with certain predisposing factors, such as obesity, advanced age, or a history of foot and ankle trauma, are at an increased risk of developing AFFS [4]. Understanding these contributing factors is essential for accurate diagnosis and effective management. The clinical presentation of AFFS can vary widely, making early recognition and diagnosis crucial for timely intervention. Patients may experience arch collapse, difficulty in weight-bearing activities, and altered gait patterns. As AFFS progresses, it can lead to significant deformity, affecting not only foot function but also overall musculoskeletal alignment [5,6]. Diagnosing AFFS involves a comprehensive evaluation that includes clinical examination, imaging studies, and dynamic assessments. Advanced imaging techniques, such as X-rays, Magnetic Resonance Imaging (MRI), and ultrasound, play a pivotal role in confirming the diagnosis and assessing the severity of the condition. Additionally, dynamic evaluations, including weightbearing imaging and gait analysis, provide valuable insights into the functional aspects of AFFS [7]. Treatment strategies for AFFS encompass a spectrum of approaches, ranging from conservative measures to surgical interventions, depending on the severity of the condition [8,9]. Orthotic devices, physical therapy, and lifestyle modifications are often employed as initial management for mild to moderate cases, aiming to alleviate symptoms and improve foot function [10]. In cases of advanced deformity or when conservative measures prove inadequate, surgical options, such as tendon reconstruction, osteotomies, and arthrodesis, may be considered to restore stability and alignment [11,12].

Conclusion

As research in the field of orthopedics continues to evolve, ongoing studies aim to refine our understanding of the pathophysiology of AFFS and enhance treatment modalities. This introduction sets the stage for a comprehensive exploration of Adult Flat Foot Syndrome, emphasizing the importance of a nuanced understanding of its etiology, clinical presentation, and diagnostic and therapeutic approaches for optimal patient care.

1. Agency for Healthcare Research and Quality. HCUPnet: 2008 outcomes by patient and hospital characteristic for ICD-9-CM principal procedure code. http://hcupnet.ahrq.gov/HCUPnet.app/

(accessed Dec 16, 2011).

2. National Joint Registry. National Joint Registry for England and Wales: 7th annual report. 2010. http://www.njrcentre.org.uk/NjrCentre/Portals/0/NJR%207th%20Annual%20Report%202010.
3. Kim HA, Kim S, Seo YI (2008). The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology. 47: 88-91.

Indexed at, Google Scholar, Crossref

4. Singh J, Vessely M, Harmsen W (2010). A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008. Mayo Clin Proc. 85: 898-904.

Indexed at, Google Scholar, Crossref

5. Culliford DJ, Maskell J, Beard DJ, Murray DW, Price AJ, et al. (2010). Temporal trends in hip and knee replacement in the United Kingdom: 1991 to 2006. J Bone Joint Surg Br. 92: 130-35.

Indexed at, Google Scholar, Crossref

6. Robertsson O, Bizjajeva S, Fenstad AM (2010). Knee arthroplasty in Denmark, Norway and Sweden. Acta Orthop. 81: 82-89.

Indexed at, Google Scholar, Crossref

7. Arden N, Nevitt MC (2006). Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 20: 3-25.

Indexed at, Google Scholar, Crossref

8. Sokka T, Kautiainen H, Hannonen P (2007). Stable occurrence of knee and hip total joint replacement in Central Finland between 1986 and 2003: an indication of improved long-term outcomes of rheumatoid arthritis. Ann Rheum Dis. 66: 341-344.

Indexed at, Google Scholar, Crossref

9. Louie GH, Ward MM (2010). Changes in the rates of joint surgery among patients with rheumatoid arthritis in California, 1983–2007. Ann Rheum Dis. 69: 868-871.

Indexed at, Google Scholar, Crossref

10. British Orthopaedic Association, British Association for Surgery of the Knee. Knee replacement: a guide to good practice (1999). London: British Orthopaedic Association.
11. Della Valle C, Rosenberg A (2003). Indications for total knee replacement. In: Callaghan J, Rosenberg A, Rubash H, Simonian P, Wickiewicz T, eds. The adult knee, 1st edn. Philadelphia, PA: Lippincott Williams & Wilkins, 2003: 1047-1057.
12. Canale S, Beaty J (2008). Campbell’s operative orthopaedics, 11th edn. Philadelphia, PA: Mosby Elsevier.

Google Scholar