Flatfeet at My Age?


Throughout the week, adults come into the Gentle Foot Care Center worried that their arch has flattened.  How can it be that that one foot is flat and painful while the other still looks normal? Adult acquired flatfoot is also called Posterior tibial tendon dysfunction(PTTD).
Tendonitis is a common problem because we are typically on our feet nonstop. One of the most commonly affected tendons is the posterior tibial tendon which holds the arch up and prevents “over- pronation”.
The posterior tibial tendon runs behind the inside bump on the ankle (the medial malleolus), across the instep, and attaches to the bottom of the foot.


Overuse of the posterior tibial tendon can result in flattening of the foot. Early symptoms caninclude aburning, shooting, tingling, stabbing pain in the inside of the foot and ankle.  Swelling, warmth and flattening of the arch also may occur. Later the toes start turning outward and the ankle rolls inward. Eventually pain shifts to the outside of the foot.foot2

How did this happen?   Aging leads to decreased strength of our muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow.  Also, heavier people have more weight on the arch and more narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears.

How do we check for this?  We start with the single heel rise.  We ask you to stand on your toes.  Typically you will not be able to perform this maneuver and if you can there will be significant pain upon the single heel rise. If you are able to do the test you will be asked to repeat it and will soon start feeling intense pain if a tendonitis is present.
An MRI (Magnetic Resonance Imaging) scan is useful to determine whether the tendon has ruptured.

How do we treat this?Many times, adult acquired flatfoot treatment can be treated nonsurgically. Treatments can include:

  • Foot and ankle supports give your arch the support it needs
  • Immobilization by wearingashort-leg boot may calm down symptoms allowing the tendon to heal
  • Physical therapy including ultrasound therapy and exercises to rehabilitate the tendon following immobilization.
  • Medications.Oral and topical Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, help reduce the pain and inflammation.
  • Shoe modifications.A change in shoes will include more supportive lace-up footwear such as athletic shoes.

For some advanced cases, surgery may be the only choice.  If the tendon has ruptured, surgery may be required to either repair the ruptured tendon. In other cases, the joints may need to be fused.

If you suspect that you have adult acquired flatfoot seek care as soon as possible with your foot doctor who will work with you to eliminate pain and improve the mobility of your foot.

Dr. Olga Garcia Luepschen and the Gentle Foot Care Center are located on US 27.  For further information visit www.Gentlefootcarecenter.com or call 863-381-4869


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