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There are numerous causes of acquired adult flatfoot, however, the most common cause is posterior tibialis tendon dysfunction. The posterior tibialis tendon is the main tendon that supports the arch in the foot.  Other causes include fracture or dislocation, tendon laceration, tarsal coalition, neurologic weakness, and iatrogenic causes.  In many adults, a low arch or a flatfoot is painless and causes no problems.

There are several reasons a person may develop posterior tibial tendon dysfunction. In one study, 60% of patients were obese or had diabetes mellitus, hypertension, previous surgery or trauma to the medial foot, or treatment with steroids.

The patient with posterior tibial tendon dysfunction initially complains of pain and swelling in the medial (inside) ankle and midfoot during weight bearing. Over time, the patient may notice loss of the arch and the tendency to walk on the inner border of the foot.


A painless flatfoot that does not hinder your ability to walk or wear shoes requires no special treatment or orthotic device

Nonsurgical Treatment:

Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ketoprofen, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation.

Initial treatments may involve resting and protecting the sore tendon. This may require the need to immobilize your foot and lower leg in a short-leg walking boot for two to four weeks.  Also, a firm arch support takes pressure off the tendon. 

Next, physical therapy is used to strengthen the tendon.  The therapist may use heat, ice, and ultrasound treatments to reduce pain and swelling. 

In the foot and ankle, there is a risk that cortisone will cause a tendon to rupture, therefore, I do not recommend injecting cortisone/steroid into the posterior tibialis tendon.

Surgical Treatment:

Surgery is reserved for those patients with pain even after several months of nonsurgical treatment.  Surgical management involves a tendon transfer (to create a “supertendon”) to the posterior tibialis tendon, as well as cutting the bones in the foot to reshape them.  Research has shown that repairing the tendon without reshaping the bones of the foot does not work well.

To find out more information on Acquired Flatfoot Deformity, please visit the Orthopaedic connection website of American Academy of Orthopaedic Surgeons.


Sara Zickuhr Designsist, south bay ortho