Adult acquired flatfoot disease

Adult acquired flatfoot disease is a common condition that results in foot pain and disability.

Epidemiology

Most commonly affects middle-aged and elderly females .

Pathology

Adult acquired flatfoot disease is a combination of:

• flattened medial arch (pes planus)
• peritalar subluxation
• externally rotated foot (hindfoot and/or midfoot valgus)

Etiology

Adult acquired flatfoot disease is often multifactorial with disease or dysfunction of the supporting structures :

• tibialis posterior dysfunction (most common)
• accessory navicular
  • type II (more commonly) and III variants can result in planovalgus foot
  • earlier presentation than tibialis posterior dysfunction
• spring ligament injury/degeneration
  • most commonly secondary to tibialis posterior dysfunction, seen in ~85% (range 74-92%)
• sinus tarsi syndrome
• deltoid ligament injury/degeneration
  • superficial ligaments, in particular, the tibionavicular and tibiospring ligaments are typically involved