Adult Acquired Flatfoot (Posterior Tibial Tendon Dysfunction)

Over 60 Million Americans suffer from Adult Acquired Flatfoot (AAF), otherwise known as Posterior Tibial Tendon Dysfunction or PTTD. This condition generally occurs in adults from 40-65 years of age, and it usually only occurs in one foot, not both.

The Posterior Tibial (PT) Tendon courses along the inside part of the ankle and underneath the arch of the foot. It is the major supporting structure for the arch. Over time, the tendon becomes diseased, from overuse, and starts to lose it's strength. As a result, the arch begins to collapse, placing further strain on the PT Tendon, leading to further decrease in tendon strength, which causes further collapse of the arch. This is described as a progressive deformity because it will generally get worse over time.

Patients will usually describe their initial symptoms as "ankle pain", as the PT Tendon becomes painful around the inside of the ankle joint. The pain will become more intense as the foot flattens out, due to the continued stretching and tearing of the PT Tendon. As the arches continue to fall, and pronation increases, the heel bone (Calcaneus) tilts into a position where it pinches against the ankle bone (Fibula), causing pain on both the inside and outside of the ankle. As the foot spends increased time in a flattened, or deformed position, Arthritis can begin to affect the joints of the foot, causing additional pain.


It is of great importance to have a full evaluation, by a foot and ankle specialist with expertise in addressing complex flatfoot deformities. No two flat feet are alike; therefore, "Universal" treatment plans do not exist for the Adult Flatfoot. It is important to have a custom treatment plan that is tailored to your specific foot. That starts by first understanding all the intricacies of your foot, through an extensive evaluation.

X-rays of the foot and ankle are standard, and MRI may be used to better assess the quality of the PT Tendon.

Considerations During Flatfoot Evaluation:

  • How Far Advanced Is The Condition?
  • Which Joints Are Most Involved With The Deformity?
  • Is Arthritis Present In Those Joints?
  • Is The Achilles Tendon Tight or Contracted?
  • What Previous Treatments Have Failed?
  • What Is The Desired Activity Level For The Individual Patient?


Like with any other painful deformity of the foot and ankle, there are two fundamental ways to treat Flat Feet in Adults:

  1. Manage the Symptoms (Non-Surgical)
  2. Correct the Deformity (Surgical)

Adult Acquired Flatfoot: Nonoperative Options

Above is a link to an excellent review article, from the Western Pennsylvania Hospital in Pittsburgh, PA. As part of the research team, Dr. McSpadden and colleagues, revealed a success rate of 87.5% when treating Adult Flatfeet with Custom AFO Bracing and Physical Therapy.

Non-Surgical Treatments For Adult Acquired Flatfoot:

  • Rest
  • Ice
  • Oral or Topical Anti-Inflammatory Medication
  • Steroid Injection
  • Physical Therapy
  • Custom AFO Bracing

Surgical Treatment

Although non-surgical treatments can successfully manage the symptoms, they do not correct the underlying problem. It can require a life-long commitment to wearing the brace during periods of increased pain or activity demands. This will lead a majority of patients to choose surgical correction of the deformity, through Reconstructive Surgery.

All of the considerations that were extremely important during the evaluation stage become even more important when creating a surgical plan. Generally, a combination of procedures are utilized in the same setting, to allow full correction of the deformity. Many times, this can be performed as a same-day surgery, without need for an overnight hospital stay. However, one or two day hospital admissions can be utilized to help manage the post-operative pain.

Although the recovery process can require a significant investment of time, the subsequent decades of improved function and activity level, as well as decreased pain, leads to a substantial return on your investment.

For Some Examples of Flatfoot Correction Surgery, See Our Before & After Surgery Picture Gallery


If you are suffering from painful flatfeet, Call us at 512-593-2949 or CLICK HERE to Schedule an Appointment.