Flatfoot is a common condition with approximately 30% of people being born with flatfeet. However, many patients are born with a normal arched foot which progressively collapses during their lifetime. This condition is known as Adult Acquired Flatfoot Deformity (AAFD) and is often symptomatic and can become debilitating. Posterior Tibial Tendon Insufficiency (PTTI) is the most common cause of AFFD and usually presents in middle aged females. Due to the progressive nature of PTTI, surgical intervention is often required, however early recognition of this condition can often be managed non-operatively.
Patients often present at variable stages of PTTI. The history should focus on the patient’s pain, joint, functional and treatment profiles along with risk factors.
When suspecting PTTI, clinical examination is essential in diagnosis and staging. The keys to the exam is to assess if the deformity is fixed or flexible, if osteoarthritis is present and the relative power of the tendons.
Palpation for areas of tenderness
Power and fatiguability of posterior tibial tendon
X-rays and MRI complement the clinical examination. X-rays assess alignment while demonstrating areas of osteoarthritis. MRI’s further delineate the degree of osteoarthritis while assessing the quality of soft tissue structures such as the posterior tibial tendon and spring ligament.
Staging the degree of PTTI aids in the management of the condition. This is based on the Johnson and Strom classification. Early stages are often treated non-operatively with up to 80% success. Joint preserving surgeries are suitable for flexible deformities while fixed deformities are treated with fusion procedures.
Posterior Tibial Tendon Insufficiency is the most common cause of adult acquire flatfoot deformity. Recognizing PTTI in its early stages may help prevent progression and allow for successful non-operative management. However, due to the natural history of this condition and often late presentation, surgical intervention is frequently required. Modern surgical techniques are utilized to minimize wound complications, increase fusion rates while providing the patient with a painless, functional foot. Due to the complex nature of the disorder most operative procedures for this condition are required to be individualized on a cases by case basis.
Dr Jason Chow is an orthopaedic surgeon whose areas of expertise and special interests include:
To arrange for a consultation with Dr Chow, please contact:
Care First Orthopaedic
Suite 1209, Level 2, 31 Lasso Rd
Gregory Hills NSW 2557
Other locations: Penrith, Hawkesbury, Dubbo