Adult acquired flatfoot

Last evidence check April 2011

In the late 1960s papers began to appear describing the development of a flatfoot deformity in association with a tear of the tibialis posterior tendon. Most of the early cases were traumatic, but in 1969 Kettlekamp and Alexander described several cases with no traumatic history. In 1989 Johnson and Strom classified the condition of "tibialis posterior tendon dysfunction" and proposed a system of treatment. Tibialis posterior tendon dysfunction came to be seen as " the commonest cause of the adult acquired flatfoot". Physical signs, as discussed later, were viewed as evidence of tibialis posterior insufficiency. Johnson and Strom discussed staging as though there were an established progression from tenosynovitis without foot deformity, through partial to complete rupture of the tendon with increasing but flexible deformity to fixed deformity without tendon function. Johnson and Strom’s treatment recommendations for most patients concentrated on replacing the function of the absent tendon.

However, further research over the last 10 years has shown that the situation is much more complex than previously thought

It is notable that a symposium in Clinical Orthopaedics and Related Research in 1999 was entitled "Adult Acquired Flatfoot". Probably adult flatfoot and tibialis posterior tendonopathy should be thought of as inter-related conditions rather than as a single disease entity. It seems likely that, in most patients, a pre-existing flatfoot may predispose to tendonopathy which permits the progression of deformity, and so on as a vicious cycle. This view of the syndrome would have the important corollary that attention to the tendon will be of little value unless the deformity is addressed to improve the biomechanics of the foot.