Flatfoot Deformity

Adult flatfoot deformity is caused by changes in the tendon, impairing its ability to support the arch, thus resulting in the flattening of the foot. This is also known as Posterior Tibial Tendon Dysfunction (PTTD).

If you are an adult, from the inside of your foot you’ll usually notice an upward curve in the middle. This is called an arch. Several tendons in your foot and lower leg work together to form the arches in your foot. When the tendons all pull with the proper force, your foot forms a moderate, normal arch. When tendons do not pull together properly, there is little to no arch. This is called flatfoot or fallen arch.


Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking or climbing stairs.

Flatfoot may also be inherited or caused by a condition such as rheumatoid arthritis, stroke, excessive weight or diabetes.


The symptoms of PTTD may include pain, swelling, flattening of the arch, and inward rolling of the ankle. As the condition progresses, the symptoms will change.

For example, when PTTD initially develops, you will feel pain on the inside of your foot and ankle. In addition, this area may be red, warm and swollen.

Later, as your arch begins to flatten, your foot and toes begin to turn outward and the ankle rolls inward. There may still be pain on the inside of your foot and ankle.

As PTTD becomes more advanced, your arch flattens even more and the pain often shifts to the outside of your foot, below the ankle. The tendon has deteriorated considerably, and arthritis often develops in the foot. In more severe cases, arthritis may also develop in your ankle.

Potential Treatments

Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery, and the progression of your condition may halt.

Early treatments:

  • Rest and ice to relieve pain and reduce swelling
  • Stretching exercises
  • Pain relief medications, such as nonsteroidal anti-inflammatories
  • Physical therapy
  • Orthotic devices, shoe modifications, braces, or casts
  • Injected medications to reduce inflammation, such as corticosteroids

In cases of PTTD that have progressed substantially or have failed to improve with nonsurgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your doctor will determine the best approach based on your evaluation.

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