Adult Flatfoot

Adult acquired flatfoot deformity (AAFD) is a condition that results in a fallen arch with the foot pointed outward and is usually caused by a variety of foot problems. Since it alters the alignment of your legs, it can sometimes lead to problems in your ankles and knees.

an adult flat foot

Some of the common symptoms of adult flatfoot include:

  • Pain and swelling on the inside of the foot and ankle
  • Pain that gets worse with activities which makes it difficult to walk or stand for long periods of time
  • Pain on the outside of the ankle when the foot collapses, causing the heel bone to shift position and put pressure on the outside ankle bone 
  • Patients with an old injury or arthritis in the middle of the foot can have painful, bony bumps on the top and inside of the foot
  • Diabetics may notice swelling or a large bump on the bottom of the foot but not feel any pain since their sensation is affected



A few common conditions that result in a flatfoot:


Posterior Tibial Tendon Dysfunction (PTTD)
The posterior tibial tendon is one of the most important tendons of the leg and its main function is to stabilise the arch of your foot when you walk. However, if it becomes inflamed or torn, the arch will slowly collapse, resulting in AAFD. 


Arthritis is another common cause of AAFD, as it not only attacks the cartilage in the joints but also the ligaments that support the foot. This changes your foot shape, causing it to become flat which also results in pain. 


Fractures of the bones in the midfoot, or injury and tears to the ligaments in the foot can cause the joints to fall out of alignment (subluxation or dislocation). This can lead to collapse of the foot arches, and the foot will become flat, resulting in pain. 


Diabetic collapse
People with diabetes or a nerve problem that limits normal feeling in the feet, can sustain repetitive foot injuries that result in arch collapse. It is typically more severe for them as they do not feel pain as the arch collapses and may not notice that the bones have fractured or disintegrated. This may result in a severely deformed foot that can affect walking, or develop pressure ulcers.


Your orthopaedic specialist will start off with a physical examination to check your feet and identify a flatfoot. You may be asked to stand on your tip-toes or on your heels to see if an arch appears. You may also be required to undergo X-rays for an accurate diagnosis, and to check for the presence of arthritis. 


Treatment for adult flatfoot depends on the cause. Non-surgical treatments include assistive devices, which can include foot tapings, braces, or shoe inserts (orthosis), with the aim to correct flexible deformities, and/or to offload pressure points. Pain and anti-inflammatory medication may also be prescribed for symptomatic relief.


If conservative treatments prove to be ineffective, your orthopaedic specialist may recommend surgery. This usually requires some form of foot reconstructive procedure, that may involve the soft tissue (tendons, ligaments) or bony corrections.


Every case is different; hence it is best to consult an orthopaedic specialist for an accurate diagnosis so that you can obtain the best treatment option that is most suitable for you. Reach out to us today if you suspect you are suffering from adult flatfoot and let us help you enjoy a better quality of life.