Sanders Clinic, Orthopaedic Surgeon Dr. Mark Sanders

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Adult-Acquired Flat Foot Deformity (AAFFD)


Adult-Acquired Flat Foot Deformity
Adult-Acquired Flat Foot Deformity (AAFFD) is most commonly caused by a progressive degeneration of the tendon (tibialis posterior) that supports the arch of the foot. As the tendon ages or is subjected to repetitive trauma, it stretches out over time, the natural arch of the foot becomes less pronounced and the foot gradually flattens out.

Although it is uncertain why this occurs, the problem is seen equally among men and women - at an increasing frequency with age. Occasionally, a patient will experience a traumatic form of the condition as a result of a fall from a height or abnormal landing during aerial sports such as gymnastics or basketball.

The types of symptoms that may indicate Adult-Acquired Flat Foot Deformity include foot pain that worsens over time, loss of the arch, abnormal shoe wear (excessive wearing on the inner side of shoe from walking on the inner side of the foot) and an awkward appearance of the foot and ankle (when viewed from behind, heel and toes appear to go out to the side).

It is important that we help individuals recognize the early symptoms of this condition, as there are many treatment options, depending upon the severity, the age of the patient, and the desired activity levels.

Options range from shoe inserts, orthotics, bracing and physical therapy for elderly and/or inactive patients to reconstructive surgical procedures in those wishing to remain more active. These treatments restore proper function and alignment of the foot by replacing the damaged muscle tendon unit with an undamaged, available and expendable one, lengthening the contracted Achilles tendon and realigning the Os Calcis, or heel bone, while preserving the joints of the hindfoot.

If this condition is not recognized before it reaches advanced stages, a fusion of the hindfoot or even the ankle is necessary. Typically this is necessary in elderly individuals with advanced cases that cannot be improved with bracing.

We hope to help patients recognize early symptoms of this condition, in order to ensure years of active, healthy living.



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