Flat foot is a fairly common condition of the foot, but most of the time merely having a lower mid-foot (arch) or flatter foot is not necessarily an issue. What is a concern is if it is progressive and becomes painful, then it is called posterior tibial tendon dysfunction or adult acquired flatfoot. In these cases the arch of the foot becomes progressively flatter and the rearfoot rolls inwards. This is usually followed by pain in the arch of the foot and in the rearfoot area. Those with this also find walking is a lot more difficult and walking consumes a lot of energy resulting in a lot of fatigue.The main cause of posterior tibial tendon dysfunction is not fully understood, but it is an issue in which the posterior tibial tendon and muscle can not just do the job that it is designed for.
The principal role of the posterior tibial tendon is to hold up the arch of the foot and prevent the rearfoot rolling inwards. For some reason the muscle and tendon unit are unable to just do their job any more, ultimately causing the progressive nature of this condition.The management of posterior tibial tendon dysfunction is somewhat urgent and should be dealt with as soon as it possibly can. This is due to the condition is progressive and it will get to a stage where non-surgical methods fail to work and surgery is the only option. As you move the surgical outcomes usually are satisfactory, they do involve the fusion of some joints to prevent the problem getting worse, that comes with some long term restrictions on gait and function, so is best avoided. In order to avoid the surgical option, treatment options ought to be started early. This will likely involve foot supports that are really supportive and position the foot back in the right position. Exercises are also encouraged, but should never be used instead of foot supports, as they are important to stop the flat foot from progressing.