Adult Acquired Flatfoot Deformity

Tibialis Posterior Tendon Dysfunction (TPTD) was first recognised in the 1950’s and is the loss of strength, inflammation and degeneration of the posterior tibialis tendon (Stein, & Schon, 2015). Many studies indicate that TPTD is a multifactorial disease with no sole causative factor, however these risk factors usually go hand in hand thus increasing susceptibility (Lester & Kim, 2011). This pathology can cause pain and biomechanical abnormalities such as abnormal gait and the drop of the medial longitudinal arch. Patients with TPTD may have pain and swelling located near the medial malleolus. Patients may also find it difficult to walk long distances on uneven surfaces and may experience a limp.


Tibialis Posterior dysfunction (TPTD) also known as “adult acquired flatfoot deformity” is a multifactorial disease that affects a large portion of the population mainly being the middle aged and or elderly women (Parsons, Naim, Richards, & McBride, 2009). Studies show this pathology can be cause by many factors including acute trauma, overuse, chronic degeneration and biomechanical abnormalities however none have shown to be the sole causative factor (Lester & Kim, 2011). Due to these dysfunctions patients may experience pain along the medial aspect of the ankle and their medial arch will drop significantly (Edwards, Jack, & Singh, 2008). Treatment of this pathology can be managed by either surgical intervention or conservative treatments. Conservative treatments such as an orthotic, stretching and medication are the least invasive and cost-effective strategy, however surgery have provided excellent results in 80% of patients (Edwards, Southgate, Jack, & Singh, 2009). It is wise to use a step wise approach to minimise cost and reduce the timeframe of treatment. Furthermore, the severity of the pathology must be taken into consideration as treatments may not be as effective with patients with a high stage pathology. The focus on conservative management is a preferred modality.