What is progressive flatfoot?

Tendons connect muscles to bones and stretch across joints, enabling you to bend those joints. One of the most important tendons in the lower leg is the posterior tibial tendon. This tendon starts in the calf, stretches down behind the inside of the ankle and attaches to bones in the middle of the foot.

What are the signs of progressive flatfoot?

• Pain and swelling on the inside of the ankle
• Loss of the arch and the development of a flat foot
• Gradual development of pain on the outer side of the ankle or foot
• Weakness and an inability to stand on the toes
• Tenderness over the midfoot, especially when under stress during activity

What causes progressive flatfoot?

Progressive flatfoot often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors, including:

• Obesity
• Diabetes
• Hypertension
• Previous surgery or trauma, such as an ankle fracture on the inner side of the foot
• Local steroid injections
• Inflammatory diseases such as Reiter’s syndrome, rheumatoid arthritis, spondylosing arthropathy and psoriasis
• Athletes who are involved in sports such as basketball, tennis, soccer or hockey may tear the posterior tibial tendon. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

Surgical options include:

• Tenosynovectomy. In this procedure, the surgeon will clean away (debride) and remove (excise) any inflamed tissue surrounding the tendon.
• Osteotomy: This procedure changes the alignment of the heel bone (calcaneus). The surgeon may sometimes have to remove a portion of the bone.
• Tendon transfer: This procedure uses some fibers from another tendon (the flexor digitorum longus, which helps bend the toes) to repair the damaged posterior tibial tendon.
• Lateral column lengthening: In this procedure, the surgeon removes a small wedge-shaped piece of bone from either your hip or that of a cadaver and places it into the outside of the calcaneus. This helps realign the bones and recreates the arch.
• Arthrodesis: This procedure welds (fuses) one or more bones together, eliminating movement in the joint. This stabilizes the hindfoot and prevents the condition from progressing further.

For all Flat Foot problems please call Nagler Foot Center 713.529.1010 or visit our website www.FootHouston.com