Home
PG College
Patient Login
International patients
Contact Us
Emergency
Download Reports
Flatfoot Deformity Treatment in Pune
Get expert adult-acquired flatfoot treatment in Pune with orthopaedic surgeons providing arch correction, reconstruction, and mobility improvement.
Overview
Adult-Acquired Flatfoot Deformity (AAFD) is a painful foot condition where the arch of your foot gradually collapses after you’ve reached adulthood. Unlike people born with flat feet, this condition develops later in life when your bones are fully mature.
Previously known as posterior tibial tendon dysfunction, the name was changed to better describe the wide range of problems this condition can cause. AAFD is a progressive disorder, meaning it gets worse over time without proper treatment. It can range from early stages with mild pain and swelling to severe deformity and arthritis.
This condition most commonly affects women between ages 40 and 60. Understanding how AAFD develops, its symptoms, and available treatments can help you make informed decisions about your care and potentially prevent the condition from worsening.
Symptoms
The symptoms of AAFD vary depending on how severe your condition is and tend to worsen as the deformity progresses. Early on, you might notice pain and swelling along the inside of your foot and ankle, where the posterior tibial tendon runs.
As the condition advances and the tendon fails, pain typically increases. Some people also experience pain on the outside of their ankle as the heel begins to shift outward.
Common signs and symptoms include:
- Pain and swelling along the inside of your ankle and foot
- Pain on the outside of your ankle as your heel shifts outward
- A flattened foot arch that makes your entire foot appear to touch the ground
- Difficulty or inability to rise up on your tiptoes (this is a key sign of posterior tibial tendon dysfunction)
- Increased discomfort at the end of the day or after standing for long periods
- Limited ability to participate in sports or recreational activities
- Your ankle may appear to turn inward
- In later stages, your foot becomes stiff, making it hard to walk on uneven surfaces
Causes
Adult-Acquired Flatfoot Deformity is a complex condition with multiple contributing factors. The most common cause is posterior tibial tendon dysfunction, where this important tendon becomes inflamed, overused, or torn.
The posterior tibial tendon plays a crucial role in supporting your foot’s medial arch and helps turn your foot inward. When this tendon stretches or loses its function, your arch can collapse. This usually happens due to gradual wear and tear over time rather than a single injury.
When the posterior tibial tendon fails, it changes how your foot and ankle work together. Other muscles and tendons may become relatively stronger, contributing to the progressive deformity. The spring ligament complex, which works with the posterior tibial tendon to stabilize your arch, is often involved as well.
In advanced stages, the deltoid ligament can also become affected, leading to ankle instability and further complications.
Risk Factors
Several factors can increase your chances of developing AAFD:
- Gender and Age: Most common in women, especially those between 40-60 years old
- Obesity: Extra weight puts additional stress on the posterior tibial tendon and supporting structures
- Pre-existing Flat Feet: Being born with flexible flat feet increases your risk
- Medical Conditions: Diabetes, high blood pressure, and rheumatoid arthritis are significant risk factors
- Steroid Use: Long-term steroid use can weaken the posterior tibial tendon
- Previous Injuries: Damage to nerves, ligaments, tendons, or bone fractures in your foot or ankle
- Poor Blood Supply: Limited blood flow to the tendon area makes it more vulnerable
- High-Impact Sports: Activities that put extra stress on your feet
- Neurologic Conditions: Conditions that cause muscle weakness
- Genetics: Family history may play a role in some cases
Diagnosis
Diagnosing AAFD involves a comprehensive evaluation that combines your medical history, a physical examination, and imaging studies.
Your doctor will ask about your symptoms, how long you’ve had them, and what makes them better or worse. The physical examination includes several important tests:
- Visual Inspection: Looking for a flattened arch and outward-turning heel
- Palpation: Checking for tenderness and swelling along the posterior tibial tendon
- Single Heel Raise Test: You’ll be asked to stand on one foot and rise onto your toes – inability to do this indicates tendon dysfunction
- Flexibility Assessment: Testing whether the deformity can be manually corrected
Imaging studies help confirm the diagnosis:
- X-rays: Weight-bearing X-rays show bone alignment and can reveal arthritis
- MRI: Shows soft tissue problems like tendon inflammation or tears
- Ultrasound: Can assess tendon condition
- CT Scan: Provides detailed views of bone abnormalities
Stages
AAFD is classified into four stages that guide treatment decisions:
Stage I: The mildest form with pain and swelling along the posterior tibial tendon but no visible deformity. You can still perform a single heel raise, and X-rays may appear normal.
Stage II: Deformity develops but remains flexible. Your arch begins to flatten, and you cannot perform a single-leg heel raise. This stage is divided into:
- Stage IIa: Foot collapse with less than 30% forefoot abduction
- Stage IIb: Greater forefoot abduction exceeding 30%
Stage III: The deformity becomes rigid and cannot be manually corrected. Your hindfoot is fixed in an outward position, and arthritis may develop in foot joints.
Stage IV: The most advanced stage involving ankle joint problems. The deltoid ligament fails, causing ankle instability and potential arthritis.
Treatment
Treatment for AAFD depends on the stage of your condition, symptoms, and goals. Conservative treatment is always tried first.
Non-Surgical Treatment
Early-stage AAFD often responds well to non-surgical approaches:
- Footwear and Orthotics: Supportive shoes with good arch support, off-the-shelf or custom orthotics to position your foot properly
- Immobilization: Removable boot or cast for acute symptoms to allow healing
- Medications: Over-the-counter pain relievers and anti-inflammatory drugs
- Activity Modification: Limiting high-impact activities and switching to low-impact alternatives
- Physical Therapy: Structured programs for stretching and strengthening foot and leg muscles
Surgical Treatment
Surgery is considered when conservative treatment fails after about 6 months. The goal is to achieve proper alignment while maintaining as much flexibility as possible.
Common surgical procedures include:
- Tendon Transfers: Moving other tendons to help support your arch
- Osteotomy: Cutting and realigning bones to correct deformity
- Ligament Repair: Fixing torn ligaments that support your arch
- Arthrodesis: Fusing joints for rigid deformities or severe arthritis
- Ankle Procedures: For Stage IV cases involving ankle problems
Rehabilitation
Rehabilitation is crucial whether you have surgery or not.
Non-Surgical Rehabilitation
- High-repetition, low-resistance exercises to strengthen the posterior tibial tendon
- Heel raises starting with both legs and progressing to single-leg
- Stretching exercises for tight calf muscles
- Balance and coordination training
- Daily exercises during initial months with consistent orthotic use
After Surgery
- Initial immobilization in cast or boot for about six weeks
- Gradual progression from no weight-bearing to full weight-bearing
- Range of motion exercises while in removable boot
- Strengthening exercises once healing allows
- Full recovery can take 1-2 years for complex surgeries
- Long-term exercise program to prevent symptom recurrence
Complications
Without proper treatment, AAFD can lead to serious complications:
- Progressive Deformity: The condition naturally worsens over time
- Increased Pain: Pain intensifies and may shift from inside to outside of ankle
- Stiffness and Arthritis: Joints become rigid and arthritis develops
- Limited Function: Difficulty with daily activities and sports participation
- Complex Surgery Requirements: Delayed treatment may require more extensive procedures
- Surgical Complications: Potential risks include nerve injury, bone healing problems, and persistent swelling
Prevention
While you cannot always prevent AAFD, early action can slow its progression:
- Early Recognition: Being aware of symptoms, especially if you’re at high risk
- Weight Management: Maintaining a healthy BMI reduces stress on your feet
- Medical Condition Control: Managing diabetes, blood pressure, and other related conditions
- Supportive Footwear: Using proper shoes and orthotics, especially if you have risk factors
- Regular Exercise: Strengthening foot muscles and stretching calf muscles
- Avoiding Excessive Steroid Use: Discussing risks with your doctor if you have other risk factors
Living With Adult-Acquired Flatfoot Deformity
Managing AAFD requires ongoing commitment to treatment strategies:
Daily Management:
- Consistent use of prescribed orthotics or braces during all walking activities
- Following your physical therapy exercise program regularly
- Monitoring activities that worsen symptoms
- Maintaining a healthy weight to reduce foot stress
Long-term Care:
- Regular follow-up appointments with your healthcare provider
- Continuing scaled-down exercise routines indefinitely
- Using pain management strategies as needed
- Having realistic expectations about recovery time and outcomes
Many people with AAFD can achieve significant pain relief and improved function with proper management, allowing them to maintain active lifestyles.
Key Takeaways
- Adult-Acquired Flatfoot Deformity is a progressive condition affecting middle-aged adults, particularly women
- Posterior tibial tendon dysfunction is the primary cause, often involving supporting ligaments
- Early diagnosis and treatment can prevent progression to more severe stages requiring complex surgery
- Non-surgical treatments including orthotics and physical therapy are effective for early stages
- Surgical options range from tendon repairs to joint fusion depending on severity
- Rehabilitation is essential for optimal outcomes and may take 1-2 years for full recovery
- Untreated AAFD leads to progressive deformity, chronic pain, and arthritis
- Weight management and consistent use of supportive devices are key to successful management
Sancheti Hospital stands as a leading orthopedic institution with decades of expertise in diagnosing and treating complex foot and ankle conditions like Adult-Acquired Flatfoot Deformity.
Our multidisciplinary team of orthopedic surgeons, physiotherapists, and rehabilitation specialists provides comprehensive care from initial diagnosis through complete recovery. We offer state-of-the-art diagnostic imaging, custom orthotic services, advanced surgical techniques, and structured rehabilitation programs tailored to each patient’s specific needs.
At Sancheti Hospital, we understand that AAFD affects not just your feet but your entire quality of life, which is why we focus on personalized treatment plans that help you return to your daily activities with confidence and reduced pain.
Meet Our Foot and Ankle Specialists
Patient Stories & Experiences
The pain in my left knee left me feeling helpless for years. After my treatment here, I can finally say I'm pain-free.
Vinita Singh
The nerves were swollen, and the body went numb. But thanks to Sancheti Hospital, I got a second life!
Parvati
I finally could walk again, a relief I've only felt after the hip pain surgery. I thank the doctors at Sancheti Hospital for their help.
Balaji Kharat
I'm a police officer, and I'm extremely thankful to Sancheti Hospital for treating my fracture without surgery.
Shantilal
My life has completely changed after the knee replacement surgery at Sancheti Hospital. It's like I can finally live again!
Kalpana Lepcha
The knee pain I've carried for years finally went away with the help of Sancheti Hospital.
Karuna
I can't believe that I get to finally live a normal and happy life, all thanks to the knee surgery I had at Sancheti Hospital.
Kishore Bhosle
Frequently Asked Questions
Will I be able to walk normally again after treatment?
Most patients see significant improvement with proper treatment. Early-stage patients often return to normal walking with orthotics and therapy. Even after surgery, most people can walk comfortably, though some stiffness may remain with fusion procedures.
Can I still exercise or play sports with AAFD?
Yes, but you may need to modify activities. Low-impact exercises like swimming and cycling are usually fine. High-impact sports may need to be limited, but many patients return to recreational activities with proper support and conditioning.
What happens if I ignore the condition and don't get treatment?
AAFD always gets worse without treatment. Your arch will continue collapsing, pain will increase, and you’ll eventually need more complex surgery. Early treatment prevents this progression and gives you better long-term outcomes.
Can losing weight really help my foot pain?
Absolutely. Even losing 4-6 kg can significantly reduce stress on your posterior tibial tendon and improve symptoms. Many patients notice less pain and better function after weight loss, especially when combined with other treatments.
