Addressing The Biomechanics Of Stage II Adult-Acquired Flatfoot

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Understanding The Progression Of The Adult-Acquired Flatfoot Deformity

1. Preexisting flatfoot deformity
2. Pronated position of the subtalar joint creates increased friction and gliding resistance of the posterior tibial tendon
3. Posterior tibial tendon gradually attenuates and ruptures
4. Pronated subtalar joint creates increased mobility of the forefoot on the rearfoot, increasing strain on the supportive ligaments
5. Sequential ligament rupture occurs beginning with the spring ligament and followed by the long and short plantar ligaments as well as the superficial and deep deltoid ligaments
6. Progressive flatfoot deformity occurs and is characterized by hindfoot valgus, lowering of the medial longitudinal arch and forefoot abduction

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Author(s): 
Douglas Richie, Jr., DPM, FACFAS, FAAPSM

   When it comes to stage II adult-acquired flatfoot, articulated ankle-foot orthoses are preferred to recruit weakened musculature, which accompanies this deformity. Studies show that the majority of patients with stage II adult-acquired flatfoot treated with articulated AFO devices can avoid surgery and many can eventually ambulate relatively pain-free without the continued use of bracing.

   Dr. Richie is an Adjunct Associate Professor within the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Richie is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice in Seal Beach, Calif. Dr. Richie writes a monthly blog for Podiatry Today. One can access his blog at www.podiatrytoday.com/blogs/301 .

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