A New Approach To Adult-Acquired Flatfoot

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Here is a view of classic adult-acquired flatfoot (AAF). According to the author, there has been increased recognition of the fact that a rupture or attenuation of the posterior tibial tendon cannot itself lead to the deformity and disability one sees in
Podiatric ankle-foot orthoses (AFOs) have become a standard of care in conservative treatment of AAF.
Podiatric ankle-foot orthoses (AFOs) have become a standard of care in conservative treatment of AAF.
Here is a view of Stage II AAF with internal rotation of malleoli on the left foot.
During the first metatarsal rise test, the foot with PTTD will supinate while the first metatarsal will not remain on the ground.
During the single heel rise test, the asymptomatic foot demonstrates elevation of the heel and inversion of the hindfoot.
In relaxed stance, the advanced AAF demonstrates medial displacement of the tibia, increasing the tibial varum angle.
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Author(s): 
By Douglas H. Richie Jr., DPM

29. Myerson MS, Corrigan J, Thompson F: Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency: A radiologic investigation. Foot and Ankle 16:712, 1995.

30. Deland JT, Anoczky SP, Thompson FM: Adult acquired forefoot deformity at the talonavicular joint: Reconstruction of the spring ligament in an in vitro model. Foot and Ankle 13:327, 1992.

31. Pomeroy GC, Manolis A: A new operative approach for forefoot secondary to posterior tibial tendon insufficiency: A preliminary report. Foot and Ankle 18:206, 1997.

32. Harper MC, Tisdel CL: Talonavicular arthrodesis for the painful adult acquired forefoot. Foot and Ankle 17:658, 1996.

33. Kitaoka HB, Zong Ping L, Kai-Nan A: Effect of the posteiror tibial tendon on the arch of the foot during simulated weightbearing: Biomechanical analysis. Foot and Ankle 18:43, 1997.

34. Hintermann B, Nigg BN, Sommer C: Foot movement and tendon excursion: An in vitro study. Foot and Ankle 15: 386, 1994.

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