Progressive flatfoot

This condition is also known, more technically, as Posterior Tibial Tendon Dysfunction (PTTD). It occurs when the posterior tibial tendon (which holds up your arch and provides support as you step off on your toes when walking) becomes inflamed, overstretched or torn. The result may be pain in the inner ankle and gradual loss of the inner arch on the bottom of the foot, leading to flatfoot.

Causes
Progressive flatfoot is quite common in women over 50, and may be due to an inherent abnormality of the tendon. However, others factors, such as obesity, diabetes and hypertension, can increase the risk of developing the condition.

Symptoms
These include:

  • Pain and swelling on the inside of the ankle
  • Loss of the arch leading to a flat foot
  • Pain on the outer side of the ankle or foot
  • An inability to stand on the toes
  • Tenderness over the midfoot, especially during strenuous activity  

Treatment 
This depends on how far the condition has progressed. In the early stages, nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen can help to relieve pain and the foot may need to be immobilised for some time (typically a few weeks) with a cast.  After the cast is removed, shoe inserts may be helpful.

If the non-invasive treatments don't work, surgery may be recommended.  Surgical options include:

  • Tenosynovectomy. This involves removing  any inflamed tissue surrounding the tendon.
  • Osteotomy. This procedure changes the alignment of the heel bone.  The surgeon may also have to remove a part of the bone.
  • Tendon transfer. Here, some fibres from another tendon is used to repair the damaged tendon.
  •  Arthrodesis: This procedure fuses one or more bones together to stabilise the hindfoot and prevent the condition from progressing.