Many foot problems can be contributed to Adult Acquired Flatfoot Deformity (AAFD), a foot and ankle condition that causes fallen arch of the foot. AAFD is also referred to as Posterior Tibial Tendon Dysfunction (PTTD). The posterior tibial tendon serves as the principal supporting structure of your foot. When this ligament is injured overtime the arches start to flatten, leaving you with a painful foot condition. AAFD is more common in women ages 39 – 65 than men.

This page will outline symptoms, conditions and treatments of AAFD. If you need more information about AAFD or treatment details, please call your podiatrist .

To start…the majority of people having Adult Acquired Flatfoot Deformity (AAFD) can be treated effectively with orthotics and custom bracing. The last resort for treating Flatfoot is surgery.

One of the tell-tale signs of AAFD is the “broad toes.” When looking from the rear (back) of the foot, the big toe will be visible. A healthy foot the fourth and fifth toes should only be visible.

Stages, Symptoms and Treatment of Adult Acquired Flatfoot Deformity


Stage I: Swelling and Inflammation of the posterior tibial tendon
Stage II: Being able to see the deformity comparing one foot to the other as foot becomes flatter and more deformed overtime. In this stage, the deformity is still correctable without surgery.
Stage III: In this stage, the foot is very rigid, painful and may need surgical intervention for correction.


Most people will notice mild to extreme pain in their feet. Below outlines some signs and symptoms of AAFD.

• Trouble walking or standing for any duration
• Pain and swelling on the inside of the ankle
• Bump on the bottom of the foot
• Ulcer or wound developing on the outer aspects of foot

Contributing Factors

There are many reasons why AAFD can occur. Flatfoot conditions can develop overtime since childhood. Below are other factors that can lead to a Flatfoot condition.
• Obesity
• Diabetes
• Hypertension
• Arthritis
• Injury

1. Obesity – Overtime if your body is carrying those extra pounds, you can potentially injure your feet. The extra weight puts pressure on the ligaments that support your feet. Also being over weight can lead to type two diabetes which also can attribute to AAFD.

2. Diabetes – Diabetes can also play a role in Adult Acquired Flatfoot Deformity. Diabetes can cause damage to ligaments, which support your feet and other bones in your body. In addition to damaged ligaments, uncontrolled diabetes can lead to ulcers on your feet. When the arches fall in the feet, the front of the foot is wider, and outer aspects of the foot can start to rub in your shoe wear. Patients with uncontrolled diabetes may not notice or have symptoms of pain due to nerve damage. Diabetic patient don’t see they have a problem, and other complications occur in the feet such as ulcers and wounds.

3. Hypertension – High blood pressure cause arteries narrow overtime, which could decrease blood flow to ligaments. The blood flow to the ligaments is what keeps the foot arches healthy, and supportive.

4. Arthritis – Arthritis can form in an old injury overtime this can lead to flatfeet as well. Arthritis is painful as well which contributes to the increased pain of AAFD.

5. Injury – Injuries are a common reason as well for AAFD. Stress from impact sports. Ligament damage from injury can cause the bones of the foot to fallout of ailment. Overtime the ligaments will tear and result in complete flattening of feet.


Treatment of Adult Acquired Flatfoot Deformity depends on the stage of progression, as mentioned above paragraphs. Below we will outline a variety of different treatment options available.

Orthotics or bracing. To give your foot the arch the support it needs, your podiatrist or foot specialist may provide you with over the counter brace or a custom orthotic device that fits your shoe. Example: Richie Brace
Casting. In some cases, a cast or boot is worn to stabilize the foot and to give the tendon time to heal.
Physiotherapy. Ultrasound treatments and exercises may help rehab the tendon and muscles.
Medications. Over-the-counter (NSAIDS) such as ibuprofen can help reduce pain, inflammation and swelling associated with AAFD.
Shoe Gear. Your podiatrist may suggest changes with your shoes you are wearing and inserts you need in your shoe to help support your arch.

When Is Surgery Suggested for Adult Acquired Flatfoot Deformity?

As mentioned before, surgery is the last option to repair AAFD. If conservative treatments have failed, this may be considered.

For more information on Adult Acquired Flatfoot Deformity, please give us a call at (561) -265-5424 or find our foot clinic location in Delray Beach Florida by clicking here.

 Posted on : September 21, 2014