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Adult acquired flatfoot deformity (AAFD) is a condition that results in a fallen arch with the foot pointed outward and is caused by a variety of problems.

With orthotics, braces and physical therapy, no matter what the cause of AAFD, can be helped. Where these fail, surgery can be a beneficial way to help with the pain and deformity.

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Pain along the course of the posterior tibial tendon - on the inside of the foot and ankle. You may experience swelling on the inside of the ankle.

Pain that is worse with high intensity or impact activities, such as running. Some people have difficulty walking or standing for lengthy periods of time.

Pain on the outside of the ankle - The heel bone may shift position and put pressure on the outside ankle bone (fibula) when the foot collapses.

Because their sensation is affected, people with diabetes may not have any pain but may notice swelling or a significant bump on the bottom of the foot. The bump can cause skin problems. Using proper diabetic shoewear may prevent an ulcer.

Your GP will examine your foot and may be able to advise you about treatments that can help.

If necessary, they may be able to refer you to a podiatrist (a specialist in foot problems) or orthopaedic surgeon to discuss possible treatments. You can also contact a podiatrist or orthopaedic surgeon directly if you're considering private treatment.

Many health conditions can cause a painful flatfoot.

Posterior Tibial Tendon Dysfunction (PTTD) - Damage to the posterior tibial tendon is the most common cause of AAFD as its primary function is to hold up the arch and support your foot when you walk. If the tendon becomes torn or inflamed, the arch will slowly collapse. People over 40 and women are more likely to develop problems with the posterior tibial tendon.

Other risk factors associated with PTTD include obesity, diabetes, hypertension, flat feet since childhood, high impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use.

Inflammatory arthritis can cause a painful flatfoot. For example, rheumatoid arthritis attacks not only the ligaments that support the foot but the cartilage in the joints. Inflammatory arthritis affecting the back or middle of the foot, not only causes pain but can result in a fallen arch.

Ligaments injuries in the foot can cause the joints to fall out of alignment as they no longer support the bones and prevent them from moving. Torn ligaments allow the foot to become flat and painful, commonly in the middle of the foot (Lisfranc injury), but can also occur in the back of the foot.

Diabetic Collapse (Charcot Foot) or people with a nerve problem that limits normal feeling in the feet, can experience a more severe condition as they do not feel pain as the arch collapses.

Your GP or podiatrist may recommend:

  • Wearing supportive shoes that fit well
  • Wearing specially made insoles (orthotics) inside your shoes to support your feet and stop them rolling inwards
  • Taking painkillers if you have any discomfort
  • Losing weight if you're overweight
  • Stretching the muscles and connective tissues in your lower legs to help stop your foot rolling over – you may be referred to a physiotherapist, who can recommend some exercises to try

These treatments won't change the shape of the feet but may help relieve some of the problems associated with flat feet.
If these measures don't help, you may be referred to an orthopaedic surgeon to discuss whether surgery is an option.


Surgery is normally only considered if the treatments above haven't helped or you have an underlying problem that can be corrected with an operation, such as abnormally developed bones in the feet.

The surgical procedure recommended for you will depend on the cause of your flat feet. A flat foot that remains flexible can be treated with operations that preserve the joints. A stiff, flat and painful flatfoot, may be most reliably treated with fusion surgery. this would be carefully assessed by your surgeon.

For example, bones that are abnormally shaped or joined together may need to be straightened or separated, while flat feet caused by a problem with your connective tissues may be treated by lengthening or repairing the affected tissues.

Your surgeon will talk to you about the operation you may need and what this involves.

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