Don't miss this flat foot condition in your patients... with tips on how to recognise it.
Flat feet don't usually hurt, especially in children. But if you notice a one-sided, worsening, painful flat foot in an adult, think.... Acquired Adult Flat Foot!!
How does it present?
- Gradual onset (usually) of medial ankle pain, and sometimes lateral ankle pain (as the condition worsens)
- Patient will be unable to do a single leg heel raise (see picture below) due to posterior tibial muscle and tendon dysfunction
- Usual age- 45 to 65, women 4x more likely to get. Risk increased with diabetes, hypertension, and obesity.
Tests to diagnose?
- Single leg heel raise (inability indicates post tib dysfunction)
- Hubschers maneuver (indicates midfoot collapse and dysnfuction in the windlass mechanism)
- Xray (to show joint position and disease) and MSK ultrasound (to assess the posterior tibial tendon integrity), although clinical assessment can identify the level of deformity
How to fix it?
This is not a condition to be complacent with! Depending on the stage of deformity, different degrees of immobilisation, orthotic support, and rehabilitation therapies will be needed. Physio's take note- these patients always will need custom orthotic therapy. Do NOT give heel raise exercises and cross your fingers and hope for the best! It will get worse, they will not be happy with you, and they will need a more corrective orthotic and possibly surgery.
At Pioneer Podiatry (here's the plug...) we specialise in treating this condition, including custom AFOs which are very effective in treating this condition. The good news is about 50% of all AAFF patients treated with custom AFOs are symptom free after 12 months, and can often go without the brace for most activities.
This article is really a very brief overview, so if you've got a hankering for the details of how to assess and treat this condition, have a squizz over at our Clinical Practice Guideline in our Referrers Portal. It's free, instant assess to clinical tests with video demonstrations, patient handouts for this condition, and treatment protocols to help you give the best treatment and advice to your beloved patients. Find it here.
Have a great day! Keep being awesome.