The following is a common scenario, enacted in homes across America. A typical protagonist is late middle aged, let’s call her Aunt Mary (although this problem occurs pretty much equally to men and women). Like her father, she has had a long history of foot and leg problems, from her arches to her knees, all the way up to her back. These maladies had never been enough to stop her; but they certainly did slow her down.

Our subject, like so many others, manages to get by, moderating their activity levels, and using various store-bought supports. Then one day, while Aunt Mary was walking in the mall, her arch fell, quite suddenly, quite dramatically! Her foot gave way, and immediately, she felt pain shoot up her leg. She had to sit, being unable to support herself.

This fictionalized account is an accurate description of a common occurrence. A certain kind of foot architecture causes chronic, repeated stress to the tendons and ligaments that help to support the arch. In particular, the posterior tibial tendon can allow this tendon on the inside of the foot to become overworked and give way, allowing the arch to fall.

This arch collapse may occur slowly, over many months, but there are certainly those cases where it is sudden, as in the scenario described above. If the tendon gradually becomes diseased, but does not tear apart completely, a variety of treatment options exist, but when a complete rupture of the tendon has occurred, surgery is required.

The timing of treatment is a crucial part of the chronology of this condition, which is often termed Posterior Tibial Tendon Dysfunction. Because there is so much more involved with this problem than the aforementioned tendon itself, the name has been recently changed to “Acquired Adult Flatfoot Deformity”, which is apropos since the sufferer will often notice they have developed, quite suddenly, a flattened foot type.

Most often, the true root of the problem is foot architecture, which is primarily inherited. Often, the joint below the ankle, termed the sub-talar joint, is poorly aligned, causing a rolling-in of the arch with weight bearing (ie standing, walking, running, etc). This excessive rolling inwards stresses the joint itself, as well as the muscle-tendon unit which is responsible for keeping the foot lined up under the leg. When the subtalar joint is pointed in the wrong direction, chronic repeated stress is placed on certain tissues. Certainly, symptoms will be experienced, but often they are not acute or sudden, an everyday occurrence, a routine part of the sufferer’s life.

Symptoms prior to true rupture include a vague aching that develops at the inside of the arch and ankle region when one is standing more. Walking or running can also be problematic. Calf pain may be experienced, and low back pain is particularly common. Other conditions can develop as a consequence of this situation, including heel pain (aka plantar fasciitis), sub-talar joint pain, and simple foot and leg fatigue since the muscles are having to work too hard to keep things “lined up”.

Like a typical tendonitis, this problem can be treated, if caught early, with immobilization, anti-inflammatories, physical therapy, and other treatments for acute inflammation. A great number of bracing strategies are used to reduce the tension placed on the Posterior Tibial tendon, and so decrease the likelihood of rupture. One of the most effective methods of maintaining foot alignment is with a prescription arch support, also known as a foot orthotic. When prescribed early in the process, they can prevent the more debilitating outcomes.

Surgical intervention used to consist of a simple tendon repair, but the primary problem, bad architecture, remained. As understanding of this complex condition grew, correction of foot alignment became achievable. There are situations where this kind of extensive work is necessary, but the recovery is long and difficult, with lots of opportunity for complications. It is now possible to prevent that collapse through a simple joint implant which blocks the abnormal motion. Recovery is simple and easy, making this technique quite appealing.

Whatever treatment is necessary, being able to stand and walk is critical to quality of life, so find out what it will take for you to walk better, and more comfortably. Being mobile makes life better!