Current Concepts on the Operative Management of Adult Acquired Flatfoot

The foot is a complex structure consisting of 28 bones with multiple joints and ligaments in between. There are two longitudinal arches (medial and lateral) and one transverse arch. They are maintained by tight compact arrangement of the bones bound together by ligaments. Muscles are dynamic stabilizers of the hindfoot.Adult acquired flatfoot includes posterior tibial tendon dysfunction, rheumatoid arthritis, osteoarthrosis, neuroarthropathy, posttraumatic deformity, neurologic weakness, and plantar fascia rupture. There are pain, stiffness deformity of the foot (valgus angulation of the hindfoot abducted forefoot and supination in relation to the hindfoot) and limitation of movements at the ankle and subtalar joints. There may also be a history of long standing rheumatoid disease or diabetes, exposure to corticosteroid either orally or parentally or by local injections.Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot deformity. The main deforming forces, tendo-Achilles and peroneus brevis act to promote hindfoot eversion and attenuate structures that stabilize the medial column. More detailed classification systems have been developed in recent years to help clarify treatment recommendations.Diagnosis of flatfoot depends on careful clinical and radiological .