Conditions & Treatments

Flatfoot Deformity

Adult acquired flatfoot is a progressive condition in which the arch of the foot gradually collapses, often driven by dysfunction of the posterior tibial tendon. Dr. Hanson evaluates and treats flatfoot deformity at all stages, from early tendon dysfunction through advanced collapse requiring reconstructive surgery.

What Is Adult Acquired Flatfoot?

Unlike the flexible flatfoot that many people are born with, adult acquired flatfoot develops over time, typically in middle-aged or older adults. The posterior tibial tendon, which runs along the inside of the ankle and supports the arch, progressively weakens, stretches, and can eventually tear. As the tendon fails, the arch collapses and the foot drifts outward.

The condition progresses through distinct stages, and treatment depends heavily on which stage has been reached. Early stages are primarily a tendon problem, while later stages involve fixed bony deformity of the hindfoot and midfoot. Identifying the stage correctly is essential to selecting the right treatment.


How Flatfoot Presents

  • Pain and swelling along the inside of the ankle and foot
  • Progressive loss of the arch, visible when standing
  • The foot drifting outward (the "too many toes" sign when viewed from behind)
  • Difficulty or inability to rise onto the toes on one foot
  • Increasing fatigue with walking or standing
  • Outer ankle pain as the heel shifts outward and the fibula impinges
  • Knee, hip, or back pain as gait mechanics change

Preserving the Foot, Restoring Function

Early intervention significantly improves outcomes. When the tendon is intact but inflamed, conservative treatment can halt progression. More advanced deformity typically requires surgery to restore alignment.

Non-Surgical
  • Custom orthotics and arch support
  • Ankle-foot orthosis (AFO) bracing
  • Physical therapy and tendon strengthening
  • Activity modification
  • Anti-inflammatory medication
  • Boot immobilization for acute tendon inflammation
Surgical
  • Posterior tibial tendon repair or augmentation
  • Tendon transfer (FDL transfer)
  • Calcaneal osteotomy (heel bone realignment)
  • Medializing calcaneal osteotomy
  • Lateral column lengthening
  • Subtalar or triple arthrodesis for rigid deformity

Published Expertise in Subtalar and Hindfoot Conditions

Dr. Hanson has published peer-reviewed work on tendon transfers and their complications, giving him a particularly nuanced understanding of the reconstructive procedures used in flatfoot correction. He has treated flatfoot deformity at every stage, from early posterior tibial tendon dysfunction through complex hindfoot reconstructions.

Take the Next Step

Request a Consultation with Dr. Hanson

Dr. Hanson will take time to understand your specific situation, review any prior imaging or records, and give you an honest assessment of all your options including non-surgical approaches.

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