The acquired flatfoot in the adult is a diferent entity from the flatfoot in children.
It usually occurs after the age of 50, and manifests as a progressive flatening of the arch with irradiated pain to the medial aspect of the leg. With time, it may progress and pain can be located more in the lateral side of the ankle and even manifest as medial ankle instability.
The first approach to treatment is weight loss (in obese patients) and medial arch support with customized orthotics.
When these measures are insufficient, careful surgical planning is fundamental: it is mandatory to evaluate the components of the deformity (hindfoot valgus, abduction, first ray elevation), stiffness or associated arthritis and soft tissue insufficiency (posterior tibial tendon, spring ligament complex, Achilles shortening, etc).
The case illustrates a less common deformity, centred over the navicular bone, with associated calcaneo-cuboid osteoarthritis (arrow).
After visualizing considerable synovitis and rupture of the posterior tibial tendon through tendoscopy, an open debridement and repair was performed. A modelling naviculo-cuneiform arthrodesis (in this case supplemented with autologous stem cells and graft) and a calcaneo-cuboid arthrodesis with tricortical graft interposition, was performed. A good foot alignment and arch restoration was acquired.
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