Flatfoot - Adult-Acquired

Adult-acquired flatfoot or collapsed arch occurs because the large tendon on the inside of the ankle – the posterior tibial tendon – becomes stretched out and no longer supports the foot’s arch. In many cases, the condition worsens and and the tendon thickens, becoming painful, especially during activities. Flatfoot or collapsed arch is also known as posterior tibial tendon dysfunction. This condition is different than having flat feet since birth (known as congenital flatfoot), although sometimes these patients develop similar symptoms and require similar treatments.

If you have flatfoot or collapsed arch, our experts at University of Michigan South Main Orthopaedics can provide you with a thorough diagnosis and a personalized treatment plan. In this area, experience is important, and every year we see a lot of patients with complicated foot and ankle conditions. 

Flatfoot Symptoms

  • Whole foot touches the floor
  • Ankle turns inward
  • Pain and/or swelling on inside of ankle
  • Pain on outside ankle
  • Unable to stand on tiptoes
  • Symptoms increase with weight-bearing activity

Flatfoot Evaluation

During your office visit:

  • We will take your complete health history and conduct a physical examination to determine your areas of discomfort, the degree and flexibility of your flatfoot, and any previous treatments you may have had.
  • We will also take X-rays of your foot and ankle to evaluate bone alignment.
  • We may need to do an MRI or ultrasound to assess the tendon further. 

Flatfoot Treatments

Your individualized treatment plan is based on your prior treatment, the severity of your symptoms and your other medical conditions.

Non-surgical Treatments for Flatfoot

We always look at non-surgical treatments first, especially if you haven't had any other treatments. This can include:

  • Orthotic anklebrace – Over-the-counter or custom shoe inserts to position the foot and relieve pain are the most common non-surgical treatment option. Custom orthotics are often suggested if the shape change of the foot is more severe. An ankle brace (either over-the-counter or custom made) is another option that will help to ease tendon tension and pain.
  • Boot immobilization – A walking boot supports the tendon and allows it to heal.
  • Activity modifications – Depending on what we find, we may recommend limiting high-impact activities, such as running, jumping or court sports, or switching out high-impact activities for low-impact options for a period of time.
  • Ice and anti-inflammatory medications – These may be given as needed to decrease your symptoms.

Surgery for Flatfoot

We consider surgery only when all appropriate, non-surgical therapies have failed. Our recommendation will depend on many factors, including your flexibility, the presence of arthritis, your age and your other medical conditions.

  • Flatfoot reconstruction (osteotomy) – This is often recommended for flexible flatfoot condition. Flatfoot reconstruction involves cutting and shifting the heel bone into a more neutral position, transferring the tendon used to flex the lesser toes (all but the big toe) to strengthen the posterior tibial tendon, and lengthening the calf muscle. 
  • Fusion (also known as triple arthrodesis) –  Fusion involves fusing, or making stiff, three joints in the back of the foot – the subtalar, talonavicular, and calcaneocuboid joints – to realign the foot and give it a more natural shape. Pins or screws hold the area in place until it heals. Fusion is often recommended for a rigid flatfoot deformity or evidence of arthritis.

Both of these surgeries can provide excellent pain relief and correction. Your University of Michigan surgeon will discuss the risks and benefits of your surgery, and will let you know if surgery is the best option for you. 

Our Approach to Care

As part of the University of Michigan Comprehensive Musculoskeletal Center, we collaborate closely with areas such as:

  • Emergency Medicine
  • Plastic Surgery
  • Radiology
  • Rheumatology
  • Physical Medicine and Rehabilitation

Our integrated, multidisciplinary approach to patient care enables us to develop an individualized plan for your treatment. 

Contact Us / Make an Appointment

  • Please call Physical Medicine and Rehabilitation (PMR) at 734-936-7175

You're about to make an important decision, and we want to help you make a good one. Visit our Contact Us page to see a list of clinics and their contact information. Our staff will be glad to talk with you about your options and how we can help.