Adult acquired flatfoot disease or progressive collapsing foot deformity is a common condition that results in foot pain and disability.
Epidemiology
Most commonly affects middle-aged and elderly females 1.
Pathology
Adult acquired flatfoot disease is a combination of:
- flattened medial arch (pes planus)
- peritalar subluxation
- externally rotated foot (hindfoot and/or midfoot valgus)
Etiology
Adult acquired flatfoot disease is often multifactorial with disease or dysfunction of the supporting structures 1:
- tibialis posterior dysfunction (most common)
-
accessory navicular
- type II (more commonly) and III variants can result in planovalgus foot
- earlier presentation than tibialis posterior dysfunction
-
spring ligament injury/degeneration
- most commonly secondary to tibialis posterior dysfunction, seen in ~85% (range 74-92%)
- sinus tarsi syndrome
-
deltoid ligament injury/degeneration
- superficial ligaments, in particular, the tibionavicular and tibiospring ligaments are typically involved