Adult-Acquired Flatfoot Deformity

Area of Science:

• Orthopedics
• Foot and Ankle Surgery
• Biomechanical Engineering

Background:

• Adult-acquired flatfoot deformity (AAFD) is a complex condition resulting from ligament and tendon failure.
• It is frequently associated with posterior tibial tendon deficiency (PTTD), influenced by various demographic, medical, and genetic factors.
• AAFD is classified into four distinct stages, guiding treatment strategies.

Purpose of the Study:

• To review the current understanding and classification of Adult-acquired flatfoot deformity (AAFD).
• To outline the spectrum of nonoperative and operative treatment modalities for each stage of AAFD.
• To highlight the ongoing research into optimal surgical techniques and indications for AAFD.

Main Methods:

• Literature review of Adult-acquired flatfoot deformity (AAFD) and posterior tibial tendon deficiency (PTTD).
• Analysis of AAFD staging (I-IV) and associated treatment algorithms.
• Synthesis of evidence regarding surgical interventions, including soft tissue procedures, osteotomies, and arthrodesis.

Main Results:

• Nonoperative treatments are effective for early-stage AAFD (Stages I and II).
• Stage II AAFD often requires surgical intervention with soft tissue procedures and osteotomies for flexible deformities.
• Rigid flatfoot (Stage III) typically necessitates triple arthrodesis, while Stage IV involves ankle joint pathology requiring arthrodesis or arthroplasty.

Conclusions:

• Treatment for AAFD is stage-dependent, progressing from conservative to surgical options.
• Surgical management for advanced AAFD involves procedures like triple arthrodesis or ankle arthroplasty.
• Further research is needed to establish optimal surgical indications and techniques for AAFD.