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The Ultimate Guide to Adult Acquired Flatfoot: Causes, Symptoms, and Treatment Options

Jul 21, 2023 | Adult Acquired Flatfoot, Foot Conditions

Adult Acquired Flatfoot is a condition that affects the arch of the foot, causing it to flatten out. It occurs when the tendon that supports the arch of the foot becomes weakened or damaged, leading to instability and collapse of the arch. This condition is typically seen in individuals over 40 years of age and can lead to significant pain, disability, and reduced quality of life.

The primary symptoms of AAF include pain, swelling, and tenderness in the inner side of the foot, ankle, and lower leg. Patients with AAF may also experience difficulty standing, walking, and running, as well as stiffness and fatigue in the foot and ankle.

While the exact cause of AAF is not fully understood, there are several risk factors that can increase the likelihood of developing this condition. These include obesity, diabetes, hypertension, and previous injuries to the foot and ankle. In some cases, AAF can be caused by underlying conditions such as rheumatoid arthritis, which can damage the joints and tendons in the foot and ankle. And, on other occasions the flat foot deformity can cause pain on the outside of the ankle due to impingement of the heel bone and the fibula which can cause damage to the peroneal tendons in that area.

Non-surgical treatments for AAF include taking nonsteroidal anti-inflammatory drugs (NSAIDs), using orthotics, and physical therapy. These treatments can help to reduce inflammation and pain, improve function, and prevent further damage to the foot and ankle; however, they will not correct the deformity. In NO cases are steroid injections recommended as this will cause irreversible damage to the posterior tibial tendon.

Nevertheless, if non-surgical treatments are not effective, surgery may be necessary. There are several surgical procedures that can be used to treat AAF, including tendon transfer, various bone cuts and realignment as well as lengthening of the calf muscle and possible fusions of bones. The choice of surgery depends on the severity of the condition, the patient’s overall health, and the goals of treatment.

In general, the prognosis for AAF is good, especially with early diagnosis and treatment. Patients who follow a comprehensive treatment plan, including physical therapy and lifestyle modifications, can expect to return to their normal activities and achieve significant improvement in their function and quality of life.


Adult Acquired Flatfoot is a common condition that can cause significant pain and disability. Early diagnosis and treatment are essential in preventing further damage and achieving optimal outcomes. Non-surgical treatments such as NSAIDs, orthotics, physical therapy, and bracing can be effective in reducing pain and improving function. For patients with severe symptoms or who do not respond to non-surgical treatments, surgery may be necessary. Consultation with a foot and ankle specialist is recommended for proper diagnosis and treatment recommendations based on individual circumstances.

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About Dr. Salvatore Meleca, DPM

Salvatore Meleca, DPM is a highly respected foot and ankle surgeon with extensive training and experience in podiatric medicine. He completed his residency at Mount Sinai Medical Center in Miami Beach, Florida, where he was mentored by Dr. Ettore Vulcano, a world-renowned orthopedic foot and ankle surgeon. Under the directorship of Dr. Jacob Silverstone, Dr. Meleca completed a 3 year surgical residency, performing and participating in various specialty surgeries such as orthopedics, plastics, vascular and more. His greatest qualities that are brought to his foot and ankle care are his sophisticated approach to conservative treatments, his careful surgical procedural selection, and his capabilities in performing minimally invasive technique surgeries.

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