Adult acquired flatfoot, or posterior tibial tendon dysfunction, is a complex disorder that results in a gradual loss of the foot arch.
The posterior tibial muscle is the muscle responsible for stabilizing the arch. If injury or illness damages the tendon connected to the posterior tibial muscle, the arch can fall, resulting in a flatfoot. Surgery can be performed to repair the tendon and improve bone alignment, which gives patients more stability when running and walking.

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Reasons for treatment

Flatfoot may not be a problem in itself, but it can contribute to more serious conditions throughout the body, most commonly the legs, hips, ankles, and lower back. A painful flatfoot is a sign of injury to the tendons and muscles of the foot. Flatfoot does not necessarily get worse over time, but it can lead to the following:

  •  Arthritis of the foot and ankle.
  •  Bunions and hammertoes.
  •  Corns and calluses.
  •  Difficulty walking and running.
  •  Knee pain.
  •  Lower back pain.
  •  Pain and swelling in the heel and arch.
  •  Stiffness and limited mobility.

The symptoms of flatfoot can be managed with anti-inflammatory drugs, but these medications fail to address the underlying cause of flatfoot. The best long-term solution is surgery that repairs the tendon.

How flatfoot correction is performed

Flatfoot can be treated with shoe modifications, custom orthotics, physical therapy, and steroid injections. When the pain associated with flatfoot becomes severe, surgery is required.

Surgical correction of flatfoot may include any of the following procedures:

  •  Fusion of the bones in the foot and ankle.
  •  Osteotomy (cutting and reshaping bone to improve alignment).
  •  Removal of bone spurs.
  •  Repair of the tibial tendon.
  •  Synovectomy (cleaning the tendon sheath).
  •  Tendon transfer.

Most flatfoot procedures involve cleaning and repairing damaged tendons. In rare cases, joint fusion is required. Fusion helps improve the alignment and stability of the foot.

Surgery can reduce the pain associated with flatfoot, but it may not work for everyone. There is also a risk of infection following surgery. The earlier flatfoot is treated, the better chance there is of repairing the damage to the tendon.

A fractured ankle, also known as a broken ankle, occurs when one or more of the three bones that make up the ankle joint are partially or completely broken. The severity of ankle fractures can vary greatly from: minor cracks in a single bone, to multiple fractures and displacement of the ankle joint.
Because it can be easy to mistake an ankle fracture for an ankle sprain, a physician should evaluate every ankle injury. Quick and accurate diagnosis of an ankle fracture is necessary to ensure proper healing of the joint.

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Causes of ankle fractures

Ankle fractures occur when your ankle joint is forced beyond its normal range of motion. If the ankle is not straightened immediately, the bones that make up the joint can crack or fracture in an instant.

Fractures often result from the same type of movements that cause ankle sprains, including:

  • “Rolling” the ankle in or out while walking or running.
  • Jumping or landing on an uneven surface.
  • Severe force applied to the ankle joint (possibly from impact during a car accident or other trauma).
  • Twisting the ankle side to side.

While many ankle fractures occur when a running or jumping athlete slips or rapidly changes direction, it is just as easy for you to sustain an ankle fracture while out enjoying a leisurely walk or carrying out typical housework.

Fractured ankle symptoms

Unlike ankle sprains, where you can usually walk on your injury, ankle fractures are more painful. Most people cannot put weight on a fractured ankle.

Common symptoms of a fractured ankle include:

  • Bruising and swelling.
  • Inability to walk (however, never assume because you can walk your ankle is not broken).
  • Severe and immediate pain.
  • Visible deformity of the ankle joint (bone looks dislocated or protrudes through the skin).

Both an ankle fracture and severe ankle sprain will produce immediate pain and swelling at the joint. While a severe sprain will heal in a week or two and pain will subside, a fractured ankle will continue to hurt until the injury is treated.

Treatment of fractured ankles

It is important to see a physician right away following any ankle injury. The doctor will examine your foot and ankle region, looking for dislocation, and may order x-rays or imaging tests to determine the extent of the injury. Because every ankle fracture is unique, treatment will vary depending on the severity of your injury. On average, a fractured ankle will require 4-8 weeks to heal.

Non-surgical treatment

Minor fractures can be managed as an ankle sprain and treated using the R.I.C.E. guidelines of resticecompression, and elevation.

Serious fractures are always treated with immobilization, where the ankle and foot are protected with a cast to allow the bone(s) to heal. Your doctor may recommend a “walking cast”, which will allow your foot to bear weight, or a non-weight bearing cast, which will require the use of crutches to move around.

Depending on the severity of the fracture and degree of discomfort experienced after the injury, your doctor may also prescribe pain medication.

Surgical treatment

If the bones in the ankle joint cannot be realigned, or if any bone has broken through the skin of the ankle, surgical intervention might be necessary. Your surgeon will select the procedure that is appropriate for the injury.

If you have sustained a serious ankle injury, make sure to visit your doctor as soon as possible. The earlier an ankle fracture is diagnosed the sooner treatment can begin.