Adult acquired flatfoot

Last evidence check April 2011

For patients with tendonopathy but no deformity a simple debridement may be considered.

Two small series have been reported. Teasdall and Johnson (1994) reported 19 patients with a wide range of ages. Five had forefoot abduction but the paper does not state whether this predated their tendon symptoms. Fourteen patients were completely pain-free at average follow-up of 30 months. Sixteen could do a single foot tiptoe test. TWo pateints continued to heave pain and had subtalar fusions. McCormack(2003), reporting surgery on eight competitive athletes, found tenosynovitis in all cases, stenosis of the distal end of the sheath in three, and a tear in one. Seven returned to full sport without problems.

This procedure may be satisfactory for a small number of patients. However, many patients have a pre-existing flatfoot and there is at least a theoretical case for improving the biomechanical environment of the debrided tendon with a posterior medial displacement calcaneal osteotomy. The problem is that the staging of these patients is somewhat unclear. In addition, Conti et al (1992) showed that surgical inspection tends to underestimate tendonopathy and therefore early good results may not last. 10% of patients in the reported series developed progressive deformity and underwent further surgery.