Flatfoot / Fallen Arches (Adult Acquired Flatfoot)

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Arch collapsing or ankle rolling in? We evaluate and treat adult acquired flatfoot—from braces and custom orthotics to minimally invasive and reconstructive options.

Adult acquired flatfoot (often related to posterior tibial tendon dysfunction, PTTD) is a progressive condition where the arch collapses and the heel tilts outward. Over time, the foot may widen, the forefoot may drift outward, and walking can become painful—especially along the inside of the ankle and arch.

Common symptoms

• Achy or sharp pain along the inside of the ankle/arch
• Swelling or tenderness behind the inner ankle bone
• Foot “rolling in” with a flatter arch and wider foot
• Fatigue with standing/walking; difficulty with single-leg heel raise
• Later stages: pain on the outside of the ankle, stiffness, trouble fitting shoes

Why it happens (risk factors)

• Overuse or degeneration of the posterior tibial tendon
• Previous ankle/foot injuries or long periods on hard surfaces
• Flatfoot since childhood, calf tightness, or ligament laxity
• Inflammatory arthritis, diabetes, obesity, or age-related tendon changes

We start with a focused history and exam (gait, single-heel-raise test, flexibility vs. stiffness), shoe review, and photos or pressure mapping when helpful.

• Weight-bearing X-rays assess alignment and joint health.
• Ultrasound or MRI may be used to evaluate the posterior tibial tendon and supporting ligaments in persistent or complex cases.

Many patients improve comfort and function with targeted support, flexibility, and strengthening—especially in earlier stages.

Support & alignment

• Custom orthotics to lift/support the arch and realign the heel
• Ankle-foot support when needed: lace-up brace, UCBL-type device, or AFO for added control
• Footwear guidance: stable shoes with firm heel counter and midfoot support

Mobility & strength

• Calf stretching to reduce pull on the arch
• Posterior tibial tendon strengthening and balance work (progressive, pain-guided)
• Physical therapy for gait and activity progression

Symptom control & activity

• Relative rest/load management during flares
• Ice and short courses of anti-inflammatory measures (as appropriate)
• Return-to-activity plan that matches your goals

If pain persists or deformity progresses despite appropriate care, we’ll review advanced options.

Surgery is considered for ongoing pain, progressive deformity, or loss of function after structured conservative care. Procedures are selected to match your stage and flexibility:

• Tendon procedures: posterior tibial tendon debridement/repair, or flexor digitorum longus (FDL) transfer to reinforce arch support
• Realignment osteotomies:
  • Medializing calcaneal osteotomy (shifts heel under the leg)
  • Lateral column lengthening (helps address forefoot abduction)
  • Cotton (opening-wedge) osteotomy for residual forefoot varus
• Ligament reconstruction (spring ligament/deltoid) when indicated
• Gastrocnemius recession or Achilles lengthening for calf tightness
• Fusion options (subtalar/double/triple arthrodesis) for rigid, arthritic deformity in later stages

We’ll discuss benefits, risks, recovery timelines, shoe milestones, and return-to-activity expectations so you can make an informed decision.

1. Evaluation: Exam, footwear review, and weight-bearing imaging as needed.
2. Plan: Clear step-by-step program—support/bracing, exercises, and activity guidance you can start immediately.
3. Follow-up: Progress check at 4–8 weeks to fine-tune support and loading.

• Sudden inability to bear weight after an injury
• Rapid swelling, redness, warmth, or fever
• Numbness, tingling, or color change in the foot

• Board-certified care led by Hannah Lee, DPM
• Emphasis on evidence-based, conservative care first (orthotics, bracing, targeted rehab)
• Full spectrum of reconstructive options when needed, matched to your stage and goals
• Practical shoe and activity guidance so your plan works in real life

Can orthotics fix flatfoot permanently?
Orthotics don’t “undo” the deformity, but they can support alignment, reduce pain, and slow progression.

How long until I feel better?
Many patients notice improvement within 4–8 weeks with proper support and exercises; progressive cases may need bracing or advanced options.

Do I need a brace?
If the arch collapses significantly or you’re in a later stage, a supportive brace or AFO can improve comfort and stability—often alongside orthotics.

Will I be able to stay active?
Yes—our goal is to keep you moving safely. We’ll tailor activity and footwear while building strength and control.

Let’s build a plan that stabilizes your foot and fits your lifestyle.