What is progressive flatfoot?

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Progressive flatfoot involves pain on the inner ankle and gradual loss of the inner arch on the base of the foot. This occurs once the posterior tibial tendon becomes inflamed, overly stretched or torn. It is important to note that this tendon is responsible for holding up the arch and provides support as one steps off on the toes while walking.


  • Pain and inflammation on the interior of the ankle
  • Gradual development of pain on the exterior side of the foot or ankle
  • Loss of the arch and steady development of flatfoot
  • Tenderness over the midfoot, particularly while under stress during activity
  • Weakness and inability to stand on the toes
    Pain and inflammation on the interior of the ankle.

What are the possible causes?

Progressive flatfoot often develops among women over the age of 50 years and might be due to an inherent irregularity of the tendon.

Other risk factors include:

  • Diabetes
  • Obesity
  • Local steroid injections
  • Hypertension
  • Previous trauma or surgery especially an ankle fracture on the interior aspect of the foot
  • Inflammatory ailments such as rheumatoid arthritis, Reiter’s syndrome, psoriasis and spondylosing arthropathy
  • Individuals engaged in sports such as tennis, basketball, hockey or soccer that can rip apart the posterior tibial tendon

Management of progressive flatfoot

If not treated, the flatfoot that forms due to posterior tibial tendon dysfunction turns rigid. Arthritis might even develop in the hindfoot. The pain intensifies and radiates to the outer side of the ankle. The manner of walking might be affected and wearing shoes becomes difficult.

The treatment recommended by the doctor is based on how far the condition has progressed. During the initial phases, the dysfunction of the tendon is managed using rest, non-steroidal anti-inflammatory drugs (NSAIDs) and immobilization of the foot for 6-8 weeks using a stiff below-knee cast or boot.

Once the cast is taken out, shoe inserts including an arch support or heel wedge might be beneficial. In case the issue is already advanced, the doctor might suggest using a customized ankle-foot orthosis or support.

In case the conservative measures fail to work, the doctor might suggest surgery. Various procedures can be utilized to manage progressive flatfoot. Generally, more than one procedure is carried out at the same time.

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