Two Different Things
A flexible flatfoot present since childhood and a painless adult flatfoot are very different from adult-acquired flatfoot deformity - a progressive collapse of the arch caused by failure of the posterior tibial tendon (PTT). The latter is what we treat aggressively.
Stages of PTTD
- Stage I: Painful, swollen tendon, normal arch.
- Stage II: Flexible flatfoot deformity - the arch collapses with weight-bearing but reduces when offloaded.
- Stage III: Rigid flatfoot deformity - the arch no longer reduces.
- Stage IV: Deformity has progressed into the ankle joint.
Why Early Treatment Matters
Stage I and early Stage II disease often respond beautifully to immobilization, custom orthotics or AFO bracing, and a structured rehabilitation program - preserving the foot’s native architecture. Untreated, the deformity progresses, and reconstruction becomes more complex.
When Reconstruction Is Needed
For Stages II–IV that have failed conservative care, surgical reconstruction - combinations of tendon transfer, calcaneal osteotomy, midfoot fusion, and lateral column lengthening - restores alignment and function. Dr. O’Carroll individualizes the procedure to your stage and anatomy.