Progressive Collapsing Foot Deformity: The New Terminology for Adult Acquired Flatfoot | Find Your Stride | Edinburgh Podiatrist

Introduction

Progressive Collapsing Foot Deformity (PCFD) is the updated name for a condition historically referred to as Adult Acquired Flatfoot (AAF). This medical issue manifests as a complex deterioration of the foot's structure, primarily as a result of posterior tibial tendon (PTT) dysfunction. As insights into foot anatomy advance, approaches to the diagnosis and management of this condition are also evolving. In today's post we take a look at information published by the American Academy of Orthopaedic Surgeons on PCFD.

Lateral view x-ray of a Progressive Collapsing Foot

Defining Progressive Collapsing Foot Deformity

PCFD is not just a superficial concern; it entails significant impairments in foot functionality. The condition may start with minimal symptoms but can progress to a debilitating deformity if left untreated. The defining characteristics include:

- A noticeable flattening of the foot arches

- Potential misalignment among foot bones

- Pain during everyday activities

The PTT is crucial for maintaining arch support and facilitating movement. When this tendon becomes compromised or injured, the arch can gradually collapse, leading to the development of PCFD.

Causes and Risk Factors

Recognising the underlying causes of PCFD is vital for successful prevention and treatment. The development of this condition may be influenced by several contributing factors:

1. Tendon Dysfunction: Inflammation, tearing, or weakening of the PTT due to repetitive strain.

2. Age and Gender: This condition is more common in women and individuals aged over 40.

3. Genetics: A family history of foot complications can heighten the risk.

4. Activity Level: Engaging in high-impact activities or wearing inadequately supportive footwear can exacerbate symptoms.

Symptoms of PCFD

Individuals with PCFD may encounter various symptoms, including:

- Discomfort along the inner ankle and foot

- Swelling near the posterior tibial tendon

- Struggles with prolonged standing or walking

- Discomfort that intensifies during high-impact activities.

The "Too Many Toes" Indicator: As the deformation advances, a visible signal known as the "too many toes" indicator may appear, suggesting altered foot alignment that results in a view of more toes than usual when looking at the feet from behind (see below).

An example of the 'too many toes' indicator, note the difference between the two feet

Diagnosis Process

An accurate diagnosis begins with a detailed medical history and a physical examination. Important factors to assess include:

- Presence of swelling and discomfort near the PTT

- Alterations in foot shape when standing

- The ability to perform a single-leg heel raise, which tests PTT capability

Imaging tests such as X-rays, CT scans, and MRIs may also be utilised to confirm the diagnosis and eliminate any alternate causes or associated problems such as arthritis.

Treatment Options

Treatment for PCFD is customised based on the condition's severity and typically falls into two main categories: nonsurgical and surgical options.

Non-Surgical Management

1. Orthotics and Footwear: Custom or standard orthotics can offer necessary support, easing discomfort and preventing further arch collapse.

2. Physical Therapy: Focused exercises may enhance PTT strength and improve flexibility in the Achilles tendon.

3. Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can alleviate pain and inflammation.

Surgical Solutions

If conservative treatments do not yield relief after a sufficient time, surgical options might be required, including:

- Tenosynovectomy: Cleaning the tendon area by removing any inflamed tissue.

- Tendon Transfer: Utilising another tendon to support the foot when the PTT is not functional.

- Osteotomy: Reconfiguring bones to restore the arch structure.

- Joint Fusion: In instances of accompanying arthritis, fusing joints may help enhance stability and reduce pain.

Conclusion

Progressive Collapsing Foot Deformity underscores the necessity of early detection and intervention to avoid severe issues regarding foot health. If you notice symptoms linked to PCFD, it’s advisable to consult with a healthcare professional to explore potential treatment pathways. With effective management, most individuals can enhance their functionality and alleviate discomfort, paving the way to a more active lifestyle.

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