Adult Acquired Flatfoot: A 13-Year Prospective Series

Introduction: Adult acquired flatfoot is a common cause of foot pain. The majority of series describe surgery although important non-surgical series exist. This series of 166 patients gives an overview of the clinical spectrum of the condition and outcomes. Materials and Methods: Data was collected prospectively on 166 consecutive patients with adult acquired flatfoot between 1995 and 2005. 104 patients were reviewed at a median of eight years (range 313). A standardised clinical examination, AOFAS hindfoot and visual analogue satisfaction scores were performed. Results: There were 40 men (median age 56 years) and 126 women (median age 60 years). 68% had other musculoskeletal problems. Patients were Truro staged at presentation; Stage 1: 26 patients. Stage 2A: 84 patients. Stage 2B: 25 patients. Stage 2C: 23 patients. Stage 3: 6 patients. Stage 4: 2 patients. Stage 1 patients were younger (p0.001). 133 patients had soft-tissue symptoms, but 33 had degenerative problems. Degenerative patients had a higher median age (p=0.0138) and stiffer deformities (p0.0001). Most patients (131, 78.9%) were managed conservatively. Surgery was commoner in the arthritic group (p=0.001). Fifty-two conservatively treated feet were clinically reassessed. In 31 (59%) patients the Truro stage had not changed, 11 (21%) had improved and 10 (20%) had deteriorated. Twenty percent of patients treated with orthoses stopped using them after 18 to 24 months. In non-surgically treated patients, the median AOFAS score was 73 100 and satisfaction score 71 100. In surgically treated patients the median AOFAS score was 74 100 and satisfaction score 83 100. Discussion: There is a young group of patients with adult acquired flatfoot, with soft tissue symptoms but no progressive deformity. There is a large group with a flexible deformity who can mostly be treated with orthoses, and an older group with stiffer, arthritic deformities who are more likely to need surgery. Conclusion: Final outcomes and satisfaction were similar in surgically and non-surgically treated patients.