Current concepts for treatment of the painful flatfoot in the elderly.

Flatfoot deformities are predominantly asymptomatic variants of normal, which do not adversely affect function. However, the acquired flatfoot deformity secondary to attrition of the posterior tibial tendon is a progressively painful condition, ultimately affecting the hindfoot, midfoot, and forefoot. It is most common during the sixth and seventh decades of life. Chronic micro-trauma to the tendon causes eventual rupture and the resulting deformity. Prior to tendon rupture, early symptoms are those of a unilateral localized inflammatory condition with tenderness and swelling behind the medial malleolus of the ankle. Early diagnosis is a key factor in limiting patient disability.