This is a patient who presented with a severely debilitating right flat foot.
This has been progressing for approximately two years; however, three months ago, the pain and disability markedly increased. He can no longer carry out weight-bearing exercises, work at his usual job or play with his kids as desired. Conservative care has been unsuccessful, and he is in a despondent state due to the impact this is having on his life.
His pain is on the lateral rearfoot with no pain medially. X-rays and ultrasound of the painful lateral region show no pathology; however, his podiatrist was sure something more was going on with the tib post tendon and referred him on.
When you see these markedly flat feet, especially when one is so different from the other, it is important to keep a tib post tendon pathology in mind. This has progressed from simply a PTTD to a full adult-acquired flat foot. The pain on the lateral foot is not the etiology of the problem, yet a symptom as the lateral subtalar joint, sinus tarsi and CC joint gets compressed from working at their end range of motion.
This has now gone way beyond conservative care, and surgery will need to be contemplated. The imaging shows the difference between the two feet and his inability to resupinate the right foot.
If you have any specific questions or would like to discuss similar cases, feel free to contact me.
Also read:
Biomechanics of a pathology (bunions and pes planus)
Post-operative pes planus/flat feet/excess pronation
Pes planus
Accessory navicular with pes planus
Hyperpronation cure
(This content is intended for healthcare professionals only)