Flat foot is a pretty common condition of the foot, but most of the time simply having a lower mid-foot (arch) or flatter foot is not always a problem. What is a problem is if it is progressive and becomes painful, then it's called posterior tibial tendon dysfunction or adult acquired flatfoot. In such cases the arch of the foot becomes progressively flatter and the rearfoot rolls inwards. This is usually followed by pain in the arch of the foot and in the rearfoot area. Those with this also find walking is a lot is a lot and walking consumes a lot of effort resulting in a lot of fatigue.The explanation for posterior tibial tendon dysfunction is not really fully understood, but it is a problem in which the posterior tibial tendon and muscle can't just do the job that it is designed for.

The principal role of the posterior tibial tendon is to hold up the arch of the foot and stop the heel rolling inwards. For reasons unknown the muscle and tendon complex can not just do that job any more, ultimately causing the progressive nature of this condition.The management of posterior tibial tendon dysfunction is almost urgent and really should be dealt with as early as it possibly can. The reason being the problem is progressive and it will reach a point where conventional methods are unsuccessful and surgery is the only choice. Even though the surgical outcomes usually are satisfactory, they do include the fusion of some joints to prevent the condition getting worse, that does have some long term limitations on gait and function, so is best avoided. In order to avoid the surgical option, treatment options must be started early. This will involve foot supports that are really supportive and angle the foot back in the right position. Exercises are also recommended, but should never be used instead of foot orthotics, as they are crucial to stop the flat foot from getting worse.