Flat foot is a fairly common problem of the foot, but most of the time simply having a lower mid-foot (arch) or flatter foot is not necessarily an issue. What is a issue 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 steadily lower and the heel rolls inwards. This is usually followed by pain in the arch of the foot and in the rearfoot region. Those with this also find walking is a lot is a lot and walking consumes a lot of energy leading to lots of fatigue.The cause of posterior tibial tendon dysfunction is not really totally, however it is an issue where the posterior tibial tendon and muscle can't just do the job that it is intended for. The primary role of the posterior tibial tendon is to support the arch of the foot and stop the heel rolling inwards. For some reason the muscle and tendon unit are unable to just do their task any more, leading to the progressive nature of this condition.
The treatment of posterior tibial tendon dysfunction is almost urgent and really should be dealt with as soon as it possibly can. The reason being the problem is progressive and it will get to a stage where non-surgical measures don't work and surgery is the only alternative. As the surgical outcomes are likely to be satisfactory, they do consist of the fusion of some joints to prevent the problem getting worse, that does have some long term limitations on gait as well as function, so is best avoided. To avoid the surgical intervention, treatments needs to be started early. This will consist of foot orthotics 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 critical to stop this problem from getting worse.