Progressive collapsing flat foot treatment in Esperance

Progressive collapsing foot deformity (PCFD) is a gradual collapse of the arch and ankle that develops in adulthood. You may also hear it called adult-acquired flatfoot (AAFD) or posterior tibial tendon dysfunction (PTTD).

It starts when the ligaments and tendon that support the inside of the foot and ankle begin to fail. Over time the foot flattens and rolls inwards, walking becomes less efficient, balance suffers, and pain gradually gets worse.

PCFD is different from simply having flat feet. Many people are born with low arches and never have a problem. PCFD is a change in a foot that used to be fine, and without treatment it tends to keep getting worse.

Thankfully, it can usually be managed without surgery. It takes commitment and a team effort, and the earlier it's treated, the better.

Signs to look for

• One foot that is getting flatter and changing shape over months or years

• The ankle rolling inwards, the heel tilting outwards, and the toes pointing outwards

• Pain or swelling on the inside of the ankle, along the path of the tendon

• Tiredness or aching in the foot and leg after walking or standing

• Difficulty rising up onto your toes on the affected foot

• Poorer balance, or feeling less confident on uneven ground

• Later on, pain on the outside of the ankle as the foot collapses further

If you've noticed one foot changing shape, it's worth getting it checked early. Treatment is simpler and more successful before the deformity becomes stiff.

Treatment options

There are several ways to manage PCFD, and the right one depends on how far it has progressed, your symptoms and your lifestyle. Rebecca will talk you through each option, including the costs. Consulting with Rebecca (or anyone for that matter), does not mean you have to go ahead with treatment – you’re simply on a fact-finding mission. You're always free to take your time, talk it over with your GP, or get a second opinion.

1. Supportive footwear and foot orthoses

For milder or early cases, supportive lace-up shoes combined with off-the-shelf or custom-made foot orthoses may be enough to ease symptoms and support the foot. Orthoses are also part of the long-term plan for people who start with a brace.

2. The Richie Brace with a targeted exercise program

The Richie Brace is a custom-made ankle-foot orthosis (AFO). It fits inside a supportive lace-up shoe and holds the foot and ankle in a better position during everyday activity. This takes the strain off the damaged ligaments and tendon so they have the best chance to settle and heal. The brace is usually worn all day, every day, for around 12 months. You build up wear gradually, and we adjust it as needed.

Research shows that combining a brace with specific exercises in the earlier stages of this condition leads to better results than a brace alone. The program focuses on strengthening the key tendon that supports the arch (tibialis posterior), along with calf and ankle strength and mobility, hip strength and balance. Exercises are done twice a day for about 4 months, tailored to you with guidance from an exercise physiologist or physiotherapist of your choice – Rebecca will refer you. 

Supportive, lace-up motion-control shoes are an important part of this plan. They hold the brace, and later your foot orthoses, securely in place.

3. Other types of ankle-foot orthosis

There are other types of AFO you can also consider. An orthotist (prosthetic and orthotic technician), such as Interface Orthotics in West Perth, can talk you through these. Off-the-shelf AFOs can also be purchased from places like Australian Physiotherapy Supplies (APE Medical).

4. A specialist opinion

Because PCFD is a complex condition, in some cases Rebecca involves foot and ankle surgeon Dr Peter Manuel (Geraldton, Kalgoorlie and Perth), who specialises in both non-surgical and surgical management of PCFD. He can arrange an MRI to assess the tendons, ligaments and joints, and discuss your diagnosis, outlook and treatment options.

Private health insurance rebates may apply, depending on your fund and level of cover.

What the Richie Brace treatment involves

If you go ahead with the Richie Brace and exercise program, this is a long-term plan, not a quick fix. Here's a general outline:

First visit: assessment, a preliminary diagnosis, imaging if needed, and an off-the-shelf orthotic for early support.

Full examination (early weeks): detailed biomechanical assessment and review of any imaging to confirm and stage the condition.

Casting (once you decide to go ahead): we cast or scan your feet for the Richie Brace.

Brace fitting (when the brace arrives): your brace is fitted and your exercise program begins.

Early reviews (at 2 weeks, then every 4 weeks for 3 months): check fit and comfort, monitor symptoms and progress your exercises.

Ongoing reviews (every 3 months): monitor progress. Custom foot orthoses are prescribed and you start alternating them with the brace, usually around 9 to 12 months.

Transition (12 to 24 months): moving out of the brace and into foot orthoses in motion-control shoes.

What success looks like

We aim for:

• no pain and less fatigue

• more confident, efficient walking

• better balance and activity levels

• less reliance on the brace over time, ideally moving into supportive shoes and orthoses alone

We don’t expect:

• a big improvement in the shape of your foot

• the existing deformity to be reversed

• a return to slip-ons, sandals, thongs or bare feet without the problems gradually returning

Many people are able to move out of the brace within 12 to 24 months, and that's what we work towards. Success depends on wearing the brace consistently, doing your exercises, and coming to regular reviews.

Book an appointment

If your arch has been dropping or the inside of your ankle is sore, book in with Rebecca at Esperance Podiatry. No referral is needed.

Call (08) 9072 1514 or visit us at Suite B, 116 Dempster Street, Esperance.