الفهرس 
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Abstract
SUMMARY
Acquired adult flatfoot deformity is a progressive flattening of the arch of the foot that occurs due to the gradual stretch of the posterior tibial tendon as well as other ligaments supporting the arch of the foot. This problem may progress from early stages with pain along the posterior tibial tendon to advanced deformity and arthritis throughout the hindfoot and ankle (Zhou et al., 2017).
Patients often experience pain and/or deformity at the ankle or hindfoot. In the earlier stages, symptoms often include pain and tenderness along the posterior tibial tendon behind the inside of the ankle. As the tendon progressively fails, deformity of the foot and ankle may occur (Lesić et al., 2013).
This deformity can include progressive flattening of the arch, shifting of the heel so that it no longer is aligned underneath the rest of the leg, rotation and deformity of the forefoot, tightening of the heel cord, development of arthritis, and deformity of the ankle joint (Arvinius et al., 2017).
The diagnosis of posterior tibial tendon dysfunction and acquired flat foot deformity is usually made from a combination of history, symptoms, examination and x-ray imaging. The site of pain, shape of the foot, flexibility of the hindfoot joints and gait are the tools that assist the diagnosis and also assess the severity of the problem (Zhou et al., 2017).
Advanced radiographic studies, such as MRI, CT, and ultrasonography can provide extra and sometimes helpful information. However, in typical cases of AAFD, an accurate diagnosis can be made based on clinical examination and weight bearing radiographs of the foot. MRI provides an accurate assessment of the status of the soft tissues, including the posterior tibial tendon, the spring ligament, deltoid ligament, and even the functional status of a muscle (Wacker et al., 2003).
Treatment depends greatly upon a patient’s symptoms, functional goals, degree, specifics of deformity and the presence of arthritis. In early stages of the disease that involves pain along the tendon, immobilization with a boot for a period of time can relieve stress on the tendon and reduce the inflammation and pain. Once these symptoms have resolved, patients are often transitioned into an orthotic that supports the inside aspect of the hindfoot (Elftman 2003).
For patients with more significant deformity, a larger ankle brace may be necessary. If surgery is necessary, a number of different procedures may be considered. The planned surgery depends upon the stage of the disorder and the patient’s main complaint. The overall complication rates for these procedures are low (Lesić et al., 2013).
The aim of this study was to review the outcomes of various surgical and/ or non-surgical procedures used in management of adult acquired flat foot deformity (focusing on stage II).
The following was done:
1. Three databases were searched for terms referring to the PTTD and AAFD.
2. A second comprehensive search using all identified keywords and index terms were then undertaken.
3. The reference list of all identified reports and articles were searched for additional studies.
4. All search results were imported in Endnote X7.
5. Data were extracted from papers included in the review.
6. A custom data extraction table was developed.
Results were as follow:
1. Twenty-two eligible studies were included in this review.
2. The sample size of the treatment trials ranged from 12 to 129 patients, with only two trials having more than 100 participants.
3. The age ranges were wide.
4. Pain, adverse effects, function or disability indices of foot, patients’ satisfaction, radiographic parameters, alignment and improvement of foot function, and quality of life were the searched outcomes.
5. Due to clinical and methodological heterogeneity, data were not pooled into meta-analysis. The evidence from the selected studies is currently too limited about each procedure compared to its counterpart to draw definitive conclusions about the use of each intervention for AAFD.
In conclusion, the evidence from the selected studies is currently too limited about each procedure compared to its counterpart to draw definitive conclusions about the use of each intervention for AAFD..