Progressive collapse of an adult foot – a new opinion on an old topic

Introduction: the problem of definition and classification system of flatfoot is widely discussed in modern literature. Most often, the term “AAFD” Adult Acquired Flatfoot Deformity can be found. Acquired flatfoot in adults is multicomponent and includes disorders such as tibialis posterior tendon dysfunction, tibialis posterior tendon rupture, peritalar foot instability and peritalar foot subluxation, as well as progressive planovalgus or equinoplanovalgus foot deformity. In view of this “versatility” of flatfoot, there is a need to identify the primary element in the pathogenesis of the disease and to create a classification that takes into account the progressive nature of the deformity. It is widely believed that dysfunction of the tibialis posterior tendon is the primary element in the pathogenesis of flatfoot. Of course, all of the described components of pes planus are associated with dysfunction of the tibialis posterior tendon. However, the question of the primacy of tendon dysfunction is currently debatable, since there are descriptions of primary deformation of the midfoot or ankle joint in acquired flatfoot in adults. One of the most common and frequently used classifications for assessing acquired flatfoot in adults is the classification presented by Johnson and Strom (1989), which was then modified by Myerson (1997). It is based specifically on dysfunction of the posterior tibial tendon, without considering the other components of the deformity. Many attempts have been made to create a more correct and complete classification system that would include all components of acquired flatfoot in adults. However, despite the fact that the new classification systems took into account the anatomical variability of the deformity, none of them was able to put an end to the issue of the primary element in the pathogenesis of acquired flatfoot.

Aim: to present a new classification system for adult flatfoot deformity.

Materials and methods: A review of the literature over the past 10 years was performed in databases such as PubMed, Scopus, Google Scholar, eLibrary. Articles, original studies, case reports, and previous systematic reviews of the literature were identified.

Results: We have presented a new nomenclature for flatfoot for use in the practice of domestic orthopedic traumatologists: “Progressive Collapse of an Adult Foot” (PCAF) and a new classification system aimed at summarizing the latest data based on the recommendations of the community of leading surgeons in this field. area, and standardize the assessment of this complex three-dimensional deformation. The proposed classification system is based on modern understanding of the causes of planovalgus foot deformity in adults and allows for a more accurate assessment of the stage of the disease and standardization of the deformity assessment process.

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