Modern Theory of the Development of Adult Acquired Flat Foot and an Updated Spring Ligament Classification System

Traditionally tibialis Posterior Insufficiency is still considered the commonest cause of acquired adult flat foot. This is still considered as the primary cause and has influenced both treatment and the diagnosis of the condition. Foot surgeons are now questioning the whole classification and the fundamental errors within this that have not been challenge for over 30 years. In this review article we examine the emerging evidence that suggests a new and alternative pathogenesis to this disease process centred on failure of the spring ligament.