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It is often associated with posterior tibial tendon deficiency (PTTD), which has been linked to multiple demographic factors, medical comorbidities, and genetic processes. AAFD is classified using stages I through IV. Nonoperative treatment modalities should always be attempted first and often provide resolution in stages I and II. Stage II, consisting of a wide range of flexible deformities, is typically treated operatively with a combination of soft tissue procedures and osteotomies. Stage III, which is characterized by a rigid flatfoot, typically warrants triple arthrodesis. Stage IV, where the flatfoot deformity involves the ankle joint, is treated with ankle arthrodesis or ankle arthroplasty with or without deltoid ligament reconstruction along with procedures to restore alignment of the foot. There is limited evidence as to the optimal procedure; thus, the surgical indications and techniques continue to be researched.<\/jats:p>","DOI":"10.1177\/2473011418820847","type":"journal-article","created":{"date-parts":[[2019,1,16]],"date-time":"2019-01-16T20:38:54Z","timestamp":1547671134000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":99,"title":["Adult-Acquired Flatfoot Deformity"],"prefix":"10.1177","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5329-8734","authenticated-orcid":false,"given":"Jensen K.","family":"Henry","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Shakked","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott J.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,1,16]]},"reference":[{"key":"bibr1-2473011418820847","doi-asserted-by":"publisher","DOI":"10.1177\/1071100712473742"},{"key":"bibr2-2473011418820847","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201307000-00005"},{"key":"bibr3-2473011418820847","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-015-4581-6"},{"key":"bibr4-2473011418820847","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715620894"},{"key":"bibr5-2473011418820847","doi-asserted-by":"publisher","DOI":"10.1177\/107110070602700102"},{"key":"bibr6-2473011418820847","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2009.01.009"},{"key":"bibr7-2473011418820847","doi-asserted-by":"crossref","unstructured":"Arangio GA, Salath\u00e9 EP. 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