{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T23:47:49Z","timestamp":1783986469503,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T00:00:00Z","timestamp":1673049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Adult acquired flatfoot deformity (AAFD) is a disorder caused by repetitive overloading, which leads to progressive posterior tibialis tendon (PTT) insufficiency. It mainly affects middle-aged women and occurs with foot pain, malalignment, and loss of function. After clinical examination, imaging plays a key role in the diagnosis and management of this pathology. Imaging allows confirmation of the diagnosis, monitoring of the disorder, outcome assessment and complication identification. Weight-bearing radiography of the foot and ankle are gold standard for the diagnosis of AAFD. Magnetic Resonance Imaging (MRI) is not routinely needed for the diagnosis; however, it can be used to evaluate the spring ligament and the degree of PTT damage which can help to guide surgical plans and management in patients with severe deformity. Ultrasonography (US) can be considered another helpful tool to evaluate the condition of the PTT and other soft-tissue structures. Computed Tomography (CT) provides enhanced, detailed visualization of the hindfoot, and it is useful both in the evaluation of bone abnormalities and in the accurate evaluation of measurements useful for diagnosis and post-surgical follow-up. Other state-of-the-art imaging examinations, like multiplanar weight-bearing imaging, are emerging as techniques for diagnosis and preoperative planning but are not yet standardized and their scope of application is not yet well defined. The aim of this review, performed through Pubmed and Web of Science databases, was to analyze the literature relating to the role of imaging in the diagnosis and treatment of AAFD.<\/jats:p>","DOI":"10.3390\/diagnostics13020225","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T03:25:58Z","timestamp":1673234758000},"page":"225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Adult Acquired Flatfoot Deformity: A Narrative Review about Imaging Findings"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-5301","authenticated-orcid":false,"given":"Chiara","family":"Polichetti","sequence":"first","affiliation":[{"name":"Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Universit\u00e0 Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Ilaria","family":"Borruto","sequence":"additional","affiliation":[{"name":"Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Universit\u00e0 Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Lauriero","sequence":"additional","affiliation":[{"name":"Department of Radiological and Hematological Science, Section of Radiology, Universit\u00e0 Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9092-225X","authenticated-orcid":false,"given":"Silvio","family":"Caravelli","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Rizzoli\u2014U.O.C. II Clinic of Orthopaedics and Traumatology, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Mosca","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Rizzoli\u2014U.O.C. II Clinic of Orthopaedics and Traumatology, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Maccauro","sequence":"additional","affiliation":[{"name":"Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Universit\u00e0 Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0463-9536","authenticated-orcid":false,"given":"Tommaso","family":"Greco","sequence":"additional","affiliation":[{"name":"Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Universit\u00e0 Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Perisano","sequence":"additional","affiliation":[{"name":"Orthopedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Universit\u00e0 Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1177\/1071100720982907","article-title":"Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity","volume":"42","author":"Auch","year":"2021","journal-title":"Foot Ankle Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1177\/1071100720950722","article-title":"Classification and Nomenclature: Progressive Collapsing Foot Deformity","volume":"41","author":"Myerson","year":"2020","journal-title":"Foot Ankle Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1071100720950722","article-title":"Consensus for the Use of Weightbearing CT in the Assessment of Progressive Collapsing Foot Deformity","volume":"41","author":"Myerson","year":"2020","journal-title":"Foot Ankle Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.fcl.2020.05.007","article-title":"Role of Minimally Invasive Surgery in Adult Flatfoot Deformity","volume":"25","author":"Bernasconi","year":"2020","journal-title":"Foot Ankle Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1053\/j.jfas.2004.12.001","article-title":"Diagnosis and Treatment of Adult Flatfoot","volume":"44","author":"Lee","year":"2005","journal-title":"J. Foot Ankle Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1016\/j.otsr.2014.07.030","article-title":"Adult Flatfoot","volume":"101","author":"Toullec","year":"2015","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1148\/rg.2019190046","article-title":"Adult Acquired Flatfoot Deformity: Anatomy, Biomechanics, Staging, and Imaging Findings","volume":"39","author":"Flores","year":"2019","journal-title":"RadioGraphics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-L\u00f3pez, D., Vilar-Fern\u00e1ndez, J., Barros-Garc\u00eda, G., Losa-Iglesias, M., Palomo-L\u00f3pez, P., Becerro-de-Bengoa-Vallejo, R., and Calvo-Lobo, C. (2018). Foot Arch Height and Quality of Life in Adults: A Strobe Observational Study. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15071555"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cianni, L., Vitiello, R., Greco, T., Sirgiovanni, M., Ragonesi, G., Maccauro, G., and Perisano, C. (2022). Predictive Factors of Poor Outcome in Sanders Type III and IV Calcaneal Fractures Treated with an Open Reduction and Internal Fixation with Plate: A Medium-Term Follow-Up. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195660"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"247301141882084","DOI":"10.1177\/2473011418820847","article-title":"Adult-Acquired Flatfoot Deformity","volume":"4","author":"Henry","year":"2019","journal-title":"Foot Ankle Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.2106\/JBJS.RVW.16.00116","article-title":"Adult-Acquired Flatfoot Deformity: Etiology, Diagnosis, and Management","volume":"5","author":"Abousayed","year":"2017","journal-title":"JBJS Rev."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"de Cesar Netto, C. (2020). Flexible Adult-Acquired Flatfoot Deformity: Comparison Between Weight Bearing and Non-Weight Bearing Measurements Using Cone Beam Computed Tomography. Weight Bearing Cone Beam Computed Tomography (WBCT) in the Foot and Ankle, Springer International Publishing.","DOI":"10.1007\/978-3-030-31949-6_15"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1177\/107110079501600911","article-title":"The Hindfoot Alignment View","volume":"16","author":"Saltzman","year":"1995","journal-title":"Foot Ankle Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"354","DOI":"10.2214\/AJR.14.12645","article-title":"Imaging of Adult Flatfoot: Correlation of Radiographic Measurements With MRI","volume":"204","author":"Lin","year":"2015","journal-title":"Am. J. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.otsr.2017.08.014","article-title":"Radiologic Analysis of Hindfoot Alignment: Comparison of M\u00e9ary, Long Axial, and Hindfoot Alignment Views","volume":"103","author":"Neri","year":"2017","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Perez Boal, E., Becerro de Bengoa Vallejo, R., Fuentes Rodriguez, M., Lopez Lopez, D., and Losa Iglesias, M.E. (2016). Geometry of the Proximal Phalanx of Hallux and First Metatarsal Bone to Predict Hallux Abducto Valgus: A Radiological Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166197"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1177\/1071100716646629","article-title":"Correlation of Talar Anatomy and Subtalar Joint Alignment on Weightbearing Computed Tomography with Radiographic Flatfoot Parameters","volume":"37","author":"Cody","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3113\/FAI.2010.0141","article-title":"Inter- and Intraobserver Reliability in the Radiographic Evaluation of Adult Flatfoot Deformity","volume":"31","author":"Sensiba","year":"2010","journal-title":"Foot Ankle Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.ocl.2019.08.005","article-title":"Outcomes of Reconstruction of the Flexible Adult-Acquired Flatfoot Deformity","volume":"51","author":"Conti","year":"2020","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1177\/107110070102200802","article-title":"Flexor Digitorum Longus Transfer and Medial Displacement Calcaneal Osteotomy for Posterior Tibial Tendon Dysfunction: A Middle-Term Clinical Follow-Up","volume":"22","author":"Guyton","year":"2001","journal-title":"Foot Ankle Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1177\/107110070102200406","article-title":"Treatment of Stage II Posterior Tibial Tendon Dysfunction with Flexor Hallucis Longus Transfer and Medial Displacement Calcaneal Osteotomy","volume":"22","author":"Sammarco","year":"2001","journal-title":"Foot Ankle Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/107110079301400305","article-title":"Effect of Calcaneal Lengthening on Relationships among the Hindfoot, Midfoot, and Forefoot","volume":"14","author":"Sangeorzan","year":"1993","journal-title":"Foot Ankle"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1177\/1071100715596607","article-title":"Contribution of Lateral Column Lengthening to Correction of Forefoot Abduction in Stage IIb Adult Acquired Flatfoot Deformity Reconstruction","volume":"36","author":"Chan","year":"2015","journal-title":"Foot Ankle Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1177\/10711007211015175","article-title":"Radiographic Outcomes of Cotton Osteotomy in Treatment of Adult-Acquired Flatfoot Deformity","volume":"42","author":"Abousayed","year":"2021","journal-title":"Foot Ankle Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e18826","DOI":"10.1097\/MD.0000000000018826","article-title":"Adult Rigid Flatfoot: Triple Arthrodesis and Osteotomy","volume":"99","author":"Yang","year":"2020","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/1938640020951031","article-title":"Subtalar Arthroereisis as an Adjunct Procedure Improves Forefoot Abduction in Stage IIb Adult-Acquired Flatfoot Deformity","volume":"15","author":"Bernasconi","year":"2022","journal-title":"Foot Ankle Spec."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Polichetti, C., Greco, T., Inverso, M., Maccauro, G., Forconi, F., and Perisano, C. (2022). Retro-Malleolar Z-Plasty of Flexor Hallucis Longus Tendon in Post-Traumatic Checkrein Deformity: A Case Series and Literature Review. Medicina, 58.","DOI":"10.3390\/medicina58081072"},{"key":"ref_28","first-page":"157","article-title":"Mueller-Weiss Disease: Review of the Literature","volume":"32","author":"Perisano","year":"2018","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1053\/j.jfas.2018.08.030","article-title":"Occurrence of Lateral Ankle Ligament Disease with Stage 2 to 3 Adult-Acquired Flatfoot Deformity Confirmed via Magnetic Resonance Imaging: A Retrospective Study","volume":"58","author":"Persaud","year":"2019","journal-title":"J. Foot Ankle Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1148\/radiology.169.1.3420263","article-title":"Rupture of Posterior Tibial Tendon: CT and MR Imaging with Surgical Correlation","volume":"169","author":"Rosenberg","year":"1988","journal-title":"Radiology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1177\/107110079801900706","article-title":"Two Reconstructive Techniques for Flatfoot Deformity Comparing Contact Characteristics of the Hindfoot Joints","volume":"19","author":"McCormack","year":"1998","journal-title":"Foot Ankle Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"205846012098014","DOI":"10.1177\/2058460120980145","article-title":"MRI Findings of Spring Ligament Injury: Association with Surgical Findings and Flatfoot Deformity","volume":"9","author":"Kimura","year":"2020","journal-title":"Acta Radiol. Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/1071100718764680","article-title":"Imaging of the Tibionavicular Ligament, and Its Potential Role in Adult Acquired Flatfoot Deformity","volume":"39","author":"Ormsby","year":"2018","journal-title":"Foot Ankle Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1002\/jmri.23792","article-title":"Postoperative Magnetic Resonance Imaging of the Foot and Ankle","volume":"37","author":"Sofka","year":"2013","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e5243","DOI":"10.1097\/MD.0000000000005243","article-title":"Ultrasound Evaluation of Intrinsic Plantar Muscles and Fascia in Hallux Valgus: A Case-Control Study","volume":"95","author":"Lobo","year":"2016","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S1083-7515(03)00019-6","article-title":"Adult Acquired Flat Foot Deformity: Clinical and Radiographic Examination","volume":"8","author":"Meehan","year":"2003","journal-title":"Foot Ankle Clin."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.fas.2018.03.001","article-title":"Influence of Investigator Experience on Reliability of Adult Acquired Flatfoot Deformity Measurements Using Weightbearing Computed Tomography","volume":"25","author":"Shakoor","year":"2019","journal-title":"Foot Ankle Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1148\/radiol.13130225","article-title":"Dedicated Cone-Beam CT System for Extremity Imaging","volume":"270","author":"Carrino","year":"2014","journal-title":"Radiology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"146","DOI":"10.2214\/AJR.12.8481","article-title":"Weight-Bearing CT Imaging of the Lower Extremity","volume":"200","author":"Tuominen","year":"2013","journal-title":"Am. J. Roentgenol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2564","DOI":"10.1016\/j.ejrad.2015.09.003","article-title":"Extremity Cone-Beam CT for Evaluation of Medial Tibiofemoral Osteoarthritis: Initial Experience in Imaging of the Weight-Bearing and Non-Weight-Bearing Knee","volume":"84","author":"Thawait","year":"2015","journal-title":"Eur. J. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e595","DOI":"10.5435\/JAAOS-D-19-00700","article-title":"Weight-Bearing CT Scans in Foot and Ankle Surgery","volume":"28","author":"Conti","year":"2020","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1177\/1071100720925423","article-title":"Three-Dimensional Biometric Weightbearing CT Evaluation of the Operative Treatment of Adult-Acquired Flatfoot Deformity","volume":"41","author":"Day","year":"2020","journal-title":"Foot Ankle Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1055\/s-0032-1320122","article-title":"Acquired Flat Foot Deformity: Postoperative Imaging","volume":"16","author":"Dimmick","year":"2012","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/j.fas.2020.12.003","article-title":"Combined weightbearing CT and MRI assessment of flexible progressive collapsing foot deformity","volume":"27","author":"Saito","year":"2021","journal-title":"Foot Ankle Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.fas.2017.05.010","article-title":"Evaluation of Peritalar Subluxation in Adult Acquired Flatfoot Deformity Using Computed Tomography and Weightbearing Multiplanar Imaging","volume":"24","author":"Kunas","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.fas.2020.04.011","article-title":"Weight-Bearing Radiographs and Cone-Beam Computed Tomography Examinations in Adult Acquired Flatfoot Deformity","volume":"27","author":"Shakoor","year":"2021","journal-title":"Foot Ankle Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/2\/225\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:02:51Z","timestamp":1760119371000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/2\/225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,7]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["diagnostics13020225"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13020225","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,7]]}}}