We regret to inform you of the closing of our Massachusetts office. This change will be effective as of September 1, 2022. If you have any questions, please feel free to call our Londonderry NH office at (603) 216-2972.

Flat Foot


 Acquired Flat Foot or “ Posterior Tibial Tendon Disease”


Sometimes, although we are not born with a flat foot, we may notice that the height of our arch falls over time and our instep and arch area can become sore and painful. This condition can range from completely asymptomatic (no pain), to extremely painful. This condition is typically progressive and can lead to ankle, knee and hip and back pain.  Regardless, if neglected the pain can become worse, and arthritis can develop. This can lead to a decreased ability to participate in sports activities and other activities such as hiking, and walking for extended period of time.


What Causes Posterior Tibial Tendon Disease?

Typically, this condition is caused by excessive pronation that occurs from the minute the heel touches the ground during gait to the moment the heel comes off the ground again.  When the heel lands on the ground, our feet pronate to make the foot more malleable to the ground so that the impact of one’s body weight against the ground is dissipated. The body does this naturally to minimize the shock to every joint, from our feet all the way up to the back. Once the foot is then planted on the ground, the foot needs to “supinate”n other words, i.e., change its position to a “locked arch” in order to become an efficient lever to propel our body forward. If the pronation is excessive, our foot is no longer able to supinate and become the rigid lever we need it to be. This places excessive stress or “load” on our posterior tibial tendon which over time can fatigue and become less and less efficient. This is why we’ll notice a progressive loss of our arches. Over time this will wear down or “degenerate” the cartilage on the joint(s) and arthritis will develop. If neglected, patients can suffer increased pain and even changes in the ankles, knees and back.


What Can Be Done to Treat Posterior Tibial Tendon Disease?

If diagnosed and treated in its early phase, this condition can be treated and arrested with a high quality custom insert.Dr. Pasquale Cancelliere will create the custom insert  after a complete, focused exam of your lower extremities and posture, and by taking specialized measurements from X-rays of your feet taken in our office for your convenience.

A high-quality insert in your shoe functions in the same way a prescription eye glass works;It optimizes your own biomechanics in order to reduce the excessive pronation.

In some cases, a simple, and extremely effective surgical procedure can be performed in order to fully correct the faulty biomechanics. The procedure is called “Sub Talar Joint Arthroeresis”

This procedure is performed under local anesthesia in our in office surgical suite. It takes approximately 20 minutes to perform and does not require any of the recovery time to be non-weight bearing.The patient will need to a wear a special boot for approximately 2 weeks after which point the patient can then transition to gym shoes for another 2 weeks. Typically, a patient can return to full activity by 4-6 weeks after the procedure if post-operative instructions are followed appropriately and the patient is in good general health. The incision is approximately 1 inch long.


In the most severe cases, a joint fusion is required. This typically requires a longer procedure and a “non weight bearing” period of 6-8 weeks. However, patients can return to full activity after this period of time.


If you or a loved one are suffering from a change in the shape of your feet, and more specifically, “falling arches”, come see Dr. Cancelliere immediately and explore all the options that are available to you. Dr. Cancelliere will perform a complete and thorough focused foot and ankle exam, provide you with an accurate diagnosis, and recommend the best treatment plan for you.


Here is a picture of a 17 year old male that was treated by Dr. Cancelliere. This patient has bilateral posterior tibial tendon disease affecting both feet/ankles. He was no longer able to complete a shift at work due to the terrible pain in his arches and ankles. He had Dr Cancelliere perform a surgical foot flatfoot correction on his left foot in our in-office surgical suite under local anesthesia and within days his left foot already showed an improved arch height and a dramatic reduction in his foot and ankle pain from the condition prior to surgery.      



In the pictures above you can see the difference between the un- corrected (right foot) and the corrected (left foot).The below pictures shows the misaligned Right heel bone relative to the leg and the corrected, perfectly aligned Left heel bone.


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