Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
PTTD Stage III: Hindfoot Arthritis with Flatfoot Deformity a relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Quick Answer
Flat feet (pes planus) means the arch has collapsed, causing the ankle to roll inward. When flat feet cause plantar fasciitis, shin splints, or knee pain, custom orthotics combined with supportive footwear resolve most cases. Asymptomatic flat feet usually need no treatment.
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Stage III posterior tibial tendon dysfunction (PTTD) — rigid, fixed hindfoot valgus deformity with secondary subtalar, talonavicular, and calcaneocuboid joint arthritis — represents the end-stage of adult-acquired flatfoot collapse where the joints of the hindfoot have undergone irreversible degenerative change and can no longer be corrected by soft tissue procedures and calcaneal osteotomy alone. Triple arthrodesis (simultaneous fusion of the subtalar, talonavicular, and calcaneocuboid joints) is the surgical standard for Stage III, providing reliable deformity correction, pain relief, and restoration of plantigrade foot function — with the talonavicular joint as the ‘keystone’ of the procedure whose correction determines the overall result.
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Stage III Criteria and Preoperative Planning
Clinical features of Stage III: rigid flatfoot deformity — the hindfoot valgus does not reduce passively or with the single-limb heel-rise test; subtalar joint stiffness on clinical examination; direct sinus tarsi tenderness and talonavicular joint tenderness; the single-limb heel-rise is absent (Stage IIB) or impossible due to pain and rigidity (Stage III). Imaging: weight-bearing CT is the gold standard for Stage III assessment — shows posterior and middle facet arthritic changes (sclerosis, cysts, joint space loss); talonavicular and calcaneocuboid joint involvement; the degree of talus head uncoverage at the talonavicular joint (key planning parameter for deformity correction). Distinguishing Stage IIB from III: the critical distinction — Stage IIB (significant deformity, flexible) is treated with soft tissue reconstruction + osteotomy; Stage III (rigid joint arthritis) requires arthrodesis. The flexible/rigid assessment guides the entire treatment pathway. Associated Stage III features: lateral ankle impingement (fibular tip impinging on the calcaneus from extreme valgus); secondary ankle arthritis from chronic valgus overload; peroneal tendon attrition tears from impingement in the subfibular space.
Triple Arthrodesis Technique and Outcomes
Surgical approach: dual-incision approach — medial (talonavicular joint) and lateral (sinus tarsi — subtalar and calcaneocuboid joints); talonavicular joint corrected first, as it determines the foot position for all subsequent fixation; complete articular cartilage removal from all three joint surfaces; deformity correction: reduce hindfoot valgus (subtalar), correct forefoot abduction (talonavicular adduction), and plantarflexion of the medial column. Fixation: subtalar joint — large cannulated screws from posterior calcaneus into talar body; talonavicular joint — two screws from navicular into talar head or locked plate construct; calcaneocuboid joint — staples or screws (the smallest/least rigid joint of the triple complex). Bone grafting: structural allograft for any significant bone defect after correction; autologous graft from resected surfaces. Recovery: non-weight-bearing 8–10 weeks; CT-confirmed union at 12–14 weeks; weight-bearing boot at 10–12 weeks; return to supportive shoes at 5–6 months. Outcomes: 80–90% pain relief and patient satisfaction; preserved ankle motion (critical — any ankle arthritis must be addressed concurrently); late adjacent joint arthritis at the ankle and midfoot in 15–20% at 10+ year follow-up. Dr. Biernacki at Balance Foot & Ankle evaluates and performs triple arthrodesis for Stage III flatfoot at our Bloomfield Hills and Howell offices. Call (810) 206-1402.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
More Podiatrist-Recommended Arthritis Essentials
Cushioned Running Shoe
Hoka Clifton 10 — max cushioning reduces joint impact for arthritic feet.
Wide Walking Shoe
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- New Balance MADE contains a domestic value of 70% or more. MADE makes up a limited portion of New Balance’s US sales.
New Balance 990v6 — wide toe box accommodates arthritic first-MTP (hallux rigidus).
Orthotic Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
- When you spend all day on your feet, every step counts. PowerStep insoles are a podiatrist-recommended orthotic to help relieve & prevent foot pain related to athletes, runners, Plantar Fasciitis, heel spurs & other common foot, ankle & knee injuries
- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
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PowerStep Pinnacle — offloads the big toe joint during gait.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
Foot and ankle arthritis progresses silently — cartilage doesn’t regrow, but joint fusion, cheilectomy, and biologic injections can restore function at every stage. Balance Foot & Ankle offers the full arthritis spectrum: bracing, injections, and reconstructive surgery. Start with a consult so we can image the joint and give you a realistic 5-year outlook.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
Do flat feet always cause pain?
No — many people with flat feet have no pain at all. Pain develops when flat feet lead to excessive pronation that stresses tendons, ligaments, and joints. Risk factors for developing pain include obesity, prolonged standing, high-impact activities, and aging.
Can flat feet be corrected?
In children, arch development can sometimes be supported. In adults, the arch cannot be rebuilt without surgery, but custom orthotics, physical therapy, and appropriate footwear can effectively control symptoms and prevent progression.
What is the treatment for adult flatfoot deformity?
Early stages respond well to custom orthotics, physical therapy, and supportive footwear. Advanced cases with Achilles tightness may benefit from stretching and bracing. Severe cases — especially stage III-IV posterior tibial tendon dysfunction — may require reconstruction surgery.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Your Board-Certified Podiatrists
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Same-week appointments available at both locations.
Book Your AppointmentDifferential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Flat Feet (Pes Planus) and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Posterior tibial tendon dysfunction (PTTD). Acquired adult flatfoot with single-leg heel-rise weakness.
- Tarsal coalition. Rigid flatfoot in an adolescent — bone bridge between hindfoot bones.
- Charcot foot (diabetic). Sudden warm, swollen, collapsing midfoot in a diabetic — urgent off-loading.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
In Our Clinic
In our clinic, the flat-footed patient who actually needs intervention is the one whose arch is collapsing progressively in adulthood — not the person who was born flat-footed and has been running 5Ks pain-free for 20 years. We evaluate for posterior tibial tendon dysfunction (PTTD) with single-heel-rise testing, check for the “too many toes” sign from behind, and get weight-bearing X-rays. Early PTTD responds well to a custom orthotic with a medial heel skive + short course of boot immobilization. Stage 2+ PTTD is a different conversation — we discuss tendon transfers and calcaneal osteotomy candidates.
Most Common Mistake We See
The most common mistake we see is: Buying motion-control shoes without a gait assessment. Fix: get a pressure-plate analysis or wet-foot test first to confirm overpronation and arch height.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Rapid collapse of an arch on one foot (possible PTT rupture)
- Walking becoming impossible
- Redness or warmth along the inner arch
- Diabetes plus progressive arch collapse
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Watch: Dr. Tom explains
Podiatrist-recommended products
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Related resources
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Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Flat Feet Treatment Michigan at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can a podiatrist treat arthritis in the foot?
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- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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