The understanding of the pathomechanics of the Adult Acquired Flatfoot (AAFF) has undergone a major evolution since its first description by Kulowski in 1936. Initially described purely as a disorder of the posterior tibial tendon, we now understand that the deformity additionally involves, among other contributors, the support of the spring ligament and as such the deltiod ligament, as well the midfoot through ligamentous laxity or degenerative collapse.
