Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle SurgeryForefoot Supination and Medial Column Instability in the Setting of AAFD: The Role of the Medial ColumnAbyar, Eildar MD*; O’Daly, Andrés E. MD†; Shah, Ashish B. MD*; Johnson, Michael D. MD*Author Information *Department of Orthopaedics, University of Alabama-Birmingham, Birmingham, AL †Orthopedic Foot and Ankle Surgeon, Coastal Orthopedics, Bradenton, FL No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s). The authors declare no conflict of interest. Address correspondence and reprint requests to Michael D. Johnson, MD, Department of Orthopaedics, University of Alabama-Birmingham, 1313, 13th St. S., Birmingham, AL 35205. E-mail: [email protected]. Techniques in Foot & Ankle Surgery: September 2019 - Volume 18 - Issue 3 - p 132-140 doi: 10.1097/BTF.0000000000000224 Buy Metrics Abstract Several variables may contribute to adult-acquired flatfoot deformity, one such variable is the medial column of the foot, which commonly manifest as forefoot varus or supination. The medial column is subjected to considerable loads during gait, and under normal conditions provides dynamic stability during the stance phase of gait. Pathology occurring along the medial column and forefoot can disrupt normal foot mechanics and lead to flatfoot deformity. A careful history and examination can diagnose dysfunction relating to the medial column and forefoot. Specifically, first tarsometatarsal dysfunction can result in malalignment, and loss of first ray stability. It is important to consider all potential sources of medial column insufficiency since dysfunction can occur at any point along its course. Stabilization and joint-sparing techniques may be used to correct multiplanar malalignment of the first tarsometatarsal joint, and offers a powerful means of preserving foot mechanics. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.