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Adult-acquired flat feet may be caused by the activity of proteolytic enzymes, a new study suggests. Researchers at the University of East Anglia found that the increased activity of these

enzymes can break down the constituents of the tibialis posterior tendon and weaken it, causing the foot arch to fall. The condition, which often goes undiagnosed, is most common in women

over 40 and occurs when the tibialis posterior tendon gradually ‘stretches out’ over time. High heels and standing or walking for long periods are thought to be risk factors for the

condition alongside known risk factors such as obesity, hypertension and diabetes. However, the exact causes of the stretching have never been identified. The researchers say their study

marks an important advance in understanding the causes of adult-acquired flat feet and may eventually lead to a new drug for the condition. The findings may also be useful in developing

treatments for other common conditions such as Achilles tendonitis, the researchers said. However, they stressed that any new treatments could be 10 to 15 years away. Further research is

needed to find out which proteolytic enzymes should be targeted and whether people could be genetically predisposed to this type of tendon injury, the researchers added. Lead author Dr

Graham Riley said: “Our study may have important therapeutic implications since the altered enzyme activity could be a target for new drug therapies in the future. “We have shown that

similar changes also take place in other painful tendon conditions such as Achilles tendonitis, so this advance may ultimately result in an effective alternative to surgery for many

patients.” The findings have been published in the journal Annals of the Rheumatic Diseases.