A flat foot is a condition whereby the whole feet meet the floor when it bears the body weight. Under extreme conditions, decisions can be made to fix flat feet with surgery.
In children, it is a normal occurrence and the arches of the feet usually take its normal shape as the child grows. In adults, it’s not as flexible as that of children.
Flat foot in adults is sometimes caused by tendon injuries, autoimmune diseases like rheumatoid arthritis, posterior tibial tendon dysfunction (PTTD), bone deformities and so on.
It is diagnosed by an orthopedic doctor through physical exams and imaging. If the flat foot is flexible, treatment is usually not recommended.
If it is rigid, a flat foot reconstruction surgery might be recommended especially if it is accompanied by pain.
Types of Flat Feet Surgery
A specific flat feet surgery or a combination of surgeries can be done to correct the fallen arches. Some of the procedures are used to correct bone deformities and some are used to repair inflamed ligaments and tendons.
It is the duty of the foot and ankle surgeon to decide the best procedure(s) to tackle the cause of the flat feet as shown in the test results.
Although flatfoot surgery can be done under general anesthesia, regional anesthesia is used more often. This is the process of blocking the spine or nerves of the foot and ankle to reduce pain during the surgical process.
One or more of the following types of surgeries can be used to treat fallen arches and rigid flat feet.
Lateral Column Lengthening
This is a procedure that is used to correct flat feet disorder where the forefoot is extending to one side. Most times, this surgery is done together with calcaneal osteotomy. The lateral column lengthening surgery can reshape feet completely.
It has been used to efficiently correct totally deformed feet, but it also has a disadvantage of forming a stiff foot which might cause further complications like pains, nonunion (bone healing delay), and nerve damage.
The lateral column of the feet is:
- The calcaneus
- The cuboid
- The fourth metatarsals
- The fifth metatarsals.
They are joined to each other in this order and extends from the heel to the midfoot. The lateral column lengthening surgery involves the insertion of a bone graft to extend the length of the column.
The bone graft to be used can be obtained from the pelvis of a cadaver and should be about 7-10mm in length and have a trapezoid shape.
Lateral column lengthening can be carried out in two ways:
- The calcaneus can be cut from the front, just before its joint with the cuboid. Then it is shifted about 7-9mm apart to accommodate the bone graft.
- The joint of the calcaneus bone and cuboid bone can be separated and moved apart to allow the insertion of the bone graft between it.
- After the bone insertion, the bone graft which is used to extend the lateral column is held in place, with a metal plate or screws.
Medializing Calcaneal Osteotomy
Calcaneal osteotomy is a procedure used in correcting bone deformities just like the lateral column lengthening procedure.
The calcaneal is one of the bones of the feet located near the heel. Osteotomy is a surgical process of cutting a bone. The calcaneal osteotomy is done to realign the heel bone and place it directly under the tibia (shin bone).
When the procedure is done to shift the heel bone towards the inner ankle, it is known as a medializing calcaneal osteotomy. When it is done to shift the heel bone towards the outer ankle, it is known as a lateralizing calcaneal osteotomy.
The heel of the flat feet (pes planus) is shifted a bit far to the outer ankle. The heel of the high arched feet (Pes Cavus) is shifted far towards the inner ankle.
The medializing calcaneal osteotomy (bone shift towards the inner ankle) is therefore used to correct flat feet while lateralizing calcaneal osteotomy (bone shift towards the outer ankle) is used to correct high arched feet.
A cut is made near the heel bone, the bone is shifted and held in place using screws.
This is best suited in the correction of hindfoot deformity that is accompanied by joint stiffness and arthritis.
Although it is the most efficient procedure, it is not often done unless the joints involved are severely deformed or damaged and can no longer be preserved.
This involves the joining of 3 joints to form one joint. The three joints joined in triple arthrodesis are
The Subtalar Joint
This is also known as the talocalcaneal joint which is positioned directly under the ankle joint. It is a joint of the calcaneus bone and the talus bone.
The Talonavicular Joint
This is a joint of the talus bone and lower half of the ankle joint and the navicular bone. This joint is responsible for the circular movement of the foot.
The Calcaneal-cuboid Joint
This is a joint formed by the calcaneus bone and the cuboid bone. The joint involves the distal surface (front) of the calcaneus and the proximal surface (back) of the cuboid bone.
To perform this surgery, two cuts are made on the foot. The inner cut is made to show the inner part talonavicular joint.
The other cut is made on the outer part of the foot to expose the calcaneal-cuboid joint, the subtalar joint, and the outer part of the talonavicular joint.
All the cartilages on the exposed joints are removed and filled with a bone graft. The bone graft can be obtained from the pelvic bone (iliac crest) or tibia of a cadaver.
The hindfoot is then realigned and the joints are joined with wires. They are all held in place using screws or a metal plate.
This is used mainly to treat the posterior tibial tendon dysfunction. This is a condition where the tendon of the tibia (shin bone) is overstretched or has damaged. This usually occurs in people with flat feet.
This surgery is done to transfer the Flexor Digitorum Longus (FDL) tendon to the position of the posterior tibial tendon. The FDL tendon is responsible for the ability of the 2nd, 3rd, 4th, and 5th toes to curl.
This surgery is done by making a cut from the inside of the ankle joint all the way to the midfoot.
The cut continues until the posterior tibial tendon and the FDL tendon are exposed. The tendon transfer can be carried out in either of these two ways:
- The Flexor Digitorum Longus (FDL) tendon is wrapped around the posterior tibial tendon and they are stitched together
- The FDL can be fixed directly on the bone where the posterior tibial tendon is originally inserted using a screw or with stitches.
This is often carried out together with lateral column lengthening and medializing calcaneal osteotomy to ease the load and stretching of the tendons. If this is not done, the transferred tendon might fail as time passes.
This is also known as Medial cuneiform dorsal opening wedge Osteotomy which is a procedure used to create an arch in flat feet. It is used to treat flat feet caused by posterior tibial tendon dysfunction.
The surgery is done to insert a bone wedge above the medial cuneiform and thus push it down. The joint is fused and held in place with a screw or a metal plate.
When Should I Consider Flat Feet Surgery?
Flat feet surgery is usually the last resort in the treatment of rigid flat feet which is causing severe pain and discomfort.
The surgeon may recommend other methods of managing flat feet first before considering feet reconstruction.
The methods that can be used to manage and correct flatfoot deformity are orthotic insoles, arch support cushions, physical therapy, and even weight loss.
How to Prepare For Flat Feet Surgery
Preparing mentally and physically for surgery is very important. This will help you to know what to expect from the process and detect if the surgery is successful or not.
It will also help you to do all that is needed to ensure a successful surgery and quick recovery.
It is a good idea to list your questions, medical conditions, supplements and medications with their dosages.
It is also advisable to attend lessons on how to use assistive devices. This will help to make the recovery process faster and less traumatic.
Certain drugs are not to be taken prior to surgery. Seek medical advice on the drugs and food to avoid while preparing for the surgery. The surgeon may ask you to avoid the following:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and supplements like Omega-3 and St. John’s Wort. They are known to increase blood flow during surgery and decrease the rate of bone healing.
- Contraceptives should be avoided after the surgery since it is known to increase the risk of developing blood clots.
- Metformin and other diabetic drugs that contain or act like metformin should be avoided at least a day before the surgery. These drugs are known to increase the risk of reacting to general anesthesia.
- Nicotine found in tobacco and cigarettes should be avoided because it can reduce the blood from the feet. It can also increase the risk of developing infections after the surgical process.
- Food and drinks (even water) should be avoided entirely at least 6 hours before surgery. This is because the presence of food or water in your intestines increases the risk of nausea and vomiting when the anesthesia is given.
Flat Feet Surgery Procedures
Flat feet reconstruction surgery is usually done in a hospital with the use of general or regional anesthesia. The purpose of the surgery might differ and so is the procedure. However, each of the surgery follows basically the same process but the recovery time may also vary.
The purpose of feet surgery may be to realign the feet, remove inflamed tissues or muscles or tendons, and to create feet arches.
When the surgery is performed, the surgeon makes some incisions and remove the inflamed tendon while replacing it with another tendon.
The surgeon may also make a cut, realign the heel bone and hold it in place with a screw. Some other procedures might be taken depending on the cause of the flat feet and the source of the flat feet pain.
After the surgery, the patient is wheeled to another room for close monitoring and recovery. Some patients might be allowed to go home from the hospital the same day or to sleep overnight if need be.
VIDEO: Flat Feet Reconstructive Surgery
This video shows how the feet looked like before and after the flat feet reconstructive surgery.
Recovery from Flat Feet Reconstruction Surgery
After surgery, a cast will be put on the feet, painkillers might be given and a schedule for another appointment will be fixed.
To avoid swelling, always place the foot on an elevated surface and avoid placing the bodyweight on it for at least two weeks.
If you are not sure how to keep yourself from bearing your weight on the leg, seek medical advice and support from a physiotherapist.
Walk around only when necessary, avoid smoking, hard drugs, and anti-inflammatory drugs because they might delay bone fusion and eventual healing. If the quantity of bloodstains in the plaster cast becomes copious, talk to your doctor.
Keep the cast totally dry. Cover it with a waterproof material before you take a shower. When the wound is healed and the cast is removed, you can shower without covering the wound.
When the cast is eventually removed, talk to your physiotherapist on how to massage the area to facilitate total healing. The wound scabs will fall off by them without your assistance and you should talk to your doctor if the wound becomes reddish or swollen.
The physiotherapist should also assist in walking lessons, gait correction, and muscle rehabilitation. Walking would be painless and easier after twelve weeks, with minimal swelling. Normal daily and even sports activities might be possible after six months.
Insoles may be recommended by your doctorr to reduce swelling, offer heel and arch support and help in physical activities.
Possible Risks of Flat Feet Surgery
- The metal used in the surgery for the fusion of the joints might become conspicuous and make the feet appear deformed. If this occurs, the metal plate can be removed after the foot heals.
- The pain and the deformities that led to the surgery might still be present after the surgery. It is important to talk to the doctor if you don’t see any changes or feel relief after the surgical procedures. Orthotics might be recommended to assist in the correction of the problem on a long-term basis.
- The nerves near the incision site may be damaged and become numb. It is usually a normal occurrence in surgeries, but the doctor should be notified in case it is due to inflammation or an infection.
- Blood clots might start to form in the deep veins of the feet. This is also known as Deep Vein Thrombosis (DVT). It is usually characterized by pain, redness, swelling, warmth, and discoloration of the skin of the affected area.