Flat Foot Surgery
Flatfoot is a condition where the arch of the foot is lowered either due to genetic reasons or a failure of the structures around the foot. It can be a progressive condition that causes various degrees of symptoms. Flatfoot surgery is usually indicated where conservative treatment for flat feet have failed. Flatfoot surgery has a wide range of operations depending on the type of flat feet, the degree of deformity and the damage occurred. It may range from minimal invasive to more extensive surgery involving bones, tendons, and ligaments.
Causes of Flat Foot Surgery
Flatfoot is a condition where the arch of the foot is lowered either due to genetic reasons or a failure of the structures around the foot. It can be a progressive condition that causes various degrees of symptoms. Flatfoot surgery is usually indicated where conservative treatment for flat feet have failed. Flatfoot surgery has a wide range of operations depending on the type of flat feet, the degree of deformity and the damage occurred. It may range from minimal invasive to more extensive surgery involving bones, tendons, and ligaments.Causes of Flat Foot Surgery
Causes of flat foot are usually could be genetics such as hyperlax ligaments or conditions such as tarsal coalition where the hindfoot bones are fused. The degree of the deformity depends on the rigidity, some are very flexible whereas over time flatfoot deformities could become rigid. Surgical intervention comes to play when conservative treatments such as bracing, anti-inflammatories, orthotics and footwear modifications have failed to resolve the symptoms.Symptoms of Flat Foot Surgery
Symptoms could include pain generalised in the legs due to flat feet, which may be in the knees or the hips, otherwise local symptoms such as medial ankle pain as well as pain in the mid arch or the hind foot, secondary problems due to degenerative changes in the tendons causing tendon failure, tenosynovitis, tears of tendons such as rupture of tibialis posterior tendon or arthritis of the hind foot joints, the subtalar, talonavicular and midfoot joints occurs. It is also associated with contraction of the calf.When is Surgery Recommended?
Surgery is usually a last resort in some cases prophylactic treatment is performed where significant flat feet where arthrodesis procedure to stabilise the arches performed techniques, but mostly it involves either realigning the bones or a mixture of realigning the bones and improving the strength of the foot by augmenting the tendons and repairing the tendons or tendon transfers. Common surgical procedures are listed below, but usually involve a combination of fusions and osteotomies to realign the bones and tendon transfers such as most common known as the FDL tendon transfer.
The HyProCure procedure is minimally invasive with the use of a stent. The procedure is carried out to reduce pain and to realign the foot and correct a flexible flat foot. The procedure is carried out for flexible flat feet when there is no indication of arthritis and typically in younger patients. The HyProCure procedure is carried out one foot at a time.Your foot surgeon will make a small incision (8-10mm) over the outer side of your foot/ ankle. A small stent is placed into the canal (sinus tarsi), which stops the foot from collapsing. You should rest at home for one-two weeks following the procedure. Light exercise can start from six weeks but high impact should not be carried out until three months following the procedure. This procedure is sometimes carried out alongside a gastrocnemius recession.
Patients with flat feet can have the heel bone shifted too far to the outside. The purpose of the calcaneal osteotomy is to realign the calcaneus (heel bone) with your tibia (shin bone), it allows the heel bone (calcaneus) to sit directly underneath the midline of the leg.An incision is made to the outer side of your heel bone. A bone cut is made along the heel bone and then the back section is aligned and fixed into position with surgical screws and/or a plate. Following the surgery you will be placed in a cast to wear for 4 – 6 weeks, this will be followed by the use of an Aircast boot for a further 2 – 4 weeks. A return to sports can take up to 6 months. This procedure may be arranged alongside additional surgeries, such as the tendon transfer, gastrocnemius recession and midfoot fusion.
Tendon Transfer can be carried out for both flat foot, high arched foot, unstable ankles and drop foot.As part of a flat foot corrective procedure, the damaged posterior tibial tendon, which attaches the muscle in the inner calf muscle to the bone on the inner side of your foot, is replaced by a transfer of the flexor digitorum longus tendon, which is found on the inner side of your leg. For dropped foot and high arched feet with unstable ankles, a range of tendon transfers are performed dependent on case by case. As part of the flat foot correction when the tibialis posterior tendon fails, an incision is made from the inner ankle so both tendons are exposed. The damaged section of the posterior tibial tendon is removed and replaced with a section of the flexor digitorum longus tendon, this is then sutured into place. The procedure is often carried out alongside a calcaneal osteotomy, gastrocnemius recession or midfoot fusion. You will require a cast for the first two weeks and will then start to use an Aircast boot for a further four weeks. At two weeks postoperative you should be able to return to sedentary work. Return to sports typically takes 6 months.
A midfoot fusion may be suggested to correct flat foot deformity or due to midfoot arthritis affecting the joints. This is carried out when the midfoot has collapsed in flat foot deformity, often the rearfoot is still well positioned or may also need alignment. The affected joints are fused and arch is raised.One – three incisions are made at the top and inner side of the foot. Fixations, such as screws, are used to fuse the joints together. You should rest at home for two-four weeks following surgery. Initially you will require a splint for the first two weeks, this will be followed by four weeks in a cast and then the use of an Aircast boot for a further four weeks. This procedure may be carried out alongside additional surgery, such as the gastrocnemius recession, tendon transfer or calcaneal osteotomy.