Flat Foot Surgery

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.

Frequently Asked Questions

What is flatfoot?

In simple terms, a flatfoot deformity is a structural collapse of the arch of the foot. From a multiplanar aspect you will see the arch collapse as well as the heel sitting in an outward position known as valgus and the front of the foot will be visible in a more abducted position as in facing towards your outer leg when you look from a person standing behind the individual. It is important to note that not all flatfoot problems are pathological and different population groups present with different arch heights.

What are the causes of flat feet?

Genetics play a big part in developing or acquiring a flatfoot. Having a low arch alone with no pain or functional disability is not of any concern. However, broadly classifying flat feet there are two main subtypes.
  1. Congenital flatfoot. This typically is a congenital problem where the most common cause is known as a tarsal coalition. Essentially the hindfoot joints do not separate and are fused resulting in increased stiffness of your foot in a flatfoot position throughout your teenage years and adult life. Typically, symptoms develop between the age of 9 and 15 and can progress from there.
  2. The second subgroup is acquired flatfoot deformity, and this can be either due to trauma or failure of the tendon and ligamentous structures through injury or disease which results in an acquired flatfoot. The initial presentation is a flexible deformity which becomes rigid over time due to arthritic changes. Some patients have an element of benign joint hypermobility in which case their ligaments are too lax and they develop flat feet which causes generalised musculoskeletal complaints of the lower limb.

What is flatfoot reconstruction?

Essentially it means that the flatfoot deformity is corrected. This can be done in a combination of methods which could involve using extra-articular implants to stabilise the feet, cutting and resetting the heel bone to realign the hindfoot, fusing the midfoot joints to reduce the collapse of the arch, tendon transfer to improve the strength of the arch and function of the foot.

What is minimally invasive flatfoot surgery?

Minimally invasive flatfoot surgery would involve using specialised instruments to cut and reset the hindfoot joints, in particular the calcaneus heel bone to centralise and then use screws through small incisions to allow the repositioning of the heel bone. However, it could also involve a procedure called an arthroereisis procedure and a typical implant used is an HyProCure implant which corrects flexible flat feet through keyhole or minimally invasive surgical intervention.

Can flat feet be corrected with surgery?

Yes. Flat feet can be corrected if they are pathological and cause pain and appear to be progressive in their nature with surgical intervention.

When is flatfoot surgery necessary?

Flatfoot surgery is necessary where there is disease or pathology related to tendons or ligaments that has caused an acquired flatfoot deformity. It is also essential where function is compromised and conservative treatments have failed. It is also essential when there is pain and functional disability.

How long does reconstructive foot surgery take?

The time ranges depending on the surgical intervention required. For example, the HyProCure procedure may only take 10 to 15 minutes whereas a full reconstruction and tendon transfers could take anything from two to two and a half hours.

How quickly can I return to activities after flatfoot construction surgery?

The return to activity would very much depend on the type of surgery. Minimally invasive surgery may require a period of immobilisation for a couple of weeks and then careful mobilisation but full return to activity may still be many months. Significant reconstructive surgery could involve 6 to 12 months before one is returning back to sports or any aggressive activity.

How much does flatfoot reconstructive surgery cost in the UK?

The cost varies again depending on the procedure. It could range from £5,000 to £10,000 depending on the type of operation.

What kind of support do you need for flat feet?

The appropriate shoes which are a rigid trainer with good arch support is essential. One could also wear orthotics or specialised insoles or devices to support their arch during the gait. A range of exercises can also be used to improve strength of the foot.

What exercises are good for flat feet?

The simple exercises that can help include single heel raise exercises to stand and try to elevate your heel and place your weight on the forefoot and to repeat this. Trying to pick a towel up with your toes from the floor or a piece of paper to strengthen your arch. Stretching the calf muscles can also help.

Can you walk after flatfoot surgery?

After a period of rehabilitation one should be able to return back to walking and exercise. This is very much dependent on individual cases in terms of exercise return.

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