What is a flatfoot deformity?

A flatfoot deformity is can be a painful condition related to flattening of the foot arch. Patients may present with pain on the inside of the ankle and the inner arch of the foot due to overloading of the posterior tibial tendon, deltoid ligaments, spring ligaments, or plantar fascia. Pain may occur on the outer aspect of the ankle due to impingement between the heel bone and ankle bone or at the subtalar joint. Depending on the severity of the deformity, the conditions may progress into arthritis in the foot and ankle.

What are the causes of flatfoot deformity?

The causes of flatfoot deformity are multifactorial. Common factors for most patients are congenital flatfoot combined with the tightness of the calf muscles. As the patient ages, there is wear and tear in the most important tendon stabilizing the foot arch, the posterior tibial tendon. There is also progressive rupture of the ligamentous structures maintaining the foot arch.

Is there any nonsurgical treatment available for flatfoot deformity?

Symptomatic patients usually benefit from the use of shoe inserts and physical therapy programs focusing on stretching exercise of the calf muscles and strengthening of the posterior tibial tendon. If the deformity is more severe, custom insoles or ankle braces may be considered. Pain from bone and joint impingement can be alleviated by cortisone injections. Unfortunately, non-surgical treatments are aimed to control symptoms without any effect on deformity correction.

What are the surgical options for flatfoot deformity?

Surgery can be very effective in the treatment of pain from flatfoot deformity. There are varieties of procedures available depending on the type and degree of deformity as well as associated conditions. The principles of surgery are to restore both soft tissue and bony balance such as gastrocnemius recession, osteotomy of the calcaneus, osteotomy of the medial cuneiform, deltoid ligament repair, spring ligament repair, and tendon transfers. These procedures can be used in isolation but most often combined in one surgical setting.

What are the risks and benefits of surgical treatments for flatfoot deformity?

Risks: wound infection, nerve damage, stiffness, nonunion, hardware related symptoms

Benefit: Pain relief, improved walking gait, avoidance of long-term bracing

What is the recovery after a flatfoot reconstruction?

Each patient may have different degrees of deformity leading to variable surgical procedures and postoperative protocols. The postoperative course can range from immediate 100% weight-bearing in a boot to a complete non-weight-bearing of up to 8 weeks. Most commonly, Dr. P’s postoperative protocols include non-weight-bearing of 6 weeks using crutches, or a walker, and/or a knee scooter. Patients will keep the postoperative splint clean, dry, and intact until the first follow-up at 2 weeks after surgery. Afterward, a boot or a cast will be put on in the clinics. At the 6-week point, postoperative X-rays will be obtained to assess bone healing prior to the start of progressive weight-bearing. Patients can usually return to normal shoes and light daily activities without a walking aid by 12 weeks after surgery. Driving can normally resume when the patient stops taking pain medication and can walk comfortably typically around week 8; a trial of driving under family-member supervision is recommended.

Author: Phinit Phisitkul, MD

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