What Is Flatfoot Surgical Correction?
Adult acquired flatfoot deformity (AAFD) is a
collapse of the arch of the foot. Flatfoot surgery addresses the bones, ligaments, and tendons that support the arch, often through a combination of procedures. The goals of the surgery are to improve the alignment of the foot and restore more normal
pressure during standing and walking. This surgery can also reduce pain and improve walking ability.
Patients with a painful flatfoot frequently mention ankle and/or foot pain and difficulty with daily activities. A foot and ankle orthopaedic surgeon should
do a complete evaluation of the foot, including a medical history, physical exam, and X-rays. Non-surgical treatments such as rest, immobilization, shoe inserts, braces, and physical therapy should be tried first. If these are unsuccessful, then
surgery may be considered.
Patients who have diabetes or take oral steroids should be evaluated by their primary care physician to determine if surgery is safe. Obese patients and smokers are at higher risk for blood clots and wound problems. Full recovery from flatfoot surgery
can take up to a year. Patients who are unable or unwilling to complete this process should not have this surgery.
Surgery can be performed under regional anesthesia,
which is numbing of the foot and ankle with a nerve or spinal block, or general anesthesia, which may require a breathing tube. A nerve block often is placed behind the knee to reduce pain after surgery.
Comprehensive surgical treatment for AAFD usually involves a combination of several procedures. Your foot and ankle orthopaedic surgeon will develop a treatment plan based on your deformity and the surgeon's preferences. The following procedures may be
In AAFD, the Achilles tendon becomes tight and contracted. Almost every surgical procedure for AAFD includes some kind of Achilles tendon lengthening. There are multiple types, each with different benefits. The
most commonly performed types are gastrocnemius recession and triple-cut/percutaneous Achilles tendon lengthening.
Medializing Calcaneal Osteotomy
Also called a heel slide, this procedure involves cutting the heel bone to shift it back into correct alignment under the leg. The bone is then held in place with screws, staples, or a plate.
Typically the flexor digitorum longus (FDL) tendon, which flexes your toes, is transferred to help bring some strength back to the posterior tibial tendon. It is cut in the foot and transferred to the navicular bone. If the
posterior tibial tendon is severely damaged, your surgeon may remove it altogether. Sometimes, tendon transfers on the outside of the foot are also done to help realign the forces working on the foot.
The spring ligament and the deltoid ligament are two ligaments that help hold the correct alignment of the foot and ankle. In patients with severe disease, one or both ligaments may be torn. In some cases, your surgeon
may recommend repair or reconstruction of one or both of these ligaments.
Lateral Column Lengthening
In this procedure, the calcaneus bone is cut on the outside of the foot and "lengthened" to help correct the foot deformity. This is typically done by inserting either a cadaver bone or a metal wedge into
the cut bone to lengthen it. Often, screws or a plate are used to help hold the bones in position while they heal.
Cotton (Medial Cuneiform) Osteotomy
In this procedure, the medial cuneiform bone is cut through an incision on the top of your foot. Spreading the cut bone apart with a bone or metal wedge helps recreate an arch.
Some patients with arthritis and/or deformity of their midfoot may require a midfoot fusion.
This may involve one or more of the multiple midfoot joints, including the tarsometatarsal joints or the naviculocuneiform joint. This procedure is also useful for restoring the arch.
This procedure is done for more severe deformities.
The talus and the calcaneus bones are fused together, which allows the surgeon to correct more of the deformity.
Double or Triple Arthrodesis
This procedure is done for the most severe deformities or ones with arthritis. In a triple arthrodesis, three joints are fused: the subtalar, talonavicular, and calcaneocuboid joints. Often, just the subtalar and talonavicular joints are fused (double
arthrodesis). The foot will be stiff after this surgery, but usually pain and alignment are improved and the foot feels more stable for walking.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Complications following flatfoot surgery may include wound breakdown or incomplete healing of the bones (nonunion). These complications often can be prevented with proper wound care and rehabilitation. Occasionally, patients may notice some discomfort
due to prominent hardware. Removal of hardware can be done at a later time if this is an issue. The overall complication rates for flatfoot surgery are low.
Will surgical correction of my flatfoot improve the cosmetic appearance of my foot?
Surgical correction of flatfoot is aimed primarily at reducing pain and restoring function. Although surgery likely will improve the cosmetic appearance
of the foot, it is not a primary goal of treatment.
What activities will I be able to do following flatfoot surgery?
With proper correction and rehabilitation, many patients return to active lifestyles. Activities such as walking, biking, driving, and even golfing are well tolerated.
It is less likely, however, that patients will be able to participate in very strenuous high impact activities requiring running, cutting, or jumping.
Original article by Jeremy Chan, MD
Last reviewed by Elizabeth Cody, MD, 2020
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute
for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.