The surgical correction of flat feet, known medically as pes planus, is not referred to by a single, simple name. Flat feet are characterized by the collapse of the medial longitudinal arch, causing the entire sole of the foot to nearly or fully contact the ground when standing. When this structure fails, it can lead to pain, instability, and difficulty walking. The specific procedures are often collectively called Flatfoot Reconstruction. Surgery is always reserved for cases where pain is severe or function is debilitating, after all less-invasive methods have failed.
Non-Surgical Criteria for Intervention
Surgery is considered a last resort for adult acquired flatfoot deformity, also known as posterior tibial tendon dysfunction (PTTD), and is only pursued after conservative care has been unsuccessful. Initial management focuses on reducing inflammation and providing mechanical support to the collapsed arch. This typically includes custom-molded orthotic shoe inserts to support the foot and realign the heel.
Patients often begin with non-steroidal anti-inflammatory medications (NSAIDs) to manage pain and swelling, alongside physical therapy. Physical therapy stretches the Achilles tendon and calf muscles, which are often tight, and strengthens the arch-supporting muscles. If these non-operative treatments fail to relieve pain or halt the progression of the deformity after several months, the patient may then be considered for surgery.
Categorizing Flatfoot Surgical Approaches
The choice of surgical procedure depends heavily on whether the flatfoot is flexible or rigid, determined through physical examination and imaging. A flexible flatfoot is one where the arch reappears when the foot is non-weight bearing or the patient stands on their toes. This type is primarily corrected by addressing soft tissue issues and realigning the bones.
A rigid flatfoot is a fixed deformity where the arch does not reappear, often due to long-standing collapse leading to arthritis or bone fusion. Surgeons group the corrective procedures into three broad categories: soft tissue repair, bone realignment, and joint stabilization. The goal is always to restore the arch’s shape and balance the forces acting on the foot.
Soft tissue procedures focus on restoring the integrity of weakened tendons and ligaments, most commonly the posterior tibial tendon. Bone realignment procedures change the physical shape of the foot’s skeletal structure. Joint stabilization procedures permanently lock certain joints to prevent movement that causes the arch to collapse.
Specific Reconstructive Procedures and Names
The names used by surgeons for flatfoot correction are highly specific, often combining several techniques in a single operation. For flexible flatfoot, a Tendon Transfer is common, where the surgeon harvests a healthy tendon, such as the flexor digitorum longus, to replace the damaged posterior tibial tendon and help create a new arch. In less severe cases, a Tenosynovectomy, which cleans the inflamed tissue from around the posterior tibial tendon, may be performed.
Bone realignment procedures are classified as Osteotomies, meaning cutting and repositioning a bone. A Medializing Calcaneal Osteotomy shifts the heel bone inward, correcting the outward roll of the heel. Another common technique is Lateral Column Lengthening, sometimes called an Evans Osteotomy, where a bone graft is inserted on the outside of the foot to lengthen the column and correct the collapsed arch.
For advanced or rigid deformities, Arthrodesis (joint fusion) is utilized for permanent joint stabilization. The most extensive fusion is the Triple Arthrodesis, which permanently fuses the talonavicular, calcaneocuboid, and subtalar joints to lock the rearfoot into a corrected position. In some instances, a small implant or stent is placed into the subtalar joint space in a procedure called Subtalar Arthroereisis, which blocks the abnormal motion causing the arch to collapse.
Life After Surgery and Recovery
Recovery from flatfoot reconstruction is a lengthy process requiring significant patient commitment. Immediately following the operation, the foot is immobilized in a cast or splint, and the patient must remain strictly non-weight bearing, often for six to eight weeks, to allow the bones and soft tissues to heal. The use of crutches or a knee scooter is necessary during this initial phase.
Once initial healing is confirmed by X-rays, the cast is replaced with a walking boot, and a gradual weight-bearing regimen begins under the surgeon’s guidance. Physical therapy is then introduced to restore strength, range of motion, and a normal walking pattern. Full return to pre-injury activities can take anywhere from six to twelve months, depending on the complexity of the procedures performed.