Flatfoot

Flatfoot

A flatfoot is in the normal spectrum of foot shapes. It becomes an issue when the flatfoot worsens and causes pain. There are many factors that lead to flattening or collapsing of the arch. The exact causes of a collapsing arch are unknown, but there are several theories including wear or degeneration of the posterior tibialis tendon that helps to support the arch on the inside of the ankle and foot. Other theories suggest that the bones in the foot start to collapse leading to increased pressure on the supporting structures on the inside or arch of the foot. The talus bone which makes up part of the ankle joint and hindfoot starts to move to the inside of the foot and downwards leading to arch collapse. Regardless of the underlying cause, treatment for a painful flatfoot is specific to the patient.

Treatment

Treatment options depend on the severity and length of symptoms along with patient goals. 

Non-Surgical Treatment

The first line of treatment in many cases of flatfoot begins with nonoperative management, including:

• Arch support
• Ankle brace
• Physical therapy
• Custom orthotic
• Short-term boot immobilization

Surgical Treatment

Flexible Flatfoot

In patients without arthritis in their joints and a flatfoot deformity that can be corrected or flexible, a “joint-sparing” or “flexible flatfoot” reconstruction is recommended. The goal of this procedure is to rebuild your arch and take the pressure off of the inside of your foot and ankle. There are many procedures that can be used to correct your flatfoot deformity. The specific type of surgery is based on each patient’s individual foot anatomy and findings on advanced imaging including an MRI. The surgery entails multiple procedures customized to your foot, including:

• Calcaneal osteotomy (cutting and sliding the heel bone to the inside of the foot)
• Lateral column lengthening (cutting and reshaping the heel bone to elevate the arch)
• Medial cuneiform osteotomy (rebuilding the arch by reshaping one of the bones in the middle of the foot)
• 1st TMT joint fusion, if needed (to correct a painful bunion and support the arch)
• FDL tendon transfer (removing the diseased posterior tibialis tendon and using another tendon to support the arch)
• Spring ligament reconstruction (fixing a supporting structure of the arch)
• Achilles lengthening

After surgery you are in a splint for 2 weeks. At 2 weeks, the splint is removed and you are placed into a boot. You are only able to place your foot down for balance, otherwise you are non-weight bearing or unable to put weight on your foot for a total of 6 weeks after surgery. You then start physical therapy and transition into a regular shoe. 

The recovery time for this procedure can take-up to a year, but has a high success rate for pain relief, improved function, and foot position.

Rigid Flatfoot

In patients who have developed arthritis in their surrounding hindfoot joints, a fusion of these joints is recommended to correct the arch. This involves fusing the joints that have collapsed back into position to restore the arch. This takes the pressure off of the inside ligaments and the posterior tibialis tendon as the bones will no longer shift. This is a very powerful procedure to correct the fallen arch and to prevent recurrence. This surgery type is based on a patient’s individual anatomy and varies based on advanced imaging findings including an MRI and/or CT scan. The surgery entails different possibilities for joint fusions including:

• Subtalar joint fusion
• Talonavicular joint fusion
• Calcaneocuboid joint fusion
• 1st TMT joint fusion
• Achilles lengthening

After surgery you are in a splint for 2 weeks. At 2 weeks, the splint is removed and you are placed into a boot. You are only able to place your foot down for balance, otherwise you are non-weight bearing or unable to put weight on your foot for a total of 6 weeks after surgery. You then start physical therapy and transition into a regular shoe. 

The recovery time for this procedure can take-up to a year, but has a high success rate for pain relief, improved function, and foot position.