Rigid flatfoot can lead to pain, discomfort, swelling, balance issues and decreased foot mobility, and although conservative treatments are available, if the condition is already in the rigid form, oftentimes more invasive treatments are required. This can lead to the need for flatfoot reconstruction surgery.

Who Could Benefit From Flatfoot Reconstruction Surgery?

There are a few different groups of individuals who could benefit from flatfoot reconstruction surgery. As we noted above, those with a fallen arch who are experiencing uncomfortable or worsening symptoms may be an ideal candidate for the procedure. Other individuals who may benefit from flatfoot reconstruction surgery include:

• Patients with posterior tibial tendon disorder (tendon weakening that leads to arch collapse)
• Patients with significant arthritis damage or deterioration
• Patients whose arch collapse is causing an abnormal gait or causing problems for upline joints, like the knee or hip
• Patients who have not responded to conservative treatment

Types Of Flatfoot Reconstruction Surgery

The arch and the foot itself can be reshaped in a few different ways based on a patient’s individual needs. Here’s a look at some of the ways a flatfoot condition may be corrected with surgery.

Tendon Repair/Tendon Transfer – For patients with a damaged posterior tibial tendon, the surgeon works to address the damage or transfer healthy tendon tissue to the area to restore shape and function to the foot arch.

Osteotomy – An osteotomy can be beneficial for patients whose arch issue is tied to bone shifting or misalignment. The surgery involves cutting or reshaping certain bones in the foot to correct the misalignment and restore the foot arch.

Fusion – For patients with severe arthritis or a very rigid case of flatfoot, a surgeon may work to stabilize joints in the feet by fusing them together and working to limit symptoms by preventing the continued progression of arthritis.

Flatfoot Surgery Recovery

Your individual recovery timeline will differ slightly, but a general recovery timeline for flatfoot surgery looks something like this:

First 6-8 Weeks – The foot will be immobilized in a cast or boot, and the patient will remain non-weight bearing while the early stages of healing occur.

Weeks 6-12 – Once you have been cleared by your surgeon, you’ll progress to partial weight bearing with the help of a walking boot or crutches. Physical therapy to improve strength, flexibility and function will also begin and continue throughout this stage.

Month 3-6 – Most patients are cleared to return to normal daily activities by the 3-6 month mark, although those who work strenuous manual labor jobs or athletes may need upwards of one year to make a complete recovery.

For more information, reach out to Dr. Silverman by filling out this contact form.

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It’s not uncommon for patients to experience a mild flattening of their foot arch as they get older due to stress and strain over the years, and it’s not really a cause for concern unless it’s accompanied by symptoms like pain, Achilles tendon soreness or other foot issues. But is there anything that can be done to prevent this natural arch flattening, or is flat foot something you just need to accept? We explain how flat foot can be prevented in today’s blog.

Preventing Flat Foot

Like almost all health conditions, there are a number of things you can do to greatly reduce your risk of developing flat foot, but it’s not completely preventable. Genetics and natural aging can increase your risk of developing flat feet, but you can combat these risk factors by taking a few steps of your own. Here’s how you can try to prevent flat feet.

Maintain An Ideal Weight – The more you weigh, the more stress you put on your feet with every step you take. Over time, all this added stress can serve to wear down the tight tissues that help to form your arch. Maintain an ideal weight, and your likelihood of symptomatic flat foot drops significantly.

Exercise – Exercising not only helps you maintain an ideal weight, but it can help to strengthen the supportive tissues in your foot arch. For best results, avoid only pursuing high-impact exercises like running. Work in some low or no impact exercises, like walking, cycling or swimming.

Wear The Right Shoes – Shoes can help to take stress and pressure off our foot arch, so make sure that you are wearing the right shoe for the occasion. Comfortable and supportive shoes that are designed for the activities you’ll be performing can help to keep your risk of flat foot low.

Manage Your Diabetes Risk – Diabetes can cause a number of different issues for your body and your feet, including increasing your risk of foot arch changes. Exercise regularly and maintain an ideal weight to reduce your risk of diabetes. If you are a diabetic, be vigilant about managing your blood sugar levels.

Give Your Feet A Break – Finally, make sure that you give your feet time off between activity. Regularly stressing your feet without giving them time to heal from this trauma can weaken the supportive soft tissues that make up your foot arch. Mix in some upper body exercises instead of always running, and avoid overdoing it when it comes to sports without giving your body enough time to recover.

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Some specialists theorized that when the bunion correction is performed with minimally invasive techniques, the foot may not be stabilized in the same way that it would if a traditional open procedure was used. When someone is already dealing with a flatfoot deformity, even if it is asymptomatic, minimally invasive bunion correction may address the bunion but fail to stabilize the foot, making it more likely that the flatfoot condition worsens or becomes symptomatic.

Bunion Surgery And Flatfoot Symptoms

Researchers put those theories to the test and conducted a retrospective study using a patient registry at HSS. They identified 35 patients with asymptomatic flatfoot and 47 patients without flatfoot who had all undergone minimally invasive bunion surgery. After conducting patient surveys about their function, pain and overall health, pre- and post-op x-rays to assess the bunion and flatfoot-related measurements, researchers found that correcting the bunion with minimally invasive techniques caused no changes to a patient’s flatfoot dimensions. In fact, of the three measurements taken to assess flatfoot formation, two measures didn’t show any significant changes, but one measurement (talonavicular coverage angle) actually improved following minimally invasive bunion surgery.

“Our research shows that you can fix the bunion with this comparatively easier procedure and not make the flatfoot worse,” said Anne Johnson, M.D, a foot and ankle surgeon at HSS and senior author on the study. “It proves that minimally invasive bunion correction is a viable option for patients with flatfoot.”

Foot and ankle surgeons need to be aware of all the ways a surgical procedure can affect an individual so that all aspects can be addressed as best as possible during an operation. There’s no point in correcting one problem if it’s going to cause one or more problems to develop down the road. It’s great that researchers wanted to confirm that patients with flatfoot weren’t risking a future foot problem if they decided to have their bunion corrected using minimally invasive techniques.

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The improved outcomes were confirmed during a recent study that was presented at the American Academy of Orthopedic Surgeons’ annual meeting. During the study, researchers evaluated a group of patients over the age of 65 with stage two adult acquired flatfoot deformity and compared their reconstructive outcomes to those of a younger subset undergoing the same procedure.

Previous research suggested that reconstruction provides better long term outcomes and improved mobility compared to fusions, although there is a slightly higher risk of surgical failure for the reconstructive operation based on the age and health of the patient.

“Overall, flatfoot reconstruction provides better long-term outcomes and mobility of the foot when compared to foot fusions,” said Scott J. Ellis, MD, senior author of the study. “However, there is a chance that reconstruction could fail, and to avoid a long, arduous recovery with multiple surgeries, patients older than 65 commonly skip reconstruction and opt for a fusion. My colleagues and I wanted to investigate if this was still a viable option for elderly patients in the hopes of maintaining flexibility in their foot.”

Adult Flatfoot Study

Researchers examined 130 patients who were placed in three different groups:

• Under 45 years old (young)
• Between 45 and 65 years old (middle-aged)
• Over 65 years old (oldest)

Researchers analyzed clinical outcomes using the Foot and Ankle Outcome Score and compared pre- and post-op scores at a minimum of two years. After looking at the data, researchers found that patients in the oldest group did not demonstrate any differences in their outcomes compared to the other two groups. Additionally, patients in the oldest group were not more likely to undergo a subsequent removal of hardware or a revision procedure than patients in the younger cohorts.

“Our initial hypothesis was that there would be increased complications for patients in the older group. However, we saw positive consistent surgical outcomes across all age groups,” said Dr. Ellis. “Depending on the severity of the condition, we believe a flatfoot reconstruction is a great option for patients regardless of their age. For the right patient, it can be the last surgery that they need.”

According to Ellis, more orthopedic surgeons should be considering adult flatfoot reconstructive surgery instead of just assuming a fusion operation is the safest route, even if it compromises mobility in the foot. Maintaining flexibility and mobility in the foot is important as we get older, as it can help us prevent against devastating fall injuries.

“This is strong evidence to support that flatfoot reconstruction can be an option for everyone, but we need to continue to follow patient clinical outcomes over an extended period of time to provide more data for this sparsely investigated topic,” concluded Dr. Ellis.

So if you have noticed that your arches have fallen and you’re dealing with tendon or foot pain, talk to Dr. Silverman about your treatment options.

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