#treatment - Foot & Ankle

Flat Foot Surgery

What problems will flat foot surgery resolve?

There are a number of conditions that predispose to a flat foot, and if conservative measures have failed, we then consider surgical correction.

Typical symptoms include arch pain on the inside of the foot, as well as pain on the outside of the foot under the fibula bone, caused by pinching – so called ‘subfibular impingement’. Surgery is primarily aimed at resolving pain, by realigning the foot better and hence taking the pressure of the arch, and to allow more space for the soft tissues on the outside of the foot.

The shape of the foot will be improved, but this is not the primary aim of surgery, and most patients still need arch supports post surgery.

What does surgery entail?

The surgery will depend on the following factors:

  1. The exact cause of your flat foot.
  2. Whether you have a fixed or flexible deformity.
  3. Whether you have any arthritis.

Surgery for - Accessory navicular bone

Your tibialis posterior tendon will have been assessed with an MRI scan. In most cases the tendon with this problem is normal. Surgery involves removal of the extra bone and reattachment of the tendon. The shape of your foot will not change but your pain should be improved. In some cases the extra bone can be fused with your main navicular bone using screws. The advantage here is that the tendon does not need reattaching. If your flat foot is very severe, then occasionally we recommend a calcaneal osteotomy (heel shift surgery), to help better realign the foot. You will discuss these options with Mr Amin or Mr Abbasian in clinic.

Surgery for - Dysfunctional tibialis posterior tendon

If you have a flexible foot, with no wear and tear, we try to perform an operation that preserves movement. Typically this involves cutting the heel bone and shifting it inwards. This can be done through minimally invasive surgery, utilising specialised instruments. Screws are used to hold the heel in its new position.

The diseased tibialis posterior tendon is removed as it is usually thickened and scarred. We then transfer the tendon that moves your little toes into the navicular bone, which then acts as your new tibialis posterior tendon and supports your arch. Additional procedures are added as necessary to put your foot flat to the ground and will vary from person to person. The most common of these will be a release of the calf muscle which is often found to be tight.

If you have arthritis or a stiff foot, a fusion will be performed. The joints at the back of your foot are repositioned to allow your arch to be restored, and are permanently fused (joined) together. Screws and plates are used to hold the bones stable during the healing phase. Following surgery the same protocol is used for rehabilitation.

What happens after surgery?

A plaster cast is applied and no weight-bearing is allowed for six weeks. Thereafter an aircast boot is used to allow gradual weight-bearing, and physiotherapy started. The overall recovery period following this major surgery is six to nine months.

Orthotics may still be required after surgery once the swelling has settled.

What are the complications?

You could develop an infection or wound healing problems, although these often settle with simple wound care management and antibiotic prescription. You can develop a patch of numbness around the wound or beyond, although this rarely causes a significant problem.

Both the heel shift and fusion procedures occasionally fail to heal. This is called a non-union. If this occurs, another operation may be required to stimulate healing.

With any major lower limb surgery, there is a risk of Deep Vein Thrombosis (DVT). Preventative measures will be employed both during and after surgery, and you will require blood thinning injections for four-six weeks.

Finally, if we have performed the heel shift and tendon transfer, this preserves movement, and whilst very successful in the medium term (five–ten years), the reconstruction can stretch out, and the flat foot can reoccur. If it does – a fusion procedure may be required.