Advanced Flat Foot Surgery treatment: Conditions and Rehab

Flat foot is a common condition and in majority of people will not need any treatment. In some, the flat foot can be painful and needs further attention. A vast majority of painful flat feet can still be treated with conservative management. 

Painful flat feet can be achy all day, but are particularly painful on walking. Swelling can be an additional problem in many. Pain would usually be along the inner and outer aspects of the feet just below the ankle joints. 

With good physical examination, the flat foot can be classified to flexible flat foot and fixed flat foot. The reason for the differentiation is that a fixed flat foot is usually due to bone deformities such as tarsal coalition, and a flexible flat foot is due to soft tissue imbalances. 

X-ray: X-ray is performed to identify the presence of accessory navicular bone and also to check for the tarsal coalition (fusion of the bones from birth). 

MRI Scan: MRI Scan helps to identify if there is a fibrous tarsal coalition. It also helps us to identify stress injuries to the bone and soft tissue secondary to the flat foot. 

​Flat Foot conservative treatment

Painful flat feet can often be managed by improving the flexibility and suppleness of the foot through foot stretches. Strengthening the Tibialis Posterior muscle by performing eccentric exercises can help as well. Wearing comfortable footwear in addition can help. In patients where the conservative management has failed, the surgical treatment needs to be considered. 

​Flat Foot Surgery

Flexible painful flat foot is treated with the soft tissue procedures such as spring ligament reconstruction with or without the removal of the accessory navicular bone and reattachment of the Tibialis Posterior tendon to the navicular bone. The Spring ligament reconstrution is performed by using either fibertape or gracilis tendon autograft. The fixation to the bone is achieved by using either Bio anchors or PEEK anchors. The surgery usually gets done under spinal anaesthesia. The cut would be around 7cm on the inner side of the foot. 

In case of fixed flat foot, the osteotomy (bone cuts) surgery may be required. This is to change the angle and alignment of the bones to improve the weight bearing axis. The cuts are usually fixed with screws or screws and plate. 

​Flat Foot Surgery Rehabilitation

Post-surgery you can expect to be either in a plaster cast or walking boot for 6 weeks if the osteotomy surgery is performed. You need to be walking with a walker with touch toe weight bearing for upto 6 weeks. You can expect to start walking outdoors comfortably by 2 months post surgery. For high impact activities such as surgery you may return after 4 months of proper rehab.