Surgery on flatfoot: why you need it, how it is carried out and possible complications



Flatfoot is a term used to describe a very small or missing arch of the foot. At the same time, the foot stops absorbing the load and this role is assumed by the ankle, knee and hip joints, as well as the additional load placed on the spine. Because of this, the joints wear faster.

There are different stages of flatfoot. It happens that a person lives with this disease for years, and it does not cause any discomfort. However, when flat feet cause pain in the legs, this can lead to significant daily discomfort and restriction of activity.

There is a flexible (elastic) and hard types of flatfoot. With a flexible flatfoot, an arch appears when the body weight is not transferred to the leg. On the contrary, a rigid flat foot “gets stuck” in a flat position, regardless of whether there is pressure on the leg or not.

The degree of flatfoot does not always correlate with the degree of symptoms. Patients may complain of pain in the foot and heel pain. There may be muscle cramps in the lower leg. Many patients feel pain during physical activity, such as walking or running. Irritation from shoes can cause redness and swelling of the foot.

When not to avoid surgery

Surgery on flat feet (foot reconstruction) is carried out to relieve pain and restore function of the foot in adults and children, in whom the arch of the foot is practically absent, and conservative treatment methods have failed. Problems with the arch of the foot can be caused by deformation, damage to the tendon that supports the arch or arthritis in the joints around the heel.



With longitudinal flatfoot

In the foot of a person there are two main sets - longitudinal and transverse. With longitudinal deformation of the foot, it becomes longer, with transverse - wider, as the distance between the bones of the metatarsus increases, but it is shorter. There is also a combined longitudinal-transverse flat-footedness when the surface of the transverse and longitudinal arches of the foot contacts the surface.

The operation on flatfoot is recommended only with a high degree of longitudinal flatfoot (2-3 degree). With the first degree of longitudinal flat-footedness, it is enough for a patient to wear orthopedic insoles.



With transverse flatfoot

For lateral flattening of the foot, flatfoot surgery is recommended for correcting the rejected first finger inward (pathology known as valgus deformity), the formation of bone growths and bumps on the thumb that prevent walking, with prolonged bursitis and displacement of the bones of the tarsus.

Features of surgery for flatfoot

The purpose of surgical correction of flatfoot is the alignment of the foot. This contributes to normal depreciation when walking and pressure when standing.

Surgery for the treatment of flatfoot is divided into three types: on soft tissues (ligaments and tendons), on bones (osteotomy or intersection of one or several metatarsal bones) and combining bones so that they grow together in a normal position.

Depending on the severity of flatfoot, structural features of the foot and the age of the person depends on the type of operation. In most cases, a combination of procedures is performed.

With flexible flat-footedness, surgery is aimed at maintaining the movement of the foot and recreating the arch. Usually, surgery involves restoring the work of the tendons along the inside of the foot. This makes it possible to strengthen the main tendon, which raises the arch.

When bone deformation is too great, the surgeon physically rebuilds the arch.

With hard flatfoot, the operation focuses on restoring the shape of the foot.

The most common operations for flatfoot include:

• Correction of the posterior tibial tendon , which passes under the arch of the foot. It often stretches and loses its function in patients with a pathology such as flatfoot. Sometimes this tendon requires removal if it has been torn. In this case, other tendons can be redirected to support the arch.
• Flat feet are often associated with Achilles tendon tensions. This can be cured by a lengthening procedure (stretching the muscle fibers).
• In severe hard flatfoot or arthritis of the foot merging of one or more joints of the foot is required. This procedure is called “ double or triple arthrodesis, ” depending on the number of joints that you want to join.
• The operation, called exostosectomy, is performed with the valgus deformity of the first toe (a bump on the leg). In most cases, the elimination of benign bone-cartilage growth (exostosis) and the inflamed sac of the MTP joint is sufficient. Such an operation on flatfoot is performed under local anesthesia. In more severe cases, it is required to reduce the angle between 1 and 2 metatarsal bones due to an artificial fracture of the distal or proximal part of the first metatarsal bone and its displacement outward.
• Subtalar artroeresis is performed in case of valgus deformity of the hindfoot . The surgeon makes a small incision on the outer surface of the foot, and twists the titanium implant, which separates the subtalane sinus. Due to this, the talus does not move in relation to the heel.
• Evans technique. It is used for flexible flat-footedness and involves carrying out osteotomy of the calcaneus proximal to the calcaneocuboid joint, one and a half centimeters. To extend the calcaneus from the lateral side, a one-centimeter implant is inserted between the bone fragments.

The cost of operation for flatfoot depends on the severity of the disease and ranges from 60 to 100 thousand rubles, not counting the price of micro screws and implants.

Recovering from a flatfoot repair operation

Immediately after the operation on flat feet, the operated leg will be knee-deep in a plaster, and numbness and pain will be felt in it.

The patient will be assigned painkillers. During the first few weeks, you need to raise the leg above the level of the heart in a lying position to reduce the swelling.

You should only move in case of emergency, for example, to use the toilet or take a shower. You can not carry weight on the operated leg. Also, you can not wet the plaster.

Smoking and taking anti-inflammatory drugs should be avoided, as this can delay or even prevent bone merging.

Primary healing takes about two weeks.

After this period of time, the doctor will check the wound, carry out physical diagnostics and radiodiagnosis, and make a new plaster cast. At this time will have to move on crutches.

After six weeks, a new radiography will be scheduled and the cast will be removed. The patient will be given an insole or bandage (support) to wear along with the shoes. At this time also have to use crutches.

After three months you will need to appear at the next medical examination. It will be possible to move without crutches, but with orthopedic insoles and comfortable shoes (not in heels).

After six months, the leg will heal completely. At this time, there is no need to use orthopedic insoles.

If the wound becomes red, swollen or painful during the postoperative period, you should contact your doctor to rule out an infectious disease.

You can return to work after three weeks after surgery for flat feet. But if it involves physical activity, it may take up to 12 weeks of rehabilitation.

Most people are able to return to normal life and play sports six months after surgery. The orthopedic surgeon may recommend wearing orthopedic insoles to help maintain the arch of the foot in good condition, especially during sports activities.

Complications after surgery

Complications after surgery for flat feet are not so many, but they should not be completely excluded.

Here is what can happen after surgery:

• Infection. The risk of infection is about 1%, and it can usually be treated effectively with antibiotics.
• Damage to the nerve near the site of the incision. Permanent damage is rare (about 5%), but if one or more fingers remain numb after surgery, this may be a sign that the nerve is damaged.
• Recurrence of flatfoot symptoms. This is an unusual complication, since symptoms rarely occur after surgical correction of flatfoot, but if it does happen, it may require repeated surgery or long-term wearing of orthopedic insoles.
• Deep vein thrombosis. To reduce the risk of this complication, the doctor may prescribe blood thinning medications to the patient after the operation. Cases of blood clots in the deep veins in the legs make up less than 3% of cases of all postoperative complications.