Flatfoot deformities can develop in adults or can occur when an individual’s arch does not fully develop during childhood. Flatfoot developed during childhood often times is asymptomatic and painless. Acquired adult flatfoot deformity (AAFD) often times is accompanied by pain behind the inside of the ankle and the hind foot. Many times proper insoles or a brace can alleviate the pain, however some patients can face knee and ankle problems over time. Often times, non-surgical methods such as the use of a brace, orthotics and rehabilitation are sufficient to alleviate pain. Flatfoot Reconstruction is an option for patients who experience pain even after non-surgical procedure have been explored.
Flatfoot can be categorized with 4 stages of severity:
- Stage I: There is pain in the big toe and the arch of the foot, but no visible signs of deformity.
- Stage II: Deformity has started to occur, but visible signs may not be present yet.
- Stage III: Deformity of the foot is evident at the arches, and foots alignment has shifted.
- Stage IV: Ankle alignments are shifted, and arthritis is usually present
Treatment plans are determined based on the the stage of the deformity and the patient’s desired outcome. Once surgery is deemed appropriate for treatment, three different procedures are available:
- Triple Arthrodesis – Involves fusing of three joints. This procedure is only recommended for patients with severe deformity, as it decreases range of motion. A long-term complications, such as arthritis may occur.
- Calcaneal Osteotomy – Involves removing part of the calcaneus (heel bone) and re-alignment of the removed piece. Once the removed piece is placed in the correct position, screws are inserted to re-attach the heal.
- Lateral Column Lengthening – The procedure starts with an incision on the outside of the foot. The calcaneus (heel bone) is cut into two pieces where a wedge (bone graft) is placed between the two pieces which result in a lengthening of the outside of the foot.
Patients will be asked to wear a brace and use crutches to be non-weightbearing on the foot. Smokers have a higher risk of complications occurring during and after surgery, and they may not be determined as an ideal candidate for this procedure. While significant healing will occur in the first few months after surgery, full recovery after surgical correction of the flatfoot deformity can take 6 to 12 months.