Flat Foot Reconstruction Surgery - Indications and Procedure

What Is Flat Foot Reconstruction Surgery?

Flat foot reconstruction is a surgical procedure that aims to rectify a flatfoot deformity where the arch of the foot caves in, causing it to remain flat on the ground. Several factors, including genetics, overuse, and injury, can cause this condition. The complexity of flat foot reconstruction surgery depends on the extent of the deformity and may involve multiple techniques.

What Are the Indications of Flat Foot Reconstruction Surgery?

Flat foot reconstruction surgery is typically recommended for patients with a severe flatfoot deformity that is causing significant pain and limited mobility. In addition, surgery is generally considered when conservative treatment options have been ineffective in relieving symptoms. The following are indications for flat foot reconstruction surgery:

• Significant Pain and Discomfort: Chronic discomfort and pain can arise in the feet, ankles, and lower legs due to flatfoot deformity. Surgery may be a viable option if traditional treatments prove ineffective in relieving pain.

• Limited Mobility and Activity: Severe flatfoot can restrict patients' daily activities, such as walking, running, and participating in sports. Flat foot reconstruction surgery can assist in restoring mobility and enabling patients to resume their routine activities.

• Progressive Deformity: Untreated flatfoot deformity cases can deteriorate over time, leading to other foot and ankle issues.

• Failed Conservative Treatments: Surgery may be taken into account if conservative relief methods, such as orthotics and physical therapy, prove to be ineffective.

• Structural Abnormalities: Structural abnormalities in the foot's bones, tendons, or ligaments can be the reason for the flatfoot deformity.

• Arthritis: Flatfoot deformity can lead to arthritis in the foot and ankle joints. This can cause pain, stiffness, and swelling, making it difficult to perform daily activities.

What Happens Before Flat Foot Reconstruction Surgery?

Flat foot reconstruction surgery is a complex procedure that involves careful planning, preparation, and recovery. Before undergoing flat foot reconstruction surgery, the patient will typically have a consultation with a foot and ankle specialist who will evaluate the severity of the deformity and determine the best course of treatment. Here are certain steps followed before surgery:

• The patient will undergo a thorough evaluation, and the surgeon will review the medical history. Sometimes, the patient may need to obtain medical clearance from their physician or any other specialists they are seeing to ensure no underlying medical conditions could affect the surgery.

• Preoperative screening is an important step. The patient may undergo certain blood tests and X-rays to ensure they are healthy enough for surgery and to help the surgeon plan the procedure. The doctor may assess vitamin D levels to maximize the surgery's benefits.

• The patient will be instructed to discontinue certain medications prior to the procedure and make necessary preparations, including fasting for a specific duration as per the preoperative guidelines. It is strongly advised to quit smoking at least eight weeks prior to surgery due to the negative impact it has on the healing process and the increased likelihood of health complications such as pulmonary embolism (a blood clot that has traveled to the lungs from another body parts) and deep vein thrombosis (blood clot in the legs deep vein).

What Is the Procedure for Flat Foot Reconstruction Surgery?

Flat foot reconstruction surgery involves the following steps.

• Anesthesia: This surgery is conducted under general anesthesia, which puts the patient to sleep. Alternatively, a spinal or regional anesthetic can be used to numb the leg. Anesthesia will be given to ensure they are comfortable and pain-free during the surgery.

• Incision: The surgeon will make an incision on both sides of the foot, exposing the bones, ligaments, and tendons.

• Calcaneal Osteotomy: If necessary, the surgeon cuts the heel bone using a saw (a surgical instrument). The bone is then repositioned underneath the ankle and secured with metal plates and screws. This is called an osteotomy.

• Soft Tissue Repair: The surgeon will first repair or strengthen the tendons and ligaments that support the foot arch. This is usually done using sutures or grafting tissue from other body parts.

• Tendon Transfer: This technique involves moving tendons from other foot parts to support the arch. The damaged posterior tibial tendon is removed and replaced with a nearby tendon (flexor digitorum longus tendon). The spring ligament (main ligament of the foot) inside the foot may also be repaired or reinforced with artificial tape.

• Bone Fusion: In severe cases, bone fusion may be necessary. This involves fusing the foot bones together to create a stable arch.

• Closure: After the surgery is finished, the surgical site will be sealed with either staples or sutures and then covered with a dressing. A temporary plaster is placed on the foot.

How Long Is the Recovery Period for Flat Foot Reconstruction Surgery?

The recovery period following flat foot reconstruction surgery may differ depending on the patient’s condition and the specific techniques used during the surgery. Generally, patients can expect several months to a year to recover. The recovery process includes the following:

• Immobilization: After surgery, the foot will be immobilized with a cast or boot for several weeks to allow for proper healing. During this time, the patient will need to use crutches or a wheelchair to avoid putting weight on foot.

• Pain Management: The patient may experience some discomfort or pain during recovery, which can be managed with pain medication prescribed by the surgeon

• Physical Therapy: Once the cast or boot is removed, the patient will begin physical therapy to regain strength, flexibility, and mobility in the foot. This typically involves exercises to improve range of motion, strength training, and balance training. Depending on the patient's progress, physical therapy may continue for several months to a year.

• Gradual Return to Normal Activities: Depending on the extent of the surgery and the patient's recovery progress, they may be able to gradually return to normal activities, such as walking and light exercise, after several months. Activities such as running and jumping may need to be avoided for longer.

• Follow-up Appointments: The patient will need to see their surgeon for follow-up appointments to monitor the healing process and make sure there are no complications.

Conclusion

Flat foot reconstruction surgery is an effective treatment choice for individuals with flatfoot deformity. Follow the surgeon's instructions during recovery to ensure proper healing and avoid complications. These may include refraining from certain activities, keeping the foot elevated, and wearing supportive footwear. Most patients can expect improved foot function and quality of life with rehabilitation and proper care.