What Is Flat Feet?
The frequent ailment known as "flat feet," or "flat foot," causes the arches on the underside of the feet to flatten under pressure. People with flat feet stand up with their feet pointing outward and their whole soles touching the floor. When the arches fail to form during childhood, flat feet may result. It may also arise later in life due to trauma or the normal wear-and-tear factors associated with aging.
Any surgical technique that attempts to restore some arch beneath the foot is considered reconstruction surgery for flat feet. According to a 2022 review, the absence of the medial longitudinal arch is the cause of flat feet. This is a strong, flexible portion of the foot. It comprises a complex network of collagen, tendons, and ligaments. Any problems in any component of this structure could lead to flat feet.
Who May Require Surgery for Flat Feet?
Some people have flat feet by birth. Nonetheless, most flat-foot instances resolve independently and do not call for medical attention.
In certain situations, doctors could advise surgery for kids with flat feet. This could occur in children with stiff, flat feet, meaning they lack a medial longitudinal arch regardless of weight bearing.
Adulthood can cause flat feet in certain people. Motion-control shoes, nonsteroidal anti-inflammatory drugs, and foot orthotics may benefit these people. Surgeons only suggest surgery in cases where no other course of treatment works. Nonsurgical treatments may not always be able to relieve painful adult and pediatric flatfoots. Surgery can be necessary if everyday life is negatively impacted by pain and edema.
Individuals would require surgical correction for flat feet when the following symptoms arise.
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Pain when walking or running, especially in the inner ankle and foot.
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Swelling in the ankles.
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Injury to the nerves that supply the inside of the ankle, resulting in tingling or numbness.
Obtaining an early diagnosis is crucial because, without treatment, the foot may grow less flexible, the issue may become more difficult to resolve, and arthritis may result.
What Are the Steps to Follow Before the Procedure?
Several things need to happen before surgery is done. The physician will obtain a complete medical history. The presence of pain, as well as its location, severity, timing, functional issues, and aggravating or mitigating circumstances, should all be included in the history.
The physician will watch patients walk to assess bone structure, joint mobility, and gait. The physician will look for excess wear by looking at the footwear and feet.
It is possible to use imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI), and X-rays. These are required to assess the foot's skeletal structure, ligaments, and tendons. They can assist the surgeon in deciding which surgical treatments are best to carry out.
What Are the Surgical Corrective Methods Available for Flat Feet?
Regional anesthesia, which numbs the foot and ankle using a nerve or spinal block, or general anesthesia, which may necessitate the use of a breathing tube, can be used for surgery. After surgery, a nerve block is frequently inserted behind the knee to lessen pain.
A comprehensive surgical treatment plan typically consists of many surgeries. The ankle and foot orthopedic surgeon will create a treatment plan tailored to the deformity and the surgeon's preferences. The procedures listed below may be undertaken.
Lengthening Achilles:
The Achilles tendon tightens and contracts in acquired flat feet. Achilles tendon lengthening is a common component of almost all flat foot surgeries. There are several varieties, each with unique advantages. The two most often used techniques are triple-cut or percutaneous Achilles tendon lengthening and gastrocnemius recession.
Medializing Calcaneal Osteotomy:
This surgery, also known as a heel slip, entails cutting the heel bone to realign it under the leg. Next, a plate, screws, or staples are used to secure the bone in place.
Tendon Transitions:
To assist the posterior tibial tendon to regain some strength, the flexor digitorum longus (FDL) tendon which flexes the toes is typically transferred. It is moved to the navicular bone through an incision in the foot. The surgeon may decide to cut off the posterior tibial tendon entirely if it has sustained significant damage. To reorient the forces acting on the foot, tendon transfers on the exterior of the foot are occasionally performed as well.
Ligament Restoration:
The deltoid and spring ligaments are two ligaments that aid in maintaining the right position of the foot and ankle. Severe illness patients may have tears in one or both ligaments. A surgeon might suggest reconstructing or repairing either of these ligaments in specific circumstances.
Extension of Lateral Columns:
To help address the foot deformities, the calcaneus bone is sliced on the outer edge of the foot and extended during this treatment. Usually, to extend the sliced bone, this is accomplished by putting a metal wedge or a cadaver bone inside of it. To assist hold the bones in place while they recover, plates or screws are frequently utilized.
Cotton Osteotomy (Medial Cuneiform):
During this process, an incision is made on the top of the foot to expose the medial cuneiform bone. Rebuilding an arch is made easier by using a bone or metal wedge to spread the sliced bone apart.
Fusion of the Midfoot:
A midfoot fusion may be necessary for certain patients who have arthritis or a midfoot deformity. A number of the midfoot joints, such as the naviculocuneiform joint and the tarsometatarsal joints, may be involved in this. The arch can be restored with the help of this process.
Fusion of the Subtalar:
When there are more severe malformations, this surgery is used. The surgeon can fix more of the abnormality because the calcaneus and talus bones are joined collectively.
The Triple or Double Arthrodesis:
For those with arthritis or more significant abnormalities, this treatment is used. The calcaneocuboid, talonavicular, and subtalar joints are joined in a triple arthrodesis. Only the talonavicular and subtalar joints are frequently joined (double arthrodesis). Following this procedure, the foot will be tight, yet generally, discomfort and posture are enhanced and the foot appears more secure when walking.
What Does the Post-Procedure Recovery Include?
After surgery, patients may leave the hospital the same day or they may need to stay overnight. During the first two weeks, the limb should be maintained elevated while it is in a cast or splint. The sutures are then taken out. Then, either a fresh cast or a detachable boot is put on.
Patients must avoid bearing any kind of load on the foot that was repaired for six to eight weeks after the procedure. Most of the time, patients can start gaining weight after the first six to eight weeks and reach full weight-bearing by the 10th or 12th week. Some people need more time to get used to bearing weight. Patients can typically begin to wear shoes after 12 weeks. Ankle braces and inserts are frequently utilized. It might be advised to undergo physical treatment. After surgery, patients may experience months of swelling and discomfort before fully recovering in one to two years.
What Are the Possible Adverse Effects and Risks After the Surgery?
Significant side effects from flat foot surgery are rare. There are dangers and adverse effects associated with every major surgery. Following flat foot reconstruction surgery, the following are possible side effects:
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Injury to blood vessels or nerves.
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Incisions or bones that fail to heal fully.
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Hemorrhage or blood clots.
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Infection.
With this kind of surgery, pain and limited mobility as the bones and tendons recuperate are to be anticipated. After the procedure, these side effects ought to start to go away six to eight weeks later.
Conclusion:
Treatment for flat feet is not usually necessary. The ailment could clear up on its own or remain asymptomatic for extended durations. On the other hand, flat feet can occasionally hurt and make walking difficult. It might also put people at risk for injury. Flat foot reconstruction surgery aims to give the foot's medial longitudinal arch its original curvature again. This can lessen the symptoms of flat feet and stop them from flattening further. Surgery, though, is not without danger.
