Flatfoot reconstruction is a combination of procedures to restore the arch of the foot and correct the deformity caused by posterior tibial tendon dysfunction (adult acquired flatfoot). It typically involves tendon transfer, osteotomy, and sometimes fusion.
Multiple incisions are made on the inner and outer sides of the foot. The procedure typically involves transferring a nearby tendon (flexor digitorum longus) to replace the failed posterior tibial tendon, performing a calcaneal osteotomy (cutting and shifting the heel bone to improve alignment), and sometimes a lateral column lengthening or medial column fusion. The operation takes two to three hours.
Surgery is recommended for progressive flatfoot deformity causing pain, difficulty walking, and failure to respond to non-operative management with orthotics and physiotherapy.
Supportive footwear, custom orthotics (medial arch support), ankle-foot orthosis (AFO), physiotherapy for tibialis posterior strengthening, and activity modification. Non-operative management is effective for many patients, particularly in early-stage disease.
Weight-bearing X-rays and sometimes CT or MRI. This is a significant procedure requiring planning for six to twelve weeks of restricted weight-bearing.
Restoration of the foot arch, improved alignment, reduced pain, and improved walking ability. Most patients experience significant improvement, though the foot may not be perfectly 'normal'.
Foot swelling persists for many months.
Some loss of subtalar and midfoot movement.
Multiple incisions may cause scar-related issues.
Osteotomy or fusion sites may fail to heal. Risk is higher in smokers.
Multiple incisions increase risk.
Sural or medial plantar nerve irritation causing numbness.
The foot may be corrected into a cavus (high-arched) position.
DVT during the period of restricted weight-bearing.
General or spinal anaesthesia with a nerve block for post-operative pain relief.
Non-weight-bearing in a cast for six to eight weeks. Transition to weight-bearing in a boot for a further four to six weeks. Physiotherapy for ankle and foot rehabilitation. Custom orthotics may be needed long-term. Full recovery takes nine to twelve months.
Regular follow-up at two weeks, six weeks, three months, and six months with X-rays.
Many patients benefit from supportive insoles or orthotics long-term, even after successful surgery.
Flatfoot deformity involves multiple structures — the tendon, the heel bone alignment, and sometimes the midfoot joints. Addressing all components gives the best result.