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Flat Foot Surgery In Children And Adults

Painful Flat Foot

Painful Flat Foot Before Surgery: Arch is collapsed and the calcaneus (heel bone) is parallel to the ground

After Surgery

After Surgery: Note the increased arch height and position of the calcaneus (heel bone)

What is a flat foot?

Flat foot is a term that refers to a collapsed arch.  The general medical term is pes planovalgus.  Many children have flat feet but have no symptoms. Some studies estimate that 80% to 90% of babies born in North America have flat foot and most of them grow up to have normal foot structure. About 20% of them, however, continue to have flat feet into adolescence and adulthood and experience symptoms as a result.

Are there different types of flat feet?

Flat feet typically can be categorized as either flexible, where the foot is easily maneuverable; or rigid, where the joints of the foot has limited motion. Flexible flat foot is more common. In this condition, the foot joints have adequate motion, and in most cases too much motion, and the arch is able to be recreated when not standing on the foot. A rigid flat foot on the other hand, has very little motion and has the same flat shape whether sitting or standing.

When to treat flat foot?

If there is pain associated with flat foot, treatment should be initiated. Common complaints with flat foot are arch pain, a “bump” on the inside of the foot often causing irritation in shoes, and “ankle” pain. The ligaments and tendons supporting the arches can become fatigued and cause pain. The ‘bump’ is often protruding bone as a result of misaligned joints, and what is often referred to as “ankle” pain is actually pain of the sinus tarsi and subtalar joints—the joints immediately underneath the ankle.  Shin splints, tightness and cramps of the calf muscles, and even keen pain are associated with flat feet.

Should children be evaluated for flat feet?

Even if your child exhibits none of these complaints, but there is a concern of flat feet or there is a familial history of flat feet it is a good idea to see a foot and ankle specialist for an evaluation. There are certainly cases where conservative treatment can prevent progression of an existing flat foot and prevent onset of symptoms.

When is surgery needed for flat foot?

In many cases, conservative treatments such as anti-inflammatory medications and injections, physical therapy, and foot and ankle orthotic devices can be very helpful in treating the symptoms and preventing recurrence. These treatments are less helpful in rigid flat feet.  In most cases of rigid flat foot, a coalition is the cause and this needs to be managed surgically.

If there is continued pain even after conservative treatments, and activities such as walking, running or participating in sports become difficulty, surgery should be considered.  The pain may be very specific in some cases but is often is described as a generalized feeling of fatigue and discomfort of the feet. In any case, flat feet with continued pain that is not resolved with conservative treatment should be evaluated for surgery.

What types of surgery are there for flat foot?

A comprehensive examination including gait analysis, weightbearing x-rays and sometimes MRI or CT scans are necessary before deciding on the type of surgery. There is no one specific surgery that will correct flat foot; often a combination of soft tissue and bony procedure is required. Often, a realignment of the heel bone (calcaneal osteotomy) is the main procedure. Additional osteotomies of the midfoot bones or tendon lengthening or transfers may be necessary. In some cases, especially in rigid flat foot, fusion of certain joints may be warranted. Each case of flat foot is different and an individualized treatment plan is necessary.

What can be expected after flat foot surgery?

Children recuperate quickly after surgery and has shorter rehabilitation periods and often do not require formal physical therapy. In adults, depending on the procedure, physical therapy might be necessary to strengthen the muscles that have weakened while in a cast or boot.

Dr. Joseph Alencherry

Author

Dr. Alencherry graduated from Cornell University with a Bachelor of Science degree in Molecular Biology and Concentration in Applied Economics & Management. He earned his medical degree in Podiatric Medicine and Surgery at the New York College of Podiatric Medicine in New York City. He continued his education with a four year Residency at the New York Hospital Queens, where he was appointed Chief Resident in his final year. He has comprehensive training in elective, reconstructive and trauma surgery of the foot and ankle. He also is trained in the most advanced non surgical and minimally invasive treatments of common foot and ankle conditions. He has an interest in treating the pediatric population and has experience treating congenital deformities. He is an Associate of the American College of Foot and Ankle Surgeons.In addition, he has completed several AO courses and has received training in external fixation and deformity correction techniques at the Ilizarov Institute in Russia. He is an active committee member for the New York State Podiatric Medical Association and the NYSPMA Young Physician section. He is a proud member of the American Podiatric Medical Association. He serves as the Director of Clerkship for the Podiatric Medicine and Surgery Residency program at New York Presbyterian/Queens. He is actively involved with Residency training and is affiliated with Long Island Jewish Hospital, North Shore University Hospital, Lenox Hill Hospital and Winthrop-University Hospital.

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