Some children require treatment for the flexible flat foot if symptoms cannot be controlled with shoe changes and orthotic arch supports. There are two types of surgical treatments that have been quite successful:
- Insert a small cylindrical plug into the heel bone joint (the subtalar joint)
- Change the shape of the foot with bone cuts (an osteotomy) and combine this with the use of a bone graft
The insertion of the cylindrical plug (Maxwell-Brancheau Arthroerisis "MBA") is a device that has proven very successful in the correction of the child’s flat foot. The surgical procedure to insert the arthroerisis implant takes approximately 20 minutes and involves the insertion of a small cylindrical plug through a one centimeter incision on the outside of the heel and ankle.
The child is able to walk on the foot after a few days using either a short leg walking cast or removable walking boot, determined by comfort and sometimes any additional surgical procedures which may be performed simultaneously. The subtalar MBA implant is typically left in place forever and does not need to be removed.
As the foot gets more deformed, the subtalar implant may not be sufficient to correct the flat foot deformity. For these children a bone cut or osteotomy is made on the heel bone (the calcaneus) to elongate it and improve the arch of the foot. As the heel bone is lengthened, the gap in the bone is filled with bone graft. The child’s bone is not used and bone is taken from the bone bank.
There is negligible risk to using bone from the bone bank. It is far less painful than taking the child’s own bone and generally means shorter operating and anesthesia time with less blood loss. Dr. Mark Myerson has pioneered the use of these types of bone grafts in both adults and children quite successfully.