Surgical treatment for an adult flat foot deformity can include several types of procedures:
- Tendon Repair and Transfer
- Ligament Reconstruction
- Bone Cuts and Realignment
- Joint Fusion
Tendon Repair and Transfer / Ligament Reconstruction
If the posterior tibial tendon (a tendon which runs underneath the arch of the foot) has ruptured and is causing the flat foot, it will not be possible to repair the tendon because it will quickly stretch out and tear again. In this case the surgeon will use a tendon transfer to correct the issue. The surgeon may also repair damaged ligaments to help support the reconstructed arch.
Bone Cuts and Realignment
There are several different types of bone cuts (osteotomies) that may be used to realign the foot and repair a flat foot.
A posterior tibial tendon transfer is often combined with a cut on the heel bone (calcaneal osteotomy) in order to shift the heel bone and add support to the tendon transfer. The heel is fixed in place with metal screws or a plate.
In more severe cases osteotomies are used to reshape and elongate part of the foot. Some of these procedures require a bone graft. Bone grafts may be taken from the patient’s own bone (typically from the hip) or a bone bank, which can significantly reduce risks associated with removing bone from the pelvis. The graft is carefully shaped and placed to reform the natural shape of the foot.
Severe, late stages of flat foot tend to be inflexible (stiff) and require joint fusion (called arthrodesis) within the foot. The surgeon may need to join one or more joints together permanently with screws. In this case inward/outward movement of the foot may be lost, however, up and down movement of the foot is maintained.
The extent of the deformity is the key factor in the decision to employ joint fusion as a treatment for flat feet.