Flexible Flatfoot Surgery

Surgical correction of flexible flatfoot is indicated for patients who have failed conservative treatments. The goal is to improve foot function, alignment and reduce or eliminate pain. There are a number of surgical procedures used alone or in combination to correct a flexible flatfoot. These include tendon procedures, joint motion controlling implants (arthroerisis), bone cuts (osteotomies) with or without bone grafts and joint fusions (arthrodesis).

In determining the correct procedure(s) Dr. Radovic must consider a number of factors including age, skeletal maturity, activity level, patient expectations and severity of the deformity.

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Flexible Flatfoot Surgery



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These and various other factors must all be considered in the surgical planning on a case-by-case basis. Except for the arthroerisis implant and gastrocnemius recession procedures all others require not only immobilization casting but non-weightbearing for at least eight weeks.
Some of the more common procedures are listed below:

Arthroerisis implants.
This is a popular and proven procedure in younger patients. A metallic implant is placed between the calcaneus and talus which controls the subtalar joint motion (pronation) preventing the arch from collapsing. It is a minimally invasive procedFlatfoot Surgeryure which does not involve the cutting of bone or tendon work. It does have the perception of being reversible by removing the implant. It is often a singular procedure for children under the age of 14 but can be used in conjunction with other procedures for adult flexible flatfoot correction.

Achilles tendon lengthening or gastrocnemius recession. These procedures address the equinus (tight Achilles tendon or calf muscle) deformity component of the flatfoot. Dr. Radovic's clinical examination can determine which of these procedures is beneficial.

Calcaneal osteotomy.
This is a bone cutting procedure of the heel bone that may be performed in adolescents as well as adults. It is indicated to correct the valgus deformity of rearfoot by realigning the heel bone and Achilles tendon. This is a mainstay procedure for the correction of flatfoot deformities. It is often referred to as the Dwyer osteotomy. Posterior tibial tendon transfers.

Advancement or "tightening up" of the posterior tibial tendon is a mainstay procedure for the correction of flexible flatfoot. Often referred to as the Kidner procedure it sometimes includes removal of the accessory navicular bone.

Bone grafting procedures.
There are two mainstay bone grafting procedures for the of correction flexible flatfoot; The Cotton medial cuneiform osteotomy and the Evans calcaneal osteotomy. They involve bone cutting with insertion of an allograft bone implant to correct the alignment of the foot. Both of these procedures can be for performed in adolescents as well as adults.

Midfoot joint fusions.
Flatfoot SurgeryMost commonly performed in adults, these fusions stabilize the arch. They include the Lapidus procedure and navicular cuneiform arthrodesis. Fusion of these non-essential joints allows for greater stabilization without loss of foot function.

Rearfoot fusions.
This type of procedure is usually reserved for the most severe cases, in particular those with arthritic joint changes or have failed from previous inadequate surgical correction. Rearfoot fusion may involve the talonavicular joint, calcaneocuboid joint, subtalar joint or combination of these referred to as a triple arthrodesis.

Symptomatic flexible flatfoot is a condition that can be difficult to control with conservative treatment such as orthotics, shoe gear and physical therapy. When such modalities fail, surgery may be indicated. Dr. Radovic is an expert at evaluating and treating such conditions and can determine which of the above procedures alone or in combination may provide the best possible outcome.