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Flatfoot reconstruction Surgery- What To Expect

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Although having flat feet is usually harmless, some people may experience pain from their flat foot structure. This is especially true if one foot is significantly flatter than the other and is taking on more pressure.

Flatfoot reconstruction surgery is a type of surgery that is done to correct the structure of the foot so that it functions properly. Flatfoot reconstruction surgery is major surgery and is only done when conservative treatment options such as orthotics/shoes and physical therapy fail. 

In this article, we’ll discuss what flatfoot reconstruction surgery entails and what you can expect during the recovery period. 

Flatfoot Reconstruction Surgery Procedure- What to Expect

Flatfoot reconstruction surgery will be performed at a hospital or outpatient surgery center. The surgery will be performed under general anesthesia. You will be sleeping during the entire procedure. The reconstruction surgery will take 2-3 hours to complete. 

When someone has a flatfoot, their foot collapses in three different planes. In addition, many people have tight calf muscles (equinus) that makes the flat foot condition worse.

Your surgeon will have to correct all three planes of the flatfoot deformity as well as fix the equinus. 

This is completed by performing the four procedures listed below:

1) Medial Calcaneal Slide Osteotomy

A medial calcaneal slide osteotomy procedure involves cutting the heel bone to allow a portion of the bone to slide inwards. This helps create a natural arch in the foot. The cut is held in place with screws and plates. 

2) Evans Osteotomy

An Evans osteotomy involves cutting the heel bone to change the angulation of the foot. Your surgeon will insert a bone graft into the heel to correct the angulation of the foot and elevate the arch. The bone cut and graft will be held in place using screws, plates, or staples. 

3) Cotton Osteotomy

A cotton osteotomy involves cutting the medial cuneiform bone. A bone graft is then inserted into the cuneiform. The cut is secured using staples or screws. This correction helps realign the forefoot and midfoot.

4) Gastrocnemius Recession

A gastrocnemius recession procedure is done to release the fascia of the gastrocnemius muscle (calf muscle) in the back of the leg. Lengthening the calf muscle allows for a better range of motion in the ankle joint and helps stabilize the foot

In some people who suffer from flat feet, their posterior tibial tendon (that is responsible for holding up the foot arch) may be torn. In these cases, the posterior tibial tendon may need to be repaired during surgery. 

Posterior Tibial Tendon Tear Repair

Your surgeon will make an open incision along the inside of your foot/ankle where the posterior tibial tendon is located. The torn tendon will be repaired using thread (sutures). If the tendon is too weak, your doctor may use another nearby tendon (flexor digitorum longus tendon) and transfer it to the posterior tibial tendon to improve strength. 

 If the tendon has ruptured away from the bone, the tendon will be secured back onto the bone using strong anchors. A strong posterior tibial tendon can improve your foot arch as well as improve balance.

If you have flat feet and severe arthritis in the joints of the foot, your doctor may choose to perform a Triple arthrodesis (fusion) procedure. 

Triple Arthrodesis

A triple arthrodesis procedure involves fusing three joints (subtalar joint, talonavicular joint, and calcaneocuboid joint) in the foot. It is a treatment option for people with flat feet who have severe arthritis, instability, and deformity.

It involves permanently fusing the joints by cutting and repositioning the bones and securing them in place with screws and/or plates. The goal of the surgery is to improve stability and reduce pain in the affected area. 

cast leg

Recovery After Flatfoot Reconstruction Surgery

After surgery, your doctor will apply a splint or cast on your leg.

You will need to remain off of your feet for at least 8 weeks to allow for the bone cuts or fusion sites to heal.

Prematurely walking on the foot can disrupt the repair. Make sure to keep your leg elevated on two pillows as much as possible to reduce foot swelling. 

Ice behind your knee to help reduce pain. Ice constricts the blood vessels and reduces the throbbing sensation in the foot. Your doctor will prescribe pain medications to help keep you comfortable post-operatively.

Use a knee scooter or crutches to help you stay off of your foot. When you shower, keep your cast dry using a cast protector. You can find all of these supplies on Amazon.

Sutures will be removed at your doctor’s office 2-3 weeks after your procedure. 

Your doctor will obtain x-rays of your foot every 3 weeks to ensure that the bones are healing appropriately. After 8 weeks, you can transition to weight bearing as tolerated in a below-knee cast boot for an additional 4 weeks before transitioning into your athletic shoes.

Make sure to keep the cast boot on while sleeping to prevent injury to the foot. 

Full recovery after flatfoot surgery can take 6 months or longer.

Physical therapy will need to be completed 3 times a week for 2 months after the surgery. Flat foot reconstruction is extensive, so the physical therapist will help you walk after surgery, improve strength, and reduce pain. 

Your foot size may change after surgery. You should go to your local shoe store after surgery to have the length and width of your feet measured. Then, ask the orthotist at the shoe store for shoe recommendations for your foot structure. You can also ask your foot doctor what shoes they recommend. 

You should have custom orthotics made after surgery to help support your arch. The custom orthotic can help prevent future arch collapse. 

Custom orthotics can be obtained at your foot doctor’s office. The price for custom orthotics can range from $300-$600. Ask your insurance company if this would be a covered benefit for you.

Complications of Flatfoot Reconstruction Surgery

Like with any foot surgery, complications can occur after surgery. 

Some complications that can occur from flatfoot surgery include: 

  • Infection 
  • Nerve injury including permanent numbness
  • Continued pain after surgery 
  • Bone or cartilage damage 
  • Blood vessel damage 
  • Scarring 
  • Weakening of the foot 
  • Delayed healing
  • Blood clots

How Long After Foot Reconstruction Can I Drive?

If you have surgery on your right foot, you will need to wait at least 6-8 weeks before you can safely drive. You have to be able to operate the gas pedal and brake pedal safely. Also, it is unsafe for you to drive with a cast on. 

If you had surgery on your left foot, you may be able to drive 3-4 weeks after the procedure (with your doctor’s permission). You need to make sure that you are not driving while on narcotic pain medications, as this can be dangerous. 

running on treadmill

Can I Run After Flat Foot Surgery?

You can start running 3 months after flat foot surgery. If your surgical site has healed and you have completed physical therapy, you should be able to start running for short distances. Make sure you wear appropriate shoes and orthotics before resuming running. 

Can a Podiatrist Fix Flat Feet?

Board-certified Podiatrists are experts in the foot and ankle, and can certainly perform flatfoot reconstruction surgery.  

What Happens if You Don’t Fix Flat Feet?

If you do not fix painful flat feet, you may experience chronic pain, fatigue, and instability in the foot. You may also develop other foot and ankle conditions that occur from flat feet such as bunions and hammertoes. Make sure you speak to your local foot doctor for advice if you suffer from painful flatfeet. 

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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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