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What is a Flatfoot?

A flatfoot refers to the loss of the inside (medial) arch of the foot. 20% of people have flatfeet and if it is not causing pain or discomfort you should not be concerned about it. Painful (symptomatic) flatfeet generally present with pain on the inside of the ankle and the inability to stand on your toes (single leg heel raise). The first line of treatment always consists of conservative treatment such as orthotics, physiotherapy, pain medication and loss of weight. If this fails to improve your symptoms, surgery will be considered.

What to expect with flatfoot surgery?

Flatfoot surgery involves a combination of bone cuts (osteotomies), ligament repair and tendon transfers (moving a tendon from one bone to another). The aim of surgery is to realign the foot and to restore the inside arch. It can be done with a combination of open and minimal invasive surgery.

How long is the recovery after flatfoot surgery?

It is important to understand that full recovery can take up to 1 year after the surgery. Generally, you will be in a cast for 2 weeks, followed by a boot for another 6-8 weeks. The 1st 2 weeks your foot must be elevated (lifted to above the level of your heart) to minimize swelling and allow wound healing. As a rule, you should keep the foot up 45 minutes out of every hour. You will not be allowed to put weight on the foot. At 2 weeks your foot will be placed in a boot and allowed to slowly increase your weight bearing over 6-8 weeks.

What are the risks and complications of flatfoot surgery?

  • Wound problems: There is a small risk of wound bleeding or infection. For this reason, you will keep your foot up until the wounds heal. Deep infection requiring further surgery is very rare.
  • Stiffness and swelling: Stiffness and swelling is normal and can persist up to 1 year after surgery. Early physiotherapy is important.
  • Nerve injury: Often you may experience numbness or pins and needles around the foot from working close to the nerves. Permanent injury is rare and most of the time this resolves over a few weeks.
  • Bone healing: The bone cuts (osteotomies) will be secured with special screw, but sometimes the bone does not heal/knit together (unite) or take longer. This is more common in people who smoke.
  • Complex regional pain syndrome (CRPS): This is a rare complication after and arm or leg surgery where the nerves have an abnormal response. The brain then experiences normal touch as pain. This can cause distress and discomfort and prolong recovery. Other symptoms can include swelling, skin colour and temperature changes and change to hair and nail growth. Treatment includes pain medication and occupational therapy and should be started early.
  • Blood clot/DVT (See information leaflet): Certain people are at risk of a blood clot and you might be put on a blood thinner for the first 2-3 weeks after the surgery.
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