Flat feet or as they are often called excessively pronating feet lead to a plethora of foot conditions and can ultimately lead to permanent deformities. In most cases orthotics and insoles can help to control this excess motion, however in some instances orthotics cannot resolve the issue or orthotics can not be tolerated.

Flexible flat foot

If the flat foot is completely reducible i.e you can raise the arch up then some of the minor minimally invasive procedures can be carried out.

Hyprocure (arthroereisis)

In these situations a minor procedure can be carried out utilising an incision approximately 10 mm can be utilised to painlessly control this motion and help resolve the issues and help negate the need for orthotics.

A small “stent” is inserted between two bones, (not into a joint) to control how these bones are positioned in relation to each other. These stents are trialed in various sizes during the procedure until the correct control is established.

This can be carried out at the same time as other procedures are being done or can be done as a separate stand alone case. Patients can walk on the foot immediately in a firm dressing and post-op shoe, taking it easy for a few weeks and the small incision heels.

It must be mentioned that this procedure is not appropriate for all feet and during the initial assessment a decision will be made.

See more here: http://www.hyprocure.com/flat-feet/

Tarsal coalition

This rare childhood condition often produces a rigid flat foot that is unresponsive to orthotics. As the foot is rigid it can not be corrected and therefore orthotics tend to be painful and may not work. This condition occurs when two bones that should function separately begin to unite. This starts as a fibrous and flexible union and tends to progress over a 5-7  year process to be solid and fused. This foot typically is painful and impacts on all aspects of life.

There are two options for this condition – non-surgical treatment is to brace the foot and hold it in as straight a position as possible until the bones fuse. The foot would be fixed and rigid and depending on where the foot ends up can be mildly symptomatic or may impact on all aspects of walking and sport. However if avoidance of surgery is important to the family then this can be an option.

There is a surgical option in the form of resecting the coalition and mobilising the foot to free secondary contractures. Other procedures maybe necessary at the time depending on the secondary deformities that may have developed while the foot was rigidly flat.

The aim of this procedure is to regain a flexible pain free foot.

Posterior tibial tendon dysfunction

This can be a very severe problem leading to a complete collapse of the whole foots architecture. There are various stages of the condition and it can ultimately lead to ADULT ACQUIRED FLAT FOOT. This condition can be catastrophic if left to progress to the end stages. When identified early on aggressive non-surgical treatment is imperative to try to prevent the end stage. This may involve, CAM boots, aggressive orthotics and physical therapy. 

If the tendon damage progresses and the foot collapses then surgery maybe considered. The type of surgery carried out depends on how the foot has ended up. The aim of maintaining motion is paramount and this can be achieved via a combination of procedures. The tendon will be repaired and then possible procedures involved may be Hyprocure, medial calcaneal slide, Evans or Cotton procedures. If the foot has developed into the end stages then fusion of the talonavicular joint maybe required.

Cotton osteotomy

This is a relatively minor procedure involving making a cut into one of the bones on the arch and implanting a graft to reproduce an arch.

Evans osteotomy

Sometimes called a lateral column procedure. This is and excellent way of swinging the front of the foot back around to realign with the heel. A cut is made into the calcaneus or heel bone and a graft is implanted to bring the front of the foot straight.

Talonavicular joint fusion

Once the tendon has lost function and secondary damage to the other soft tissue restraining mechanisms develop then it maybe necessary to fuse this joint. This is a powerful procedure and allows the alignment to be reinstated, yet can avoid the triple arthrodesis that involves fusing three  major joints in the back of the foot. This will require longer recuperation than the above procedures yet maybe a necessary life changing procedure in certain situations.