Reconstruction of the Flexible Flatfoot

Instead of understanding a flexible flatfoot as a single condition, it should be understood that it is in fact multiple simultaneously occurring conditions resulting in mechanical failure. And since there are multiple components:

The surgeon should ask themselves "What component of the deformity am I correcting?"

Every operation has a purpose. Every procedure corrects a different deforming force.

That framework helps both patients and residents understand why flatfoot reconstruction is often a combination of several procedures rather than a single operation. And for patients, why they emerge from an operating room with incisions on the medial and lateral sides of their foot along with the back of their leg thinking I am just "giving them an arch."

Careful assessment of the dominant planes of deformity clue the surgeon into where the pathology lies. For example, strictly sagittal plane dominance may be a result of spasticity in the heel cord only. This is often the case in pediatric presentations. Likewise, frontal plane dominance may occur in the forefoot, the hind foot, or both. Consequently procedures designed to correct on these planes may be required at one or both levels depending on extent of deformity. 

Some procedures have a powerful impact in multiple planes. For example the Evans osteotomy will effect transverse plane (forefoot abduction) and frontal plane (forefoot supinatus) simultaneously. This is why we often use these procedures to complete a correction, so as to minimize the total surgical disruption and recovery time. 

It should also be noted that correcting a flatfoot is not necessarily about arch restoration, which is an obvious external sign of success. It's about creating a mechanically stable propulsive foot that is pain free. We can't make someone an olympic-level runner simply by raising an arch, but we can improve the mechanics that lead to a failure of the arch mechanism. 

The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.