Flat Foot Reconstruction

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What is a flat foot reconstruction?

A flat foot reconstruction is an operation to restore the shape of your foot and reduce pain. An operation is only recommended as a last resort, once all non-operative treatment measures for a flat foot have been exhausted and if your symptoms remain significant. If you have a flat foot with arthritis in the joints, you might be offered a different operation to fuse the joints (triple fusion).

What happens during a flat foot reconstruction?

In most cases the operation is performed under general anaesthetic (whilst you are asleep). Alternatively, you can have a spinal or regional anaesthetic, which just numbs the leg.

The operation involves surgical cuts on the inside and outside of the foot. The heel bone is cut with a saw (calcaneal osteotomy), repositioned underneath the ankle, and then fixed with metal plates and / or screws. Then the damaged tendon on the inside of the foot (posterior tibial tendon) is removed and substituted with another tendon close-by (flexor digitorum longus tendon). At the same time the main ligament (spring ligament) on the inside of the foot can be repaired or reinforced with artificial tape.

Once the operation is completed, the wounds are closed with stitches, local anaesthetic is given to provide pain relief for the first few hours after surgery and you will be placed in a temporary plaster.

What are the risks of a flat foot reconstruction?

The risks of any operation generally relate to the anaesthetic and the surgical procedure.

You will be able to discuss your anaesthetic options and associated risks with the anaesthetist before your surgery. With a general anaesthetic, the risks will vary depending on your general health.

The main surgical risks of a flat foot reconstruction surgery are listed below, but it is not exhaustive. These will be further explained in the outpatient clinic.

Swelling – The foot will swell after surgery in response to the surgery itself and the healing process. It will take more than 12 months for the swelling to settle.

Non-union – There is a risk the bones in your heel that were cut will not heal back together. Patients who smoke are at a much higher risk of this complication. We will therefore ask you to stop smoking (including nicotine vapes) before surgery and until your heel bone has healed. We can direct you to services that can help with smoking cessation.

Nerve injury – With an operation there is always a small risk of injuring or stretching the surrounding nerves, which can lead to numbness. These symptoms mostly resolve in time, but they can persist.

Infection – The wound usually heals within two weeks. In a small number of cases the wounds become infected. The majority are minor infections that can be simply treated with antibiotics. Occasionally, some patients can develop a deeper infection that might require another operation.

Blood clots (leg or lung) – There is small risk of developing a blood clot after major surgery. You will be individually assessed and may be given blood thinning medication to reduce the risk of developing a blood clot.

Chronic regional pain syndrome – Following foot and ankle surgery a small proportion of patients can develop chronic regional pain syndrome. Your foot becomes indefinitely painful, swollen and sensitive. If you develop this, you may require specialist care from a pain consultant.

Change of foot position – Overtime the arch on the inside of your foot can collapse again. Wearing an orthosis (medical insole) in your shoes can help reduce this risk.

Continued symptoms – Despite restoring the shape of your foot it cannot always guarantee full resolution of symptoms, especially if you have some arthritis in the surrounding joints.

Chronic Regional Pain Syndrome – Irrespective of the type of operation you are having in the foot and ankle, a very small proportion of patients can develop this condition where you are left with a painful, sensitive foot. If you develop this, you may require specialist care from a pain specialist.

What happens after my operation?

When will I go home after surgery?

After surgery, most patients can go home the following day. You may require additional time in hospital, if you have other significant medical problems or general poor mobility.

Will I be able to walk on it after surgery?

For the first six weeks after surgery you are advised not to put any weight through your operated leg. Before you go home the physiotherapist will make sure you are safe to get around on crutches. Some patients though find crutches difficult. A knee scooter can be easier to use and information can be provided on this. Also, in the first few weeks keep your leg elevated as much as possible to help reduce the swelling and aid wound healing. It is important that your cast remains dry and you may find using a waterproof cover helpful (www.limboproducts.com).

When will I be seen after surgery?

You will be seen two weeks after surgery in the outpatient clinic. Your wounds will be checked, your stitches removed, and a lightweight fibreglass cast will be applied.

You will then be seen six weeks after surgery with an X-ray. If everything is progressing well, you will be provided either with a removable cast or a surgical boot and you can slowly put weight through your operated leg as your comfort levels allow.

You will be seen again 12 weeks after surgery with another X-ray. You can then go into your own supportive shoes (preferably a lace-up boot with an orthosis) and will be referred to our specialist physiotherapists. Further appointments will depend on your individual progress.

When can I go back to work?

If you have a sedentary job (desk based) and are able to elevate your foot, you can return to return to work six weeks after surgery. If you have a more physically or strenuous job you may need significantly longer off work. Generally, after a flatfoot reconstruction it takes up to 12 months to gain the full benefit.

When can I drive?

You can start driving when you are comfortably walking in your own footwear. If you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. Start by sitting in the car and trying the pedals, then drive round the block. Drive short distances before long ones. If you are having surgery on your left leg and drive an automatic car, you could consider to start driving sooner, but only if you are safe to do so.

How quickly can I return to activities?

After a flatfoot reconstruction it varies how quickly people can return back to some activities. When comfortable in your own shoes gradually build up your walking distances. You will be guided by our physiotherapists during the rehabilitation program.

When can I fly after surgery?

If you are flying after recent surgery you are at an increased risk of developing a blood clot in one of the deep veins in your body, usually the leg (deep vein thrombosis or DVT). Please ask your surgeon for individual guidance on how long to delay flying after your surgery. Also, each airline has its own regulations about flying after surgery and you will need to check with your airline before flying.

Wellbeing Advice

Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.

Taking vitamin C supplements for six weeks before surgery and six weeks after surgery can also be beneficial. You can purchase them from your local pharmacy or supermarket.

If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.

We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.