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Bunion Clinic

Adult Acquired Flatfoot

This is a gradual, progressive flattening of the foot with loss of the medial arch. This problem occurs most commonly in women older than 50 years. It is thought to be due to dysfunction of the tibialis posterior tendon which runs behind the ankle joint into the foot on the medial or inside of the foot and ankle. It is often not associated with a traumatic event, but related more to a soft tissue imbalance and degeneration.

Weight-bearing X-rays of the foot and ankle are required. At times CT or MRI scans are required.
Flatfoot due to failure of the tibialis-posterior tendon cannot be reversed with surgery, but many patients can manage their symptoms with non-operative measures. These measures do not modify the course of the disease.

  • Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
  • Footwear modification: lateral heel wedge, flared sole
  • Activity modification: improve fitness and strength via non axial loading exercises e.g. cycling, swimming.
  • Physiotherapy: strengthening of peroneal tendons, proprioception including wobble board and/or stretches
  • Weight loss management
  • External lace up ankle brace support or taping
  • Protected weight-bearing may be required

Considered if symptoms are progressing and function is decreasing after a trial of non surgical treatment.
Depending on the extent of disease, surgical options may include:

  • Bone realignment osteotomy: cutting the heel bone and fixing with a screw
  • Bone realignment osteotomy: cutting the medial cuneiform bone and inserting a wedge.
  • Fusion of the first TMTJ may be required
  • Debridement and repair of the tibialis posterior tendon with its adjacent tendon (Flexor Digitorum Longus) or performing a transfer
  • Spring ligament repair or reconstruction.

Please find more information in the post-operative protocol section for your specific surgical procedure.
All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

  • Infection: superficial wounds or deep infections
  • Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
  • Nerve damage: tingling, numbness or burning
  • Ongoing pain
  • Stiffness
  • Non union: in a fusion the bones may not heal together adequately
  • General or anaesthetic risks including to the heart and lung
  • Drug reactions/allergy
  • Hardware complications
  • Revision surgery
  • Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery

Non weight-bearing in a plaster cast for 2 weeks.
Partial weight-bearing or non-weight-bearing in a CAM boot between 2 to 6 weeks (depends on nature of surgery).
Commence physiotherapy at 6 weeks.
Return to most activities around 6 months.
A full recovery may take up to 12 months.

General info:

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

  • Infection: superficial wounds or deep infections
  • Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
  • Nerve damage: tingling, numbness orburning
  • Ongoing pain
  • Stiffness of the ankle joint
  • General or anaesthetic risks including to the heart and lung
  • Drug reactions/allergy
  • Scarring or tethering of the skin
  • Rerupture
  • Calf weakness
  • Revision surgery
  • Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery

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