How is the Surgery Performed?

There is a range of surgery performed for flat feet in adults. The surgery you have depends on how far the disease process has progressed in your tendon.

At an early stage, the tendon is very sore but it is still working. Cleaning out the sheath around the tendon can settle symptoms.

When the tendon has stretched or snapped, then surgery is considered if insoles have not been successful in alleviating symptoms. This surgery involves either fusing bones in the back of your foot or breaking the heel bone and re-aligning it to support the arch of the foot and plugging a different tendon into the arch. These operations tend to work if the joint are still mobile. This surgery can take two hours.

If the disease process has progressed beyond this and the joints are not mobile, then bony surgery is all that can be performed. This involves fusing three of the joints in the back of the foot - a triple fusion. The incisions are shown on the left. This re-aligns the foot, and relieves pain, but at the expense of side to side movement of the foot. This surgery often takes three hours. In order for the bones to fuse, ‘spare’ bone is taken from inside the  top end of the shin bone to fill in any spaces.

If the disease has progressed even further, the ankle is arthritic as well. The only solution here is surgery and this involves inserting a metal rod up through the heel into the shin bone. This is called hindfoot nailing. This can take three hours. The bottom few inches of the fibula bone is removed to allow the joints to be fused properly.

After all bony surgery, the leg is encased in plaster of paris. You can go home 48 hours after surgery, so long as your pain is well controlled and you are mobile with crutches.

Surgery is carried out under general anaesthetic, but I also give local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation.

Risks of Surgery

Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation. If you are in plaster of paris, we can decrease the risk of DVT by using a blood thinning injection each day.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

triple fusion surgery

triple fusion surgery

hindfoot nailing

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