Flexible Flatfoot Deformities: Treatment Options

Flexible Flatfoot Deformities: Treatment Options

This video will provide an overview of treatment options for flexible flatfoot deformities. Given this condition occurs on a spectrum of progression, treatment options must be tailored to the stage of the condition and may vary depending on underlying patient factors such as general health and severity of symptoms. Multiple treatments are agreed upon, and thus, a variety of options are presented here.

In most cases of flexible flatfoot deformity, treatment without surgery will be considered first. The goal of treatment without surgery is to help with pain and tension along the posterior tibial tendon, the main tendon associated in this condition in early stages. Rest may be prescribed along with bracing to offload the tendon's movement, including options like a boot or a cast. Despite encouraging rest, it is important to continue walking in a supportive device as this may encourage healing of the tendon.

While anti-inflammatories by mouth may be helpful along with rest and bracing, steroid injections, which also minimize inflammation, are not typically used in early stages due to concern that this could weaken the tendon. Physical therapy is a key portion of treatment without surgery, as this can minimize inflammation in the tendon. Once pain is relieved, additional strengthening exercises may be provided. Lastly, custom orthotics or braces may be ordered to support a long-term, nonoperative approach.

Surgery may be warranted in patients who continue to have symptoms despite a thorough trial of treatments without surgery over several weeks. There are several surgical options for correction of flexible flatfoot deformity. Treatments may address soft tissue and bone alignment issues. In the earliest form of flatfoot deformity, the posterior tibial tendon is inflamed and thickened and is the primary cause of pain. A procedure called a tenosynovectomy may be offered. This procedure removes the inflamed layer of tissue surrounding the tendon to improve function and minimize pain. This can be done in a minimally invasive approach.

When the posterior tibial tendon is beyond repair in this fashion, additional surgical options may be warranted to include a procedure called a tendon transfer in which a nearby tendon is moved into a position to help support the function of the damaged tendon. Rarely is this procedure done alone. There are several other soft tissue and bony procedures that may be required. Soft tissue procedures may include the surgical release of tight muscle in the calf, or internal support sutures for the additional weakened structures around the ankle. Bone procedures may include an osteotomy in which bone is cut and realigned. These can be done in a variety of areas on the foot.

Surgical recovery times vary depending on the procedure or procedures chosen. A patient will be placed in a protective splint, cast, or brace for several weeks after surgery and may be non-weight-bearing for a period. Physical therapy will likely be ordered and will be tailored to the patient's individual needs. For any treatment path, these foot deformities will be monitored over time to watch for any progression of symptoms.