Rigid Flatfoot Deformities: Treatment Options

Rigid Flatfoot Deformities: Treatment Options

This video will review the treatment options for rigid flatfoot deformities, which may be referred to as progressive collapsing foot deformities. Flatfoot deformities occur on a spectrum, with rigid deformities being a more advanced stage of this condition in which the deformity is fixed and often accompanied by arthritis. In more advanced forms of rigid flatfoot deformities, the ankle joint is involved and arthritic as well.

Because the condition involves many structures in the foot, especially in the later stages, treatment options may vary and be combined. There is not one accepted treatment path for this condition in later stages. Given the structural compromise of the condition and progressive symptoms of pain, surgical intervention is often warranted in later-stage deformities. Given underlying health issues, some patients may not be candidates for surgery. Therefore, nonoperative treatments may be advised, such as rest, bracing, physical therapy, and anti-inflammatories to assist with symptoms.

A health care provider may recommend a custom molded support brace, also called an AFO, to improve the stability of the ankle and provide support to the foot. Surgical treatments may focus on soft tissue and bony procedures in various regions of the foot and ankle. Beginning with the inside of the foot and ankle, soft tissue repair may focus on the deltoid ligament. This vital ligament maintains the stability of the inside of the ankle and arch. It may require repair or reconstruction. This procedure is typically done with bony fusion procedures that correct the underlying structural issues that have occurred.

Depending on the patient's needs, fusions may require screws, plates, or staples, and can be done in a variety of places on the foot. Procedures in the back of the foot may include the soft tissue release of the muscles in the calf to improve ankle mobility. This may be accompanied by joint fusing surgery due to arthritis and pain. One such procedure is called a subtalar fusion. Here, the talus and calcaneus bones are fused. A talonavicular fusion, in which the talus and the navicular bones are fused, may be done in conjunction with the subtalar fusion. If so, it is called a double fusion.

On the outside of the ankle, the calcaneocuboid joint may require fusion. This joint is located between the heel bone and the cuboid bone. It will be called a triple fusion if it is completed with the subtalar and talonavicular fusions. A triple fusion is a reliable treatment for improving pain and functional limitations associated with a rigid flatfoot deformity. It has been described and refined as a treatment approach since 1923.

A forefoot deformity may occur in compensation for a rigid flatfoot deformity. An osteotomy, or cut in the bone, may be needed in the front of the foot to address this. This typically is done with other procedures. If a patient has developed severe ankle arthritis because of the condition's progression, an ankle fusion could be required in addition to the other procedures.

If treatment with surgery is required, most patients will have a period in which they will be non-weight-bearing to allow fusion sites to heal fully. Once healing is seen on x-rays, patients will be transitioned to weight-bearing and may require several weeks of additional bracing. Physical therapy will be ordered to assist with this transition.