The Complete Guide to Flat Foot Surgery
Immediate walking after stent implant Flat Foot Surgery!
While having flat feet doesn’t sound like a big deal, they are actually throwing the entire body out of alignment, which affects our ability to stand, walk, run, and exercise. Our doctors treat the more severe cases with procedures that require re positioning of the heel bone.
- No casts (stent procedures)
- No crutches (stent procedures)
- Our Board Certified Physicians are trained in all types of flat foot surgery.
- We are stent expert surgeons and ranked among the most experienced in the world.
Everything you need to know when considering flat foot surgery. For people who have flat feet and want to understand how to surgically correct flat feet. Medical Term: pes planus or fallen arches
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What are the different types of flat foot?
There are three different types of flat foot:
Flexible Flat Foot: This is the most common form of flat foot. It means that there is an arch when there isn’t any pressure on the foot, but when you stand the arch collapses. This type of flat foot can be put back into its “normal” position during standing.
Semi Flexible Flat Foot: With semi flexible flat foot, there isn’t much of an arch with or without pressure on the foot. The foot flattens out more during standing. This type of flat foot cannot be put fully back into its “normal” position.
Rigid Flat Foot: With rigid flat foot, the foot has no arch on or off the ground and it cannot be manually forced back into its normal position on or off the ground.
Surgical experience is crucial to success. Identification of possible bone blocks, called coalitions, and other deforming forces is very important. Our Physicians have the experience to properly evaluate your flat foot.
What Causes Flat Feet?
Flat feet occur when their is a misalignment in the hindfoot (ankle bone and heel bone) that is “forcing” the natural arch in your feet to lower.
When your feet are aligned: your ankle bone (talus) sits directly on top of your heel bone (calcaneus). The front edge of each bone is almost aligned with the other (the front edge of your ankle bone slightly overlaps the front edge of your heel bone) and there is a naturally occurring space in between them, called the sinus tarsi.
When your feet are misaligned: your ankle bone falls forward and out of line with your heel bone. This causes the sinus tarsi to collapse and the natural arch in your foot to fall flat as shown in the video below. In fact, having flat feet is not so much a symptom, as it is the visible collapse of the sinus tarsi.
More About Flat Feet
The term adult acquired flatfoot is more appropriate because it allows a broader recognition of causative factors, not only limited to the posterior tibial tendon, an event where the posterior tibial tendon looses strength and function. The adult acquired flatfoot is a progressive, symptomatic (painful) deformity resulting from gradual stretch (attenuation) of the tibialis posterior tendon as well as the ligaments that support the arch of the foot. Most flat feet are not painful, particularly those flat feet seen in children.
In the adult acquired flatfoot, pain occurs because soft tissues (tendons and ligaments) have been torn. The deformity progresses or worsens because once the vital ligaments and posterior tibial tendon are lost, nothing can take their place to hold up the arch of the foot.
The painful, progressive adult acquired flatfoot affects women four times as frequently as men. It occurs in middle to older age people with a mean age of 60 years. Most people who develop the condition already have flat feet. A change occurs in one foot where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Why this event occurs in some people (female more than male) and only in one foot remains poorly understood. Contributing factors increasing the risk of adult acquired flatfoot are diabetes, hypertension, and obesity.
The Scheme of Events Thought to Cause the Adult Acquired Flatfoot
A person with flat feet has greater load placed on the posterior tibial tendon which is the main tendon unit supporting up the arch of the foot. Throughout life, aging leads to decreased strength of muscles, tendons and ligaments. The blood supply diminishes to tendons with aging as arteries narrow.
Heavier, obese patients have more weight on the arch and have greater narrowing of arteries due to atherosclerosis. In some people, the posterior tibial tendon finally gives out or tears. This is not a sudden event in most cases. Rather, it is a slow, gradual stretching followed by inflammation and degeneration of the tendon.
Once the posterior tibial tendon stretches, the ligaments of the arch stretch and tear. The bones of the arch then move out of position with body weight pressing down from above. The foot rotates inward at the ankle in a movement called pronation. The arch appears collapsed, and the heel bone is tilted to the inside. The deformity can progress until the foot literally dislocates outward from under the ankle joint.
How are my Flat Feet Affecting Me?
It is important to understand that not all people who have misaligned feet have flat feet. About 25% of people with a foot misalignment have a normal arch. This is because of individual bone structure—the tilt in their heel bone is higher than usual. It is common for those with flat feet to be prescribed expensive orthotics or insoles. While these may provide slight relief, they don’t prevent your sinus tarsi from collapsing and only work when you are wearing shoes.
While having flat feet doesn’t sound like a big deal, they are actually throwing the entire body out of alignment, which affects our ability to stand, walk, run, and exercise. Think of the wheel alignment on a car—when the alignment is correct, the wheels provide a sound foundation for the car. However, if the wheels are out of alignment, you feel abnormal vibrations throughout the car and a “pull” on the steering wheel as the car slides in the direction emphasized by the misalignment. Your body works in a similar fashion.
When your feet are correctly aligned, so is the rest of your body. However, if your feet are flat, or misaligned, it creates a chain reaction of misalignment up the rest your body. This results in abnormal strain and pressure acting not only on your feet, but on your ankles, knees, hips and back, which leads to a variety of seemingly unrelated symptoms including: bunions, heel pain (plantar fasciitis), hammertoe, growing pains, back pain, knee pain, hip pain, shin splints and weight gain.
The Three Stages of the Adult Acquired Flatfoot:
Stage I: Inflammation and swelling of the posterior tibial tendon around the inside of the ankle.
Stage II: Visible deformity comparing one foot to the other, as the symptomatic foot becomes flatter and more deformed. The deformity is movable and correctable in this stage.
Stage III: The foot progresses to a rigid, non-movable flat foot deformity that is painful, primarily on the outside of the ankle.
Flat Feet. How Can Minimally Invasive Stent Procedures Help?
Stent Procedures require a small titanium stent that is inserted into the sinus tarsi fixing flat foot at its root by keeping the sinus tarsi in a stable open position. This keeps your ankle bone from sliding forward and off of your heel bone and the rest of your body in its natural alignment. Our implants have many advantages over other’s on the market.
- Safety tm Stents are the most advanced implant we have used.
- Removable with minimally invasive surgery.
- Value based. If not covered by insurance, are more cost effective than many others.
While stent procedures can take as little as 10 minutes to perform, choosing a position with experience can make a big difference when it comes to implant sizing and selection, patient selection, ancillary procedure selection, and reducing potential for any complications. Our surgeons are some of the most experienced in the world at this procedure.
What can be done for more severe cases?
Our doctors treat the more severe cases with procedures that require re positioning of the heel bone. Common among these are the Evans calcaneal osteotomy, the cotton osteotomy, and other sliding or wedge procedure designed to get the heel back under the body. The important take away here is the we have the experience to perform the necessary treatment. “The best way to find a skilled surgeon is to ask a hospital OR nurse or scrub tech who they would use if they needed to have surgery”.
Travis’ Story of Flat Feet
Ryan’s Story of Flat Feet
We Offer Individualized Treatment Options Specifically Tailored For Your Feet
Why Choose Feet For Life
Feet For Life Centers located in St. Louis and Chesterfield MO offer the most innovative and up-to-date solutions in treating flat feet. You can expect little downtime, fast healing, minimal scarring, and minimal chance of complications when you choose to be treated at our Center. Read about our State-Of-The-Art Surgery Center Here.
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Dr. Horwitz is the leading podiatrist in the country and top podiatric surgeon in Midwest. His commitment to professionalism through extensive research, innovation and practice along with providing the best possible care in a patient friendly medical environment has given him a great reputation and trust among thousands of his patients.
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