Patient information
Flat foot / feet
Introduction
You have been diagnosed with a flat foot or feet. This leaflet explains what it is, how it is
diagnosed and outlines the treatment options.
What is a flat foot and why do I need treatment?
A flat foot or low arched foot is not considered abnormal - the height of the arch does not
have any bearing on how well a foot can function. However, a foot that rolls in excessively
with most of the weight passing on over the inside border, is a cause for concern.
Treatment is required in the severe cases where the degree of mal-alignment is such that
you currently experience pain or fatigue or are likely to do so. These patients are
considered to have a pathological flat foot.
Normally
aligned foot
Pathological flat foot
From behind the left
foot rolls in excessively
in comparison to a
relatively normal, right
foot. On the left side the
tibialis posterior tendon
has torn allowing the
foot to roll in
excessively.
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Patient information – Flat foot / feet
There are two types of flat feet:
Flexible
Here the foot is poorly aligned when standing but when sitting with the weight off the foot,
the deformity corrects itself. In these cases a reconstructive approach is normally
considered with the aim of producing a flexible but correctly positioned foot.
Rigid
Here the foot remains in a poor position irrespective of whether it is weight bearing or not.
In these circumstances it is not always possible to produce a flexible foot, the surgery
often requires fusion of bones in order to restore alignment.
What causes flat feet?
 Congenital (present at birth) mal-alignment..
 Tendon injuries, typically Tibialis posterior.
 Neurological and muscular diseases.
 Joint hypermobility (unusually large range of movement).
 Abnormal joining of two bones (coalition) resulting in a rigid flat foot.
 Arthritis.
How is it treated?
In the majority of cases pathological flat feet normally respond well to stretching exercises,
orthoses (shoe inserts) and supportive footwear. However, if you don’t respond to
conservative treatment or only in a limited fashion, then surgery might be considered.
Surgical treatment options are:
1. Talo-navicular fusion (lengthening of the calf tendon)
A tight calf muscle will cause your foot to roll in. This can be
rectified by lengthening the tendon just below the calf muscle
(gastrocnemius). An incision of approximately 10cm is made in
centre of the back of your leg and the tendon lengthened.
Lengthening of the tendon allows normal foot function but the calf is
often weaker than the other side. Rarely, the sural nerve is irritated
leaving numbness or hypersensitivity to the lower leg.
Here an incision is made on the back
of the calf and the tendon lengthened
in a tongue and groove fashion.
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Patient information – Flat foot / feet
2. Fusion of the foot
In cases where the foot is rigid either as a result of arthritis or the abnormal formation of
bones (coalition) then a fusion of part or all of the major (large) joints in the foot might be
considered. The ankle is not included, allowing the foot to move up and down, but the
rolling in and of the foot would be restricted. The foot would be repositioned to restore
alignment and stability.
The fusion might be of an individual joint
as seen below with a talo navicular
arthrodesis.
Or of multiple joints with a triple fusion of
three joints of the hindfoot.
What does surgery involve?
On the day of surgery you will be admitted to the ward and one of the nursing staff will
check you in, take your blood pressure and any other tests that may be required. The
surgeon will remind you of the surgical process and possible complications and ask you to
sign a consent form. You can eat before the operation as it is under local anaesthetic only
– the surgeon will numb your foot via a series of injections around the ankle. At some
point during the morning/afternoon you will be escorted to theatre. You may bring a
personal stereo or ipod with you.
The duration of the operation depends on the specific procedure you are having. The
wound will be closed using dissolvable stitches, after which you will have a bulky dressing
on your foot and a plaster cast on your leg, probably extending to your knee. You will be
shown how to use crutches. After surgery you will be given something to eat and drink and
you should start taking your painkillers. Once ready, you will be discharged home with an
escort.
You should not drive after foot surgery and should be accompanied home by a responsible
adult.
You will be advised of your follow up appointment date, either on the day or by letter in the
post.
How will I feel afterwards?
Although long-acting local anaesthetic, administered during the procedure, should control
most of the pain for about 8 to 10 hours, you can expect some pain or discomfort after the
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Patient information – Flat foot / feet
operation. Painkillers will be discussed with you prior to your operation and you should
bring these with you on the day of surgery.
Recovering from surgery
 You must rest with the leg elevated for the first 48 hours (and only move when necessary).
 It is important that you keep the cast clean and dry.
 You will be seen for review approximately 7 days after the operation.
 Around 2 weeks after surgery you will have a change of cast and X-rays taken.
 For some patients an additional partial weight-bearing cast or aircast walker boot is
applied for 4 weeks. The length of time you are in a cast for depends on the procedure
and how well you are healing. Once the cast has been removed exercises will be
prescribed.
 Depending on the type of operation you have had, an additional X-ray might be
required at 8 weeks.
 Returning back to activity and regular footwear is gradual and very much depends on
the type of operation, your body’s healing response and the individual’s level of
motivation.
 Once the cast is removed, you will be advised to return to a supportive shoe, e.g.
trainers.
 You can resume driving, as long as you feel safe and can perform an emergency stop.
What are the possible risks and complications?
The successful outcome of any operation cannot be guaranteed. The following information
outlines the more common complications relating to foot surgery in general and more
specifically to the type of operation that you are having.
General complications of foot surgery
 Pain. There will be post-operative pain. For most people the pain passes after 24-48
hours and is tolerable with regular painkillers (following dosage recommendations).
 Swelling. This is a normal outcome of any operation. The extent of post-operative
swelling varies and cannot be predicted. In some people the swelling reduces within a
matter of weeks and in others could take many months. Application of an ice pack
greatly reduces swelling.
 Infection. There is a small risk of infection with all surgery. If this occurs it will be
treated with relevant antibiotics. Look out for redness and discharge from the wound.
 Deep Vein Thrombosis. Also known as Venous Thromboembolism (VTE), this is a rare
complication of foot surgery under local anaesthetic. The risk increases if you are
having a general anaesthetic. There is also an increased risk if you take the
contraceptive pill, HRT or smoke. Immobilising the leg in a cast also increases the risk
of a DVT. If you have had a DVT in the past, please tell your surgeon. If you do have
certain risk factors you will have an injection to thin your blood on the day of surgery.
This might need to be repeated for up to 7 days following surgery.
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Patient information – Flat foot / feet
 Complex Regional Pain Syndrome (CRPS). This is a rare but difficult complication.
This is an abnormal response of the nervous system to surgery but can happen after
simple trauma. This can lead to a variety of painful sensations in the foot, which require
medical and pain relieving techniques.
 Scarring: As a result of your surgery you will have a scar on your foot. To begin with
the scar will be raised, red and sensitive but with time it will normally settle.
Specific complications of flat foot surgery
 Prolonged swelling taking more than 6 months to resolve occurs 1 in every 500
operations.
 Haematoma – a painful collection of blood within the operation site. (No recorded
incidents at WBCH).
 Thick and or sensitive scar.
 Screws and plates may need to be removed. This is often planned but can occur as a
result of irritation.
 Adverse reaction to the post-operative painkillers. 1 in every 50 patients report that the
codeine preparations can make them feel sick.
 Delayed healing of soft tissue or bone.
 Loss of sensation can occur although this is usually temporary but can take up to a
year to resolve.
 Reoccurrence of the deformity or failure of the operation: incidence is 1 in every 500
operations.
 Development of secondary problems including overloading of joints adjacent to the
ones operated on occurs in 1 in every 700 operations.
 For more information visit: www.footsurgery.uk.com.
Useful contacts
Day Surgery Unit, West Berkshire Community Hospital
WBCH Outpatient Department (WBCH)
Townlands Outpatients Department (Henley)
01635 273492
01635 273 348
01865 903 363
For more information about the Trust visit www.royalberkshire.nhs.uk
This document can be made available in other languages and formats
upon request.
Podiatric Surgery at West Berkshire Community Hospital, April 2015.
Review due: April 2017
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