DEFORMITY CORRECTION

When discussing treatment of the adult flatfoot, most patients can be helped with orthotics, braces, and physical therapy. In patients who have tried these treatments without any relief, surgery can be a very effective way to help with the pain and deformity. Surgery is focused on reconstructing the foot to as close to its normal anatomy and alignment as possible. This usually includes tightening of the posterior tibialis tendon, which originates in the posterior leg and extends into the arch becoming a key support structure. Surgery may include osteotomies (cuts and movement of bone) to the foot to improve proper functioning alignment. Lastly, surgery can include an array of other ligament & tendon rebalancing to support the renewed alignment of the foot.

Adolescent Flatfoot:

Adolescent flatfoot is treated with even more conservation due to the

Adult Acquired Flatfoot:

Flat feet are a very common and often asymptomatic deformity that occur due to how the foot functions during walking or standing. Most patients describe the condition as a fallen arch with their foot pointed outward. Over time, these deformities can become painful or worse in appearance and need to be treated. Common causes of flat feet in the adult can be associated with degeneration of the supportive soft tissue and joints that create the arch of the foot. This is usually secondary to how our foot functions and compensates during normal walking and daily activity.

fact that children are still growing. Parental concern is understandable, however most children with flat feet eventually gain some form of an arch and natural foot function. When discussing treatment of the adolescent flatfoot, most children can be helped with orthotics, braces, and physical therapy. Children with persistent pain associated with a flatfoot is concerning and can often be due to what is known as a tarsal coalition. Tarsal coalitions are an abnormal connection of two or more of the bones in the foot. The bones affected are located near the back of the foot and the heel, and can result in a rigid and severe flatfoot. In some cases, treatment for tarsal coalitions usually requires surgery to resect the fused bones.

High Arch (Cavus Foot):

A high arched foot (cavus foot) is the opposite of a flatfoot. Cavus foot is a condition in which a patient has a foot with a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. Patients also complain of worsening hammertoe deformity, calluses on the ball, side, or heel of the foot, pain when standing and walking, and an unstable foot due to the heel tilting inward.  

There are a variety of underlying causes of a high-arched foot structure. In many cases, the cause is unknown. In other cases, the cause is a nerve disease, clubfoot or injury. Treatment ranges from conservative to surgical intervention. Conservative therapy consists of custom orthotics, ankle-foot orthoses, shoe gear modification, and physical therapy. If conservative management fails, surgery is occasionally required to realign the foot. There are a wide range of surgical procedures involved with the correction of the cavus foot. These procedures may include correction of the bony deformity, tightening of ankle ligaments, tendon transfers to offset the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.

 

Diabetic Charcot Foot:

Charcot Arthropathy is a condition characterized by fractures and dislocations of bones and destruction of joints in the foot and ankle with minimal trauma. This condition occurs due to complete loss of sensation in the lower extremity, also known as peripheral neuropathy. ​Initially, there may be swelling, redness and increased warmth of the foot and ankle. Later, when fractures and dislocations occur, there may be severe deformities of the foot and ankle, including collapse of the midfoot arch (often known as a “rocker-bottom” foot) or deformity and instability of the ankle and hindfoot. These deformities may cause ulcerations which can become infected and require antibiotics, hospital admissions, and even amputations. In the early stages of this condition, patients are typically immobilized in a cast called a total contact cast. To prevent further complications, different conservative modalities may be utilized such as custom molded diabetic shoes and Charcot restraint orthotic walker boots. These devices are fitted from a personal mold of the patients foot and assist to prevent ulcerations or to offload wounds to allow healing. When the deformity is to great and the patient is medically optimized, surgical reconstruction of charcot deformities may be considered. Surgical options range from realignment osteotomy and fusion (correction of deformity), ostectomy (removal of bony prominence that could cause an ulcer), tendon lengthening (correction of Achilles tendon contracture). The goal is to rebuild the foot so the patient has a stable plantigrade foot without pressure points causing ulcerations.

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© Copyright 2019 by Jonathan Hook DPM, MHA. All Rights Reserved.