Flat Foot Reconstruction
Flat foot reconstruction is surgery to restore the arch and alignment of a foot that has flattened and become painful. It is not a single operation but a combination of procedures selected for the individual foot, which may include tendon transfer, bone realignment and fusion of specific joints.
Many people have flat feet and never need treatment. Surgery is considered when the flattening is progressive, painful, and no longer controlled by non-surgical measures.
Why do flat feet become painful?
The most common cause in adults is failure of the tibialis posterior tendon, which runs behind the inner ankle and supports the arch. As the tendon stretches and weakens, the arch collapses, the heel drifts outwards and the forefoot turns away from the midline. Left unaddressed, what begins as a flexible deformity can become stiff and fixed over time.
Other causes include arthritis of the midfoot or hindfoot, previous injury, and inflammatory conditions such as rheumatoid arthritis.
What is tried before surgery?
Non-surgical treatment is the first approach and is often effective, particularly earlier in the condition:
Custom orthotics to support the arch
Supportive footwear
Bracing for more advanced cases
Physiotherapy focused on strengthening the tendon and surrounding muscles
Activity modification
Weight management where relevant
What does the operation involve?
The procedures are combined to match the deformity. Commonly used elements include:
Calcaneal osteotomy: Cutting and shifting the heel bone to bring the heel back under the leg, correcting the outward drift.
Tendon transfer: Using a neighbouring tendon to take over the work of the failed tibialis posterior.
Lateral column lengthening: Lengthening the outer border of the foot to correct the forefoot turning outwards.
Gastrocnemius recession: Releasing a tight calf, which contributes to the deformity in many patients.
Selective fusion: Where joints are already arthritic or the deformity is stiff, fusing specific joints to hold the correction.
Which combination is right depends on whether the deformity is flexible or fixed, which joints are involved, and the condition of the tendon. This is determined by examination and imaging, and is discussed in detail before proceeding.
Recovery
This is major reconstructive surgery and recovery is measured in months rather than weeks:
First six weeks: In a plaster or boot with no to minimal weight through the foot. Elevation matters a great deal in this period.
Six to twelve weeks: Imaging is used to confirm bone healing. Weight-bearing is introduced gradually in a boot.
Three to six months: Out of the boot into supportive footwear, with physiotherapy to rebuild strength and walking pattern.
Six to twelve months: Continued improvement in comfort and walking distance. Swelling commonly persists throughout this period and is expected.
Risks
As with any major operation there are risks, which will be discussed with you beforehand. These include infection, wound healing problems, blood clots, nerve injury, non-union where bone does not heal across an osteotomy or fusion, incomplete correction, and stiffness. Because several procedures are often combined, the operation is longer and the recovery more demanding than for most foot surgery.
Dr Janan's approach
Dr Janan completed fellowship training in Bristol, a major United Kingdom foot and ankle centre, and in Tokyo under Professor Satoru Ozeki, past president of the Japanese Society for Surgery of the Foot, where reconstructive and joint-preserving techniques are a particular focus.
Flat foot reconstruction is planned individually. The aim is to correct the deformity while preserving as much movement as possible, fusing joints only where they are already worn or where correction cannot otherwise be held.
Flat feet becoming painful or changing shape?
Book a consultation with Dr Janan Chandrananth to have your feet assessed and discuss what can be done, surgically or otherwise.
FAQs
I have always had flat feet. Do I need surgery?
Almost certainly not. Many people have flat feet lifelong without pain, and those feet generally need no treatment at all. Surgery is considered for feet that are painful and progressively flattening, not for the appearance of the arch.
Will orthotics fix the problem?
Orthotics do not correct the deformity, but they support the foot and can control symptoms well, particularly earlier in the condition. Many people manage indefinitely with orthotics and appropriate footwear.
Should I have surgery earlier rather than later?
There is an argument for it. While the deformity remains flexible, correction can often be achieved with osteotomy and tendon transfer, preserving joint movement. Once the deformity becomes stiff and the joints arthritic, fusion is more likely to be required. That said, surgery is still only appropriate when symptoms justify it.
How long will I be off work?
This depends heavily on your job. Desk-based work is often possible within a few weeks with the foot elevated, while work requiring standing or walking generally needs three months or more. This is worth planning for before surgery rather than after.
Will my foot look normal afterwards?
The aim is a well-aligned, comfortable foot that fits in normal shoes. The arch is usually improved but the goal is function rather than appearance, and a foot that has been reconstructed will not look identical to an unaffected one.
Will I need surgery on the other foot?
Not necessarily. Flat foot deformity often affects both feet but frequently to different degrees, and each is assessed and treated on its own merits. Both are rarely operated on at the same time given the weight-bearing restrictions involved.