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Flatfoot Reconstruction

Flatfoot Reconstruction

What is Flatfoot Reconstruction?

Foot reconstruction is a surgery performed to correct the structures of the foot and restore the natural functionality of the foot that has been lost due to injury or illness.

Flatfoot or pes planus is a condition in which the foot does not have a normal arch when standing.

What are the Indications for Flatfoot Reconstruction?

The primary objectives of flatfoot reconstruction are reduction of pain and restoration of function and appearance. This can greatly benefit your medical and aesthetic needs. The surgery to be performed depends on several factors such as your age, severity, and duration of the symptoms.

It is often recommended when conservative treatments fail to resolve the symptoms.

How is a Flatfoot Reconstruction Performed?

The traditional method of treating flatfoot is replaced by a minimally invasive technique (arthroscopy) that can be performed on an outpatient basis.

This procedure is usually performed under general anesthesia. A few tiny incisions are made by your surgeon to insert an arthroscope and miniature surgical instruments into the joint. The camera attached to the arthroscope displays the internal structures on a monitor and your surgeon uses these pictures to evaluate the joint and direct the small surgical instruments either to repair or remove the damaged bone or tendon depending upon the extent of the injury.

At the end of the procedure, the surgical incisions are closed by sutures or protected with skin tapes and a soft dressing pad is applied. Depending upon the surgery, your surgeon will place a cast or a splint to prevent movement of the foot until it regains normal functioning capacity.

What are the Advantages of Arthroscopic Flatfoot Reconstruction?

Some of the advantages of arthroscopic surgery include:

  • Minimal trauma to the surrounding structures
  • Shorter recovery time with less post-surgical complications
  • Greater range of motion with less postoperative pain
  • Decreased muscle atrophy

What is the Post-procedural Care for Flatfoot Reconstruction?

Following are the post-surgical guidelines to be followed after reconstruction:

  • Make sure you get adequate rest and avoid using the affected foot for a few weeks.
  • Take medications to help alleviate pain and inflammation as prescribed by your doctor.
  • Apply ice bags over a towel to the affected area for about 15-20 minutes to reduce postoperative pain and swelling.
  • Compression dressings (bandage) are prescribed to support the foot and reduce swelling. Take care not to wrap the bandage too tightly, which could constrict the blood vessels.
  • Keep the foot elevated at or above the level of your heart to help minimize swelling and discomfort.
  • A wheelchair may be required for a few days in more severe cases.
  • Start rehabilitation (physical therapy) as recommended by your surgeon to improve range of motion.
  • Crutches or a walker may be used to maintain balance or stability while walking. You should begin appropriate exercises to stretch and strengthen the muscles.
  • Cover the splint while showering to keep it clean and dry.
  • Return to sports once the foot has regained its normal strength and function with your surgeon's approval.

The outcome of flatfoot reconstruction surgery is greatly improved when you, your surgeon, and the physical therapist work together as a team.

1. Nano Tendoscopy (including Bioresis Screw)

This includes:

  • Visualizing the PTT through keyhole surgery, debriding the tendon.
  • Using the placement of a biorhesis screw through the calcaneus to lift the foot, creating an arch.
  • Seeding of stem cells from patient’s iliac crest.

When it is needed:

  • PTT

2. All American Procedure

This includes:

  • A heel bone slide, tarsal metatarsal fusion, lateral column lengthening as well as tendon transfer and ligament reconstruction.
  • Seeding of stem cells from patient’s iliac crest.

When it is needed:

  • Grade II or early Grade III PTT

You can get around this if:

  • You can unilaterally toe raise and have limited degeneration or tearing of the PTT.

Old Approaches vs. New Approaches

Surgery has traditionally been involved with tendon transfers and bone osteotomies that used to take up to one full year to recover. This so called All-American procedure has excellent outcomes but it is not always required for lower grade PTT deficiencies. NYU surgeons have pioneered minimally invasive procedures that allow the foot to be realigned with small incisions and allow the tendon to regenerate when mild to moderate degeneration of the tendon is present. This has changed recovery times drastically. Using a nanoscope through a 2mm incision allows us to visualize the PTT and subsequently remove areas of degeneration. Then the patient’s own stem cells obtained from their bone marrow can be injected into the tendon to facilitate repair.