Flat feet surgery: when is it really needed?
Flat foot, also called Pes Valgus (technically “valgus pronation of the foot”) is a lowering of the internal plantar arch that can be of varying degrees. In the extreme case it can can even reach a complete flattening. But when flat feet surgery is really needed?
Flat foot is a common worry for parents and it is the first cause for paediatric orthopaedic consultations. First of all, it must however be considered that children are naturally born with flat feet. It is actually during the growing process that the plantar vault forms. And the foot reaches its maturity only around the age of 10-12 years.
Once the child has reached this age and it becomes clear that the child’s foot has not developed normally, then the parents must consult a paediatric orthopaedic surgeon to figure out if any treatment is needed, including flat feet surgery.
There are different opinions on the effectiveness of exercises that can improve flexibility and foot maturation, such as standing on tiptoes and moving the big toe. Also the use of insoles might help the maturation of the foot in a positive way.
Insoles are certainly useful for small children who have a severe deformity of the foot, because they help the bones to better reach maturity, allowing them to mould together, but they don’t guarantee the solution of the problem.
However, the foot reach or doesn’t reach maturity almost independently from external actions.
If around puberty, the foot has not yet reached maturation and an abnormal flatness of the medial arch persists, there is the possibility of carrying out a minor flat feet surgery that can immediately correct the foot arch and restore the normal biomechanics. This is a simple and minimally invasive surgery. The orthopedic surgeon shares the decision with the family and, of course, after a clinical evaluation based on a physical and X-ray examination.
Specifically, flat feet surgery consists of inserting a screw into the calcaneus at the level of the sinus tarsi. This is a virtual cavity in front of the lateral malleolus. The technique requires a one centimetre incision under deep sedation and local anesthesia. After flat feet surgery, no plaster is needed and the child is discharged from hospital the same day and can return home. By the next day the child can already stand on the foot and after about a week the child can walk without any support.
After flat foot surgery, only a small percentage of cases experiences intolerance to the screw, which can create discomfort and also pain: in this case the treatment is initially conservative with drug therapy, physical therapy and manipulation. If the pain persists and is very disabling, the screw is removed; in this case about 35% of the feet keep the correction previously obtained.
A not obvious observation is that this condition affects both feet in the child; therefore flat foot is double-sided, although the flattening may be of a different entity.
However, any surgery for flat feet will initially be performed only on one foot, observing the improvements and reactions to the inserted screw in the following 6-8 months. This is way it often happens that the second foot “spontaneously” corrects after the operation on the first one. Flat foot surgery actually acts on a complex system of motor control, regulated by the spinal cord, which allows a reconditioning of the muscular forces acting on both feet.
In conclusion, if parents observe a tendency to develop flat feet in their child, they should not be in a hurry and wait until they are 10-12 years old before undergoing a first specialist examination aimed at diagnosing and planning an eventual surgical correction.
On the other hand, the problem should not be underestimated when the foot is flat after its maturation. If flat foot is not treated, in growing child, the child may experience an evident foot deformity with pain and difficulty to walk.