Treatment options for flatfoot
Treatment for flatfoot depends on the diagnosed stage or degree of the malposition. To determine the stage, we examine the foot in lying and standing positions (under load) and check its mobility. Further information can be obtained from an X-ray image taken while the foot is under full weight bearing.
Especially during the first stages of flatfoot, conservative (i.e. non-operative) measures such as orthopaedic insoles and strengthening exercises, as well as physiotherapy, can offer valuable support.
Operative treatment in the progressive stages:
When conservative means of manageing flatfoot are exhausted, a smoothing and cleaning of the strained, irritated tendon (endoscopic tenosynovectomy) can often bring relief and support the patient with straightening the arch of the foot. An alternative to endoscopic surgery at this stage is open tendon surgery, which maintains the functionality of the tendon.
An important measure at this stage is examination of the ligament’s stability. In case of instability, an operative ligament reconstruction surgery (ligamentoplasty) is advised, reconstructing the weakened spring ligament. This helps counteract a further lowering of the foot’s arch as well as any subsequent malpositioning.
At this stage, with instability being a constant companion, reconstruction of the ligamentous apparatus and muscle-tendon function is advised. In order to enable mobility and actively raise the arch, tendon transfer is usually necessary. An adjacent tendon in the body is inserted into the tibialis tendon, which is responsible for the active stabilization and straightening of the longitudinal arch of the foot.
Very often, however, soft tissue measures are no longer sufficient and bony corrections are additionally necessary. These corrective osteotomies are joint-preserving surgical measures, maintaining the function of ankle joints.
In such cases the Foot and Ankle Center Berlinapplies an adjustive combined realignment, comprising an individually adjustable Rhise-factor, which additionally supports the stabilizing effect of ligament surgery.
In the case of a pronounced malposition in stage 3, the joint-preserving bone corrections (corrective osteotomies) introduced in stage 2 become absolutely necessary as a biomechanical therapy procedure to correct the malpositions.
In cases of pronounced instability and/or considerable contracture (soft tissue scarring and incapacity for muscle tendon regeneration, as in the case of underlying rheumatic diseases), the stiffening of a facet joint (arthrodesis/fusion) may be necessary to achieve a sustainable result. This completely preserves the mobility of the upper ankle joint.
A selectively-adaptive facet-fusion developed by Dr. Boack, combined with a joint-preserving adjustment, can further add to a stabilizing effect, allowing for mobility of the foot with almost no noticeable impairment.
If secondary arthrosis of the ankle joints occurs in stage 4, in addition to joint-preserving bone corrections (corrective osteotomies) (see stages 2 and 3), a stiffening of the affected facet joints (arthrodesis) is also necessary in order to enable a good positioning and pain-free function of the leg/foot.
Arthrodesis is one of the most important procedures in foot and ankle surgery. There are 26 different joints in the foot and ankle. By targeted stiffening of facets, the individually-adaptive technique applied at the Foot and Ankle Center Berlin achieves significant stability, a good position of the foot, and, by relieving pain, an improvement in its functionality – so long as the upper ankle-joint is retained.
In cases where the upper ankle joint is also compromised, we usually recommend at this stage the targeted use of an ankle replacement rather than complete stiffening, thus avoiding overload of the neighboring joints and enabling a largely natural motion sequence.
Having conducted over 1,200 ankle endoprosthesis implants, Dr. Boack is one of the most experienced surgeons worldwide in this field.