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Symptoms, consequences, treatment, exercises & surgery

Flatfoot

Learn everything you need to know about flatfoot and flatfoot surgery in this article by foot expert Dr. Florian Wenzel-Schwarz, from Vienna. He talks about how to recognize flatfoot, how to prevent flatfoot surgery, and most importantly, why many patients can be greatly helped by flatfoot surgery to get their symptoms back under control. Before flatfoot surgery, always find out about possible surgical methods and whether bone screws (screws made from human bone), such as the Shark Screw®, can be used in your surgery to avoid possible further surgery to remove metal, as with screws and plates made from metal.

Reading time: 6 min

Author of the article: Dr. Florian Wenzel-Schwarz
Specialist in orthopedics and traumatology
Updated 19.01.2023

What are the reasons for flatfoot surgery?

“For a Flatfoot surgery often offers the chance of long-term pain relief. Screws made from human bone in particular have proven their worth here, as they do not have to be removed during a possible second operation like metal screws and plates.” The expert explains, Dr. Florian Wenzel-Schwarz, which is in Vienna and Neusiedl am See as a podiatrist and orthopedist is active.

“Many patients try to manage the symptoms of flatfoot in the first step without surgery, that is, conservatively. Here, above all, targeted physiotherapy plays an important role. Furthermore, orthopedic insoles or orthopedic shoes can help. However, if there is no pain relief or if it is only short-lived and the foot malposition is too advanced, in most cases only surgery will help to relieve the pain in the long term,” the expert continues. Many experts therefore advise flatfoot surgery for advanced flatfoot symptoms, as this can relieve the symptoms, in most cases, in the long term.

“Before your flatfoot surgery, clarify what materials will be placed in your foot and what techniques your doctor practices. As a result, many clinics are trained to work with Shark Screw® and are familiar with common flatfoot surgical techniques. But not every clinic is trained to provide Shark Screw®. In addition to these Shark Screw® experts and centers, there are also clinics that insert metal screws and metal plates into the bone for flatfoot surgery,” said Thomas Pastl, CEO of surgebright.

Are you looking for a flatfoot expert who can provide you with Shark Screw®, saving you from a possible second metal removal surgery? Feel free to ask. An experienced Shark Screw® expert in your area will be quickly recommended.

What is a flatfoot?

Flatfoot is a foot deformity that can be either congenital or acquired. The foot is said to be flat-footed if the entire sole of the foot lies flat on the ground. The reason for this is the lack of natural arching of the foot and the consequently sinking, inner foot edge. In more extreme cases, the Achilles tendon may also be shortened or the tibialis posterior/ FDL tendon may be non-functional / torn. Special forms of flatfoot include buckling flatfoot, or dropfoot. If you want to clarify whether you have a flatfoot, we always advise you to talk to a specialist such as Dr. Florian Wenzel-Schwarz, orthopedist and foot orthopedist from Vienna.

Learn everything about flat feet in this expert talk with Dr. Florian Wenzel-Schwarz. To watch more videos from the playlist, click here.

Click here for the complete flatfoot playlist on YouTube!

How can a flat foot be treated?

“The most appropriate therapy depends on the extent of the deformity. Basically, however, there are two ways to treat a flatfoot: The conservative flatfoot therapies and the surgery of the flatfoot. Mild deformities can be treated well with conservative therapies. These include special orthopedic shoe inserts or custom orthopedic shoes that restore the shape of the foot. Targeted physiotherapy and specific gymnastic exercises are also essential. In case of involvement or inflammation of the tibialis posterior tendon, anti-inflammatory drugs and plaster immobilization can be resorted to. Depending on the stage of the flatfoot or the discomfort it causes, it makes sense to treat it with surgery in advanced stages.” Says Dr. Florian Wenzel-Schwarz, who relies on Shark Screw® for the treatment of his patients.

Testimonials during flatfoot surgery

Testimonials about flatfoot surgery are often hard to find on the internet. To get real testimonials, it often helps to exchange with other sufferers in a forum. In such a flatfoot forum, for example, affected people talk about their experiences and how they managed to get their flatfoot problems under control. Why young athlete Roman Peherstorfer decided to have surgery for his flat foot, he tells in this video.

Does surgery really help with flatfeet? Or are conservative treatments more appropriate. Roman Peherstorfer talks about his experience with flatfoot surgery.

Plattfuß vor einer Plattfuß-Operation
Plattfuß nach einer Plattfuß-Operation

Left/Top: Illustration of a flat foot before surgery.
Right/bottom: Image of a flatfoot after surgery with Shark Screw®.

6 points to know about flatfoot surgery!

When should you operate on a flat foot?

“Especially in patients with a very pronounced flatfoot, in whom no success can or could be achieved with conservative therapy attempts, I recommend surgery. If the cause of the flatfoot is an underlying disease, e.g. of neurological or rheumatic origin, this must also be clarified and treated. Instability of the foot and osteoarthritis or damage to the tibialis posterior tendon are also common triggers for pain and increasing deformity. Often, pain triggered by this can only be alleviated by flatfoot surgery and symptoms of flatfoot can be permanently eliminated.” Thus the foot expert with ordinations in Vienna and in Neusiedl am See.

Die Pathologien Des Fußes: Plattfuß, Normaler Fuß Und Hohlfuß

The 3 stages of flatfoot according to Klass:

Stage 1:

Flatfoot can be treated with conservative therapies. In this case, it is corrected with the help of wearing special orthopedic insoles. The Achilles tendon may already be slightly shortened at this point. The lowering can still be corrected occasionally by wearing custom-made insoles. The rear part of the foot can already point outward. Talk to your doctor.

Stage 2:

There is a shortening of the Achilles tendon. In addition, the rear part of the foot shifts additionally there is an abduction of the front foot. Conservative therapies such as orthopedic insoles in combination with special shoes are usually futile. Many patients opt for surgery at this stage.

Stage 3:

The heel stands tall and the anklebone head protrudes from the inner edge of the foot. The forefoot is also permanently splayed. Conservative therapies do not improve the foot deformity at this stage. Check with your doctor about each surgical option and whether screws made from human bone would be considered to prevent a second surgery.

What are the surgical methods for flatfoot?

OP-Methode

Vorgehen

Calcaneus Osteotomie / Fersenbein Osteotomie

Verschiebung des Fersenbeines, Fixierung durch Schrauben

Operation der Tibialis-posterior-Sehne

Transfer einer Sehne

Gelenkversteifung

Versteifung mit Schrauben

Calcaneus-Stopp-Schrauben - Arthrorise / (bei Kindern)

Schraube wird in das Fersenbein gebracht - verhindert somit das Abknicken des Fußes

Evans-Osteotomie

Verlängerung des Fußaußenrandes

Cotton-Osteotomie

Anheben des Fußgewölbes

Calcaneus osteotomy / calcaneal osteotomy
In the calcaneus osteotomy, the calcaneus is osteotomized i.e. cut and moved inwards or outwards by about 1cm. The displacement of the calcaneus is fixed by screws. Calcaneus osteotomy is sometimes the most commonly practiced surgical technique for the correction of flexible flatfoot deformity without advanced osteoarthritis. Screws from bone (bone screws) no longer need to be removed. On the other hand, the use of metal screws and plates may result in metal removal, as the surrounding tissue (Achilles tendon, skin, etc.) may be irritated by the foreign material.

Tibialis posterior tendon surgery
Transplantation of a healthy tendon in the case of a severely degenerated tendon or removal of the inflamed connective tissue around the tendon while preserving function.

Joint stiffening
under correction of the hindfoot, this usually involves the lower ankle joint and is stiffened with screws.

Calcaneus stop screws – Arthrorise / (for children)
In this procedure, a small skin incision about 0.5 to 1cm long is made directly on the outside in the area of the outer ankle on the foot. A screw is then inserted into the calcaneus at this point. The inserted screw is thus intended to prevent the foot from bending inwards. Growth causes the foot skeleton to still be able to adapt accordingly. Disadvantage of this surgical technique: In the vast majority of cases, the screw is removed again after about 3 years, at the latest when growth is complete. Advantage: Fast and in experienced hands simple operation with low risks.

Evans osteotomy
In this case, the bone (the calcaneus) at the outer edge of the foot is lengthened (with or without arthrodesis of the joint between the calcaneus and the cuboid bone). An osteotomy is performed between the anterior middle facet of the joint.

Cotton osteotomy
The 1st beam is lowered, which raises the arch of the foot.

What are the surgical materials for flatfoot surgery?

Material

Vorteile

Risiken

Shark Screw® / Schraube aus menschlichen Knochen

Integration in Knochenumbauprozess | Keine Metallentfernung | Keine Wetterfühligkeit bekannt | Geringe Schmerzen nach der Operation | Hohe Festigkeit

1-4 Wochen nach der Operation besondere Vorsicht bei der Belastung des Fußes

Schrauben aus Metall / Metalllegierungen

Hohe Festigkeit

Metall im Körper | Einsatz bei Allergikern & Wetterfühligkeit vermeiden
Metallentfernung möglich

Plattensysteme

Hohe Stabilität und Festigkeit

Kann Gewebeirritationen hervorrufen | Einsatz bei  Allergikern & Wetterfühligkeit vermeiden
| Metallentfernung wahrscheinlich 

Can Shark Screw® help with flatfoot?

Yes it can. Many surgeons rely on Shark Screw® for flat foot surgery. The advantage of Shark Screw® is that it is integrated into the natural bone remodeling process. Shark Screw® is colonized by the body’s own cells after implantation. This is made possible by the so-called Havers channels, which are located inside the screw. Bone cells and endogenous vessels can therefore settle in the structure of these channels. This process allows new bone structures to develop, which thus adapt to the requirements of the respective foot and eventually become the body’s own bone. This saves patients who are operated on with a Shark Screw® a second operation, which often has to be performed with conventional metal screws in order to remove them again. However, unless they are removed by a second operation, metals remain in the bone as foreign bodies without function. However, if this second operation is cancelled due to the Shark Screw®, this means an enormous alleviation of the associated risks for the patient and, of course, a shortened period of sick leave.

The info video for the screw made from human bone, the Shark Screw®.

The left/upper image shows an untreated flatfoot before surgery. The right/bottom picture shows the flatfoot treated with Shark Screw® after surgery.

What is the procedure for flatfoot surgery?

Most flatfoot surgeries are performed under general anesthesia. Typically, flatfoot surgery takes between 60 and 120 minutes, depending on the extent. This operation can be performed as an outpatient or inpatient procedure. How the operation is performed and which materials are used you clarify in consultation with the attending physician. In the following video you can see how a flatfoot surgery is performed. Attention here is blood to see!

Why is aftercare important for the success of the surgery?

Most flatfoot surgeries are performed under general anesthesia. Typically, flatfoot surgery takes between 60 and 120 minutes, depending on the extent. This operation can be performed as an outpatient or inpatient procedure. How the operation is performed and which materials are used you clarify in consultation with the attending physician. In the following video you can see how a flatfoot surgery is performed. Attention here is blood to see!

What are the causes of flatfoot?

A flatfoot can have many causes. There are many factors that contribute to or promote this foot deformity. Therefore, in the following list the most common causes are mentioned.

  • Overloading & incorrect loading of the feet
  • Diabetes
  • Lack of exercise
  • Taking cortisone (over a long period of time)
  • Overweight
  • Injuries
  • Not suitable footwear
  • Joint inflammation
  • Arthrosis
  • Paralysis
  • Nerve damage
  • Instability
  • Alteration / injury of the tibialis posterior tendon

What are the symptoms of flatfoot?

Which symptoms indicate a flatfoot always depends on the cause and the form of expression. However, there is often pain on the sole of the foot, the inner edge of the foot and in the area of the inner ankle. Other complaints of a flat foot include more difficult movement, but also that parts of the foot are more worn than others. This can lead to late effects such as osteoarthritis. Watch the video below to see how patient Roman Peherstorfer managed his flatfoot symptoms.

The author - Dr. Florian Wenzel-Schwarz

Dr. Florian Wenzel-Schwarz is a specialist in orthopedics and traumatology in Vienna and Neusiedl am See. He works in the Department of Pediatric Orthopedics and Foot Surgery, Special Team Foot and Ankle Surgery at the Orthopedic Hospital Speising. He completed his specialist training at the University Clinic for Trauma Surgery at Vienna General Hospital, the Vienna Trauma Center (Vienna Meidling site) of AUVA and the Orthopedic Hospital Speising.

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