CALCANEAL OSTEOTOMY AND FDL TRANSFER (flat foot correction)

What is it?

It is an operation to realign the heel bone (calcaneum) and re-route a tendon (flexor digitorum longus) to treat a flat foot which has developed over several months or years. This is often due to weakness in another tendon and ligaments on the inside of the foot (tibialis posterior dysfunction).

Why would it be done?

It would be done for a foot which has gradually collapsed and become flat and often painful but still flexible.

What does it involve?

Two cuts are made, one on either side of the foot. The heel bone is cut and then part of it is moved slightly to realign the foot. It is held in place with a screw. Sometimes this part of the operation can be carried out by minimally invasive surgery which means just a small puncture wound to do the operation and 2 more for the screws used to fix it.

One of the toe flexor tendons is divided and moved to reinforce the stretched tendon on the inside of the foot. Often, it is also necessary to lengthen the Achilles tendon or calf muscle also.

How successful is operation for this condition?

In general, you can expect a substantial improvement in your level of symptoms after surgery.

How long will I take to recover from surgery?

You will be in plaster from just below the knee to toes for 6 weeks. Usually, you are not allowed to put weight through the foot for the first 6 weeks.

You will be seen in clinic at 10-14 days after surgery to check the operation site and change your plaster. You will be seen again at 6 weeks. At this stage you will require an X-ray. You may be put into a brace at this point for a further six weeks.

Physiotherapy is often recommended after the plaster is removed. Your foot will gradually improve but it commonly takes 6 to 12 months to fully recover.

Are there any risks associated with the surgery?

As with any operation, there are risks associated with the anaesthetic.

Occasionally, some patients have complications such as infection, nerve or vascular damage or loss of correction with ongoing discomfort, and occasionally the osteotomy does not heal, which may require a further operation. If you have screws, they sometimes become tender and then they would be removed at a later time.

How long will I be in hospital?

Most people come into hospital on the day of their operation and need to stay one or two nights, but some may be able to go home the same day. You will go home on crutches and will need to keep your foot elevated when you get home especially for the first two weeks to allow the swelling to subside.

Are there any alternatives?

Other forms of treatment will usually have been tried if appropriate e.g. anti-inflammatory medication, orthotics (shoe inserts) or a period of time rested in plaster then physiotherapy. Surgery will only be recommended if you have not benefited from these treatments or your foot is not suitable for them.

If I need surgery how soon can I….

Go back to work?

If your foot is comfortable, you have a sedentary job, you can keep it elevated and work in a plaster, you may return to work after 2 to 3 weeks. However, if you have a manual job or work in a dirty environment, you may need 3 months off work.

Drive?

If the operation is to your left foot and you drive an automatic car, you may drive within a few weeks of the surgery. Otherwise, you will need to wait until the plaster has been removed and your ankle is strong and flexible enough to use the pedals. This is for the safety of other road users as well as yourself!

Please remember that your insurance is invalid if you are unable to do an emergency stop or manoeuvre.

Play sport?

After your plaster has been removed, you may gradually increase your exercise regime under the guidance of the physiotherapist. Usually, walking, swimming and cycling can be undertaken initially. Gradually, more energetic pursuits may be undertaken if appropriate! This may take 6 to 12 months.