Flatfoot Reconstruction Surgery: When Orthotics Don’t Work

Adult-acquired flatfoot develops when the tendons and ligaments that support the arch weaken or become damaged. In early stages, custom orthotics, supportive footwear, bracing, and physical therapy may help manage symptoms. But this condition can quickly progress to the point that these treatments no longer provide enough relief.

When persistent symptoms interfere with walking or daily activities, flatfoot reconstruction surgery can be an option. Read on to understand how this condition develops and where to find the best foot surgeon in Los Angeles for treatment. 

What Is Adult-Acquired Flatfoot?

Adult-acquired flatfoot is a condition in which the arch gradually loses its shape as you age. Podiatrists and foot surgeons also call it progressive collapsing foot deformity, or PCFD. The change can affect more than the arch of your foot; it can also involve the heel, ankle, tendons, ligaments, and joints that support the foot.

One structure closely linked to adult-acquired flatfoot is the posterior tibial tendon. This tendon runs along the inside of the ankle and helps support the arch as you stand, walk, and push off the ground. When the tendon becomes inflamed, stretched, or torn, it may no longer provide enough support. The arch can begin to flatten, and the heel may shift outward. As the foot changes position, other soft tissues and joints may also come under added stress.

Adult-acquired flatfoot can develop for several reasons, including:

• Posterior tibial tendon dysfunction: This happens when tendon damage weakens the support system that holds up the arch.
• Ligament injury or stretching: This includes damage that affects how the bones stay aligned.
• Arthritis: A common condition that causes joint changes that directly affect foot alignment and movement.
• Injury or repeated stress: Another common cause, where ongoing strain affects the tendons, ligaments, and bones that support the foot.

Foot discomfort and a subtle change in arch height are usually the first signs of adult-acquired flatfoot. As it progresses, the deformity and pain may become more noticeable.

How Can You Tell if Flatfoot Is Getting Worse?

A flat arch alone does not mean you need surgical treatment. However, that changes when you start having changes in foot shape, new pain, or growing difficulty with standing and walking. As adult-acquired flatfoot progresses, you may notice:

• Pain or swelling along the inside of the foot or ankle
• A lower arch when standing
• The heel tilting outward
• The front of the foot turning outward
• Shoes that feel uncomfortable or fit differently
• Fatigue or aching after standing or walking
• Difficulty standing on your toes on one foot
• Pain along the outside of the ankle as alignment changes

Some people also notice that more of their toes become visible when viewed from behind. This can happen when the front of the foot shifts outward. Pain may also spread beyond the inside of the foot. As the heel and other parts of the foot change position, the outside of the ankle can become irritated. 

Why Orthotics May Not Provide Enough Relief for Adult-Acquired Flatfoot

Custom orthotics support the foot and help manage the forces placed on it during standing and walking. Braces can provide added stability, while physical therapy may improve strength, flexibility, balance, and control. These treatments can help manage adult-acquired flatfoot in its early stages. However, they may not be enough as the condition progresses and the arch continues to collapse. 

When Should You Consider Flatfoot Reconstruction Surgery?

Flatfoot reconstruction surgery is usually recommended when pain and mobility limitations continue despite conservative treatment. Especially if you’re experiencing: 

• Persistent foot or ankle pain that interferes with daily activities
• Progressive loss of your arch or worsening foot alignment
• Tendon or ligament damage that affects foot stability
• A deformity that has become difficult to correct without surgery

Can Foot Surgery Rebuild a Collapsed Arch?

Flatfoot reconstruction is a group of procedures designed to improve foot alignment, address damaged tissues, and create a more stable structure. There are several techniques that can be used during one operation to achieve this goal: 

• Tendon Repair or Tendon Transfer: The damaged posterior tibial tendon may be repaired with sutures or supplemented with a tendon transfer, such as the flexor digitorum longus tendon, to help restore arch support and foot function.
• Calcaneal Osteotomy: A surgical repositioning of the heel bone to improve alignment and reduce the forces contributing to arch collapse.
• Lateral Column Lengthening: Where a surgeon lengthens part of the outer foot, typically using a bone graft, to improve alignment when the front of the foot has shifted outward.
• Ligament Reconstruction: A damaged or stretched ligament, including the spring ligament, is repaired or reconstructed to improve stability and support the arch.
• Joint Fusion: Also called arthrodesis, this procedure joins selected bones together to create a more stable, better-aligned foot when arthritis or a rigid deformity limits other reconstruction options.

What Happens During Flatfoot Reconstruction Recovery?

Recovery depends on the procedures performed, the condition of your foot, and your overall health. Because reconstruction may involve bones, tendons, and ligaments, healing takes time. In the early stages, you may need to keep weight off the affected foot and use crutches, a knee scooter, or another mobility aid. Your recovery plan will likely include:

• Immobilization in a cast or boot protects the foot while the tissues and bones heal
• Limited weight-bearing
• Follow-up visits and imaging to monitor healing and alignment
• A gradual return to walking and activities 
• Physical therapy to help restore strength, flexibility, balance, and walking ability

Where to Find the Best Foot Surgeon in Los Angeles for Flatfoot Reconstruction

Flatfoot reconstruction requires a careful assessment of the tendons, ligaments, bones, and joints that support the foot. For effective treatment with a high degree of surgical skill, patients across the Los Angeles area choose Dr. Megan Ishibashi, DPM, FACFAS. Her patient-first approach emphasizes clear communication, patient education, and individualized care, including comprehensive treatment for a wide range of conditions and reconstructive surgery, with plans tailored to each patient’s needs and goals. 

Ready to discuss whether flatfoot reconstruction surgery with the best foot surgeon in Los Angeles can help you move more comfortably?