Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience.

"It's important that the medical community understand that through arch reconstruction and realignment, we can do much more these days to correct this painful and degenerative condition in patients of all ages," said Kirstina Olson, M.D., chief of foot and ankle surgery at UCSF's Orthopaedic Institute at Mission Bay.

Indications and Outcomes for the Procedure

As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include:

• Pain
• Inability to function
• Failure to improve after a six-month course of specific, directed physical therapy
• Failure to improve after using arch supports, orthotics, or ankle and foot bracing

Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. /p>

"In the past, we would realign and fuse the three hind joints, which would cause patients to lose motion, leaving them with a significantly stiff hind foot, Olson said. "With these newer procedures, if the foot is still flexible, we can realign it and usually restore a close-to-normal or functional range of motion in the joints."

How It's Done

The procedure involves cutting and shifting the bone, and then performing a tendon transfer.

• First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position.
• Second, the surgeon transfers the tendon. "We reroute the flexor digitorum to replace the troublesome posterior tibial tendon," Olson said.
• Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient’s specific foot deformity.
• Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten.
• Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot.
• Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.

"It's gratifying to offer both pain relief and the chance to regain a range of motion to patients suffering from this condition," Olson said.

Conditions treated and procedures performed at the UCSF Orthopaedic Institute at Mission Bay include:

• Achilles tendon disorders
• Ankle fractures
• Bunion and hammertoe surgery
• Charcot-Marie-Tooth cavovarus reconstruction
• Flat foot reconstruction
• General arthritis of the ankle and hind foot
• Rheumatoid arthritis forefoot disorders
• Sports injuries (ankle arthroscopy)

Dr. Kirstina Olson can be contacted at (415) 353-9400.