Flat Foot Reconstruction – Soft Tissue vs. Fusion Surgery

Flatfoot is a condition caused by the collapse of the foot arch, bringing the entire sole into contact with the ground. Many people acquire flatfoot as they age, suffering varying degrees of pain and disability when they stand or walk. Though surgery is rarely required, flatfoot reconstruction can become necessary to correct abnormal positioning of the feet and any issues with posture when nonsurgical treatment fails.

If you're considering reconstructive surgery for flatfoot, this informative guide will help you understand the difference between soft tissue and fusion surgery, the two primary operative techniques offered by our team at the Orthopedic Institute of North Texas.

What Is Flatfoot Reconstruction?

X-ray image comparison of a patient’s foot before flatfoot reconstruction surgery and after flatfoot reconstruction surgery.

Flatfoot reconstruction is a surgical technique used to correct a collapsed arch. In particular, reconstructive surgery treats the posterior tibialis tendon that supports the foot's arch. If the posterior tibialis tendon becomes weakened, the structural support of the arch is reduced. This causes the midfoot and hindfoot to bend outward and develop wear and tear, affecting the entire foot, ankle, and, possibly, your posture.

There are several goals that surgery for flat feet should achieve:

  • Realignment and restoration of the normal shape of the foot
  • Correction of the underlying causes of structural failure in the foot
  • Pain relief
  • Preservation of mobility

Reconstructive surgery should also prevent the recurrence of flat feet and ongoing pain.

The two leading techniques for flatfoot reconstruction are soft tissue reconstruction and fusion surgery. Both surgeries create an arch but differ in indication, technique, advantages, and disadvantages. By understanding what these two major types of flatfoot reconstructive surgery involve, you can make informed decisions about your orthopedic care.

Soft Tissue Reconstruction for Flatfoot

Soft tissue surgery is a reconstructive procedure for flat feet that repairs the ligaments, muscles, and tendons in your foot since damage to these soft tissues is a key cause of flatfoot. We can support and stabilize your foot by repairing and realigning these soft tissue structures, relieving pain.

The main surgical approaches for soft tissue correction of flatfoot include the following:

  • Reconstruction of the posterior tibialis tendon by using another tendon in the foot to recreate the arch
  • Repairing the spring ligament complex to restore its support of the foot's medial arch
  • Performing an osteotomy (bone cut) through the calcaneus to realign the heel
  • Performing an osteotomy (bone cut) through the middle of the foot to restore the arch

Fusion Reconstruction For Flatfoot

X-ray images of patients feet who have undergone flatfoot reconstruction surgery.

Fusion surgery, known as arthrodesis, involves the bones and joints of the foot, which are permanently fused to strengthen and support the foot. A triple arthrodesis (fusing the talus, calcaneus, navicular, and sometimes the cuboid) is a common approach that fuses some or all of the bones that comprise the foot's arch. This can be a good approach since these joints move very little in patients with severe flatfoot, meaning fusion procedures minimally affect foot movement.

Fusion surgery for flatfoot reconstruction requires a detailed preoperative assessment to determine the joints that will be fused. Surgery involves creating one or two incisions in the foot to access the joints and stiffening them with screws, plates, or grafted bone from your heel or pelvis.

Soft Tissue vs. Fusion Surgery For Flatfoot Reconstruction

Here are some of the notable differences between these two types of flatfoot surgery:

  • Soft tissue surgery for flat feet primarily involves the lengthening or replacing of tendons.
  • Fusion surgery uses fixation hardware, like screws and plates, to immobilize joints in your foot.
  • Soft tissue surgery might be a good choice if your flat feet are caused by weakened soft and connective tissues.
  • Fusion surgery could be more appropriate if your flat feet have structurally deteriorated and become rigid with rearfoot arthritis.
  • Soft tissue surgery strengthens your foot and enables it to move more normally.
  • Fusion creates a more appropriate alignment of your foot by fusing one or more joints.

Another option is a combination of soft tissue and fusion procedures to achieve alignment and restoration of function. We may also choose to perform osteotomies, which involve cutting and grafting bone, to achieve the best result for your feet.

Justin M. Kane, M.D.

Board Certified Foot & Ankle Orthopedic Surgeon

Justin M. Kane, MD, is an orthopedic surgeon educated at Rensselaer Polytechnic and Thomas Jefferson University. He trained at Temple University Hospital and completed his residency at The Rothman Institute at Thomas Jefferson University Hospital. Following a foot and ankle surgery fellowship at Baylor University Medical Center, he practiced at Baylor and directed research at the Human Motion and Performance Center.

Dr. Kane founded the Orthopedic Institute of North Texas, where he treats a range of foot and ankle conditions and performs advanced reconstructive surgeries. He has published extensively and contributes to orthopedic education and research.

Beyond his practice, Dr. Kane is involved in international medical missions, including in Vietnam with AOFAS and MOI, and in the Dominican Republic with Rush University. His personal interests include cycling, golf, international cooking, and animal rights activism.

Flatfoot Reconstruction in North Texas: Talk to Dr. Kane

If you have flat feet and want to know what flatfoot reconstructive surgery can achieve for you personally, talking with an orthopedic surgeon is the next step. Contact Dr. Kane to schedule a consultation with the skilled team at the Orthopedic Institute of North Texas in Frisco. We are on hand to listen, assess, and explore your surgical options so that you can live an active, pain-free life with maximized mobility.

Frequently Asked Questions

Who Is An Appropriate Candidate For Flatfoot Reconstructive Surgery?

Flatfoot reconstructive surgery is appropriate if you've been diagnosed with flat feet and have not been able to manage the condition with nonsurgical methods like physical therapy. You may also benefit from flatfoot surgery if you have the following characteristics:

  • No space between the collapsed foot arch and the floor when standing
  • Continual pain and the development of arthritis due to flat feet
  • Loss of mobility due to flat feet
  • Signs of nerve damage in the foot, like numbness and tingling

What Does Preoperative Care For Flatfoot Surgery Involve?

Before surgery, we will review your medical history and imaging of the foot, counseling you on our approach and the outcomes you should expect from surgery. An anesthetist will also assess your health for surgery so you can safely be put under a general aesthetic. You may also need to discontinue any medication that could cause excessive bleeding, such as non-steroidal anti-inflammatory drugs and arthritis medications.

What Should I Expect After Flatfoot Surgery?

Flatfoot surgery is often an outpatient procedure, though you may need to stay the night depending on your recovery speed. We will discharge you with a cast on your foot to keep it immobilized. While you may use crutches after two weeks to move around as needed, you'll need to avoid putting weight on your foot for at least six weeks post-surgery. After six weeks, we will assess your progress and plan a physical therapy program to help you recover your foot's full range of movement.