A pediatric flatfoot, or pes planus, is a condition in which the longitudinal arch of the foot does not develop normally and is lower or flatter than expected. There is a distinct difference in the painful vs. the non-painful flatfoot. Many flatfoot conditions are inherited, especially when seen in children, but may also be due to an injury or other systemic conditions. Children and adolescents with painful flat feet that do not respond to conservative care may require surgical correction. It is important to determine if the child has a flexible or rigid condition as this determines what treatment is needed.
Flatfoot surgery is often performed to give the patient a more functional and stable foot. Flatfoot surgery in children differ from adults as many adults have advanced arthritis with their condition which necessitates joint fusion. In pediatric flatfoot, the presence of joint arthritis is rare, thus joint sparing procedures are favored to maximize future function. Several procedures may be required to correct a flatfoot deformity, depending on the severity of the problem. These may include:
Lateral Column Lengthening A procedure that implants a small piece of bone, usually from a cadaver, outside of the heel bone to create the proper bone alignment and rebuild the arch.
Midfoot Osteotomy-This procedure is also known as a Cotton Procedure. Implants of a small wedge of bone, usually from a cadaver, into the medial arch preserves joint function but realigns the arch.
Gastrocnemius Recession A calf muscle lengthening procedure to reduce stress on the arch and allow the foot to function flat on the ground after arch alignment correction. This is a common and often necessary procedure.
Flatfoot reconstruction is a complex surgery for a highly variable problem. Even a highly experienced surgeon, needs flexible surgical plan to tailor the surgery to the deformity and maximize function. Some of the procedures will be listed as possible and will be performed only as needed. This approach provides a much higher level of success while maximizing functional outcome.