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Surgery for Flat Feet

Posted by Mary M. on 9/08/03 at 19:19 (129199)

My 17 year old son has very flat feet (flexible) but has had no foot pain most of his life. A little over a year ago, he started running on a regular basis. Eventually, he started having foot problems and saw a podiatrist. First, he tried over the counter orthotics, then custom orthotics, then a removeable cast worm for 2 months on one foot then 2 months on the other foot, than night splints. He has been on NSAID's for months. After all this, he still has pain when standing still, though not when walking. The podiatrist has recommended surgery--Evans Procedure, Cotton Procedure, tendoachilles lengthening and Kidner Procedure. What do you think about this? Is there anything else that can be tried?

Re: Surgery for Flat Feet

BGCPed on 9/08/03 at 20:16 (129208)

If he is flexible flat foot and has the usual tight gastroc, post tib tendon weakness etc. I am not sure why a good motion control running shoe and the PROPER orthotic wouldnt work. There are many ways to make an orthotic (broken record here) but they are not all the same.

The flexible hyper mobile foot usually responds vey well with a good orthotic and proper shoe. You may want to get a 2nd opinion in that regard. That is a heavy duty procedure, even more so on a 17 y/o. Just a thought but the gastroc slide is the easiest part of that procedure, and can do a great deal to reduce the pronatory force on his feet.

When a person is tight back there the dont get proper motion from the ankle. The foot has to get it from somewhere so they usually collapse the midfoot/arch. He probably also has an abducted stance/gait e.g. walks like a duck with his feet turned out. These are ways that the body figures out to make up for the tight heel cords. Sometimes a slide alone with PROPER foot orthotics and a shoe like a Brooks Beast or New Balance 587 will make him pain free or at least reduce it greatly.

At 17 he has many years to get that complicated procedure done. Perhaps one of the Drs on here can help you with your decision. What state do you live in? Another opinion id fine. Most people get 2 or 3 when they are getting a deck built so when it is your feet I wouldnt be shy about checking some other options.

I know a few Doctors around the country that specialize in that type of procedure. You want somebody that does a few of those per month not a few per year

good luck

Re: Surgery for Flat Feet

Ed Davis, DPM on 9/08/03 at 20:32 (129214)

I have to second all of your good advice. Some practitioners view orthotics as a stopgap measure to try before surgery and don't take the biomechanics seriously. I cannot count the number of patients who simply needed the right orthotic combined with a motion control shoe to be okay.

Giving someone a higher arch surgically is serious and risky surgery so patients need to do a lot of homework before proceeding.

Re: Surgery for Flat Feet

BGCPed on 9/08/03 at 20:45 (129216)

Thank you Sir I take that as a compliment. I just saw a kid the other day. I first saw him about 4 years ago when he was about 9 His parents were ready to have somebody do a total reconstruction bi-lat. His orthotics that didnt work were terrible and he had them in crummy skateboard shoes.

I just did his 3rd or 4th pair and he is about 13 in taller and gained about 60 pounds. He plays football and is doing great. When his shoes or orthotics get a bit old he gets some leg and foot pain. We either post his current one and or a new shoe and he is fine for another year. I am happy to say his case is not uncommon.

BTW the DR that sent him to me for orthotics 4 years ago specializes in flatfoot correction and does several per week.

Re: Surgery for Flat Feet

Joe B. on 9/09/03 at 07:23 (129252)

You mentioned that a gastroc slide procedure would help someone with flat feet. Does that mean any type of flat feet or just flexible?? I'm not sure what I have, but I know that my calves hurt when I'm on my feet and I even use orthotics. Should I consider the gastroc slide first before recontructive surgery?? What does the gastroc slide procedure entail?? Can it be done as an outpatient?? What is the recovery process??

Re: Surgery for Flat Feet

BGCPed on 9/09/03 at 18:17 (129339)

I would leave that question for Dr Ed or one of the others to answer. It helps reduce the load on the feet when certain combinations of structure, biomechanics and other issues cross. It doesnt work on all types of feet and you need to have a solid examination and eval which you may already have.

As for the orthotics they are not all equal and you can try 4 pairs from 4 people and they can be less than helpful, then the 5th pair works great. This is not the norm but it does happen. Thats why I suggest you explore the more conservative routes and get the orthotics and shoes evaluated by another party

Finding the best person is not always easy. What area are you located in?

Re: Surgery for Flat Feet

JoeB on 9/10/03 at 06:16 (129406)

I'm located about 20 miles west of Philadelphia, very close to the King of Prussia and Valley Forge area.

Re: Surgery for Flat Feet

Mary M. on 9/11/03 at 07:36 (129567)

Thanks for the input. We live in Northern Virginia. I don't know that much about orthotics, but my son's were made with his foot in a relaxed position so that he had some arch. They have a small heel wedge which cause his heels to rotate slight outward. He wears the orthotics in a pair of Brooks Adrenaline GTS running shoes every day. The foot problems arose when he had been running regularly for about 6 months. He was running 5 - 7 miles a day with an occasional 8 - 10 mile run in cross country practice. After a 12 mile run back in October, he first had ankle pain, then pain in his arches. He stopped running almost a year ago. After trying all of the strategies mentioned, he does not have pain when actually walking, but the pain becomes unbearable when standing for more than a minute or 2. He is tired of the pain and sees surgery as an easy cure. I am concerned that surgery could create more problems than it solves.

Re: Surgery for Flat Feet

BGCPed on 9/11/03 at 22:09 (129670)

I would be happy to see him and evaluate his shoe and orthotics. If I thought I could improve on what he has I would make them at no charge all you would have to do is come to Detroit . That may seem far but at 17 years old I would want to make double sure the orthotics and shoe are perfect.

Shoes and orthotics are easier to undo than foot surgery. You may also want to time it and get a second opinion regarding the surgery aspect if shoes and orthotics fail. One of the best in the country at flat foot reconstruction is located about 10 minutes from me. He does several of those per week.

Again I am not trying to second guess your Dr or create more for you to think about. I am just offering a conservative approach first. At 17 he has many years to get surgery done. That is a complex procedure and there is lots of down time so I would caution your son to not want to rush to have it.

Let me know if I can help