- Q: How does flatfoot deformity occur and how is it diagnosed?
- Daniel Murawski, M.D.: Flatfoot deformity in adults can go by many different clinical terms. The one that probably is easiest to understand and utilize is ‘adult acquired flatfoot deformity’. It happens in the adult, it’s acquired meaning the patient has a normal arch and with time it collapses, and it's a deformity. It's a deformity that involves both the soft tissue, meaning the tendons and ligaments, and also the bones. As it progresses, it's really more of a syndrome. It goes through stages. It starts as just an inflammatory condition. We honestly don't know how it starts, but it involves a combination of one of the strong ligaments of the of the foot and ankle degenerating in combination with some laxity of the ligaments of the bony arch. So there's a combination of that bone and ligament problem with a tendon problem. Once the arch collapses, the tendon becomes involved and the arch goes through a progressive collapse.
- Q: What are the non-surgical treatment options for flatfoot deformity?
- Daniel Murawski, M.D.: There are a lot of different options for flatfoot deformity non-surgically. When it first starts, it's usually this inflammation along that tendon. Flatfoot is a combination of a tendon injury with collapse of the bony arch. When it starts though, it's mostly a tendon problem where it's inflamed. So that responds usually to anti-inflammatory medications and over-the-counter arch supports. Flatfoot deformity goes through stages one, two, and three. As it progresses from stage one to stage two, that's when you start needing more aggressive treatment and usually you start with a custom-made arch support. That can be combined with physical therapy. As you go from stage two to stage three, it means that the deformity is becoming more rigid and more advanced and in for those cases you may need a custom-made brace which can also be combined with physical therapy.
- Q: If surgery is required, what can a patient expect from the procedure and the recovery?
- Daniel Murawski, M.D.: Surgery for flatfoot deformity is quite complicated. There really isn’t an easy answer. The treatment has to be tailored to the individual patient. So usually it requires a good relationship between the patient and the physician and going over the options. It really depends on age, activity level and expectations. But for the most part, the surgery involves reconstructing the tendon and moving the bones around to reconstruct the arch. In the later stages, I have to resort to fusion procedures – which means taking the bones, realigning them and then fusing the bones together. But generally it requires an outpatient surgery. It can take an hour to two and you're in a splint, then a cast with non-weight-bearing for six to eight weeks. So there's quite a long recovery time to let that tendon and bones heal. Following that there's basically weight-bearing in a in a boot for about four to six weeks, followed by physical therapy, and the final recovery time is usually around six months even a little bit longer for flatfoot reconstruction.
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