Percutaneous Surgery for Flat Feet – Dr. Julien Lopez
As a specialist in percutaneous surgery for flat feet, Dr. Julien Lopez performs minimally invasive procedures for non-arthritic flat feet.
This podiatric condition is characterized by a weakening and reduction of the arch on the inner side of the foot. The foot consists of an internal bony structure supported by ligaments, tendons, and muscles that bear the body's weight. The flattening of the plantar arch, resulting in a loss or absence of curvature, gives rise to "flat feet." It is often a degenerative condition that develops slowly. Flat feet encompass various stages of progression, and when discomfort becomes debilitating, surgery is recommended.
Most commonly idiopathic, this condition is widespread and can have disabling consequences without appropriate treatment. Dr. Julien Lopez advises on non-surgical solutions and performs corrective surgeries using minimally invasive or percutaneous techniques whenever possible.
Before Minimally Invasive Surgery for Flat Feet: Symptoms, Diagnosis, and Stages of Progression
Before considering minimally invasive surgery for flat feet, it is essential to ensure you have this condition and determine the stage and potential aggravating factors.
The most visible aspect of flat valgus feet is the reduction or absence of the arch under the foot (curvature). The formation of a valgus in the hindfoot or a heel that tends to tilt outward can also be alarming. Your foot is inclined inward due to this misalignment of joints known as "pronation."
These deformities often lead to:
- Pain in the sole or soles of the affected foot or feet.
- Pain in the ankle, back, and/or calves.
- Knees that tend to turn inward.
- Heels that tend to shift outward.
- Potential limping and a sense of unstable walking.
- Shoes that wear down on the inside.
If you identify any of these symptoms, we recommend consulting a specialist with expertise who will conduct a comprehensive examination of your arches and ask specific questions to provide suitable solutions.
The diagnosis of flat feet relies on several tests and clinical examinations to establish a positive diagnosis, determine the stage, and identify potential exacerbating factors.
To begin, the imprint of the plantar arch is examined using a podoscope. This device provides an accurate representation of your foot's sole, allowing assessment of the stage of the condition.
Radiological assessment is essential to visualize the alignment of the hindfoot (calcaneal valgus or deviation of your heel), the loss of medial arch height, and other specific radiological criteria. MRI and ultrasound are often useful for analyzing soft tissues such as the posterior tibial tendon or the spring ligament.
All these elements allow the doctor to determine the stage you are in and consider the appropriate non-surgical or surgical treatment.
Valgus flat feet have several stages, mainly depending on pain and the flexibility (or reducibility of deformations) of the joints.
In stages 1 and 2, flat feet are considered "flexible" because they retain their flexibility but become painful. Both feet are often affected simultaneously, which can interfere with walking, sports, and daily life.
More advanced stages are characterized by stiffness of the valgus flat foot, becoming "non-reducible" (stage 3), leading to genuinely disabling ankle arthritis in the final stages (stage 4).
Early treatment and management of flat feet prevent complications such as:
- Hallux valgus.
- Inflammation of the membranes covering the knees, shins, or hips.
- Lumbar problems.
- Ligament-related pain.
- Ankle problems.
- Worsening of the deformation.
Plantar arches serve to stabilize the body's weight, provide shock absorption during walking or other movements, and support the joints in your lower limbs. Without their proper functioning, the movements of your lower limbs can become painful or difficult.
Treatments to Consider Before Minimally Invasive Flat Foot Surgery
Before considering minimally invasive flat foot surgery, non-surgical treatments should always be attempted, especially during the early stages of the condition.
Among the factors that can exacerbate this degenerative condition or accelerate its progression are:
- Chronic ankle instability.
- Certain degenerative or inflammatory diseases.
- Close and repeated pregnancies.
- Ligament hypermobility.
- A history of trauma.
Some non-surgical treatments are often tried during the early stages of the condition to alleviate pain:
- Orthopedic insoles to control the slow and progressive development of this condition by reducing pain and correcting the feet, particularly by supporting the longitudinal medial arch of the foot.
- Custom-made shoes designed to strengthen the plantar arch, recreate curvature with a heel support, prevent imbalances, and toe compression.
- Physical therapy with posterior stretching to delay or avoid flat foot surgery by strengthening the "posterior tibial" muscle.
- Regulation of excessive weight through dietary monitoring and regular physical activity.
While these solutions may not suffice, they can delay the need for minimally invasive flat foot surgery later on.
Non-Invasive Flat Foot Surgery: When Is It Necessary?
Non-invasive flat foot surgery, when is it necessary?
If none of the medical treatments have been able to reduce your daily pain or if your valgus flat feet remain disabling, minimally invasive flat foot surgery should be considered and discussed with the surgeon.
What Does It Involve? Depending on the stage of the condition, it is considered either conservative or non-conservative. Currently, there is no known or recognized laser surgery for flat feet.
Procedure for Minimally Invasive Flat Foot Surgery
The goal of minimally invasive flat foot surgery is to recreate and straighten the longitudinal arch to correct the deformity of the plantar arch, involving some or all of the following actions:
- Examination of the posterior tibial tendon affected by the condition, possible removal of inflamed areas, and repair or reconstruction of the tendon.
- Osteotomy or cutting of the deviated heel bone to realign and varus it.
- Lengthening the lateral column of the foot by performing a calcaneal osteotomy, correcting the forefoot abduction.
- Lengthening the Achilles tendon.
- Lowering the first ray to correct forefoot supination.
This minimally invasive surgical technique allows for minimal incisions and reduces post-operative pain. It leaves only a 2mm scar thanks to percutaneous minimally invasive flat foot surgery. This simplifies recovery and the return to daily activities. However, please note that not all surgical procedures can be performed using percutaneous techniques. The patient is informed about the care and surgical steps during the consultation.
In the most severe cases of flat feet, with arthritic joints or irreducible deformities, more extensive surgeries are required. Arthrodesis (fusion) must be performed, but in most cases, minimally invasive flat foot surgery is not feasible, and traditional "open" surgery is necessary. Arthrodesis helps reposition the affected joints correctly and "lock" them permanently. This will straighten the arch and reduce hindfoot deviation, allowing for weight-bearing again.
Treatment After Minimally Invasive Flat Foot Surgery
Dr. Julien Lopez accompanies you throughout the process of minimally invasive flat foot surgery.
The surgeon's recommendations are important after percutaneous flat foot surgery:
- Immobilization for 3 to 6 weeks in a brace.
- Dressing changes every 2 days.
- Light weight-bearing allowed for 21 days for flexible flat feet and 4 to 6 weeks for rigid flat feet.
- Work leave for 2 to 6 months.
- Resumption of physical activity from 3 months onwards, depending on the procedures performed.
- Rehabilitation with physical therapy acts to strengthen the muscles and restore flexibility and range of motion to the foot joints.
- Driving is allowed after removal of the splint or brace (unless you have surgery on the left foot and drive an automatic vehicle).
Swelling caused by percutaneous flat foot surgery is common and typically resolves by about 80% in 2 months. The foot will be completely de-swollen within 6 to 9 months.