Procedure
Flatfoot Reconstruction
For Progressive Collapsing Foot Deformity
What It Involves
Surgical reconstruction of the adult acquired flatfoot is a complex and individualised operation. There is no single standard procedure — the operation is built around the specific deformity present in each patient's foot, using a combination of techniques selected to correct each element of the collapse.
Common components include a flexor digitorum longus (FDL) tendon transfer, rerouted to take over the arch-supporting role of the damaged posterior tibial tendon; a calcaneal osteotomy, where the heel bone is cut and shifted medially to correct outward heel drift; lateral column lengthening, using a bone graft to restore the arch and correct forefoot abduction; a reverse Cotton osteotomy to correct residual arch collapse; and gastrocnemius recession or Achilles tendon lengthening, performed in the majority of reconstructions as a tight calf is one of the main deforming forces in flatfoot. Dr Hogan will explain precisely which combination of these steps is planned for your foot.
Recovery Timeline
Everyone heals at a different rate — this timeline is a guide.
Weeks 1–6
Non-weight-bearing in a cast, with strict foot elevation. The wound is checked and sutures removed at 2 weeks. Sedentary work is possible from around 4–6 weeks if the foot can be elevated.
Weeks 6–12
Transition from the cast into a boot at 6 weeks, remaining non-weight-bearing for a further 6 weeks while healing consolidates, ahead of the next X-ray around 12 weeks.
Weeks 12 onwards
If the X-ray is satisfactory, graduated weight-bearing in the boot commences, transitioning into supportive footwear with an orthotic, with physiotherapy for gait rehabilitation and strengthening. Roles requiring prolonged standing or walking typically need around 4 months off.
3 months
Most patients are walking comfortably and low-impact activities resume.
6–12 months
As this is a major reconstruction, full recovery — including return to higher-demand activities — takes 6–12 months minimum, with a final review and discharge once recovery is complete.