Is Surgery Needed For Flat Feet?
If you have flat feet and are suffering from some associated symptoms, you may have been wondering if surgery is needed for flat feet, and if it will even lead to a significant improvement.
In this article we’ll explain the details surrounding flat feet surgery – when it’s not needed; when it’s needed; the types of surgery available and what they involve.
When Surgery Is Not Needed
Many people with flat feet never need surgery and whether surgery is needed depends on symptoms, severity, and response to conservative treatment.
Non-surgical treatments are usually effective including:
- Orthotic inserts (custom or over-the-counter)
- Supportive footwear
- Physical therapy to strengthen foot and ankle muscles
- Stretching, especially for tight Achilles tendons
- Activity modification to reduce strain
- Anti-inflammatory meds (if recommended)
If the condition is flexible, painless and not limiting daily activity, surgery is almost never recommended.
When Surgery May Be Recommended
Doctors consider surgery only in specific cases:
- Persistent Pain – If pain continues despite months of conservative treatment.
- Progressive Adult-Acquired Flatfoot – Often caused by posterior tibial tendon dysfunction (PTTD). The tendon loses function and the arch collapses over time.
- Severe Structural Deformity – Rigid flat feet or severe misalignment that limits walking or standing.
- Arthritis or Bone Problems such as joint degeneration, severe bunions or heel alignment issues or tarsal coalition (bones fused together).
- Children With Structural Issues – This is rare, but sometimes used if flat feet are rigid (not flexible), causing severe pain or due to bone abnormalities.
What Flat Foot/Feet Surgery Involves
Surgery varies depending on whether the flat foot is flexible vs. rigid, child vs. adult, and whether it’s due to tendon failure, bone deformity or arthritis.
Here’s a breakdown of the different types of surgeries for flat feet and what it entails:
1. Tendon Surgery (Posterior Tibial Tendon Reconstruction)
Best for: Adult-acquired flatfoot caused by posterior tibial tendon dysfunction (PTTD).
Goal: Restore arch support by repairing or reinforcing the failing tendon.
Types of tendon procedures:
- Tendon Debridement – Removes inflamed or damaged tissue and is typically used in earlier cases.
- Tendon Repair or Reconstruction – Repairs tears or replaces the tendon with one from the foot (usually the flexor digitorum longus tendon). This is often combined with bone realignment surgery.
Recovery Time
- 6–8 weeks non-weight-bearing
- Full recovery approx. 6–12 months
- High success rate when deformity is not severe
2. Osteotomy (Bone Cutting & Realignment)
Best for: Flexible flat feet or moderate deformity.
Goal: Reshape or reposition foot bones to restore the arch.
Types:
- Medialising Calcaneal Osteotomy – The surgeon cuts the heel bone and shifts it inward and corrects heel alignment so the arch can reform.
- Evans Osteotomy (Lateral Column Lengthening) – A piece of bone graft is added to lengthen the outer side of the foot and is used for severe flattening at the midfoot.
- Cotton Osteotomy (Medial Cuneiform Opening Wedge) – Lifts the arch by placing a wedge of bone in the midfoot.
Recovery
- 6-8 weeks in a boot/cast
- Gradual return to full activity in 3-6 months
3. Arthrodesis (Joint Fusion)
Best for: Rigid flat feet or those caused by arthritis, tarsal coalition or severe deformity.
Goal: Fuse painful or unstable joints so they no longer move.
Common fusions:
- Subtalar fusion
- Triple arthrodesis (fuses 3 major hindfoot joints)
Pros
- Very effective for pain relief
- Creates stable, functional foot
Cons
- Eliminates some foot mobility
- Longer recovery
Recovery
- 8-12 weeks non-weight-bearing
- Full recovery 9-12+ months
4. Implants (Arthroereisis)
Best for: Children with flexible flat feet (rarely used in adults).
Goal: Place a small implant in the subtalar joint to prevent excessive inward rolling.
Pros
- Minimally invasive
- Often reversible
Cons
- Can cause discomfort
- Not effective for severe deformity
- Not ideal for adults
Recovery
- Walking within days
- Full activity in 4-8 weeks
5. Soft-Tissue Lengthening
This type of surgery is used when tight tendons or muscles contribute to flat feet.
Types:
-
Achilles Tendon Lengthening – Helps if tight calves are pulling the heel upward and collapsing the arch.
- Gastrocnemius Recession – Lengthens part of the calf muscle to improve ankle flexibility.
Recovery
- 2–4 weeks in a boot
- Often combined with other procedures
Which Surgeries Are Combined?
Flat foot reconstruction usually involves multiple procedures done together, such as:
- Tendon reconstruction + heel bone shift
- Bone realignment + tendon lengthening
- Fusion + Achilles lengthening
This combination approach is why recovery times can vary widely.
| Surgery Type | Best For | Goal | Recovery |
| Tendon Reconstruction | PTTD, flexible flat foot | Repair/replace failing tendon | 6-12 months |
| Osteotomy | Flexible deformities | Realign bones, rebuild arch | 3-6 months |
| Arthrodesis | Severe/rigid/arthritic flat foot | Fuse joints for stability | 9-12+ months |
| Implants | Children with flexible flat foot | Limit excessive motion | 1-2 months |
| Soft-Tissue Lengthening | Tight calf/Achilles | Improve flexibility | 2-4 weeks |
Conclusion
Most instances of flat feet doesn’t need surgery and is considered only when there is significant pain, function is limited and other treatments have failed. We offer a wide range of products designed to treat flat feet and relieve associated symptoms.
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