Key Points
What Is Adult Flatfoot?
Why Does Adult Flatfoot Develop?
Recognizing the Symptoms
How Doctors Examine the Foot
Imaging Studies: X-rays, Ultrasound, MRI, and CT
Types and Classifications of Flatfoot
Non-Surgical Treatment
Surgical Treatment: Hindfoot Procedures
Surgical Treatment: Ankle Procedures
Surgical Treatment: Midfoot Procedures
What This Means for Patients
Frequently Asked Questions
Source Information

Key Points

Adult flatfoot involves hindfoot, ankle, and midfoot, not just the arch.
Only symptomatic flatfoot requires treatment; many people have painless flat feet.
Weight-bearing X-rays are essential; some deformities disappear when lying down.
Non-surgical care includes insoles, physiotherapy, and up to 6 weeks of casting.
Late treatment raises risk of ankle arthritis, making surgery more complex.

What Is Adult Flatfoot?

Adult flatfoot is defined by a flattening of the medial (inner) arch of the foot when standing (weight-bearing), combined with a lack of propulsive gait, meaning the foot cannot push off the ground effectively during walking. It is not a single problem but a syndrome — a combination of multiple static and dynamic deformities that work together.

The key to understanding flatfoot is recognizing that all forms share one common failure: the foot fails to "lock" during gait. Normally, the foot transforms from a flexible shock absorber to a rigid lever when pushing off. When this locking mechanism fails, the arch collapses and deformities progress.

The article highlights three anatomical levels that can be involved:

The talonavicular joint (where the ankle bone meets the navicular bone in the midfoot)
The tibiotarsal joint (the main ankle joint)
The midfoot joints (including the Lisfranc and Chopart joint lines)

The subtalar joint (the joint below the ankle that allows side-to-side foot movement) is also damaged as a result of the rotational deformities that occur in flatfoot. Understanding which of these levels is primarily affected is crucial because treatment must target the correct location.

Why Does Adult Flatfoot Develop?

Flatfoot develops when the structures that support the arch become strained or fail. The research identifies three key anatomical zones where locking failure can occur:

1. The Talocalcaneonavicular Joint (the "Coxa Pedis")

This joint sits at the summit of the medial arch. During standing and walking, it bears pressure from the talar head (the top ankle bone), which increases as the tibia (shin bone) advances forward over the foot. A critical support structure called the mid-plantar tendon-ligament sling — made up of the calcaneonavicular (or "spring") ligament and the posterior tibial tendon — provides elastic support to this area. Progressive strain on this sling is the most common cause of flatfoot, leading to midfoot abduction (the front of the foot turning outward).

Interestingly, the article references a specific anatomical variation: researcher Bonnel described a type-III morphotype in which the talus bone is longer than the calcaneus (heel bone), causing greater pressure on these supporting tendons and ligaments.

2. The Medial Collateral Ligament (MCL) of the Ankle

When the heel strikes the ground, the medial collateral ligament (the ligament on the inner side of the ankle) is subjected to stress because the calcaneus and tibia are not naturally aligned in a straight line. If this ligament becomes stretched out (distended), it causes tibiotarsal valgus — the ankle tilts inward — and weight-bearing shifts progressively toward the inner edge of the foot, putting additional strain on the joints further along the foot.

3. The Midfoot and the Windlass Mechanism

Raising the heel during walking automatically causes the toes to bend upward (dorsiflexion), which creates tension in the plantar muscles and the plantar fascia (the thick band of tissue across the bottom of the foot). This is known as the "windlass mechanism" and it locks the midfoot joints, creating a rigid lever for push-off. If this locking fails — for example, due to first-ray hypermobility (excessive looseness of the big toe metatarsal bone) — the first metatarsal elevates during weight acceptance, leading to a defect during single-leg stance and toe-off.

The article notes that trauma can also play a role. Long-standing injuries, such as ankle sprains that involved the medial side of the ankle or midfoot, should be investigated in any flatfoot assessment because they can contribute to the deformity.

In summary, a proper flatfoot evaluation must examine all three of these levels plus the subtalar joint, which experiences abnormal rotational stress in flatfoot.

Recognizing the Symptoms

An important point from the research: flatfoot is only considered pathological (a disease) when it causes symptoms. Many people have flat feet without pain.

Medial (Inner) Pain

Pain is generally located in the medial part of the hindfoot (the inner side of the back of the foot), along the path of the posterior tibial tendon. There may be swelling (effusion) within the tendon sheath. Pain that is located deeper and on the sole of the foot may indicate a spring ligament lesion. However, the article warns that similar pain can also be caused by other conditions, including:

Talocalcaneal synostosis coalition (an abnormal bone connection between the talus and calcaneus)
Osteoarthritis (wear-and-tear arthritis) in the talonavicular, subtalar, or mediotarsal joints

Lateral (Outer) Pain

Pain on the outside of the foot can result from several impingement (pinching) problems:

Fibulocalcaneal impingement — pinching between the fibula (outer lower leg bone) and calcaneus, occurring in severe ankle valgus
Calcaneocuboid impingement — pinching between the heel bone and the cuboid bone in the presence of severe forefoot abduction
Impingement between the lateral tubercle of the talus and the dorsal angle of Gissane (a specific landmark on the anterior apophysis of the calcaneus), caused by rotation and slippage of the talus

How Doctors Examine the Foot

The clinical examination has two main goals: determine the characteristics of the deformity and determine whether the deformities are reducible (correctable by manual manipulation) or fixed. Doctors also assess range of motion and screen for joint stiffness, which could point to synostosis coalition or osteoarthritis.

Hindfoot Examination

The bipedal tiptoe test (rising onto both toes) normally causes the hindfoot to invert (turn inward). If inversion is lost or the foot actually everts (turns outward), this signals dysfunction of the subtalar and Chopart joints (either stiffening or excessive looseness) and/or weakness of the posterior tibial muscle.

Abduction (outward turning of the forefoot) is assessed with the patient standing while the examiner observes from behind, looking for the "too-many-toes sign" — more toes visible from behind than normal, indicating the forefoot is drifting outward. Abduction can also be observed in a lying position by examining the sole of the foot for a break in the lateral (outer) edge. Hallux valgus (bunions) is often associated with flatfoot.

The posterior tibial tendon is tested by asking the patient to invert the foot against resistance while starting from an everted (turned-out) position. The doctor notes any resulting pain and loss of muscle force. A complete motor assessment of all foot muscles is performed to rule out a neurologic cause.

The unipedal tiptoe test (single-leg toe raise) is a powerful diagnostic tool that assesses both the posterior tibial muscle and the spring ligament. The results are interpreted as follows:

If the foot moves into eversion during single-leg toe raise (or the heel fails to rise), even though the patient can perform a normal bipedal tiptoe, the posterior tibial tendon is involved.
Reduced active inversion in this test may suggest a spring ligament lesion.
Pain along the posterior tibial tendon when repeating the test is a sign of tendinitis (tendon inflammation).

The article also warns that in some cases, tendon-muscle retraction (tightness) may hold the deformity in place even when not weight-bearing. The calf muscle (sural triceps) can fix the valgus position, and the fibular muscles can fix abduction. To determine whether there is an underlying joint stiffness, the doctor examines the ankle in plantar flexion (pointed down), which relaxes these tight tendons.

Tibiotalar (Ankle) Joint Examination

Doctors assess ankle dorsiflexion (the ability to bend the foot upward) with the hindfoot valgus corrected, first with the knee in extension and then with the knee flexed. This is called the Silfverskiold test, and it helps identify gastrocnemial retraction (tightness of the gastrocnemius calf muscle).

Hindfoot valgus when standing can be due to medial laxity of the ankle (loose ligaments on the inner ankle) or to forefoot supination (the front of the foot rolling outward). Medial ankle laxity is not always easy to detect. Forefoot supination is analyzed with the patient lying on their back with the hindfoot valgus corrected. The reverse Coleman test uses a 2-cm block placed under the first metatarsal head to demonstrate whether hindfoot valgus corrects when the first ray is supported.

Midfoot Examination

Three elements are explored in the midfoot: supination, first-ray hypermobility, and osteoarthritic stiffness.

Supination: The Hintermann test determines whether supination is fixed. The doctor externally rotates the leg while the foot is weight-bearing. If the first metatarsal head rises, the supination is fixed; if not, it is reducible.

First-ray hypermobility: The doctor holds the first ray (big toe metatarsal) between thumb and index finger and moves it up and down while stabilizing the other metatarsals. Signs that suggest hypermobility include a plantar corn under the second metatarsal head (due to abnormal weight transfer) and gait that shows first-ray elevation during forefoot weight acceptance. The Jack test (passive hallux dorsiflexion — pushing the big toe upward) explores whether the medial arch rises. Normally, dorsiflexing the big toe tightens the plantar fascia and the flexor hallucis longus tendon, which stabilizes and lowers the medial arch. In first-ray hypermobility, the foot does not arch, and the first metatarsophalangeal joint shows excessive dorsiflexion with a "soft stop" (a mushy endpoint rather than a firm one), indicating a plantar muscle locking defect.

Osteoarthritic stiffness: This is indicated by dorsal (top-of-foot) swelling due to osteophytosis (bone spurs) and impaired motion in the Lisfranc joint line.

Imaging Studies: X-rays, Ultrasound, MRI, and CT

X-rays (Weight-Bearing)

X-rays are the first-line imaging assessment and must always be taken in weight-bearing position, because some flatfoot deformities completely disappear when the patient is not standing. The standard set includes three views:

Dorsoplantar view (top-down) — used to measure abduction. Doctors measure the angle between the talus and the first or second metatarsal, the amount of talar head uncovering, and the talocalcaneal divergence angle, which shows the degree of talar rotation.
Lateral view (from the side, patient standing) — used to assess flattening. Key measurements include the angle between the talus and first metatarsal (normal = 0°), the calcaneal slope (normal = 15–20°), and the talocalcaneal divergence angle (normal = 25–35°). It is essential that the first ray is weight-bearing for this view; otherwise the lateral view may appear falsely normal. This view identifies where the arch is breaking, dorsal impingement in osteoarthritis, and "plantar gap" in hypermobility — best detected by placing a block under the first metatarsal. Tibiotalar equinus (a downward-pointing ankle position) can also be measured.
AP (front-to-back) ankle view with Méary cerclage — used to assess valgus. This measurement is considered pathological if greater than 8°. This view reveals tibiotalar joint morphology, occasional fibular fracture, medial laxity, and osteoarthritis with lateral joint-line narrowing and talar displacement (indicating grade IV disease).

Stress X-rays are used to screen for joint laxity: forced valgus-varus views for the tibiotalar joint, abduction-adduction views for the Chopart joint, and elevation-lowering views for the Lisfranc joint.

Ultrasound

Ultrasound is an inexpensive but operator-dependent technique. It assesses the posterior tibial tendon and spring ligament, as well as all of the tibiotalar and medial midfoot ligaments.

MRI

MRI detects lesions in the posterior tibial tendon, spring ligament, and interosseous ligament, although the article notes that certain fissures or tears may be missed. In cases of impingement with the lateral tubercle of the talus, MRI can reveal cancellous bone edema (bruising) and cysts in the anterior apophysis of the calcaneus.

CT Scan

CT is used when the flatfoot is stiff (fixed). In younger patients, it screens for talocalcaneal or calcaneonavicular synostosis coalition (abnormal bone bridges). In older patients, it screens for osteoarthritis in the subtalar, tibiotalar, talonavicular, or Lisfranc joints. 3D CT reconstruction provides more precise analysis of bone and joint morphology, including the subtalar joint surface of the calcaneus (using a talar subtraction technique) — categorized per the Bunning classification — which is essential for planning an Evans' osteotomy (a calcaneal lengthening procedure).

Types and Classifications of Flatfoot

At the end of the clinical and imaging assessment, the flatfoot should be classified according to severity and cause.

Secondary Flatfoot

Some specific etiologies (causes) may be identified:

Osseous (bone) origin: post-traumatic deformity or growth disorder
Articular (joint) origin: rheumatoid destruction, diabetic Charcot foot, or Marfan syndrome hyperlaxity
Tendon-muscle or neurologic origin

Traumatic causes are the most frequent, including neglected medial tibiotalar ligament or Lisfranc injuries, or malunion of talar or calcaneal fractures.

Congenital Flatfoot

Reducible (flexible) idiopathic flatfoot in adults is rarely symptomatic. However, stiffness should always raise suspicion of a contracted flatfoot, synostosis coalition, or congenital or neurologic bone dysplasia. In congenital flatfoot, further morphologic changes continue to occur during growth.

Degenerative Flatfoot

Degenerative flatfoot typically affects overweight menopausal women. It is important to distinguish between reducible and fixed forms. Researcher Bluman further divides these into valgus and abduction forms for therapeutic planning. Doctors should systematically look for medial tibiotarsal (inner ankle) or first-ray hyperlaxity when evaluating degenerative flatfoot.

The Raikin RAM Classification

For surgical planning, the Raikin classification (RAM) organizes flatfoot by three levels — hindfoot, ankle, and midfoot — with progressive severity (I, II, III). Below is a simplified summary:

Stage I (Hindfoot): Tenosynovitis (Ia) or tendinitis (Ib) of the posterior tibial tendon, with neutral alignment of the ankle and midfoot.
Stage IIa (Hindfoot): Flexible (supple) valgus flatfoot with talar coverage less than 40%, a talo-first metatarsal Méary angle under 30°, and a talocalcaneal incongruency angle of 20–45°. The ankle shows mild valgus (under 5°) or deltoid insufficiency, with mild flexible forefoot supination.
Stage IIb: More severe supple valgus flatfoot with talar coverage over 40%, Méary angle over 30°, and talocalcaneal incongruency angle over 45°. The ankle may show valgus with deltoid insufficiency and tibiotalar osteoarthritis; the midfoot shows supination with instability (but not yet arthritis).
Stage IIIa (Hindfoot): Stiff, osteoarthritic valgus flatfoot (talar coverage under 40%, Méary under 30°, incongruency 20–45°). The ankle valgus is secondary to bone loss in the lateral tibial plafond with normal deltoid; the midfoot shows arthritic changes isolated to the medial column.
Stage IIIb: Stiff, osteoarthritic valgus flatfoot with talar coverage over 40% and Méary angle over 30°. The ankle valgus is due to both lateral tibial plafond bone loss and deltoid insufficiency; the midfoot shows medial and middle column arthritic changes.

In the hindfoot, Raikin analyzes reducibility and abduction; in the ankle, valgus, medial laxity, and osteoarthritis; and in the midfoot, supination, first-ray hypermobility, and Lisfranc osteoarthritis.

Non-Surgical Treatment

Before considering surgery, medical treatments should be tried. The article notes they are of varying efficacy:

Insoles and shoes with rigid counters are most commonly advised. They may acceptably alleviate pain, but the deformity itself is not corrected by this approach.
A supination wedge or medial arch support can correct the valgus component but may worsen abduction. This can be compensated with an anterior pronation wedge if the deformity is reducible.
In severe, non-operable forms, customized orthopedic shoes are prescribed.
Rehabilitation (physiotherapy) should not be forgotten. It combats retraction of the triceps muscle (calf) or fibular tendons and reinforces the toe flexors to compensate for posterior tibial muscle weakness.
In cases of acute pain, the foot is immobilized for 2–6 weeks in a resin cast or strapping with the foot held in inversion (turned inward) — this can provide significant relief.

Surgical Treatment: Hindfoot Procedures

When medical treatment fails, surgery is indicated. All hindfoot techniques described below can be used for reducible (flexible) flatfoot, but only hindfoot fusion is appropriate for fixed deformity.

Medial Translation Calcaneal Osteotomy

This procedure, assessed and popularized by Myerson, corrects hindfoot valgus by shifting the calcaneal tuberosity (the back part of the heel bone) toward the inner side. This realigns the pull of the calcaneal (Achilles) tendon. The main drawback is that it increases lateral rotation of the foot, which must be compensated by tightening the posterior tibial tendon or repairing it with a tendon transfer if it is torn.

Arthroereisis (Sinus Tarsi Implant)

Arthroereisis was originally described for congenital childhood flatfoot, and its application in adults is controversial. It works by limiting the abnormal motion in the subtalar joint. Two techniques are described:

The "calcaneo-stop" technique: a screw is placed vertically in the anterior apophysis of the calcaneus, positioned anterior to the reduced lateral process of the talus.
A metal or polyethylene expansion screw placed in the sinus tarsi (a small canal on the outer side of the foot).

This procedure acts on the subtalar joint but does not always fully correct the flatfoot, and it often needs to be combined with other tendon or bone procedures. The main drawback is frequent sinus tarsi pain, which may require removal of the implant while trying to avoid secondary loss of correction.

Evans' Calcaneal Lengthening Osteotomy

This procedure lengthens the anterior apophysis of the calcaneus using a triangular bone wedge. It corrects abduction and automatically raises the medial arch due to the oblique position of the talar head. The osteotomy pushes the navicular bone against the talar head, reducing talocalcaneal divergence and partially correcting hindfoot valgus through talar rotation. To achieve a proper windlass effect, it is essential to restore the talo-first metatarsal axis.

Drawbacks and considerations include:

Increased calcaneocuboid pressure, which can be compensated by lengthening the fibularis peroneus brevis tendon, provided talonavicular reduction is good.
Alternatively, calcaneocuboid fusion with a lengthening graft can be used, but carries a risk of non-union (failure of the bones to heal together).
Performing the osteotomy through a blind lateral approach can involve the anteromedial or anterolateral subtalar joint surfaces, especially in Bunning type B2 feet — though the article notes that the secondary osteoarthritis described in the literature was not consistently observed.

A variation, the Z or Scarf calcaneal osteotomy described by Malerba and Weil, allows displacement in several planes at once: lengthening, varization (inward tilt), and translation.

Hindfoot Fusion

The most common procedure is subtalar and mediotarsal fusion, which corrects subtalar valgus, medial arch collapse, and Chopart joint supination. Reduction should include talar rotation and anterior talar slide, reducing the height between the posterior edges of the calcaneus and tibia. This can, however, be very difficult or even incomplete.

Additional surgical details from the study:

Calcaneocuboid fusion is not systematic but is necessary in osteoarthritic flatfoot with abduction, and should be combined with a lengthening graft.
A dual approach is classic, but a single medial approach is recommended to limit skin tension, reduce the risk of cicatricial necrosis (scar tissue breakdown), and allow tensioning of the posterior tibial tendon if it is not torn.
Isolated talonavicular or subtalar fusion may be appropriate in cases of incipient (early) localized osteoarthritis.

Surgical Treatment: Ankle Procedures

Tibiotalar (ankle) valgus is a sign of severe, degenerative valgus flatfoot. It can be treated, but the article notes that results are most reliable in post-traumatic valgus with medial collateral ligament injury, and less predictable in degenerative cases.

Medial Ligament Repair

For traumatic lesions of the medial collateral (deltoid) ligament, the ligament is re-tensioned using a "pants over vest" suture or a shortening suture after resecting part of the distended ligament. The valgus should systematically be corrected with an associated calcaneal osteotomy.

Repairing a degenerative medial tibiotalar ligament with involvement of the spring ligament and posterior tibial tendon is difficult and currently under assessment. Because isolated re-tensioning and transosseous reinsertion tend to fail, the following tendon transfer options are recommended:

Plantaris tendon for Hintermann
Fibularis peroneus longus tendon for Deland
Heterologous tendon graft (donor graft) for Myerson

These transfers are placed in a non-anatomic trajectory because of the numerous bundles of the medial collateral ligament.

Valgizing Tibiotalar Osteoarthritis

The valgus may be reducible or fixed, and treatment differs accordingly:

In moderate osteoarthritis with misalignment, a supramalleolar osteotomy (a corrective cut in the lower tibia) is feasible, sometimes combined with a malleolar repositioning osteotomy (lowering the lateral malleolus and shortening the medial malleolus).
In severe osteoarthritis where the foot can be realigned (usually by corrective fusion of the subtalar and Chopart joints), total ankle replacement may be indicated if the surgeon is experienced.
In severe osteoarthritis where the foot cannot be realigned, tibiotalocalcaneal fusion or combined ankle-and-hindfoot fusion will relieve pain — but with imperfect functional results.

The article makes a strong point here: given the difficulty of managing tibiotalar involvement, symptomatic flatfoot should be treated before osteoarthritis sets in.

Surgical Treatment: Midfoot Procedures

After treating the hindfoot, the midfoot should be systematically reassessed. The article warns that persistent postoperative supination will induce valgization and jeopardize consolidation (bone healing).

Supination: First-Ray Lowering Osteotomy

The first ray can be lowered at several levels:

Plantar subtraction of the first cuneiform (removing bone from the bottom) causes shortening.
Dorsal addition of the first cuneiform — recommended by Cotton — or addition at the first metatarsal base causes lengthening, with a stabilizing effect on hypermobility.

The drawback is a risk of creating a "tarsal hump" (a bump on the top of the foot), which can make shoe-wearing difficult. When hallux valgus (bunion) is also present, lowering is achieved through a Scarf or chevron first metatarsal osteotomy.

First-Ray Hypermobility

Dorsal addition of the first cuneiform can stabilize the first ray through a dorsal block effect. However, the treatment of choice is the cuneometatarsal fusion (the Lapidus procedure) and its variants. These are demanding techniques:

The metatarsal bones must be positioned precisely to avoid metatarsalgia by transfer (pain under the smaller toes) or excessive pressure under the first metatarsal head.
Non-union is frequent, caused by insufficient fixation or by midfoot torsion from a short first metatarsal or abnormal metatarsal rotation.
A bone graft may be necessary to maintain first metatarsal length, combined with anti-rotation fixation using an axial compression screw plus a dorsal plate.

Midfoot Osteoarthritis

Osteoarthritis in the midfoot is either secondary to excessive midfoot torsion from supination, or from midfoot hypermobility that causes dorsal cuneometatarsal or cuneonavicular joint-line narrowing. Axial midfoot hyperpressure is also associated, due to first-ray insufficiency caused by hallux valgus or hypermobility. Treatment requires fusion of the first three cuneometatarsal joints and correction of the pronation-supination malalignment.

Managing Tendon Imbalance

Management of calcaneal and fibular peroneus tendon retraction depends on severity and the technique used. In Evans' osteotomy and some arthroereisis cases, the fibularis peroneus brevis tendon (and more rarely the peroneus longus) is lengthened by two hemitenotomies on either side of the tendon — a technique that partially releases the tight tendon while preserving some function.

What This Means for Patients

The article's central message is clear: adult flatfoot is often diagnosed and treated too late, and this delay has consequences — particularly for the ankle joint, where treatment is complex and poorly codified (lacking standardized protocols).

For patients, the key takeaways are:

Pay attention to symptoms: Flatfoot only requires treatment when it causes pain or functional problems. Persistent inner-ankle pain, outer-foot pain, or difficulty walking should prompt evaluation.
Seek a thorough assessment: A proper workup includes a detailed physical exam (not just looking at the arch) and weight-bearing X-rays. MRI, ultrasound, or CT may be needed to assess tendons, ligaments, and bone structure.
Try non-surgical options first: Orthotics, supportive shoes, physiotherapy, and short-term cast immobilization (2–6 weeks) can manage many cases.
Consider surgery early if indicated: Once arthritis develops in the ankle joint, surgical options become more limited and results less predictable. Treating symptomatic flatfoot before osteoarthritis sets in gives surgeons the best chance of preserving foot and ankle function.
Surgical success depends on correcting all levels: Because flatfoot affects the hindfoot, ankle, and midfoot, a comprehensive surgical plan may combine multiple procedures — bone cuts (osteotomies), tendon transfers, and/or fusions — tailored to the specific deformities found.

Frequently Asked Questions

What is adult flatfoot and what causes it?

Adult flatfoot is a syndrome where the foot's inner arch collapses, often because it fails to lock during walking. It can involve the hindfoot, ankle, or midfoot, and is commonly caused by strain on the spring ligament, posterior tibial tendon, ankle ligaments, or midfoot structures. Trauma, such as old ankle sprains, can also contribute.

What symptoms should I pay attention to with flatfoot?

Flatfoot needs treatment only when it causes symptoms. Look for pain on the inner side of the foot along the posterior tibial tendon, swelling, or deeper pain in the sole. Outer foot pain may signal impingement. Also notice difficulty pushing off, bunions, or trouble walking. Persistent pain or functional problems should prompt evaluation.

How is adult flatfoot diagnosed by a doctor?

A doctor will examine your foot while standing and lying down, testing arch collapse, heel position, toe raises, joint flexibility, and muscle strength. They look for signs like the 'too-many-toes sign' and assess whether deformities are flexible or fixed. They also check for joint stiffness or retracted tendons.

What non-surgical treatments are available for flatfoot?

Non-surgical options include insoles, shoes with rigid counters, and medial arch supports, which may ease pain but do not correct the deformity. Physiotherapy combats muscle retraction and reinforces toe flexors. For acute pain, foot immobilization in a cast or strapping for 2–6 weeks can provide significant relief.

When is surgery for flatfoot recommended and what does it involve?

Surgery is considered when non-surgical treatment fails. For flexible flatfoot, procedures like calcaneal osteotomy, arthroereisis, or Evans osteotomy can realign bones. For fixed deformity, hindfoot fusion is used. Ankle or midfoot procedures may also be needed. Surgery targets all affected levels, often combining bone cuts, tendon transfers, or fusions.

Source Information

This patient-friendly article is based on the following peer-reviewed research:

Original title: "Adult flatfoot"
Author: E. Toullec
Journal: Orthopaedics & Traumatology: Surgery & Research
Publication date: February 2015 (Volume 101, Issue 1, Pages S11–S17)

Note: This article has been substantially rewritten in plain language for educational purposes. It does not replace professional medical advice. Patients experiencing foot pain or flatfoot symptoms should consult a qualified healthcare provider, preferably a foot and ankle specialist or orthopedic surgeon.

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