Ankle and flatfoot reconstruction

Conditions we treat

Adult flatfoot

The tendon that helps hold up your arch (the posterior tibial tendon) can get weak or stretched over time. When it does, the arch can slowly drop and the heel can tilt out. This is called adult-acquired flatfoot. Newer names are posterior tibial tendon dysfunction and progressive collapsing foot deformity. It often gets worse over time if not treated.

Ankle arthritis

Arthritis means the smooth cushion (cartilage) in the joint wears down. In the ankle, this often follows an old fracture or many sprains. It causes pain, stiffness, and swelling.

Chronic ankle instability

After one or more sprains, the ligaments on the outside of the ankle can stay loose. The ankle may feel wobbly or "roll" often, even on flat ground.

Signs to watch for

• Pain or swelling along the inside of the ankle and arch
• An arch that looks lower than before, or toes that point outward
• Trouble rising up on your toes on one foot
• Ankle pain and stiffness, worse after activity
• An ankle that gives way or feels unsteady
• Shoes wearing out unevenly

Treatment without surgery

Most people start here. Options include:

• Ankle braces or a supportive boot
• Shoe inserts (orthotics), store-bought or custom-made
• Supportive shoes
• Physical therapy for strength, balance, and motion
• Medicines to ease pain and swelling, if safe for you
• Injections into the joint for some types of arthritis pain
• Activity changes and weight management

When surgery helps

Surgery may be an option when pain or instability keeps you from daily life after a fair trial of non-surgical care. The right surgery depends on the problem, how far along it is, and your health. Common types include:

• Tendon or ligament repair: fixing, tightening, or rebuilding (reconstructing) a damaged tendon or loose ligament. A healthy nearby tendon may be moved to take over the work.
• Realigning bones (osteotomy): cutting and shifting a bone, often the heel bone, to put the foot in a better position. Screws or plates hold it while it heals.
• Joint fusion: joining two or more bones so they heal as one. This stops painful motion in a worn-out or collapsed joint. It may be done in the back of the foot (hindfoot) or the ankle. For severe problems, the ankle and the joint below it may be fused together with a rod. This is called a tibiotalocalcaneal (TTC) fusion.

For ankle arthritis, some patients may be candidates for other options, which he will discuss.

Recovery

Reconstruction surgery usually means time off the foot, often several weeks, followed by a boot and then shoes. Physical therapy is common. Full recovery often takes many months, sometimes up to a year. Your time frame depends on the surgery, your bone healing, and your overall health.

How Dr. Nafal can help

Dr. Nafal is board qualified by the American Board of Foot and Ankle Surgery in Reconstructive Rearfoot and Ankle Surgery, and in Foot Surgery. Reconstructive rearfoot and ankle surgery is a main focus of his work. He explains every option in plain words, including options that don't involve surgery.

Common questions

Will I be able to walk normally after a fusion?

Many people walk well after a fusion, often with less pain than before. The fused joint will not bend, so some motion is lost. Dr. Nafal will explain what to expect for your foot.

Can flatfoot get worse if I wait?

It can. Early care may slow it down and keep more options open. An exam can show how far along it is.

Do I have to try braces before surgery?

For most people, yes. Many find enough relief that they never need surgery. Your plan will be based on your goals and your exam.