A flat foot that has failed non-surgical treatment tends to get slowly worse rather than better. The tendon stretches further, the arch sinks lower, and the heel drifts further outwards. Over months and years this changes the way the foot loads the ground, and the joints of the hindfoot begin to wear out. Once arthritis has developed, the joints have to be fused — a bigger operation with a stiffer result. Correcting a flexible flat foot while it is still flexible is therefore about restoring the shape of the foot now and protecting the joints for the future.

What the operation is trying to achieve

• Less pain. Most patients have pain on the inside of the ankle, along the course of the tendon, and many also develop pain on the outside of the heel where the bones are being squashed together. Realigning the foot relieves both.
• A foot that works properly again. When the arch collapses, the foot cannot lock into a rigid lever for push-off. Restoring the arch restores the push-off, which means better walking, better balance and less fatigue.
• A normal shape and a normal shoe. Correcting the heel and the arch means shoes fit again and wear evenly, and the ankle sits over the heel where it should.
• More walking, more sport. Patients who have had this reconstruction generally report significant improvement in pain, function and quality of life, and those improvements are still there years later.
• Protecting the joints. Realigning the foot takes the abnormal load off the hindfoot joints and the ankle. The aim is to avoid, or at least delay, the need for a fusion or an ankle replacement later on.

Flat foot correction is not one operation. It is a set of building blocks, and your surgeon chooses the combination that matches the shape of your particular foot. Some people need two of the procedures below; some need four or five. Not all of them are necessary in every case — the plan is made from your examination, your weightbearing X-rays and, where helpful, a weightbearing CT scan, and it is confirmed in the operating theatre once the foot can be assessed with the muscles relaxed.

Recovery from flat foot reconstruction is slow, and it is worth being realistic about that from the start. The bone cuts have to heal, and the tendon transfer has to bed into bone — neither can be rushed. The good news is that the improvement continues for a long time: most patients feel the full benefit at around a year.

Early Recovery: The First Two Weeks

• Two weeks at home with the leg elevated above the level of your heart for the great majority of the day. This is the single most important thing you can do to protect the wounds and prevent swelling.
• No weight at all through the operated foot. Crutches, a frame or a knee scooter for moving about.
• Blood-thinning tablets to reduce the risk of clots in the leg, continued while you are not weightbearing.
• Simple painkillers, and regular gentle movement of the toes, knee and hip.
• At around two weeks you come back to clinic for a wound check and stitch removal, and the backslab is exchanged for a full plaster cast.

Mid-Term Recovery: Weeks Two to Nine

• Weeks 2–6: still no weight through the foot, in the full cast. Blood thinners continue. Keep elevating whenever you sit down.
• Around six weeks: X-rays are taken to confirm the bone cuts are healing. The cast comes off and you move into a removable walking boot.
• Weeks 6–9: you begin walking in the boot, building up the weight gradually as comfort allows, and start physiotherapy. Early physiotherapy focuses on restoring movement and reducing swelling; strengthening the calf and the transferred tendon comes next.

Longer-Term Recovery

• Around 3–4 months: most patients are out of the boot and into a supportive trainer, often with an insole to begin with. Driving usually becomes possible once you can safely perform an emergency stop — typically at this stage for a right foot, earlier for a left foot in an automatic.
• Swelling is normal for six to twelve months and is worse at the end of the day. Continued elevation, and physiotherapy, both help.
• Sport is reintroduced progressively — swimming and cycling first, then low-impact walking and gym work, with running and impact sport usually from around six to nine months if strength and comfort allow.
• Maximum benefit is usually seen at around 12 months, and the improvement is maintained in the long term.

Mr Matthew Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH), Stanmore, and Honorary Associate Clinical Professor at University College London (UCL).

He specialises in complex hindfoot reconstruction and flat foot correction, total ankle replacement, cavovarus and flatfoot deformity, ankle ligament reconstruction and sports injuries of the foot and ankle, and has a particular research interest in weightbearing CT imaging.

He has published more than 50 peer-reviewed papers and has been awarded the EFAS Best Publication Award, the David Marsh Prize and the Watson-Jones Prize. He sees private patients at HCA and Spire hospitals across London and North London.

This page is for general information and does not replace individual medical advice. If you would like an assessment, please book a consultation.