Flat foot

• Valgus alignment of the heel bone
• Lowering of the longitudinal arch of the foot (longitudinal flatfoot)
• Pain: initially around the medial ankle, and in advanced cases below the lateral ankle
• Inability to stand on the toes of the affected limb

• Insufficiency of the posterior tibial tendon due to chronic inflammation – the most common cause
• Tarsal coalition (failure of the talus and calcaneus to separate naturally during childhood)
• Injuries

This involves corrective insoles or orthopaedic footwear that corrects the deformity. It does not permanently cure the condition but relieves symptoms by passively correcting the defect. It is reserved for early disease, when changes are limited to the posterior tibial tendon and the deformity has not become fixed. Conservative treatment may also help very ill patients whose comorbidities or general condition prevent surgery.

This treatment aims to correct the deformity and thereby relieve pain. Depending on disease severity, various surgical techniques are used, such as:

Transfer of the posterior tibial tendon (or other tendon-repair techniques) combined with a calcaneal osteotomy correcting its valgus position
Various arthrodeses, that is, fusion of hindfoot joints (subtalar, talonavicular, calcaneocuboid, triple tarsal and tarsometatarsal arthrodesis, etc.)

After corrective surgery for pes planovalgus, immobilisation in a below-knee cast is required, with crutches for support (a lightweight synthetic cast may be used). The cast is later replaced with a special brace (a lower-leg and foot orthosis). Postoperative rehabilitation according to an individual programme precisely developed at the clinic is a very important stage of treatment.

In foot surgery, ensuring a pain-free operation and minimising postoperative pain have always been major challenges. 

Modern anaesthesiology aims, wherever possible, to use regional anaesthesia techniques – from central blocks such as spinal and epidural anaesthesia, commonly known as lumbar anaesthesia, to peripheral nerve blocks at various levels performed under ultrasound guidance, especially when operating on one foot. 

The possibility of using a particular type of anaesthesia depends mainly on the extent of surgery and any coexisting conditions. 

For flatfoot surgery, spinal anaesthesia is preferred because of the extent of the procedure. It is combined with peripheral nerve blocks during recovery to provide maximum patient comfort.