Flexible Flat Foot



Complain of pain with prolonged standing


Complain feet tire easily




Adult Flatfoot Clinical Valgus Hindfoot Clinical


Overall alignment


Heel raises


Flexibility of Flat foot / STJ


T Achilles tightness




Planovalgus Lateral XrayPlanovalgus Foot Meary's Angle


Meary's angle

- Talus - first MT angle

- lateral weight bearing view



- 0o normal

- mild - 15o

- severe  - 30o


Non Operative


Medial arch support

Medial heel raise






- failure non operative measures

- inability to wear shoes




1.  Evans anterior calcaneal osteotomy



- lateral column lengthening



- incision tip of fibula to base of 4th MT

- elevate EDB anteriorly

- peroneal tendons anteriorly

- sural nerve posteriorly

- identify CCJ joint but do not open capsule

- insert Homan retractor and identify interval between middle and anterior facet

- osteotomy between the two, 1.5 cm from CCJ

- insert lamina spreader, assess arch at this point

- insert tri-cortical iliac crest bone graft (slightly trapezoidal) with bone tamp

- 1cm opening wedge

- stabilise with plate or screws


Evans Osteotomy + MT Osteotomy + FDL transferEvans Osteotomy + MT Osteotomy + FDL transfer Oblique


2.  Medial reefing / repair spring ligament / FDL Transfer

- incision at inferior aspect head of talus

- above tibialis posterior tendon

- excise segment of spring ligament approximately 6mm

- reapproximate ligament with non absorbable sutures


3.  Medial Cuneiform Plantarflexing Osteotomy



- Restore weight bearing tripod




Dorsal osteotomy mid-substance cuneiform

- lever open with osteotome

- 4 - 7 mm tri-cortical graft

- fixation with 2 x screw


Post operative

- back slab

- wound check at 1 week

- sutures out at 2 weeks unless DM or RA

- SL POP for 6/52 NWB

- then WBAT in boot 6/52


4.  +/- T Achilles lengthening

- if unable to passively DF ankle past 10o with knee extended


Post op

- POP for 6/52 (mould into arch)

- arch support / UCBL for 6/12