Look beyond fusion as flatfoot reconstruction is effective for older people, says new research

Older people with acquired adult flatfoot deformity should be offered reconstruction as well as fusion, experts conclude after carrying out new research.

Acquired adult flatfoot deformity is a progressive flattening of the arch of the foot that occurs as a tendon becomes insufficient. Early stages involve pain along the tendon; latterly people may experience deformity and arthritis throughout the foot and ankle.

One treatment option is reconstruction or foot fusion depending on the severity of the flatfoot and the age of the person. Reconstructions are usually performed in younger people, while older people have fusion even though it can limit mobility.

“Overall, flatfoot reconstruction provides better long-term outcomes and mobility of the foot when compared to foot fusions,” says Dr Scott Ellis, senior study author. “However, there is a chance that reconstruction could fail, and to avoid a long, arduous recovery with multiple surgeries, patients older than 65 commonly skip reconstruction and opt for a fusion.”

Dr Ellis’s team has now compared the outcomes of reconstructions of 130 people with stage 2 acquired adult flatfoot deformity aged younger than 45 years, 45 to 65 years and 65 years and older.

The team found that people in the older age group did not demonstrate any differences in their outcomes compared with those in the young and middle-aged groups. And older people were no more likely to have revision procedures than people in the younger groups.

“We saw positive, consistent surgical outcomes across all age groups,” says Dr Ellis. “Depending on the severity of the condition, we believe a flatfoot reconstruction is a great option for patients regardless of their age.”

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