Surgical Procedures for Deformities, Instability, and Post-Traumatic Damage
The midfoot and hindfoot play a central role in the stability, mobility, and load-bearing capacity of the entire foot. When deformities, instability, or pain occur in this area—due to injury, degeneration, or congenital conditions—surgical reconstruction may be necessary. The goal is to restore the foot’s function, relieve pain, and restore or preserve its natural shape.
When Is Surgery Necessary?
Reconstruction of the midfoot is usually considered when non-surgical measures such as special footwear, orthotics, or physical therapy are no longer sufficient. Common indications include:
- Painful instability or deformities of the midfoot and/or hindfoot after injury
- Osteoarthritis in the midfoot, hindfoot, or ankle
- Deformities such as flatfoot (pes planus) or high-arched foot (pes cavus)
- Tendon damage, e.g., to the posterior tibial tendon (a key stabilizing tendon) or muscle failure due to neurological conditions
Which Surgical Procedures Are Recommended?
Dr. Tonio Gottlieb:
„Based on insights from leading foot surgeons, there are several proven methods for hindfoot reconstruction. Over more than 20 years of experience, I have successfully applied these techniques in many individual cases. Depending on the specific diagnosis, different combinations are considered. Below, I present an overview of the most common procedures.”
|
Procedure |
Description |
|
Corrective Arthrodesis |
Fusion of individual joints in a corrected position to restore the anatomical axis. Indicated when joints are worn out, irreversibly damaged, or immobile, or when joint-preserving surgery is not feasible. Includes: |
|
Subtalar Arthrodesis |
Fusion of the joint between talus and heel bone for arthritis or deformity, aiming for pain relief. |
|
Triple Arthrodesis |
Fusion of the three joints of the hindfoot in severe deformities such as rigid flatfoot, post-traumatic conditions, or advanced arthritis. |
|
Naviculocuneiform Arthrodesis / Miller Procedure |
Non-essential joint between midfoot and hindfoot positioned at 45° to both. Ideal for corrections in all three planes. Commonly fused in young patients with very flexible flatfoot. |
|
Lisfranc Joint Arthrodesis |
First three joints between midfoot and hindfoot are often unstable or degenerated. Fusion in a physiological position is the preferred treatment. |
|
Tendon Transfer / Tendon Reconstruction |
Repositioning or repairing damaged tendons to restore foot function and balance muscular forces. Common examples include reinforcement of the posterior tibial tendon using the flexor digitorum longus, or weakening overactive tendons (e.g., via gastrocnemius release). |
|
Corrective Osteotomy |
Bone cutting and realignment to correct flatfoot or cavus foot. Joint-preserving approach requiring healthy adjacent joints. Includes calcaneal, talar, tibial, fibular, or cuboid osteotomies. |
|
Subtalar Arthroereisis |
Insertion of a small implant into the hindfoot to prevent excessive pronation, useful especially in pediatric flexible flatfoot. |
Dr. Tonio Gottlieb:
„Rarely is only one of these procedures performed. Most cases require a combination of bony realignment and correction of muscular forces. Precise diagnosis and individualized recommendations are crucial."”
Details on Specific Procedures
Subtalar Arthrodesis
Fusion of the joint between talus and heel bone in its natural position to eliminate arthritis-related pain. Prioritizes stability, alignment, and pain relief over mobility.
Triple Arthrodesis
Fusion of the three hindfoot joints. Used in cases of severely deformed or destroyed joints, or when reconstruction is not feasible or the joint is already immobile.
Tendon Transfer
If important tendons like the posterior tibial tendon fail, a neighboring intact tendon is repurposed and fixed to maintain foot function.
Osteotomy
The bone is precisely cut and realigned to correct the foot’s axis.
Arthroereisis / Arthrorisis with Stop Screw
A small plastic spacer (arthroereisis) is inserted between the talus and heel bone, or screw (arthrorisis) is screwed into the calcaneus (arthrorisis) to reduce excessive foot pronation. Particularly helpful in children with flexible flatfoot.
After Surgery: Healing Timeline
Structured and well-supervised aftercare is essential:
- Phase 1 (0–2 weeks): Immobilization with cast or special shoe. Use of crutches for non-weight bearing.
- Phase 2 (2–8 weeks): Gradual weight-bearing, physical therapy, gait training.
- Phase 3 (from week 8): Return to daily life, potential use of orthotics or special footwear, ongoing scar care.
Dr. Gottlieb’s clinic in Berlin-Zehlendorf offers regular follow-up sessions, orthotic consultations, and physiotherapy through long-standing partners to ensure continuous monitoring and intervention as needed.
Risks & Complications
Standard surgical risks apply but are rare. The better the planning and preparation, the lower the risks.
Why Choose Dr. Tonio Gottlieb?
Dr. Gottlieb is a passionate foot surgeon and holistic orthopedic specialist. His expertise is recognized nationwide, and he is often recommended as one of Germany’s top foot surgeons. His engagement in research ensures both high-quality and up-to-date practices. Key strengths include:
- Personalized Approach: Every foot and every surgery is unique
- Modern Techniques: Focused on minimally invasive, joint-preserving, and functional methods
- Sustainable Results: Emphasis on long-term mobility and pain relief
- Holistic View: Full-body posture and alignment are integral to foot health
For the Best Surgical Results, Choose Top Foot Specialists
Midfoot reconstruction can provide the foundation for a pain-free, stable, and resilient foot. The key to success: extensive surgical experience, precise diagnostics, and a patient-centered strategy—just as practiced by Dr. Tonio Gottlieb.
References
- Klaue, Kaj (2015): The Foot – from Evaluation to Surgical Correction, Springer
- Hansen, Sigvard T. Jr. (1991): Functional Reconstruction of the Foot and Ankle, Lippincott Williams & Wilkins
- Banks, A. S. et al. (2012): McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, Lippincott Williams & Wilkins
- Wülker, Stephens, Crachiolo (2007): Operationsatlas Fuß und Sprunggelenk, Thieme
- Zwipp, Hans (1994): Chirurgie des Fußes, Springer
