Flat foot correction surgery allows Andrew to hike again

49-year-old Andrew Hughes from Chiswick in London loves swimming, scuba diving and hill climbing despite having suffered for years with pain in the arch of his foot and around his ankle due to flat feet.

Over the years the pain in Andrew’s feet got worse and he initially managed this with orthotics. However, his feet continued to deteriorate resulting in a severe flat foot deformity which caused disabling pain on the sides of the ankle.

Andrew was referred to a podiatrist who specialised in surgery and after a consultation he had surgery on one foot. Unfortunately, he developed complications from the surgery, with deep infection (osteomyelitis) and severe, disabling pain. Further surgery with the podiatrist failed to resolve the problem.

Andrew said: “After doing some research I found out about Mr Peter Rosenfeld, Head of Foot and Ankle Surgery at Imperial Hospitals, and I arranged for a referral to see him at Fortius Clinic in Marylebone. I was immediately impressed with the high quality and efficiency of the clinic. Mr Rosenfeld was instantly welcoming and after an in-depth consultation and several specialised investigations he diagnosed a sural nerve injury and continued osteomyelitis.”

Andrew had extensive surgery to both the calcaneum and the sural nerve and after an initial period of recovery, he was thrilled to find that all the pain in his foot had gone for the first time in 18 months. 

When Andrew started to get increasing problems in the other foot, he immediately went to see Mr Rosenfeld for advice.

After a thorough examination and assessment of his foot, Andrew had an MRI scan and a weight-bearing x-ray which confirmed he had adult acquired pes planovalgus deformity of the foot - one of the conditions that causes a flat foot deformity. Mr Rosenfeld also identified a 30-year-old fracture which had been misdiagnosed as a ligament sprain.

Andrew’s deformity was complex as there was collapse and deformity of the ankle/hindfoot and at the midfoot/forefoot. The correction involved realigning the ankle and hind foot through the heel bone (calcaneum) and repositioning the subtalar joint (the joint below the ankle), with surgery to reconstruct the diseased and failed tendon on the inside of the ankle (PTT tendon) with a tendon transfer (FDL transfer). At the same time the stretched ligaments on the inside of the ankle were reconstructed (spring ligament) and finally the midfoot and forefoot were repositioned and realigned (Cotton osteotomy). This involved several bones being cut and realigned - all held in position with titanium screws and specialised titanium bone blocks.

Andrew was pain free immediately following his surgery at Fortius Surgical Centre and went home the next day in a plaster-cast. He had to keep weight off the foot for six weeks so initially he used crutches but found he coped better using an i-Walk - a type of knee crutch.

After two weeks, Andrew returned for a wound review, was given the all clear and an orthopaedic boot instead of the plaster cast. He started having physiotherapy and at six weeks, he was able to put weight through the boot. He began a daily exercise programme and weekly appointments with his physiotherapist.

Andrew said: “I worked hard to increase the distance I walked each day, before needing to rest and elevate the foot. I used a step-counter on my phone to help me measure my daily activity and keep me motivated.”

At 14 weeks following surgery, Andrew returned to his pre-operation activity levels and resumed mountain climbing in Snowdonia, without the arch pain that he had suffered previously.

Now at four months post-surgery, he completes 11 mile walks in North Wales and has started a new job which involves jumping on and off trains.

He said: “I want to thank Mr Rosenfeld for fixing both my feet. Without him I could not have returned to hiking on the mountains which I love. I am forever grateful to him.”

"I want to thank Mr Rosenfeld for fixing both my feet. Without him I could not have returned to hiking on the mountains which I love. I am forever grateful to him."

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