This problem results in a fallen arch with the foot pointing out. It happens as the posterior tibial tendon becomes insufficient, hence one of its other names, PTT. The main function of this tendon is to hold up the arch, so when it is damaged, the arch collapses. The foot becomes flat and painful.


Heel pain, arch pain, heel spurs and plantar fasciitis can all be felt, with more pain upon weight-bearing during walking. There may be swelling on the inside or the outside of the ankle. Bony lumps may be present which can pinch nerves and result in tingling sensations in the toes. Diabetic patients are prone to an ulcer developing on the bottom of the foot.


Flat foot deformity takes place in four stages, so treatment is related to these. The first two stages allow for manual manipulation, as the deformity has not become fixed. Over the counter pain-killers, change of shoe, orthotics, and physiotherapy can all relieve milder symptoms.

A customised brace may be used to provide support. If these conservative treatments fail, surgery can be considered. An ideal surgical outcome is to attain alignment and keep flexibility. Surgical procedures used by Mr. Samarji, a specialist in treating Flat foot deformity in Manchester are fusion (‘arthrodesis’), osteoctomy, and lateral column lengthening. This latter method restores the arch with a bone graft. A fourth method is tendon transfer, whereby another tendon is moved to help control the forces and angle of pull on the arch. The relevant surgery depends on the type and severity of the deformity, the age of the patient, and type of activity they need to achieve.

Do I need an operation?

Whether or not you need an operation will depend on the nature of the flat foot deformity. Some of the causes for flat foot are not amenable to correction by surgery. However flat foot deformity as a result of a tendon problem is potentially amenable to surgical correction. Whether you need an operation will be based on a consideration of the stage of the flat foot deformity and consideration of the alternative options to surgery and not least what an operation would involve including chance of success and the post operation requirements as well as consideration of the risks of surgery. At the consultation, a full evaluation of the foot and problem would be made along with scans and X-rays. Following a discussion of the problem and the various options you should be in a position to decide whether or not an operation is something you would wish to undergo. The stage of the flat foot deformity as a result of a tendon problem will also affect the type of operation that might be needed.

If I need an operation what is involved?

In the early stages of flat foot deformity, all that is needed is a debridement of the tendon removing any inflamed tissue. In the intermediate stages where the tibialis posterior tendon is not working satisfactorily and where deformity has started to develop, an operation to take one of the neighbouring tendons to replace the tendon that is not functioning is carried out. This is also done often in conjunction with a realignment of one of the bones in the heel. The operation takes between one and two hours to perform. It is generally carried out under a general anaesthetic. Following surgery, if a tendon transfer has been done a plaster cast is needed for approximately six to eight weeks. For surgery in the early stages of the disease, no plaster is needed.

In the very late stages of flat foot deformity, a fusion of the hindfoot joints is carried out and this will require plaster treatment for two to three months.

How long will it be before I can get back to work or sports?

Getting back to work and playing sports following surgery for flat foot deformity (tibialis posterior tendonitis) will depend on what type of operation has been carried out. For relatively minor surgery in the early stages of the disease return to work is at approximately two to three weeks and return to sports at approximately two to three months. Following surgery for tendon transfer, a plaster cast is needed and hence this will have an impact potentially on returning to work. It is generally possible to return to work at about three to four weeks following the procedure. Arrangements would need to be made for getting to and from work particularly if the right leg has been operated on which will affect driving. It may not be possible to drive following a tendon transfer for approximately six to eight weeks following the operation.

Returning to sports is at approximately three to four months following tendon transfer surgery. It is at approximately six to eight weeks following minor surgery.

Will I need any physiotherapy?

Following surgery to the tendon for flat foot deformity (tibialis posterior tendonitis / tendinopathy), physiotherapy is needed to regain strength and rehabilitate the leg. Usually, six to ten sessions of physiotherapy are needed.

What are the risks of the operation?

All surgery carries the risk of complications these include infection, deep vein thrombosis, pulmonary embolus, nerve or vessel injury and complex pain. Prior to any surgery, it is important to consider the risks as well as the benefits and other options open to you in order that you are able to make an informed decision regarding an operation. A consent form with the risks set out on it is usually signed at the consultation if it is decided to go ahead with surgery.