Successful Surgical Option for Flat Foot
Adult-acquired flat foot deformity (AAFD) can be successfully treated if diagnosed early. John Bleazard, DO, an orthopedic surgeon with Northland Bone & Joint, treats all stages of AAFD, but is one of only a few physicians in the Kansas City area who specialize in the All American procedure (also called Manoli-Pomeroy procedure). The All American is a surgical technique that has proven effective when performed during Stage 2 AAFD, while the joints around the hindfoot and midfoot are still flexible. The procedure maintains the foot’s flexibility and functionality.
Dr. Bleazard says AAFD patients who report pain is a key treatment indicator, “While flat feet can be normal anatomy, if the patient is experiencing pain, he or she should seek additional treatment sooner rather than later. There are good operative and nonoperative treatment options if diagnosed early.”
Causes and Treatment
AAFD is typically caused by a dysfunction in the posterior tibial tendon that occurs either genetically or due to injury. The condition progresses in four stages and treatment is determined based on accurate staging, with both surgical and nonsurgical options available.
Stretches, therapy, and anti-inflammatory medications are common nonoperative treatment approaches for Stage 1 AAFD; when the arch is still intact and the patient is relatively pain-free. The Stage 1 surgical option is debridement of the tendon. During Stage 2, the tendon is painful and the arch is collapsing or has collapsed. When the disease progresses to Stage 3, the foot becomes rigid and the joints are arthritic and inflexible. Treatment in Stage 3 is a triple arthrodesis which fuses the subtalar, talonavicular and calcaneocuboid joints. This fusion technique provides good pain relief, but loss of motion. By Stage 4, the deformity has progressed into the ankle joint where the preferred surgical treatment is often an ankle and subtalar arthrodesis, resulting in even more loss of joint motion.
Three Procedures in One
The All American procedure is a technique designed to treat Stage 2 AAFD while the foot is still flexible and the joints are still functioning and viable. This procedure specifically treats the insufficient posterior tibial tendon and flat arch with a flexor digitorum longus tendon transfer, medial displacement calcaneal osteotomy and lateral column lengthening. “The arch can be successfully recreated by combining the soft tissue tendon transfer and bony technique in one procedure,” explains Dr. Bleazard who has performed the All American on more than 200 patients from 17-70 years old. “The main benefit of this joint-sparing procedure is pain relief and preserving the natural motion and function of the foot.”
Historically, surgeons would treat Stage 2 AAFD by performing the flexor digitorum longus tendon transfer, medial displacement calcaneal osteotomy or lateral column lengthening in isolation. Greg Pomeroy, MD, and Arthur Manoli, MD, combined the three separate procedures into one, creating the All American.
After 8 weeks of nonweight-bearing recovery in a cast, patients gradually resume their presurgery activities and are at 95% activity level within one year. “Candidates for this procedure are very active people like runners and cyclists,” Dr. Bleazard says. “The goal of the surgery is to keep patients active and return them to a good quality of life.”
An intermediate five-year follow-up study used the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale to assess postsurgical outcomes. The procedure had a high patient satisfaction score, and radiographic data indicated long-term viability of the corrective procedure.
John Bleazard, DO
Dr. Bleazard earned his medical degree from The University of Pikeville-Kentucky College of Osteopathic Medicine and completed his residency in orthopedic surgery at St. Mary’s Medical Center. He fellowship trained under Gregory Pomeroy, MD, in foot and ankle surgery with New England Foot and Ankle Specialists at Mercy Hospital, Portland, ME. Dr. Bleazard specializes in the treatment of complex foot and ankle reconstruction including flat foot and cavovarus deformities, trauma, and tendon and ligament reconstructions. He has expertise in ankle replacements and fusions of the foot and ankle.