It All Fell Apart ... Now How Do I Reconstruct My End-Stage Flatfoot?

Plantigrade mechanical alignment is the hallmark of a successful extra-articular flatfoot reconstruction. When executed appropriately, joint-preserving flatfoot realignment surgery often results in good functional outcomes and acceptable patient satisfaction. However, flatfoot reconstruction can fail for multiple reasons including progressive arthritis at adjacent joints, soft-tissue hyperlaxity, nonunion of an osteotomy, and under or overcorrection of the deformity. The reasons for failure must be identified and adequately addressed to achieve a successful outcome following revision surgery. We frequently perform a triple arthrodesis, with an extended medial column fusion (as necessary), after recurrent medial column collapse. We present our diagnostic algorithm, surgical techniques, and pearls for the treatment of the failed extra-articular flatfoot reconstruction.