Foot & toes
Progressive collapsing foot deformity
Painful adult flatfoot and tibialis posterior dysfunction: support, reconstruction and fusion options.
Understanding the condition
Progressive collapsing foot deformity can involve failure of tendons and ligaments that support the arch. Pain may occur inside the ankle or beneath the outer ankle as alignment changes. Assessment checks flexibility, strength and arthritis, usually with standing X-rays.
Treatment options
Supportive footwear, insoles or braces, activity changes and physiotherapy may help. A boot can be useful for an irritable tendon in selected cases. Not every flat foot requires treatment. Surgery is considered for persistent pain or progressive functional difficulty.
What a procedure may involve
A flexible foot may be reconstructed using a heel-bone osteotomy, tendon transfer and ligament repair, sometimes with calf lengthening or additional bone work. A rigid arthritic deformity may require fusion. The combination is individual; tendon surgery alone may not correct alignment.
Risks and benefits to discuss
The intended benefits are less pain, better alignment and improved walking. Risks include wound or nerve problems, infection, blood clots, nonunion of bone work, recurrent or excessive correction, persistent symptoms, painful implants and further surgery. Lengthening or tendon transfer can affect strength.
Any operation also carries bleeding and anaesthetic risks. Occasionally, complex regional pain syndrome causes prolonged pain and sensitivity. Your health and the extent of surgery change your personal risk.
Rehabilitation and aftercare
Protect both bone and tendon repairs. Use the prescribed cast or boot and walking aids. Weight bearing and exercises progress according to the specific reconstruction and healing. Plan practical support at home; physiotherapy gradually rebuilds walking, balance and strength.
Expected outcomes and recovery
Recovery after reconstruction is lengthy, often extending over many months towards a year. Some swelling, stiffness or need for supportive footwear may remain. The aim is a comfortable, functional foot; normal shape or unrestricted activity cannot be assured.
When to seek urgent help
Seek prompt advice for rapidly increasing pain, spreading redness, wound discharge, fever, new numbness or a cast or boot causing pressure. New calf pain or swelling needs urgent assessment. Chest pain or breathlessness needs emergency help: call 999.
Your consent discussion
Ask which treatment best addresses your symptoms, what alternatives are reasonable, what the main risks mean for you, and what recovery will involve at home and work. This guide supports that discussion; consent is completed with your treating team. Your individual written instructions take priority.
Your consent discussion
Use the patient pack to record your priorities, the proposed procedure, its alternatives, the benefits you hope for and risks that matter to you. A clinician will discuss your individual circumstances and complete the appropriate hospital consent process with you.
Reading or downloading a guide does not give consent. You can ask further questions, decline treatment or change your mind before the procedure.
Further reading & sources
Prepared 10 October 2026 for the practice of Mr Peyman Bakhshayesh. Professional background. General patient education; your clinical assessment and written instructions determine your care.
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