Flatfoot Surgery: Implant Concerns and Recovery for Kids

Flatfoot, valgus foot, subtalar joint fusion implant?

At Kaohsiung Chang Gung Memorial Hospital, prior to surgery, it was mentioned that if there were no issues, the implant would not need to be removed.
Three months post-operation, the wound healed normally, but the doctor stated that the implant would need to be removed in a few years.
During this period, the child should only walk and avoid running or jumping.
The doctor explained that since it is a foreign object, it is better to remove it.
Is this correct? Additionally, before the surgery, the child was able to run for a while, so why after the surgery is the child advised not to run? Why is the situation worse post-operation than it was pre-operation? I also asked the doctor why this is the case, and he simply replied that there is no need to run and that swimming is a better form of exercise.
I previously recommended this specialist based on online reviews.
What exactly is going on here? The child underwent surgery and is now told they can only walk, and in a few years, another surgery will be required.
What is the long-term treatment plan for? Is this a surgical failure, or is the child being treated like a guinea pig?

Bojeng Jiarang, 30~39 year old female. Ask Date: 2017/12/11

Dr. Chen Yongxue reply Orthopedics

Hello, regarding your situation, it would be best to ask your attending physician in person rather than relying on another doctor for answers.
They may not fully understand the surgical process, the method used, or the postoperative condition, and their comments may not be entirely fair.
Thank you.

Reply Date: 2017/12/11

More Info

Understanding the complexities of flatfoot surgery, particularly in children, is crucial for parents navigating the postoperative landscape. The concerns you've raised about the necessity of implant removal, limitations on physical activity, and the overall recovery process are valid and warrant a detailed exploration.

Firstly, it's important to recognize that flatfoot surgery, particularly in children, is often approached with caution. The primary goal of such surgeries is to correct structural deformities and improve function. In many cases, surgeons may opt to use implants to stabilize the foot during the healing process. These implants can include screws, plates, or other devices designed to hold bones in the correct position as they heal.
The statement from your child's surgeon regarding the potential need for implant removal in the future is not uncommon. While many surgeons may initially indicate that implants can remain indefinitely if there are no complications, the reality is that over time, the presence of foreign materials in the body can lead to issues such as irritation, infection, or discomfort. Therefore, some surgeons recommend removal after a certain period, especially in growing children, to prevent any potential complications as the child matures.
Regarding the postoperative restrictions on physical activity, it is standard practice to limit high-impact activities such as running or jumping during the initial recovery phase. This is primarily to allow the surgical site to heal properly and to prevent undue stress on the foot, which could compromise the surgical correction. While it may seem counterintuitive that a child who could run prior to surgery is now being advised against it, this precaution is essential for ensuring long-term success and stability of the surgical outcome.
The surgeon's suggestion to engage in swimming or walking instead of running is a common recommendation. Swimming is a low-impact activity that allows for cardiovascular exercise without placing excessive strain on the healing foot. Walking, while also low-impact, helps maintain mobility and encourages circulation, which is vital for healing.

Your concerns about the child's recovery and the perception of being treated like a "guinea pig" are understandable. Surgery, especially in children, can be a daunting experience, and the recovery process can sometimes feel prolonged and frustrating. However, it is essential to remember that the healing process varies significantly among individuals, and what may appear as a regression in function could simply be a part of the normal healing trajectory. Swelling and discomfort are common after surgery, and it can take time for the body to adjust and for the child to regain their pre-surgery level of activity.

If there are ongoing concerns about the recovery process, the best course of action is to maintain open communication with the surgeon. Asking for clarification on the reasons behind specific recommendations and expressing any worries about the child's progress can provide reassurance and potentially lead to adjustments in the recovery plan if necessary.

In summary, while the postoperative journey following flatfoot surgery can be challenging, it is designed to promote healing and ensure the best possible outcome for your child. Understanding the rationale behind surgical decisions and postoperative care can help alleviate concerns and foster a more positive recovery experience. If doubts persist, seeking a second opinion from another pediatric orthopedic specialist may also provide additional insights and peace of mind.

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