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Adult acquired flatfoot deformity is a painful condition resulting from the collapse of the longitudinal arch of the foot, frequently caused by the rupture of a large tendon. Problems associated with the condition vary, from a moderate level at early stages to disabling pain accompanied by major impact on the joints in late stages. Mild forms are treated with orthopedic insoles and shoe modifications. Insoles are insufficient therapy for the more severe cases of flatfoot deformity and chronic tendon rupture. At this stage, surgery is the only alternative. Various surgical techniques are used, alone or in combination, for different stages of flatfoot deformity. The target group is estimated to be 600 patients per year in Sweden, primarily women aged 40 to 60 years who are not helped by insoles or shoe modification.
Currently, there are no controlled studies that compare reconstructive foot surgery with insoles or no treatment. Compiling the results from followup studies shows that about 40 percent of the patients were very satisfied, about 40 percent were satisfied, and about 20 percent were uncertain or dissatisfied with the results of surgery. Several studies have shown a complication rate of surgery between 5 percent and 20 percent. Complications include delayed or no healing in bones, wound infection, and nerve injury.
There are no studies that present information on what percentage of patients can return to work after surgery. Roughly, the average healthcare costs for reconstructive foot surgery are calculated to be 30 000 SEK per treatment. Since the condition is very debilitating, even moderate treatment effects would represent a major benefit to patients and society.
Scientific documentation on the short-term effects of reconstructive foot surgery in adult acquired flatfoot deformity is poor*. There is no* scientific documentation on the long-term effects or the cost-effectiveness of the method.
The research presented in the literature is comprised of retrospective studies or biomechanical studies in a laboratory environment. It is essential for the method to be subjected to further assessment in randomized trials before it is disseminated. Assessments should include economic evaluation.
*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.
This summary is based on a report prepared at SBU in collaboration with Assoc. Prof. Fredrik Montgomery, Malmö University Hospital and has been reviewed by Jan Lidström, MD, Sahlgrenska University Hospital.
The complete report is available in Swedish only.
Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.