Surgery: Hindfoot Valgus

Severe hindfoot valgus correction: arthroereisis, osteotomies for rigid or symptomatic cases. Dr. Priano, Milan.

Surgical correction for severe hindfoot malalignment

Surgical Techniques

Subtalar Arthroereisis

Minimally invasive insertion of an implant in the sinus tarsi to limit excessive pronation and correct hindfoot valgus. Same procedure as for flatfoot.

When it is used

Symptomatic flexible hindfoot valgus in children 8-14 years not responding to conservative treatment.

Recovery

Protection and loading follow the technique and any associated procedures. Implant removal may be planned or considered for symptoms: it depends on implant type, growth and the surgeon’s plan, rather than one deadline for everyone.

Medializing Calcaneal Osteotomy

Correction of severe hindfoot valgus through displacement of the calcaneus to restore normal alignment.

When it is used

Severe rigid hindfoot valgus, failed arthroereisis, older adolescents.

Recovery

Cast or boot and protected loading, often for about 6 weeks. The surgeon decides progression based on stability and union; recovery over several months is an approximate reference.

Postoperative Overview

Hindfoot valgus treatment follows similar principles to flatfoot correction. The choice between arthroereisis and osteotomy depends on flexibility, severity, and patient age.

Recovery Pathway (indicative)

Note: This is an indicative pathway, personalised after surgery. Some elements are relatively stable (goal of the procedure, approximate hospital stay, presence of a cast or brace); others depend on the individual case (weight bearing, range of motion, imaging, sport, hardware removal, follow-up intervals) and on the surgical technique chosen.

Hospital stay
Day-surgery for arthroereisis. 1 night for osteotomy.
First weeks
Arthroereisis: follow the specific technique’s protocol, as described for flatfoot. Osteotomy: cast or boot protection and non-weight bearing for the prescribed period.
Second month
Full weight bearing is not automatic at 2-3 weeks. After arthroereisis it depends on technique and symptoms; after osteotomy it requires assessment of union and the surgeon’s instruction.
Third month
Gradual resumption of activities when authorised, according to healing and function. Orthotics when indicated.
Return to sport
References of about 2 months after arthroereisis and 3-4 months after osteotomy are approximate. Return gradually after clinical and functional assessment and, for osteotomies, confirmation of union; associated procedures may extend recovery.
Follow-up
Individualised reviews as in the flatfoot pathway. Implant management differs between endosinotarsal and exosinotarsal techniques: planned removal and removal for intolerance are different indications. Agree the need and timing with the surgeon.