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Foot reconstruction surgery

Why does my child need foot reconstruction surgery?

A child who has difficulty with movement may have changes to how their muscles work. These changes can create an imbalance of forces leading to altered resting, standing and walking patterns which place uneven forces on bones and joints. These uneven forces can cause feet to develop in a poor position which may get worse over time. This can happen to any child with a movement disorder regardless of how able to move they are.

How can surgery help?

The position of the foot can be improved with an operation. This would involve the positions of the bones being changed and the muscles and tendons being lengthened or moved to improve the balance around the foot and ankle.

This operation may be considered if your child’s ability to stand and walk is being affected by their foot position or they are having difficulty tolerating their splints.

Illustration of boot cast which goes to below the knee

Benefits of surgery include improving the shape of the feet to provide a stable base for standing and walking. The aim is to reduce pain and prevent potential pain and skin problems related to splints.

There are risks, as with any operation and the surgeons will go through these with you.

Your orthopaedic team will discuss the options and what is best for your child and family. You will have the opportunity to ask any questions you may have.

What does the surgery involve?

The operation to reconstruct the foot is done under a general anaesthetic where your child is asleep. After the operation children usually need to stay in hospital for 3 to 7 nights. The length of their stay in hospital will depend on how comfortable they are after the operation, if they have had one foot or both feet operated on and how they manage transferring out of bed.

What happens during the operation?

The operation to reconstruct the foot involves the surgeon making multiple cuts around the foot and lower leg. Through these cuts changes to the position of the bones of the foot and balancing of the muscles and tendons are made. Screws may be used to hold the foot in the new position or sometimes a bone graft is needed to help the bones heal in their new position. This involves taking a small sample of bone from the top of the pelvis and placing it in the foot. Exactly what your child’s surgeon does will depend on your child’s specific needs. Your child will have a cast put on their foot at the end of the operation to support and protect the foot.

Illustration of child laid in bed with their leg outstretched with a boot cast on up to their knee

What else happens in hospital?

Controlling pain

Children may have some pain and experience muscle spasms after the operation. If that is the case your child will be given medication to help control this.


After this surgery it is important for the bones and muscle to heal in their new position. The therapy team will see your child on the ward after their operation. They will go through exercises, positive positions and things you can do to help your child get the most from their surgery. After the operation exercises will need to be carried out a minimum of 3 times a day. Your local physiotherapist will guide your child’s rehab journey however it is your responsibility to ensure they complete the necessary exercises. The therapy team at the hospital will speak to your child’s local physiotherapist requesting they see them after discharge and will pass on any important information.


Your child will have a cast put on at the end of the operation to maintain a positive position. The cast will be from their toes to just below their knee. The cast must be kept dry at all time.


There is likely to be a lot of swelling after the operation. It is important to keep the foot elevated to help manage this. Your child will be encouraged to rest with their knee as straight as they can. They may be provided with gaiters, splints that hold the legs straight, to help with this.  This helps with swelling and provides a stretch to the newly lengthened muscles. The heel should be supported off the bed to reduce the risk of pressure damage whilst in cast.

Illustration of child laid down with gaiters on their legs to keep them straight

Standing and walking

Your child will not be able to put any weight through their legs after the operation for around 8 weeks. This will be discussed at pre assessment clinic with the hospital therapists. If your child will require additional support and equipment to manage transfers and mobility a plan will be made to make sure they are safe after the operation.

Illustration of child strapped into a standing frame to support their standing and walking


Your child will need elevating leg rests for their wheelchair if their wheelchair can accommodate these. If not then the therapy team in hospital will look at alternative options. This is to support their legs out straight to help manage swelling and provide a stretch to the newly lengthened muscles.

The therapy team at the hospital will speak to your child’s local physiotherapist requesting they see them after discharge and pass on any important information.

What happens after leaving hospital?

An appointment will be arranged for you to come back to clinic at around 2 weeks for the initial cast to be removed, wounds checked and a new cast put back on. You will need to return at 4 to 6 weeks after the operation for another check, the cast will be removed, a mould will be taken for a splint and a new cast will be put on.

You will need return around 2 weeks after this for the cast removing and the splint fitting. You will have an X-ray at 6 to 8 weeks after the operation to check how the foot is healing. You will be told when your child can begin standing and weight bearing at one of these appointments. Once your child’s consultant confirms they can begin weight bearing they must gradually build up activities and only stand and walk with their splint on.

What happens next?

It is important for your child to be followed up after the operation to monitor progress. If your child had a gait analysis assessment before the operation they may have another one once they are back walking and have been engaging in rehabilitation.

Further resources

Please read our resource for more information about risks of anaesthetics.

Is something missing from this resource that you think should be included? Please let us know

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

Resource number: ORP17

Resource Type: Article

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