Pain while walking
Pain in the heel, middle, or front part of the foot, stronger under load.
CONDITION / ARMS AND LEGS
Post-traumatic foot deformity.
Post-traumatic foot deformity — a change in the shape of the foot after a fracture or dislocation, when the bones healed incorrectly or osteoarthritis developed in the joint. It is corrected electively when pain and deformity interfere with walking and orthopedic shoes do not help.
CONCEPTUAL VISUALIZATION- What it is
- The foot changed shape after a fracture or dislocation because the bones healed incorrectly or the joint was destroyed.
- Which bones
- Calcaneus, talus, Lisfranc joint in the midfoot, metatarsal bones.
- When corrected
- Electively, after X-ray and CT, when pain interferes with walking and orthopedic shoes do not help.
- Who treats it
- A surgeon who performs reconstructive operations on the bones and tissues of the foot.
01 / WHAT IS ITWhat is
What is
post-traumatic deformation.
The foot consists of many bones and joints, which together support the body’s weight. If, after a fracture or dislocation, the bones have healed with displacement, the joint remains unstable, or arthritis has developed in it, the foot changes shape: the heel becomes lower, wider, or tilts to the side, the arch becomes flatter, and the forefoot is displaced.
These can be the consequences of fractures of the calcaneus, talus, or metatarsal bones (metatarsals account for almost 50% of foot fractures according to examinations) and injuries of the Lisfranc joint — where the middle of the foot connects with the metatarsal bones.
Such changes can be corrected even a long time after the injury. What exactly to do — whether to preserve the joint or fuse it — depends on the type of deformation and whether the cartilage has been preserved.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
deformation presents.
Changes depend on which bones and joints were damaged. Most troubling are pain while walking and uncomfortable shoes.
The shape of the heel has changed
The heel is lower and wider than on the other side, tilts inward or outward; a bone may protrude on the side.
Shoes do not fit
Regular shoes press or rub, making them difficult to choose.
Joint stiffness
Pain and limited movement in the foot joints — this is how post-traumatic osteoarthritis manifests.
Pain under the toes
If a metatarsal bone has fused downward, painful pressure may appear under its head.
Soft tissues
Scars, retractions or lack of skin, tight tendons.
Soft tissue defect03 / REASONSWhy bones?
Why bones?
grow incorrectly.
Deformity is not the patient's fault. It is associated with the severity of the injury, how it was recognized, and how the bones healed.
Heel fracture
Calcaneal fractures account for up to 2% of all fractures, most often after a fall from height. After non-surgical treatment, the bone may heal with displacement, and after fractures extending into the joint, arthritis often develops in the joint under the talus.
Injury was missed
Lisfranc joint injuries are incorrectly diagnosed in about 20% of cases upon examination. When surgeons assessed standard X-rays of 307 patients with such an injury, non-displaced injuries were recognized on average in 76.7% of cases.
The fragments were aligned inaccurately
In a meta-analysis of 14 studies (686 patients), osteoarthritis after injuries to the medial part of the Lisfranc joint developed in 33% during follow-up averaging about 60 months; the risk was increased by inaccurate alignment.
Talus
After talar neck fractures, according to the meta-analysis, bone necrosis developed on average in 31.2% of cases, joint osteoarthritis underneath it in 49%, and in studies with follow-up over 2 years — in 81%.
Bone defect after injury
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
If the injury is old and the bones have already healed, urgent correction deformation is usually not required — it is a planned situation. Urgent signs occur after a fresh injury, cast, or surgery: according to NHS data, such signs require 103.
103 immediately if:
- sudden severe pain in the foot or lower leg;
- suddenly having difficulty breathing;
- pain in the chest or upper back;
- the heart beats very often;
- being unconscious or unresponsive;
- confusion of consciousness;
- very frequent breathing;
- cold, clammy, or pale skin;
- purple spots on the skin.
Do not delay:
Immediately in the emergency department (do not drive) after a fresh injury, if the foot or ankle is at an unnatural angle, a bone is visible, there is a deep wound, or the toes are blue, pale, or numb, especially under a cast. Immediately — to the surgeon who operated or is treating the fracture, and if not possible — to the emergency room: Pain or swelling of the foot after injury or surgery is increasing, not decreasing; cast or bandage has become tight. On the same day: after a fresh injury you cannot put weight on your foot; the calf or thigh of one leg is painful and swollen (it could be a blood clot); the skin around the wound is painful, hot, and swollen; very high fever or chills; you are coughing up blood. In the coming days: if after a midfoot injury an X-ray shows nothing, but pain and swelling do not go away, — see a surgeon: a regular X-ray can miss some of these injuries, so if suspected, a CT scan is needed. Planned: if the injury is old, but the foot hurts when walking, has changed shape, or does not fit into shoes, — schedule a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to fix
- Conversation and documents
When and how the injury happened, how it was treated, what surgeries were performed; discharge summaries and old images.
- Review
The doctor assesses the shape of the foot, gait, joint movements, skin and scars, circulation, and sensitivity.
- X-ray and CT scan
X-ray shows the position of the bones, CT shows exactly how they have fused and whether the joint surfaces are damaged. If Lisfranc injury is suspected, but the X-ray shows nothing, a CT scan is performed.
- Condition of the cartilage
It determines whether the joint can be preserved or if it is better to fuse it.
- Planning
With CT, the angles and cut lines can be pre-modeled in a special program.
06 / TREATMENTHow to fix
How to fix
deformation
Treatment depends on which bones are affected, whether the cartilage is preserved, and how much the deformity interferes with walking. The goal is to reduce pain and restore support to the foot.
01
Without surgery
The first step if the deformity is moderate.
- Shoes and insoles
- Orthopedic shoes or custom insoles unload painful areas. Surgery is considered when they no longer help.
- Not every displacement interferes equally
- According to the review, displacement of the metatarsal bones to the side is usually easier to tolerate than the lowering of the bone downward.
02
Preserve the joint
If the cartilage is still intact.
- Corrective osteotomy
- A bone that has healed with displacement is cut, put into the correct position, and fixed with plates or screws. The review of studies describes seven types of such operations on the calcaneus; they are chosen based on the type of deformity and the condition of the cartilage.
- Remove the bone protrusion
- If part of the heel bone protrudes from the side, that part is removed.
- Old Lisfranc injury
- In a review of 10 series of patients without osteoarthritis after delayed surgery, foot function assessed by the AOFAS scale increased on average from 55.7 to 88.1 points, with few complications.
03
Immobilize the joint
If the joint is destroyed by osteoarthritis.
- Arthrodesis
- Remaining cartilage is removed, and the bones are fused together in the correct position. This eliminates osteoarthritis in this joint but results in loss of movement in it.
- With a bone block
- To restore the height and length of the heel, a bone graft is inserted between the bones. In a systematic review, the bones healed in 95.78% of cases, with an overall complication rate of 38%.
- Large bone defects
- For large defects of the rear foot and ankle joint, custom titanium 3D implants are used. In a meta-analysis of 15 studies (142 patients), the bones healed in 88.2% of cases, and complications occurred in 16.9%.
04
What to expect
- The result
- According to a systematic review, properly selected surgeries reduce pain, correct deformity, and improve function; however, the studies had a moderate to high risk of bias.
- Soft tissues
- Sometimes, along with the bones, the Achilles tendon is lengthened or lateral foot tendons are released; scars and skin deficiencies are covered with flaps.
- Recovery
- After foot surgery, patients walk for several weeks in special shoes with limited load; exact terms depend on the surgery.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Post-traumatic foot deformities at the Valikhnovskyi Institute of Surgery are treated under the 'Hand and Foot Restoration' program. Surgery is planned when pain or deformity interferes with walking and orthopedic shoes do not help; the plan is made based on examination and CT scan.
CLINIC SERVICE
Hand and foot rehabilitation
Grasping, sensitivity, support, and movement after injuries, wounds, and burns: fingers, tendons, nerves, and bones.
View service
What we do for this condition
- Osteotomy according to a virtual plan — the bone is cut and placed in the correct position; angles and cut lines are modeled in advance using a special program.
- Anatomical stable plates — low-profile titanium plates for small foot bones allow beginning movement earlier than after a cast.
- Grafts and individual 3D implants — replace lost fragments; according to CT data, titanium implants replicate the shape of lost foot bones, for example, the talus.
- Local and microsurgical flaps, Z-plasty — cover skin defects and release scars that deform the foot.
- Special footwear after surgery — restriction of load for several weeks.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photos and pictures onlineSend photos of the feet, X-ray, CT, and discharge summaries — the doctor will preliminarily assess the situation.
- ConsultationExamination of the foot and gait; if necessary — new images and CT.
- PlanWhat to correct, whether it is possible to preserve the joint, whether a graft or custom implant is needed, and how many stages there will be.
- SurgeryRepositioning of bones and fixation; soft tissues — at the same or the next stage.
- RecoverySpecial footwear, load restriction, follow-up examinations, and imaging.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to correct the foot if the fracture was a few years ago?
Yes. Bones that have healed in displacement are cut and repositioned, and if the joint is destroyed by arthritis, it is fixed in the correct position.
Is it possible to do without surgery?
If the pain is moderate, orthopedic shoes and insoles help. Surgery is discussed when they no longer help and the pain and deformity interfere with walking.
What is arthrodesis?
It is the fusion of a joint: the bones are joined together in the correct position. This eliminates arthritis in the joint, but movement in it is lost.
Why wasn't the fracture noticed immediately?
Damage in the middle of the foot, in particular the Lisfranc joint, is not always visible on a regular X-ray, especially without displacement. Therefore, if suspected, a CT scan is done.
Is it possible to place an implant instead of a lost bone?
For large defects, individual titanium 3D implants are used. Whether this is suitable for you will be told by the doctor after a CT scan.
How long does recovery take?
After foot surgery, for several weeks one walks in special shoes with limited weight-bearing. The exact timing depends on the surgery.
What to bring to the consultation?
X-ray and CT scans (disc or link), records of fracture treatment and surgery, photos of the feet. If you do not live in Kyiv, they can be sent for preliminary evaluation.
Sources
19 sources · systematic reviews, meta-analyses, Cochrane and NHS reviewsshowCollapse
- The Effectiveness of Surgical Interventions in the Management of Malunited Calcaneal Fractures: A Systematic ReviewThe Journal of Foot and Ankle Surgery, 2019doi:10.1053/j.jfas.2018.08.034 ↗
- Malunited calcaneal fracture: the role and technique of osteotomy — a systematic reviewInternational Orthopaedics, 2021doi:10.1007/s00264-021-05130-1 ↗
- Management of Calcaneal Fracture Malunion with Bone Block Distraction ArthrodesisClinics in Podiatric Medicine and Surgery, 2019doi:10.1016/j.cpm.2018.10.011 ↗
- Managing Severely Malunited Calcaneal Fractures and Fracture-DislocationsFoot and Ankle Clinics, 2020doi:10.1016/j.fcl.2020.02.005 ↗
- Management of the Subtalar Joint Following Calcaneal Fracture MalunionFoot and Ankle Clinics, 2022doi:10.1016/j.fcl.2022.08.001 ↗
- Surgical versus conservative interventions for displaced intra-articular calcaneal fracturesCochrane Database of Systematic Reviews, 2013doi:10.1002/14651858.CD008628.pub2 ↗
- Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal FracturesFoot & Ankle Orthopaedics, 2022doi:10.1177/24730114221101609 ↗
- Lisfranc fracture dislocation: a review of a commonly missed injury of the midfootEmergency Medicine Journal, 2016doi:10.1136/emermed-2015-205317 ↗
- Is the diagnostic validity of conventional radiography for Lisfranc injury acceptable?Journal of Foot and Ankle Research, 2023doi:10.1186/s13047-023-00608-0 ↗
- Medial tarsometatarsal injuries lead to overall post-traumatic osteoarthritis in 1 in 3 patients: a systematic review and meta-analysisEuropean Journal of Orthopaedic Surgery & Traumatology, 2026doi:10.1007/s00590-026-04855-2 ↗
- Surgical outcome of chronic Lisfranc injury without secondary degenerative arthritis: A systematic literature reviewInjury, 2020doi:10.1016/j.injury.2020.04.005 ↗
- Outcomes of Talar Neck Fractures: A Systematic Review and Meta-analysisJournal of Orthopaedic Trauma, 2015doi:10.1097/BOT.0000000000000297 ↗
- Metatarsal MalunionFoot and Ankle Clinics, 2025doi:10.1016/j.fcl.2024.04.003 ↗
- Tibiotalocalcaneal Arthrodesis With 3D-Titanium Implants for Management of Critical-Sized Osseous Defects of the Hindfoot and Ankle: A Systematic Review and Meta-AnalysisFoot & Ankle Specialist, 2026doi:10.1177/19386400261420376 ↗
- Broken ankleNHS, 2025nhs.uk/conditions/broken-ankle ↗
- Compartment syndromeNHS, 2026nhs.uk/conditions/compartment-syndrome ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
The figures on the page are from these sources.
The foot has changed
after an injury?
Send photos of the feet, X-ray, and CT scan. The doctor will say what can be corrected and whether it is possible to preserve the joint.