Recovery after flatfoot surgery with subtalar arthroereisis (Pro Stop)

🏥 What happens on the day of surgery?

After flatfoot surgery using subtalar arthroereisis and placement of a device called Pro Stop (an implant), you stay on the ward until you are awake and your pain is controlled. The anaesthesia team chooses the type of anaesthesia, whether general or local, according to the patient's age and condition. You may go home the same day; an additional procedure or the need for more care may change the length of your stay.

When you leave hospital, your foot will be dressed, and you will receive a prescription, instructions for walking and a follow-up date. Before going home, practise moving safely with the care team. If both feet have been operated on, you may need a wheelchair and help from a carer on the days when you are not yet allowed to put weight on your feet.

As the anaesthetic wears off, pain around the wound and swelling in the foot may become more noticeable. You may see a little bruising or a small blood stain on the dressing that is gradually decreasing. Rest and the prescribed medicine should keep pain under control; the next section describes signs that need assessment.

⚠️ Warning signs: when should you get urgent help?

1Care in the first few days after surgery

In the first few days, the aims are to control pain and swelling, keep the dressing dry and move safely. Keep activity at a level that does not leave your foot more uncomfortable afterwards.

Who is this plan for? The main instructions are for a child or adolescent following Pro Stop alone, on a pathway without a cast. If the Achilles tendon (at the back of the ankle) or a calf muscle was also operated on, you have a cast or protective walking boot, or you have been given different instructions, the restrictions on your discharge sheet take priority.

🩹 Keep the dressing clean and dry

Do not remove the original dressing before the time set by the care team. If you have been taught to change it at home, follow the steps below. A trained carer should do this for a child and should not remove a cast or specialist dressing without instructions.

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• Wash your hands and prepare a fresh dressing and the recommended supplies on a clean surface.
• Gently remove the outer covering. If it is stuck to the wound, do not pull it off; ask the care team for advice.
• Look at the wound without pressing on it or touching the wound line. A small stain that is decreasing is different from a dressing that keeps becoming soaked.
• Clean the wound only as you have been taught. Do not apply alcohol, povidone-iodine, ointments or home remedies without instructions.
• Do not touch the dressing pad or the wound surface. Apply a clean, dry covering without wrapping it tightly around the foot.
• If the dressing becomes wet, dirty or loose, contact the treatment centre to arrange an appropriate change; do not cover up a wet dressing by adding more layers.
• Do not pick off stitches, skin glue or wound closure strips. The time for their removal depends on how the wound was closed and how it is healing.

🚿 Keep the wound dry when washing

Until you know that showering is allowed and how to protect the dressing, wash your body in sections. Covering the foot with plastic alone does not guarantee that the dressing will stay dry.

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• When showering, use a suitable protective cover and a stable seat, with a carer nearby.
• Keep the foot out of the direct stream of water and do not scrub the wound. Permission to shower does not mean you can wash the wound directly.
• If water gets inside the cover, ask for advice on changing the dressing. Do not remove a cast or walking boot for washing without instructions.

💊 Use the prescribed medicine dose

Give pain medicine according to the discharge sheet so that your child can rest and make necessary movements. A child's dose depends on weight, age and the strength of the product; do not use a prescription intended for an adult or another child.

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• Write down the names and times of medicines, and use an oral syringe or medicine measure for liquid medicines.
• Check the labels of combination medicines so that the same pain medicine, especially paracetamol, is not given twice through different products.
• Do not start antibiotics, blood clot prevention medicine or supplements without instructions. Having an implant does not by itself mean that every patient needs these medicines.
• If a medicine makes you drowsy or dizzy, get help with walking and avoid activities that require balance.

🧊 Reduce swelling with rest and elevation

When sitting or lying down, rest your lower leg on a pillow to keep the foot raised without putting pressure on the wound. Leaving the foot hanging down for a long time or suddenly walking more can increase swelling and pain.

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• Keep daily activities brief, with breaks between them to rest and raise your foot.
• If swelling or pain increases after an activity, do less the next time; do not push through pain to make progress.
• Use cold treatment only as recommended, with protection for the skin. Do not put ice directly on the skin or on a numb area, and keep the dressing dry.
• Avoid firm massage beside the implant or forcing the ankle and calf into a stretch during the first few days.

🚶 Three walking plans: why do instructions differ?

Different protocols follow three broad patterns. In the first, walking starts earlier with crutches and no cast. In the second, after 3 days, walking begins with a fixed walking boot and crutches for 25 days. In the third, a cast is used with no weight-bearing for 4 weeks, followed by the start of walking. The surgeon makes the final decision based on the severity of symptoms, the patient's age, associated findings and the details of surgery. The main instructions in this article cover only the pathway without a cast.

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• On the pathway without a cast, weight-bearing as tolerated with two crutches starts on day 4 after surgery on one foot and day 7 after surgery on both feet. Do not put weight on the operated foot or feet before the specified start day.
• Weight-bearing as tolerated means putting only as much weight on the foot as allows you to walk comfortably and with control using crutches; you do not have to take your full body weight from the start.
• The crutches should be adjusted to your child's height before discharge. Start on a level surface with short steps and a carer supervising. If both feet have been operated on, the instruction to lead with the unaffected foot does not apply; learn how to move and use stairs in person.
• Crutches are usually stopped around 2 weeks after surgery, provided walking without them is safe and without a limp. If you still need to lean on the crutches or you are limping, keep using them and arrange an assessment.
• Having no cast does not mean you can run, jump or twist the foot suddenly. Increase walking distance gradually, without causing more pain or swelling.

🚗 Returning to school and everyday activities

Returning to class is different from returning to PE. The right time depends on pain control, safe travel and the school's ability to accommodate the restrictions on your foot.

• 🎒 School: agree arrangements with the school for sitting, raising the foot, reducing long walks and temporary exemption from running and sport. There is no single return day that suits every child.
• 🪜 Stairs: use stairs only after practical instruction, with a handrail and help from a carer. After surgery on both feet, or while weight-bearing is not allowed, prioritise a route without stairs.
• 👟 Shoes: when swelling and the wound allow, wear roomy, supportive shoes that do not press on the operation site. Do not stop using prescribed footwear or a protective device earlier than instructed.
• 🏊 Swimming: on the pathway without a cast, swimming may be considered from around 1 month after surgery, provided the wound is fully closed and the surgeon approves. You must also be able to walk on wet surfaces and get into and out of the pool safely.
• ⚽ Sport: other sports are usually considered from around 3 months, depending on clinical progress. This does not guarantee readiness for football, jumping or competition; the type of sport, foot strength and balance also matter.
• 🚗 Driving: this guide is for children and adolescents. A teenager with a driving licence should not drive while unable to move the foot quickly and with control, while wearing a protective device or while taking sedating medicine; the time to return to driving needs a separate assessment.
• 🕌 Prayer: while sitting on your feet or getting up from the floor causes painful pressure, pray on a chair without loading the operated foot; ask your religious authority for guidance on the religious ruling.

❓ Common questions after Pro Stop flatfoot surgery

✅ Summary

After Pro Stop, wound care and a gradual return to walking matter. The main instructions in this article cover the pathway without a cast; the surgeon chooses between this approach, a walking boot and a cast. To guide progress, consider the quality of your steps and how your foot responds to activity, and do not treat dates on a calendar as a guarantee of readiness for sport.

This content is for general education only and does not replace an examination, advice from the treating doctor, your discharge sheet or your surgeon's individual protocol. Timing, range of movement, weight-bearing and the amount of exercise vary with the operation, any additional procedures and each person's circumstances. Do not change medicines, dressings or your exercise plan without discussing it with the care team.

📚 Scientific sources