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Old 02-14-2007, 11:22 AM   #1
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David767 HB User
Flexible flat feet with hyperpronation

My 11 year old son has flexible flat feet with extreme hyperpronation. He is currently wearing the Richie brace. I have taken him to several D.P.M.'s and all have suggested surgery. Dr. Kieran Mahan, DPM from Temple University School of Podiatic Medicine, first saw my Son, 2 years ago. His approach I thought was way to radical. He suggested that my Son "would not respond well to an MBA type of device, but rather would best be repaired with an Evan's calcaneal osteotomy, medial colunm suspension,tendo Achilles lenghthening and Cotton osteotomy.". Well, that visit just about made me sick. We continued with the more conservative approach, orthodics and within the last year the Ritchie brace. A year ago he achieved his Black Belt in Tae Kwon Do, but has stopped due to his feet and I think boredom. He complains of pain in the upper part of his feet, and rarely walks more then a block or so before needing to sit down.
My Wife and I have started visiting other surgeons in the area for second(third, fourth) opinions. A recent visit to Dr. Brent Bernstein of Bethlehm, Pa suggests a Talonvicular fusion, Achilles tendon lenghening and a MBA implant. A different approach from Dr . Mahan's suggestion, but still I consider it a bit radical since a Talonvicular fusion seems like overkill and has it's own possible problems. He would do the fusion to decrease the wide range of motion that he has now.
I don't understand why Dr. Mahan seems to think that my son would not respond well to a MBA implant, but Dr.Berstein hadn't even blinked an eye when recommending his technique.
I have noticed in previous threads on the MBA implant, the patient only received achilles tendon lengthening with the implant. Not all three procedures.

I have two more Doctor's to visit this month. We would like to have a procedure done in June, so my Son can go to school in the Fall.

I was hoping for any information, opinions, etc. that may help my Wife and I make the most informed and educated decision possible. Thank you in advance any input.

Last edited by David767; 02-14-2007 at 12:40 PM.

 
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Old 02-14-2007, 06:01 PM   #2
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Re: Flexible flat feet with hyperpronation

Hi! I had the SAME problem, and I ended up having surgery on both my feet. I too went to MANY surgeons until I found one that I liked, with the best procedure. I decided against an orthopedic surgeon, as they tended to have more invasive procedures. I went with a podiatric surgeon, credited with the american board of podiatric surgery. I had a calcaneal osteotomy, achilles lengthening (done arthroscopically), tendon repairs, and two joint fusions with screws and cadavar bone. Im not going to lie, it was INCREDIBLY painful for the first week, and after that, it was all uphill. I spent two months in a non weight bearing cast, and then one month in a walking boot. After that I did physical therapy. I am four months out of my second foot, and I can already jog. I have no pain, and my knees back and hips feel much better than they ever did before. I have screws in that eventually will have to be removed, but I already had one taken out, and it was so easy. I was able to walk that day. I am so happy I went ahead with the surgery. My only wish is that I would have had it done sooner. I am 23 and already have arthritis in some of my foot joints, and knee damage from walking with such flat feet.
Here are my opinions-
1. avoid the MBA implant. I worked at a physical therapy clinic, and most patients we saw, the implant slipped out after a while. Also, four out of five doctors I saw said the same thing.
2. Use a WELL acredited podatric surgeon.
3. Request a nerve block in the femoral and sciatic nerves to control pain after the surgery.
4. It doesnt matter how well the surgery went if you dont have great physical therapy. Make sure the therapists are hands on, and have a sports therapist on staff, as they are the most informed about ankles.

I hope this helps! Good luck with your choice!

P.S. I also went from orthotics to the richie brace and then to AFO's. If he is having problems this young, like I did, it can only get worse. The tendons stretch to compensate for the saging foot, and everything else tightens up. The braces are only buying time.

Last edited by pugluver31902; 02-14-2007 at 06:02 PM.

 
Old 02-14-2007, 06:42 PM   #3
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Re: Flexible flat feet with hyperpronation

Thanks for input. I was thinking the MBA was the way to go, but according to your post I might be wrong. Dr. Mahan, stated my Son was not a good candidate for the MBA, maybe he is right. The much younger Dr. Bernstein thought Mahan's procedures were a bit "old fashion", would use the MBA inplant. I thought Bernstein's method had some merit, with the exception of the talonavicular fusion. I will print out your procedure and present it to the next few surgeons. Thanks

 
Old 02-14-2007, 07:58 PM   #4
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Re: Flexible flat feet with hyperpronation

For your records, here is a more precise account of what was done.

1. Gleich displacement calcaneal osteotomy
2. evans calcaneal osteotomy
3. percutaneous tendo achilles lenghtening
4. posterior tibial tendon repair and resection of an enlarged navicular
5. fusion of the first naviculocuneiform joint
6. repair of lateral ankle joint ligaments

I hope that helps some. Your son is younger so maybe he wouldnt #6 and the second part of #4. Like I said in the previous post, Im not going to lie. It was very painful, but most of the pain was gone by the end of the first week, and then once in a while you get shooting pains from the nerves regenerating, but nothing to bad. It gets sore from therapy, but that goes away quickly. Im only four months out of my second foot, and totally pain free. I can jog, jump on the trampoline and anything else I want to do. The foot that I did first, the scars are almost completley gone, and I only did that one a year ago.

I really havent heard good things about the MBA. And personally, I have seen patients that I worked with at the therapy clinic have thier MBA's slip out.

 
Old 02-15-2007, 10:48 AM   #5
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Re: Flexible flat feet with hyperpronation

I always feel bad for the youngsters. When I was a child, I had the same problem. Back then we used arch supports and wore shoes with Thomas Heels.

I wore orthotics, "Special Shoes" and also had the Ritchie Brace. I always told my mom that I would "kick myself" when I walked.

There are a lot of opinions. Well, here is mine. I had the MBA Implant about a year and a half ago. After I had the procedure, I could not walk again and was in a wheel chair. I know that KBEST had bilateral MBA and loves them. My PT said that it is rare that a person can walk with them placed in the joint.

Dr. Mark Myerson in Baltimore Maryland originally came up with the procedure for MBA. He does not even suggest it anymore. As for fusion, they try not to do that either (if they don't have to). If you fuse a joint, another joint takes the brunt and deteriorates.

They do suggest a calcanial osteotomy (sp) and tendon transfer. This puts the heel back under the foot. The reason that they do the transfer instead of a repair is that, after the repair, the tendon tears again.

I have had four joints fused in my left foot and to be honest, you are never the same. I have also had an MBA Implant in the left and tendon repiar.

It took a while before I was out of the wheel chair. I am walking now but I am up for a Calcanial Osteotomy, mass removal, ankle replacement, and nerve repair. (On the left).

I am glad you are getting several opinions. Your son will thank you when he gets to be an adult. I would see Dr. Myerson for an opinion. He is considered one of the best in this country. There is also Dr. Vora at Northwestern University in Chicago. He is also considered one of the best.

Please let us know what you decide.

 
Old 02-15-2007, 02:47 PM   #6
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Re: Flexible flat feet with hyperpronation

Thanks for all the information and opinions. WTWCT, thank you for recommending Dr. Myerson. I did a little research on this gentleman, and I will be making an appointment to see him. We live in the Allentown Bethlehem area of PA, so driving to Baltimore is doable for a consultation and possible surgery. I think he could be our man.

Thanks so much, and I will keep you posted. If their is anybody out there who would like to add this thread, please feel free!

Thanks,

David

 
Old 02-15-2007, 09:15 PM   #7
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Re: Flexible flat feet with hyperpronation

Its good that you are doing research and not just jumping into what the first doctor told you to do.

I was told that a tendon transfer was bad bc you are taking the tendon from somewhere where it should have been, thats why it was there. I had a tendon repair, and it has worked just fine. Since I dont have flat feet anymore, the tendon isnt being stretched out to much. As for the joint fusions, my foot actually feels better because the joints arent being bent beyone thier limits. I personally dont feel like my other joints are being worked to hard. I only had two joints fused though, not the four the previous poster talked about, so Im sure that made a differnce. Plus I think age has a lot to do with it. I had the surgery when I was 22 and 23, and my doctor told me that if you have it past 25 it would be a long painful recovery. But every person is going to react differently to surgery. Good luck!

 
Old 02-16-2007, 03:51 PM   #8
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Re: Flexible flat feet with hyperpronation

Although I have never had an MBA implant, and I was curious what it is for, I have had some of the other procedures being discussed on this thread. I developed a tear in the tendon which supports the arch on my right foot about 6 years ago- this is after a couple ligament repairs to the same foot. My surgeon gave me two options: either a tendon reconstruction with calcaneal osteotomy or a fusion of the talonavicular and calcaneal-cuboid (the midfoot). I went with the first and the recovery wasnt too bad. Unfortunately, my foot became unstable again (not sure exactly why) after about a year and I had the midfoot fusion in 2002. As with a lot of fusions, I had limited range of motion but the stability was back in my foot.... Again, I was okay for a while but then developed arthritis in another joint...and so on...I could go on for a while!!!
My opinion is that the fusion is great for pain relief and stability, but can do a number on your other joints....but still it might be a good option. Good luck with your decision!

Diane

 
Old 02-17-2007, 02:01 AM   #9
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Re: Flexible flat feet with hyperpronation

The MBA implant is like a screw/pin that they place between two joints in the foot to keep the arch from going flat. It is supposed to be good bc you arent cutting any bone, and the inscion is tiny - although - from most people I have heard and seen at the therapy place I work, the results havent been good. The implants slip out, are too painful to walk, or dont do a lot of help since you arent correcting any of the other foot problems. But I may be wrong, you may be able to find some people who had great results, I just havent seen them.

 
Old 02-17-2007, 10:08 AM   #10
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Re: Flexible flat feet with hyperpronation

pugluver. Tell me more about the problems with transfers.

 
Old 02-17-2007, 10:59 AM   #11
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Re: Flexible flat feet with hyperpronation

I dont know too much about the tendon transfers. Personally, I was just told by two surgeons that it is best to repair a tendon if you can, rather than transfer it from somewhere else. Because if you are taking it from somewhere else, you are leaving that area weakened. Plus, I was told there is more pain and recovery time from a transfer than a repair. Thats what my doctor told me, but Im sure many doctors have many different opinions. I would be interested in hearing how others transfers went. I had a repair on both of my ankles, and I have had fabulous results. I had quite a bit of work done on each foot, and four months out of each surgery, I was already able to jog, run, and jump in moderation. Im a year out of my first foot surgery, and I am astounded at the results and the fact that I have NO pain at all. The second foot, the one that is four months out, I also have no pain, with the exception that I had surgery to remove the screws yesterday. Im not even on pain meds for that though, its just sore.

 
Old 02-17-2007, 11:04 AM   #12
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Re: Flexible flat feet with hyperpronation

I forgot to add something. I had practically no tendon left at all. When the surgeon opened my foot up, he said it was just shredded. The first foot, he just repaired it. I have had no problems with the repair. The second foot, he repaired it and reinforced it with a grafting material. I have had no problems with the repair either. Im not sure why he repaired the second one with grafting and not the first. I think the grafting material is a new thing. Either way though, no problems and I am a very active girl. My feet take a lot more abuse than they probably should be taking at this point in time, lol. Running, acting like a dork, jumping over things. Yeah, not the smartest, but your only young once.

 
Old 02-20-2007, 02:41 PM   #13
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Re: Flexible flat feet with hyperpronation

I have an appointment on Thursday a.m. I will ask about this. David, please keep up to date about your son. Talk to you soon.

 
Old 02-21-2007, 11:21 AM   #14
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Re: Flexible flat feet with hyperpronation

I, too, have (or had) very flat feet, particularly on the right side. The left one is more normal. On December 26, I underwent several procedures - a double calcaneal osteotomy, a Cotton procedure (cuneiform wedge), and gastroc recission (basically lengthening the calf muscle). My podiatric surgeon in Denver was excellent. After 6 weeks non-weightbearing in a cast, I've been in a walking boot for 2 weeks and am about to go to my first PT session. Even though the foot is still somewhat swollen, I can tell you that it looks wonderful. I don't know if I'll be jogging in 4 months, but I'm very optimistic.

The orthopedist who gave me the second opinion had mentioned the tendon transfer, but my surgeon said that the Cotton procedure was the correct one for someone with flatfeet from birth, rather than acquired flatfeet.

David, you're right to do your research. The American College of Foot and Ankle Surgeons has guideliens for adult flatfoot treatment. Perhaps they have them for pediatric flatfoot, too?

 
Old 02-22-2007, 05:50 PM   #15
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Re: Flexible flat feet with hyperpronation

We went to another DPM, he wanted my son to stop using the Ritchie Braces and let his office fit him with another orthotic. One that built up along the inside of his feet, almost to his big toe, with a deep heel cup. This in conjunction with a running shoe specifically for hyper-pronation. He did not think the Ritchie Brace was appropriate for an 11 year old. He felt he could do better with his approach, instead of the whole Forrest Gump thing going on! He did state however that surgery is an option and that it a personel choice. He could do well with the proper orthotics and shoes for the rest of his life. Possibly never getting arthitis or other types of problems associated with severe flat feet. By getting surgery there is also a chance of complications(arthitis, etc.). After his consultation, he called in Dr. Ann Anderson who does most of the surgical procedures in the group. She agreed with him, but also thought Dylan would do very well with surgery. Her M.O. would be a Evans osteotomy, with a Cotton osteotomy, a Gastic tendon lenghtening and achillies lenghtening.

So, here we are, what to do? For now, we are getting Dylan the new orthotics and shoes, we will see how he does. If he still has pain and fatigues easily, we will get the procedures done. One thing the Dr's both agreed on, was that someone that young should not have a fusion done. It will cause arthitis and possible complications later on in his life.

Comments and advice always welcome, and thanks for your stories. I have truly learned from your posts!
David

Last edited by David767; 02-22-2007 at 06:14 PM.

 
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