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Old 06-17-2007, 01:43 AM   #1
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Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Hi. I'm a 28 year old guy in New York, always had flat feet but they never bothered me too much until about 3 years ago, when I got plantar fasciatis, which was successfully treated with prescription orthotics and physical therapy. Then starting about a year old, my left foot began to pronate inwards, and it just keeps getting worse and worse. I've been seeing a specialist at the Hospital for Special Surgery here, who saw what was happening and tried to treat it with a new, even more supportive orthotic--but my arch has just insisted on collapsing, and now when I stand without shoes on there's no arch on my left foot at all.

At this point the doctor has said there's nothing else that he can try except surgery. I trust him, as he really wasn't eager to do surgery and it seems like nothing else will work. But I do want to know more. The procedue he's suggesting involves moving my heel bone back to the center of my foot, doing a bone fusion to help create an arch and hold the foot in place, and possibly (but not for sure) doing something with a chip of bone to stabilize the ankle as well. It would be 3 nights in the hospital, followed by 8-10 weeks of no walking, and then another 8-10 weeks of walking in a boot, then physical therapy.

Given my age and what I want to do with my life--travel, exercise, stand for more than 10 minutes without feeling pain--I feel like it would be best to do the surgery now and hopefully it will really improve the rest of my life (as it is, the rapidity with which my activity level has changed due to this condition has really depressed me).

I'm **terrified** of the procedure though, so I'd like to hear from those who have gone through it (or something like it). Was it worth it? Do you still have pain after it's all done? Can the arch collapse again? I've read through the boards here and am particularly frightened by posts from people indicating that they've had multiple surgeries on the same foot--what can cause this, and how common is it for the initial surgery to fail? Has anyone experienced severe complications?

Sorry for the long post... I wanted to be as specific as possible in describing my situation. I'd be deeply grateful for any and all responses. Thank you!

 
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Old 06-17-2007, 04:35 AM   #2
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

I've never had an arch in my foot, not even a small one. I get plantar fasciitis once in a while and my feet get tired but not that bad. My podiatrist explained the procedure to me once. But he said if I'm not in excruciating pain he would not even do the procedure. He said it was hell.

 
Old 06-17-2007, 08:25 AM   #3
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Well, it's not plantar fasciatis at this point--it's much worse. The left foot is quite visibly falling in at the ankle, meaning I'm walking on the very inside of my foot. Without my orthotics in, I'd be limping, and even with them in it's hard to stand or walk as I end up balancing almost all my body weight on my right side. It's starting to make me get sore in my knees and hip as well.

 
Old 06-17-2007, 10:09 AM   #4
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Hi,

I just went through surgery, but it sounds like it was a little different than yours. I haven't suffered from flat feet my whole life, but have had increasing problems in the last 10 years or so. I went through plantar faciitis (went away with OTC orthotics and 1 round of physical therapy), and last year my posterior tibial tendon started giving out, resulting in the excruciating pain and my arch collapsing. We tried every non-surgical route we could, but it just was not healing.

So far I'm very happy with my surgery (but yes, it was hell going through it). I'm at 12 weeks post-op, and given how well I'm progressing and how happy the doctor is with my results, I am looking forward to a great new quality of life.

I have started a long thread called "Posterior Tibial Tendon Surgery" below; you can check it out to see what others have gone through and how they're doing. Most of us posting there have had good results.

My specific procedure was:
1) Evans calcaneal osteotomy - heel bone is cut and spread; a wedge-shaped bone graft is inserted to realign the bones of the foot and shift them over, helping re-create the arch
2) Debridement of the PT tendon
3) FDL tendon transfer, reinforced with horse heart tendon; secured with a hole drilled in the navicular bone

Good luck to you,
Deb

 
Old 06-17-2007, 11:18 AM   #5
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

my daughter had surgery in both feet for flat foot. she had ankle pain for years and no one could figure it out. at 10 she could not walk/stand more that 20 mins or so. the surgery involved nicking the achilles tendon and placing a pin in the ankle to force the arch. the dr said that they used to do the surgery you describe but the pin is simple and reversible. we did both feet a few months apart and she now has no pain.

 
Old 06-30-2007, 12:25 AM   #6
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

I'm just a few years older than you and have always been an active person. Not being able to run and be active, let alone walk, has been the hardest part of this.

I had surgery almost 5 weeks ago to repair the posterior tibial tendon and to do the Evans osteotomy (putting a bone block/chip in to lengthen/straighten the foot, thus creating an arch). My dr indicated that the osteotomy and bone block are quite successful and should be permanent. What I had done and what your dr is reccomending are a bit different though. Have you talked to your dr about your concerns? If he's done these procedures with others, he should be able to give you an idea of what to expect and what the success rates are.

I decided to stay overnight at the hospital, as I have had issues with nausea and keeping pain meds down following anesthesia before. I was on morphine for the first 24 hours, then went on to Percocet. That worked really well and I tapered it and stopped taking it after 3 weeks. It gets more sore than painful now. I'm sure the feelings will change when I start PT and walking again.

For me, one of the hardest parts has been having to rely on crutches or my "Turning Leg Caddy" and others. Everything just takes more effort and energy. I had a splint for 2 weeks after surgery, then had the stitches removed and a fiberglass cast put on. I have 1 more week to go in the cast, then will move to the boot (8 weeks NWB in the end). The caddy has been a godsend (also called a roll-a-bout)...I would encourage checking that out if you decide to go ahead w/ surgery. They can be rented from medical equipment companies.

Ask lots of questions of your dr, people on this board and reseach info on the web...it helps to be informed. Then it's a matter of taking the plunge...which is not easy, but if you can't do much, waiting doesn't help either (at least this is how I felt).

I would recommend the Posterior Tibial Tendon Surgery thread that deb mentioned, as others share their experiences and ideas on how to prepare for it. That was and is a huge help to me, in preparing for and recovering from the surgery. My family and friends have been a huge help too...no way I could have done this without them.

Good luck as you wade through all of this and decide what you're going to do.

 
Old 07-09-2007, 03:13 PM   #7
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Thanks to all for your thoughtful replies--it's very much appreciated. Darin, I would love to keep in touch as we go through this. I'm certainly not glad that anyone else has to have the same surgery I'm going to have, but it is oddly comforting to know that at least some other people are dealing with the same thing.
I'm still scheduled for a week from today, July 16th. The strange thing is that since I've scheduled the surgery, the pain has calmed down a lot! I'd almost rather it hurt much more so that I know I am doing the right thing...but still, every time I look down at the foot and see how it's totally not aligned with my ankle anymore, I know this needs to get done. It's not just about standing and walking, it's about being an active young person to me as well. I know the recovery is going to be hard, but here's hoping we both back on the slopes pretty soon!

 
Old 07-09-2007, 03:49 PM   #8
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

I had the same problem. The inside of my ankle would touch the ground. That happened six years ago. Also, the end of my fibula was bone on bone with my heel. I had my surgery about seven weeks ago.

I can tell you that I am in physical therapy now. When the pt works my ankle, I do not have that "jamming" any more. I know that I did the right thing, I know that the recovery is going to be long, I know that I procrastinated about the surgery.

I can tell you that I am glad I had the surgery. I can tell already that I am going to be walking better because of it. I am very happy and thankful that I had it done.

I noticed that you live in NY. Are you going to have Mark Myerson do the surgery?

 
Old 07-09-2007, 06:32 PM   #9
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Thank you so, so much for posting that reply! With surgery only a week away, it's so reassuring to hear someone on the other side of this experiece with a really positive outcome. And if you're already seeing such a differece at 7 weeks, imagine how great you'll feel in 6 months!

I think I'm at a somewhat earlier stage of the problem than you--my ankle's not touching the ground yet, but I think in time that's probably what will happen. Hopefully with this surgery, I'll never end up feeling what that's like; I've already experienced enough discomfort to want this taken care of.

My surgeon isn't the one you mentioned--I have a guy I really like at the hospital for special surgery. Where did you have your procedure done?

Thanks again for your post!

Quote:
Originally Posted by wtwct View Post
I had the same problem. The inside of my ankle would touch the ground. That happened six years ago. Also, the end of my fibula was bone on bone with my heel. I had my surgery about seven weeks ago.

I can tell you that I am in physical therapy now. When the pt works my ankle, I do not have that "jamming" any more. I know that I did the right thing, I know that the recovery is going to be long, I know that I procrastinated about the surgery.

I can tell you that I am glad I had the surgery. I can tell already that I am going to be walking better because of it. I am very happy and thankful that I had it done.

I noticed that you live in NY. Are you going to have Mark Myerson do the surgery?

 
Old 07-16-2007, 09:47 PM   #10
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Rosinbertfoot,

I had exactly the same condition as you and had exactly the same surgery as you (except for the heel movement--it was scheduled but the doc decided that my heel was well aligned and elected not to move once inside). I had the achilles lengthening and the bone fusion. My surgery was a complete success. I am now 6 weeks post op and have been in a cast ever since the surgery. I have 3 weeks to go and have been told that when the cast is removed on August 9th, a soft shoe will be put on so that I can gradually reintroduce weight to the foot. Like you, my surgery was on my left foot as it was worse than my right foot. And, like you, I have had flat feet all of my life, however, the pain had become increasingly unbearable, especially around the ankle. I note that today was the day of your surgery, so I will reserve further comment until you log back onto the board. As this is my first time back on the board since my June 8th surgery, I won't be surprised if you take awhile to return (hopefully not as long as me).

Take care.

 
Old 07-19-2007, 06:40 AM   #11
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Hi all,

Thanks for your encouraging replies. I did indeed have my surgery this Monday, June 16. The doc ended up doing 5 things: moving the heel back over, doing a bone graft over my arch, lowering the big toe, achilles tedon lengthening, and a tendon transfer in the foot. So, a lot happened! All I remember is th anaesthesiologist putting the nerve blocker in the back of the knee, and the next thing I know I'm waking up in the recovery room over 4 hours later!

My surgeon, whom i like a lot, was really pleased with how things went. Since I was a "grey area" case and decided to go ahead with the surgery anyway (the condition of the foot was just impeding my lifestyle way too much), I was relieved to hear that things were a bit *worse* inside than the doc originally thought from the MRI. Specifically, the spring ligament had a lot of fissures in it, an early sign that things were definitely headed in a bad direction and the tendon probably would have worn out very soon too. So, i did the right thing by having surgery sooner rather than later--better chances for recovery.

First night in the hospital wasn't too bad, until about 5 am when my nerve blocker started to wear off--unbearable pain! But the nurses were pretty good at managing it. The narcotics in the pump made me very nauseated as well. But I was doing very well with the pain yesterday so they sent me back home to recover. It's a loooooong road ahead of me, I realize--let's hope it's really worth it! I'm mostly using the rollabout at home, since I suck at crutches and don't want to risk falling at all (although mostly I'm not even rolling about, just lying on the couch with my foot propped up on a stack of pillows).

Two questions for anyone who is reading. First, how long did you all have to take painkillers for? I have a 60-pill prescription of Percocet. I was feeling so good coming home from the hospital yesterday that I thought I might be off them pretty soon, but then the heel pain kicked in again yesterday and this morning it was even worse again.

Second, did anyone rent a hospital bed? I find that I kind of miss it--it was so much easier to keep my feet elevated above my heart and head!

Thanks, as always, for your replies.... I'm really glad I can turn to people on this board for advice and sympathy.

Last edited by rosinberfoot; 07-19-2007 at 07:55 AM.

 
Old 07-19-2007, 12:16 PM   #12
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Hi there,

Wow, you had a LOT of work done on your foot. Glad to hear the surgeon thought everything went well. You do have a long road of recovery ahead of you, so be patient as the weeks roll on.

I was on pain pills longer than some other people. I took Lorcet, and my doctor also gave me a scrip for an anti-nausea med (phenergan?) since it made me very queazy. In the very beginning I was taking meds every 4 hours or so, then got down to 4-6 hours and then 6-8 hours. I'd say I was on Lorcet for about 3 or 4 weeks total. By the 4th week I was definitely needing something, but not as strong as the Lorcet. At my 4-week check up I was put onto Feldene, but only used that for a few days before switching over to Advil "as needed".

With the extensive repairs made to your foot, I would recommend laying with your foot up as much as possible. I know it's a pain and you'll get bored real soon, but it is the absolute best thing you can do for yourself for the first month.

Good luck to you,
Deb

 
Old 07-19-2007, 03:54 PM   #13
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Wow, you really went through a lot in surgery! Glad to hear that it went well and hopefully, eventually, you'll be able to say you were pleased that you went through it. I wanted a nerve block like you had, but they didn't have a "younger" trained anesthesiologist available to do it. Sounds like it was helpful in your case...until it wore off! That was one of my drs. concerns (had I gotten it)...that it would be 2am and the block would have worn off, leaving me in pain.

I was also prescribed Percocet, 60 pills to start (2 pills every 4hrs) and have had a number of refills since (1 pill every 4-6 hrs or as needed). I weaned off them after 3 weeks, but now that I am walking in the boot and doing PT, I am finding that I need them again. My dr told me to take a Percocet before PT. I also take Celebrex (have since before surgery) for inflammation and pain. The pain has changed over time...not so acute like it was in the beginning. It does get better! Take the drugs, stay ahead of the pain and just let your body tell you what it needs....you'll feel better and have a better recovery.

I never thought about a hospital bed. Just bought extra pillows to keep in my bed and on the couch, the two places I spend a lot of time! You'll get used to it...you could use a soft folded blanket or other things to make it more comfortable...I've molded things around my ankle to support it better.

Hang in there...it's a tough recovery...let your family and friends help you and support you...too tiring to try to do it all! Keep us posted on how you're doing!

Last edited by sunny77; 07-19-2007 at 03:55 PM.

 
Old 07-20-2007, 08:38 AM   #14
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

I pretty much had the same surgery as you did just about 6 months ago. I really never experienced a lot of pain, more an uncomfortable feeling. I was in the hospital for 48 hours and started on Percocet there. Once I was home I took it for only a few more days (only 8 pills) and then went off it. After that time I mainly took Ibuprophen or Tylenol as needed and that worked for me just to make it feel a little less achy at times. I managed to keep my foot elevated pretty well by living in my recliner chair and leaning back with my foot up on about three pillows. I thought this worked pretty well, however I have had more than normal edema that I'm still trying to get under control.

Best of luck with your recovery.

 
Old 07-20-2007, 09:02 PM   #15
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Re: Flat Foot Reconstruction Surgery--Share your advice & experiences please!

Rosinberfoot-

First off, congrats on a successful surgery!

I had your surgery way back in 1999, unfortunately, mine is a case of what can go wrong will go wrong but because of that I can give you ooodles of advice on what to do and what not to do.

First off... keeping that leg elevated... beg borrow or steal a microbead pillow or get your hands on a "knee pillow" (they are sold in stores and have a shape almost like an hourglass from the side and are made to place between your knees when you sleep) both of these will help keep your foot in the cast from rolling or shifting as you sleep. One of the best gifts I was ever given was a spiderman childs beanbag chair... keeps the leg up great!

Second... resist the urge to 'just let the foot rest on the ground' even when visiting the restroom... zero weight means zero weight, not even the weight of your leg!

Third... when you feel that your pain meds are starting to give out and there is an hour or so before you can take more eat some bread! (Bread is almost solid carbs, and pain killers in your system will bond with the sugar in carbs to be absorbed better)

Fourth... yeah it itches, but don't stick anything down that cast! (You could scratch yourself and cause an infection or unwittingly push foriegn matter close to your inscisions)

Fifth... freeze water in large ziplock bags over an empty 2 liter bottle in the freezer. (That will freeze the water in the perfect shape to form to the bottom of your cast, regular ice in bags for the top and wrap them in place with t-shirts. The cold will take time to sink through the plaster, but will make a world of difference)

Finally... take this time to pamper yourself and enjoy the things that an active life gave you little time for.

Best of luck and please let us know how things go for you.

Peny
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