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Old 02-26-2008, 05:16 PM   #1
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Question HELP!!!! Need tons of info re: flat foot reconstruction

Hello, I'm a 27 year old athletic female in the armed services who has been recently diagnosed with plantar fasciitis, pes planus(both feet) and posterior tibial tendon tear in right-driving foot only. After having customized orthotics for almost 2 years now, cast for 4 weeks, ultrasound, physical therapy for almost 2 months none of these treatments worked. So now my options are to have my orthotics customized again and be permanently tied to them, wear a bilateral brace for a month or have surgery with the latter being the best option. I've been actively running since high school and started to have debillatating shin splints in college. I received treatments which never seemed to work. It was my shin splints that caused me to get the customized orthotics, that was almost 2 years ago. So last August as I was training(running, weight resistance) I started experiencing foot pain, no longer shin pain. My whole foot had a burning sensation that I never felt before. I went to a doc, was diagnoosed with plantar f. Went to Phy therapy for a month, did the exercises, iced and rested. Still had problems so I went back had xrays and mri done and that's when I was diagnosed with pes planus and pb tendon tear. The surgery is invasive and would consist of lengthening Achilles tendon, cut in heel bone-bone graft to create an arch and cleaning out excess in tendon area. For now, the right foot would be done with a 85% chance that the other foot will have to be operated on as soon as the right foot is stable.
I'm anxious, scared to death, petrified of what to expect pain wise. I understand that getting around will be extremely tough for about 2 wks post op, how can one bathe? With meds is the pain bearable or is it still mild? Are u able to get up to use the restroom? Are you able to do vigorous exercising after recovery? What is it like immediately followimg the surgery, the 1st week? How much help do I need ro should request? Do I need someone to stay home from work-I'm single with no kids, just a yorkie-lol? Any recommendations of med euipment, advice, suggestions or encouragement you can offer would be very well received. Thank you so much for your time!!!!!!!!!!!!

 
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Old 02-26-2008, 07:34 PM   #2
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Re: HELP!!!! Need tons of info re:flatffot reconstruction

I was in the same boat as you are. always had flat feet, but a soccer injury caused it to finally tear. Everyone just kept saying it was a "strain," but i knew something was wrong. I heard it snap when it happened. I continued to play for a few weeks, though i could barely walk. after the season i had an mri done, found the tear and a partial tear in the posterior tibial tendon. was put in a walking boot for 5 or 6 weeks, which helped only until i started running again. All the docs kept saying the only option was the pf release, or reconstruction, neither of which had exceptionally high success rates.

it finally got unbearable, and i saw a bunch of the top docs in the chicagoland area. Was given two options (extracoropreal shockwave treatment, and topaz procedure). I was told the shockwave may not work on scar tissue, and it wasnt covered by insurance and was about $5,000. Topaz sounded better. It is minimally invasive (small incision, although my doc did it without an incision). Theres a wand thats inserted through the incision and "pokes" tiny holes into the PF and soft tissues (my doc did holes directly through the skin, so no stitches or anything). It removes some of the damaged tissue and encourages healing and bloodflow in the area. I was an extensive case and had it done in 3 places, totaling about 40 holes, but usually theres only like 15 holes. It was done under twilight anesthesia/sedation. Because mine was extensive i was on crutches for 4 weeks, and continued in a boot till about the 7th week i believe. after that was able to walk long distances without an issue. i had custom orthotics made and am doing absolutely great, no real pain at all.

The first couple of weeks i just had some soreness and slight pain, nothing too bad as long as you kept it elevated and didnt bump it. my foot was wrapped in surgical dressing under the boot, and couldnt get it wet for 10 days. the first few days being upright made it hurt, so i washed my hair in the sink with some help. After that, i put a stool in the shower, wrapped my foot in a garbage bag with some tape, and propped my foot up. it was alright for a quick shower.

Sorry this was so long, but i would definitely look into this if theres a doctor in your area that does it. its not a new procedure, but is new for treatment of the PF. Its been used for tendon treatment for a while, and famous athletes have had it done. Good Luck!

 
Old 02-26-2008, 10:23 PM   #3
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Sounds like your doc is planning on the reconcstruction surgery. If you plan to go along with that I can give you some idea of recovery. I had this surgery 2 years ago. I had a tendon transfer as the PTT was mush and the calcaneal osteotomy (heel bone cut off). The pain is pretty intense but controllable with pain meds. Elevation is key. You must be "toes above your nose" 95% of the time for the first several weeks. If at all possible I would plan to have some help for the first few weeks. Although I have talked to people who live alone and have done fine with preparation in advance. You will probably be non-weight bearing (NWB) for about 6 weeks. During this time you can use crutches or a roll-a-bout where you put your knee on a pad and push with the other leg, or a wheelchair or walker. Personally, I used the wheelchair as it freed my hands for things like preparing food, carrying food, washing hands, etc. I also used crutches some. Some people really like the roll about. I have never tried one, so I can't speak to that. The walker I tried and it is awful. You have to hop on one leg and it is exhausting. I don't recommend that. you will need a shower chair. If you have a tub you may want to get the one that is a transfer seat where part of it is outside the tub. You slide over and keep your leg on the side of the tub. I had a hand held shower in my tub so it was perfect. If you are using a shower you will need a cast cover which can be purchased online or thru a medical supply house. A toilet chair was a wonderful thing as well. The handles come in handy during the the NWB stage. It is hard to get up from a seated position on one leg with no armrests! It is helpful if you have access to a little mini refrigerator so you can put drinks, snacks, etc close at hand to reduce trips to the kitchen. You may want to board your pet for a few days at least. If it needs to be walked outside daily that will be rather difficult at first so some help with that would be great. Once you get to the partial weight bearing (PWB) stage it will get much easier. This will be done either in a walking cast or a removable boot, depending on your surgeons preference. Mine, thankfully, likes the boot so at least my foot could breathe now and then! Ahead of time you want to assess your home for obstacles such as narrow passageways, throw rugs, etc. Rearranging furniture temporarily is much easier before hand than after you are on one leg and can't get to where you need to go!. Regardless of what device you choose to use, I would get it ahead of time and practice negotiating with it. I quickly found the best routes thru the house that way.
The recovery is rather long. You will be PWB for a few weeks, again at your doctor's discretion. You will be in therapy for probably a few months. Full recovery takes at least a year, longer for some. Most of these surgeries are successful, just rather difficult. You can do it, though, even living by yourself. Hope this helps. If I think of other things, I'll post them. Good luck!

 
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Old 02-27-2008, 06:38 AM   #4
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Emmie54- Thanks a bunch for this info!!!!!!!!!!!!!!!! I have about a week to get back to the doc to decide whether to have the surgery or get the bilateral brace for a month because she wants to prevent further damage. My cast was removed in the 13th so I could have the MRI done and the doc is nervous about my feet not having any protection. I also went and got a second opinion yesterday and that doc validated everything that my doc told me without me mentioning what she said. I'm very comfortable with my doc but I sought advice to help me with my decision and that doc said that for my age and activity level the 3 part surgery would be the best option. Both docs mentioned that the brace just provides stability for the tendon rather than fixing the problem that caused it and I will always run the risk of damaging it again because of my feet. I was told that one's heel should be 21 degrees above the ground whereas mine is 0-5 and that I have pathology in the tendon area-whatever that means, lol!!! Did you have both feet done or just one? They both mentioned that I severe flatfoot deformity in both feet and that the left foot will eventually need surgery as well. One of my mom's co-workers had this surgery about 20 years ago and she told me that it was the worst surgery she ever had and she's had quite a few. She also mentioned that the meds did nothing to alleviate her pain and that she too was told the other foot would have to be done. She opted not to do the other foot because she couldn't imagine having to go through the procedure again. She also mentioned that not much has changed in terms of her having pain and discomfort prior to surgery but she also mentioned that she did not wear her orthotics. So I'm not sure if that had anything to do with it but to this day she said she can't stand for too long or walk far. I know each patient is different according to their body and how it reacts to trauma. Again, just nervous and scared. Did you have a popliteal block? I've been researching and checking boards like mad and a couple of folks have mentioned that this was a lifesaver for managing postop pain along with the meds. I also heard that Vicodin is not strong enough and that Percocets may be more effective. I'm not really fond of or knowledgeable when it comes to presribed medications-I'm a health nut and take tylenol or midol for cramps only and a once a year sinus infection, the side effects freak me out but I'm willing to do whatever the doc tells me to do to ensure top notch recovery.

Socrissi18-Thank you very much as well for your feedback!!!!!!! Does the topaz procedure treat only the tendonitis? In addition to the severe flatfleet, I also have plantar fasciitis that seems chronic. Even after physical therapy, resting and icing it's still here since last August and I haven't been in the gym for almost 5 mos now. Also, I had customized orthotics a year before I started experiencing foot problems and it's now going on 2 years and I'm worse off than I was before I had them. I need a procedure that will address the deformity that caused the tendon insufficiency in addition to the insufficiency itself. I will discuss this option with my doc to see if it's considerable for my condition. I just want to do whatever it is that will allow me or at least increase my chance to be able to live my life again because the sedentary lifestyle is not for me-lol. I get sad when I see people jogging and I don't even like running, I just like the benefits of it and unfortunately, I have to do it for my job. It's just the mere fact that it's not even an option for anymore that bugs me, I can't even walk or stand too long, I'm too young for this. I need to get back to mt squats, elliptical, bike and jogging sprints eventually. I know this recovery is a lengthy one especially because I'll have to get the other foot done once the right foot is stable but I rather have something done that seems like forever to recover to correct the problem that will increase my likelyhood of getting back to training than not having anything done, repeating procedures that didn't work to begin with, continue to experience debillating pain/discomfort just doing day to day normal activities and running the risk of doing further damage and picking up arthritis along the way. Either way I look at it, I can be screwed both ways, the surgery could prove to be unsuccessful or I'm just doomed for life but I'm trying to be optimistic and give the surgery a chance because at this point I really don't have much to lose since my feet seems to be deteriorating-lol.

Sorry for my spiel and rambling but I just found out like 2 days ago that surgery is the way to go and I'm not experience with having someone cutting into my body and putting foreign objects in it to hold things together and be expected to heal no less than 3 mos-lol! It'a a lot to take in, not to mention that I am a certified drama queen, please forgive me-lol.

 
Old 02-27-2008, 07:08 AM   #5
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Good morning!

These foot problems sure aren't fun, are they?! But with all the knowledge that doctors have these days, thankfully there is hope!

I've had flat feet allll my life and finally had my posterior tibial tendon snap. It was totally severed and couldn't be saved, so I had the transfer. Unfortunately for me I had to have a second surgery because the first one failed. Basically what happened is that I was out of my cast and in therapy too early. However, it's okay because I've accepted that "it is what it is" and I just have to deal with it now. I found a new surgeon for the second surgery on 12/27/07, and he was/is wonderful. After all is said and done, I will have been in some sort of a cast for 12 weeks this time before even starting physical therapy, but I would rather be safe than sorry... and I really trust my doctor.

Okay...... Now with that being said, I want to tell you that during alllllllll of this, throughout both surgeries and recoveries so far, I have had either very little swelling and pain, or none at all. This is pretty unusual from all I hear, but I'm telling you that it can happen to some fortunate people... it happened to me. You never know, you could just be one of those people. I'm very surprised and grateful to be one myself. But remember that each person's case is different. The best advice I think anyone could ever give is: Listen to your body very closely while you're going through this, be as positive as you can, take every part of the surgery and recovery in small pieces, get help or medications when/if you need them, and be patient!


I love the suggestions I got on this board. I read a lot here before my last surgery, but not before the first because I didn't know it existed! You are already ahead in that area. One of the best equipment/supply tips I picked up between one surgery and the next was the cast cover... called an Aqua Shield where I come from. It's like a rubber material boot, thick enough to be protective and resilient while pulling it on and off, yet thin enough not to be clumsy. It goes up over your knee and is tight enough there to keep water out. I am a shower type of a person, so this was PERFECT for me. The first time I had a shower chair and hand held shower, etc. I had to keep my leg (covered in a plastic bag) outside of the shower.... very messy and I absolutely hated it!

From my experience, I would say to make sure you get some help for at LEAST the first few days if you can.... then see how it goes. Again, each case is different. Have somebody "on hand" that you can rely on with a quick phone call once you're feeling comfortable enough to try being alone. Well, you won't be totally alone since you have a loving little doggie.... but once he gets tired from cooking and fetching things for you (LOL), you may want some backup help. Oh, and get your house well stocked and try to place things within easy reach.

Good luck! I'm sorry if I missed this part, but have you scheduled the surgery already? If so, when? Hang in there! Believe me, it's wonderful to be on the other side of this surgery, and you will be there too before you know it!

Last edited by hey19; 02-27-2008 at 07:17 AM.

 
Old 02-27-2008, 08:06 AM   #6
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Hi Hey19-Thank you for taking the time out to respond!!!!!!!! No, I have not yet scheduled a date for surgery but I have to get back to the Doc to inform her of my decision. I'm still researching and finding out new info on these procedures. I hope I'm one of the fortunate folks like yourself who will experience minimal to no pain but my procedure is more invasive so hopefully that fortune will come in handy because I have to get the other foot done too-lol.

So as far as equipment goes for postop, here are the following recommendations that I received;

Wheelchair-crutches is a given from doc
Aqua Shield
Mini Fridge
Wedge
Scooter if wheelchair is unavail
Shower Chair w/transfer seat
Toilet Chair

Am I missing anything? Is there anything that can elevate your feet above your nose besides pillows? When I wore the cast my foot kept slipping from the pillows when I fell asleep or even while awake after some time.

 
Old 02-27-2008, 08:11 AM   #7
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

One thing I would definelty look into before you have the surgery is ask your doctor if you will be able to run again after the surgery. I am active also and you might have to go to a couple different doctors before you find one that understands being active is important. Good luck to you
Another thing to add to your list is a backpack. If you are on crutches for a long period of time you can carry stuff easy in a backback from point a to b



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Old 02-27-2008, 09:12 AM   #8
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Mine is what is called "acquired flat foot deformity" which simply means I was not born with flat feet but for reasons unknown the arch starts to collapse. I have only had one done so far. Not to scare you, because my case was a little unusual, I ended up tearing both of my peroneal tendons during rehab. So I had to have a second surgery a year later to repair those. I then got a stress fracture while recovering from that surgery. I had an arthroscopy to clean out scar tissue in my joint 2 weeks ago due to the lengthy complicated recovery I had. That is NOT typical so I am sure you will do fine. I will most likely need the other foot done eventually according to my surgeon. It is collapsing slightly but I will do what I can to help it. Unfortunately, research has shown that once that tendon starts failing, you can possibly delay it but you can not prevent it, as I think you said your doctor told you as well. Don't let the comments of your mother's friend scare you too much. Everyone is different. That being said, I think you will need percocet at least for the first few weeks. What I did for pain control was this: I had the popliteal block which is awesome. Mine lasted 3o hours. I started taking the percocet on schedule even with the block so the level would build up in my system for when it wears off. Then I took Percocet every 4 hours. I could gradually reduce this over several weeks, then switched to Lortab which is much milder. I ended up taking that for months afterwards during rehab. Of course I reduced the dosage as my pain level got better. But I always took it prior to PT to help me move better during therapy. I would take it afterwards because PT is painful. I never had a problem walking away from the pain meds. Studies have shown that if you are in pain, you do not get addicted. I don't understand that, but it seems to be true. The problem comes when you aren't in pain and take it because you like the feeling. I never had problems with the Percocet controlling the pain. What happens to a lot of people is they take it after they start hurting. It is almost impossible to "get ahead of the pain" again once you let that happen, especially in the beginning. Don't get me wrong, this is a painful surgery. But you can manage it by elevating, elevating, elevating, staying ahead of the pain, don't crash and burn on your crutches like I did twice (once in the mud!). After the first few weeks it gets much better. If you are planning on having some assistance I would plan on about 3-4 weeks then you should be fine for most basic things.

 
Old 02-27-2008, 09:19 AM   #9
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

There are some foam wedges that have a scooped out tunnel that your leg can fit in. Some people have liked these. I always did this: put two pillows cross-wise then one length wise on top. This helped support the knee. I found doing it this way the two cross wise pillows sort of puff up around the length wise one, keeping my leg stable. I spent most of my time in a recliner at first. I found it easy to keep "toes above the nose" and still feel like I could see TV well, etc. I did the pillows the same way in bed and recliner

Last edited by emmie54; 02-27-2008 at 09:20 AM.

 
Old 02-27-2008, 09:42 AM   #10
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Hello again Emiie54 and thank you for this, I do feel a lot more at ease but still nervous about the pain-lol. How did you manage to stand to go to the bathroom and bathe during the rough part-the first couple of weeks following surgery? I heard that leaving the elevated position at any time is horrible during that time. With meds and following docs orders to a t, on a scale of 1-10 how would you rate your pain level when you underwent your procedures? Also, did you have general anesthia or local? I wanted local with sedatives to be knocked out without being completely under but my doc said that I might have to be completely under because it's a 3 part difficult procedure. That scares me too because u always hear about the occassional horror story about the ones who never woke up or had serious issues as a result of it. Did you have foot twitches or painful jerks during the recovery period, this seems kinda common for foot surgeries from what I've read so far?

Hi Bearsnumber1!! Welcome and thank you for your response!!!!!!! Yes, that was the first goal that I mentioned to my doc who advised me that this surgery had a higher success rate in terms of getting me back to normal-extremely active for me but she was honest with me and told me that with any surgery there is no guarantee. She discussed risks and complications asociated with the procedures but in my case I'm truly at a crossroads, either I continue on and modify the orthotics that I have, continue to have deformed feet that progresses, run risks of further complications to include arthritis or have the surgery and run the risk of it not being successful or being successful. I'm scared as heck, I don't think I've ever been this afraid. The idea of having to rely on people to take care of me even for a few weeks is tough and not to mention the pain, possible complications, etc...

Again, thank you for putting my mind at ease bcuz I have not been able to sleep.

 
Old 02-27-2008, 10:21 AM   #11
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Yes, putting your foot down during those first few weeks is tough. That is why I think the toilet seat is the best invention in the world. If you choose not to use a wheelchair then you need to have a stool available for bathroom use. Maybe two. Let's face it, some bathroom experiences take longer than others :=). You put your foot either on the seat of the wheelchair or the stool while "taking care of business" as well as blow drying your hair, putting on makeup, etc. If you don't have a wheelchair use the other stool. While standing, I would bend my knee and place it on the wheelchair (or the 2nd stool). It can be done! If you use a stool make sure it is a. high enough and b. lightweight enough to carry around from room to room easily. The pain scale is difficult as it is different by individual. As "hey19" said, she had very little pain. I have to say she is the first person I have ever talked to that had this surgery and said that. (sorry) but hey, if she can do it with no pain, maybe you can! For me, the pain would escalate to about an 8 when it was time for pain meds again. This was only in the very beginning, though. It would surge to a 6 or 7 when the foot was lowered for any reason during the first few weeks. The pain meds kept it at a tolerable 2-4 most of the time. But in the beginning I was counting minutes to time for meds. it depends on how extensive your surgery is, too. As far as anesthesia, yes there are risks, but complications are rare. You need general I would suspect because the surgery is rather lengthy. Mine was 4 1/2 hours. I have problems with nausea afterwards so I ended up staying 2 nights but was scheduled for one. Some docs do it outpatient. Personally, I think you need at least one night for pain control. Ice will be your new best friend. A hint someone gave me which really does work is while your foot is in a cast or splint and it's hard to ice it, put the ice behind your knee as well. It really does work.

 
Old 02-27-2008, 10:25 AM   #12
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Hi again! I have the wedge pillow... forgot to mention it earlier.... and I love it. I didn't have one the first time and wish I had. I can just pick that thing up wherever I go... so easy to transport and very comfortable for me. I even took it in the car to Chicago a few weeks ago.

I am very active, so I can appreciate your comments about physical activity. I ran a few years ago and that never really went well for me... shin splints, etc. Now I understand why I had those problems because I understand what was happening to my ankles all these years! Instead I now belong to a gym and walk a LOT... for miles. I miss that very much these days. Last year when I had my first surgery, I was back to the gym within three months, more full-time at four months. From what I hear, this is not normal, and granted, I wasn't doing allllll the exercises and classes that I was doing prior to surgery, but plenty enough to make me feel good again. I felt fortunate.

Looks like you've got a great handle on the things you'll need to help you. I would suggest having a chair (or two, depending on size of your home) with wheels -- a chair that you can get to easily. These can come in handy, especially if you're going to be alone. Make sure you've got a good cell phone/portable phone setup as well. We bought new phones with four handsets because of the different levels in our home. I had been leaving one of our other two phones lying around and then when the phone would ring, I couldn't get to it quickly, so my husband got tired of that whole mess and bought a set with FOUR handsets. Pathetic, I know, that I couldn't keep track of two phones, but having more handsets does the trick for us now. I guess my point in this regard is just to make sure people can reach you and you can reach others quickly and efficiently if needed. People will certainly worry if there is no open line of communication for you... at least it was a big concern for my family because I'm here all day alone.

I agree with those who recommend the popliteal block.... easy and painless to have done. I agree, too, with pain meds. Even though, as I say, I didn't really have much in the way of pain issues, I know from working in the medical field that you should always "stay ahead of the pain" as emmie says. I'm another one who's heard that you don't get addicted to those meds when you use them properly. That's what they're there for.... to keep you comfortable.

I hope you feel more comfortable each day with all of this. Just think... before too long, you may be on the other side of these posts trying to help others!

Last edited by hey19; 02-27-2008 at 12:48 PM.

 
Old 02-27-2008, 10:53 AM   #13
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Lateasha,
I just wanted to mention that I have a walker that has done wonders for independence! I don't think they are manufactured. I have posted info about it on another PTTD surgery thread, so check it out. I did have my daugter bring meals for a few days aftert the surgery (her idea, but oh, I was so grateful!), but the walker allows lots of freedom for most tasks. Many of those who post offer some very good advice and tips. Wishing you the very best. CeCe

 
Old 02-27-2008, 10:53 AM   #14
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

Oh, emmie, you don't know how odd I felt at first having minimal pain and swelling, but it seeed like a positive thing worth sharing. Minimal pain and swelling can happen. I know it's odd, and I'm actually sometimes concerned/confused about it. For instance, if I had experienced earlier/more severe pain, I might have gotten through all of this with a "repair" rather than an entirely severed tendon for which I had to have the tendon transfer and a good amount of reconstruction. I might have sought help earlier. It's why I keep emphasizing that each case is so different.... and that people should try to be as in tune as possible with their bodies.... and to be patient during the recovery.

As "hey19" said, she had very little pain. I have to say she is the first person I have ever talked to that had this surgery and said that. (sorry) but hey, if she can do it with no pain, maybe you can!

Last edited by hey19; 03-06-2008 at 06:02 AM.

 
Old 02-27-2008, 11:28 AM   #15
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Re: HELP!!!! Need tons of info re: flat foot reconstruction

I personally would recommend surgery instead of orthodics. I ran threw pain for 5 years or so and now I am having a surgery in April that not only is fixing my flat foot but fusing my subtalar joint. (Which means never running again)Also I have bad arthritis in my ankle. For the most part this could have been avoided if I would have seen a doctor when the pain started. So I would recommend not running threw the pain. Bite the bullet and get it fixed. Hope everything works out and you are out running this time next year


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