Doubts about flat foot reconstruction - What have been your symptoms?
I am a brand new member to this site but have been very engaged ever since my podiatry appointment several weeks ago. I apologize for the long post but my question if anyone had chronic knee pain/aching symptoms for their flat feet?
My history is that I have had knee pain in both knees since I was a kid. Initially it was all focused directly under my patella. In college, after all non-surgical options failed to alleviate the pain, I had both knees scoped. It helped a little bit but knee pain continued to occur. Over the past 2-3 years, the knee pain/aching has been coming back on a daily basis. It is a bit different now since it is definitely more of a constant aching pain. I went back to an orthopod for my knees, got an MRI but nothing jumped out to him as surgery worthy (just like in college). He did comment on how flat my feet were so that has led me to begin seeing if my feet have been causing my knee pain. On a side note, I have had custom orthotics for 6-7 years with some improvement to the daily knee pain.
I recently went to a podiatrist and after explaining all of this to him he told me I basically have two options. 1. Continuing to try different orthotics, stretching, and looking at custom footwear or 2. A pretty large flat foot reconstruction surgery for each foot that would involve significant recovery. His goal on the surgery would be to alleviate up to 80% of my knee pain. Below are what each surgery will entail as written down by my doctor.
• Gastrocnemius Recession
• Medial Displacement Calcaneal Osteotomy
• Navicular Cuneiform Arthrodesis
• Kidner procedure or flexor transfer
Due to this surgery being pretty invasive, I went to another podiatrist and an orthopedic surgeon for a second/third opinion. The second podiatrist thought my feet were flat and that I definitely overpronate but to continue with testing various orthotics, stretching exercises, and looking for custom footwear to try and alleviate my knee pain. He does feel the knee pain is coming from my feet. If after some time, this still does not work, reconsider the surgery. The orthopod said he did not feel foot surgery would correct my knees at all and thinks I should go along the PT route and another MRI like I did in college.
Pain wise at the moment, my calves and hamstrings are incredibly tight 24/7 and my knees start throbbing just standing for 10+ minutes. Even just attempting to walk 18 holes of golf is beyond difficult with multiple ice/heat sessions and tons of Ibuprofen afterwards. I look crippled for several days after. I now walk around my house with my tennis shoes and orthotics because walking around barefoot kills my knees very fast. I just turned 30 and have been dealing with the "I have bad knees" but with no definite diagnosis. Since the pain has come back to a daily basis, I like the surgery option but am fearful that this will be one that does not help like the knee scopes.
So my question to this group is if anyone has/had symptoms like mine and has had any success from the flat foot reconstruction? I guess where I am concerned is that I don't really have foot/ankle pain, it has always been in my knees. Looking through all of these posts, I have not seen anyone specify knee pain without any foot pain.
I apologize for the long post but I greatly appreciate any advice, comment, personal experience and/or suggestions to my dilemma.
Last edited by pacsman; 02-03-2010 at 10:18 AM.
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Re: Doubts about flat foot reconstruction - What have been your symptoms?
I didn't have knee pain without foot pain but I do have knee pain because of my foot problems. I think it's important to realize that you can always have surgery in the future but once you have it you can't go back and change it. Because of this I really think you should try some non-surgical options before doing any surgery. I had the reconstruction for flat feet (a little different than yours though) and it's a LONG recovery. Maybe try a new pair of orthotics or maybe some physical therapy where they might be able to give you some stretching and exercise advice. If your calfs are really tight you should REALLY work on stretching them because even if you end up with surgery they will cause you problems. When you walk up the stairs just stop and drop your heels off the ledge and you'll really feel that stretch. I know you've had pain for years but I would be scared to have a foot surgery with know foot pain, knowing that the surgery could cause some pain....Good Luck!
Re: Doubts about flat foot reconstruction - What have been your symptoms?
Hi, I wish I had the surgery long ago, am now 8 weeks postop after ankle fusion PTTD repair etc...I have already had both knees replaced, maybe that could have been avoided but know one put it all together until i saw orthopedic surgeon foot & ankle specialist 2 years ago...I have been flatfooted for more than 20 years, have worn custom orthodics, proper shoes lots of physical therapy, wish someone had connected the two. as I result I stopped doing most activity, but continued to work as a nurse half time & in great pain for several years..but joy was gone as everything hurt & I have become unfit. I have continued to do a cardio workout in deepwater at pool so I am not weight bearing. i wish i had had surgery sooner even 2 years ago but was scared then. Its not bad...the first 6 weeks non weight bearing is a drag but I am now in a walking boot & have way less pain in my surgery foot than in my other foot which needs surgery. so weigh it all out . Do go to doc. who does many of these surgeries per year & is one used by athletes.. I drove to seattle Swedish orthodedic Hosp.to have it as that was the best place ( 120 miles) for me. I was in hospital for 2 nights. Good luck to you.
Thank you all for your responses! I have a follow up with my original podiatry doctor this week. I am still a bit nervous to do that in-depth of a surgery knowing my feet do not give me any issues. So I will discuss my non-surgical options with him. I think I want to give yet another set of orthotics along with shoes and PT (stretching) one last try before I commit to surgery. I think, at least for me, it will help me be convinced surgery is the only option if this does not improve my condition.
Concerning orthotics, I have always done the plaster casting but one of the podiatry doctors uses a digital 3d modeling system. Does anyone have a strong opinion towards one versus another?
If you are not suffering pain etc with your feet, I would be very hesitant to do surgery also,, be sure to consult with an Orthopedic surgeon who has done a fellowship in foot and ankle & has lots of experience before deciding to have surgery. Best wishes to you,
Hi there, I just came across your post and thought I'd share my experience with you. I've severe flat feet, very flexible, and severe pronation from a young age. My pediatrician even recommended surgury to my parents, but they opted for alternative solutions to protect me from a painful experience. Throughout adolescence and into my college years, I had to wear orthodics which basically did nothing due to my extreme case. By the time I turned 21, I was completely walking on the insides of my feet, having knee problems, and could not wear shoes with support because of the pain I experienced along with awful blisters on the insides of my feet. I finally turned to surgery to get the relief I needed and to fulfill my hopes of becoming a teacher, a profession that requires significant amounts of standing and walking.
For the past 3 or so years I've had a series of four surgeries, 3 on my left foot, 1 on my right, however, one that was on my left foot was a minor one to remove some screws. I did one foot at a time (strongly recommended), starting with the left. Not sure of the official medical terms, but they did an achilles lengthening, inserted an implant on the left side of my left foot and cut out a piece of bone from the right side of my left foot. The did the same process to both of my feet.
The first surgery didn't go too great, and I think it's because the doctor allowed weight-bearing too soon. The best thing you can do is to keep off your foot while you're healing, which is difficult because you get impatient. Since I was sent to physical therapy too soon, my bone graft did not fuse correctly into my bone, and I was left with a huge bump where the implant went. They did my right foot while my left got worse and worse since it was used as my primary support through my other surgery. A year later, when my right was pretty much healed, they revisited my left. I was told that when they went in there, the bone graft was not even solid anymore, it was a pile of mush.
It's been almost a year since my last surgery on my left foot and I'm still having pain. What they did this last time is they used a bone graft from my heel rather than using a donor's. My surgeon explained that this hopefully would work better since they insert my own bone immediately and it doesn't have to go through all the chemical processing that a cadaver's bone goes through. For my current foot pain, I'm taking Vicodin and my primary doc put me on Nortriptyline, used for chronic pain/nerve pain. However, it's not working after 1.5 months, so I don't think I have nerve pain although I'm still incredibly sensitive at the incisions sites. I also, unfortunately, think I have bone pain on my left foot, which means surgery. Keeping my fingers crossed that there's an alternative though.
In addition to foot pain, I'm having pain in my left knee as well. My knee is a whole other issue, although related. It occasionally "gives out," meaning my kneecap dislocates then relocates itself, an excruciatingly painful experience. This is due to mal-alignment caused by severly flat feet and overpronotion. I have kneecap pain (aka Runner's Knee) and knee tendonitis (aka Jumper's Knee). The PT I went to a couple years back said it should get better on it's own after all my foot surgeries were finished. It hasn't. In fact, I'm in so much pain at times I feel nauseated and faint. I'm going back to my primary care doctor who has to refer me to a new podiatrist and/or orthopedic doctor since I've relocated. I went to an orthopedic doctor who specializes in knee injuries and he told me that in most cases, kneecap pain tends to just go away on its own after a long while (6 mos to a year), and to keep stretching your calves and strengthening your quadricep muscles so that it can pull the kneecap up. Also, you can use a knee brace strap that fits right under the knee. In rare cases, surgery is required. After about 8 years of this being a problem for me, I'm coming to realize that I'm probably that rare case.
Sorry for the incredibly long post, I just wanted to give you the full scope on my experience and how involved the foot reconstructive surgery is. I jumped into it headlong and I now wish that I thought about about it, researched it more, and got second and third opinions. There are a number of ways to do this surgery, each with a long list of possible complications. Good luck with whatever decision you come to.
I was wondering what you decided to do and how it is going? You posted a while ago and I just came across your post today. I have a similar story.
I started with foot pain when I was 13 (I'm 43) and i went to a myriad of doctors for it but nothing helped. By the time I was in college my foot pain was minimal but my knees really started to ache. I went to see a bunch a knee specialists but they never found anything and they never looked at my feet. I had my knees scoped too. This past decade I was reduced to NEVER being without my custom orthotics except in the shower. A 10 minute shower was about all I could last before the knee pains set in. Walking was a bear. My feet were relatively comfortable because of the great orthotics but I couldn't walk barefoot without them really hurting too. My main complaint was my knees but I put up with it. About 5-6 years ago the pain started in my hips and I knew I had to be more aggressive to get to the bottom of it because I couldn't tolerate knee AND hip pain and my back was next.
I went to PT, core trainers, orthopedists.. etc. Finally I found an orthopedic surgeon who did a lot of flat feet surgeries and he said he had a few patients who came in with knee pain as their primary complaint. Since I had done all of the conservative treatments already he suggested surgery. But first, to make sure the alignment fix would take care of my knees he had custom molded AFOs made for me which held my feet and ankles in the correct position much more than an orthotic can. They were heaven... OK, they look terrible but after the first day my knee pains were GONE. That confirmed that the pain came from my foot/ankle alignment. I scheduled the surgery and I am now almost 16 weeks post op and I am glad I did it. Yes, the recovery is LONG but I couldn't live with the constant pain and I had to wonder where I would be in 20 years if I didn't make a drastic permanent shift in my structure.
Now, my foot is healing and it is painful relearning how to walk but when I am standing my foot and ankle feel so "solid". I feel like the bones are in the right place because I don't feel the gravitation force on my leg. I can't explain it. My surgery side feels like I don't have to put much muscular effort into standing -- like my joints do it all like they are suppose to. On my non surgery side I still get the pain up my leg and my leg muscles are always tired.
To conclude my long post -- I recommend that you look into getting custom AFOs just to see if the proper alignment in your foot would correct your knee. They were expensive ($1300 and I pain $400 after insurance) but they difinitively told my doctor that surgery would help me. GOOD LUCK!! And I want to hear what happens!!
Hi, I had this surgery on December 15, 2009. It was actually 7 procedures - 6 hours of surgery. The surgeon broke my foot in 3 places and reshaped it, put in 2 cadaver bones, took a tendon from the back of my leg and put it in my foot in 2 places and lenghtened the achilles. I did not want to have this surgery because it is very complex so I had physical therapy for 6 months and wore a custom foot and ankle brace in hopes that the tendon in my arch would respond without surgery. Unfortunately my flat feet was too severe and I had to have the surgery. I was in so much pain prior to the surgery that I was taking 6 percocet everyday just to get through the day. It has been 5 months now and I am in less pain than before the surgery and I feel positive that I will continue to progress. After the surgery I was not allowed to bear weight on my left foot for 3 1/2 months. I had a cast for 2 months and lost a lot of muscle tone in my calf. I am currently still in physical therapy and I am now walking without an assistive device. Up until a month and a half ago I was using a knee cruiser which is like a skateboard for the knee. I know this sound discouraging but I don't mean for it to. I only want to stress that it is a very very complex surgery and recovery. You will not be able to do your normal routine for quite a while. They won't correct both feet at once. I will have my right foot corrected at some point. I had planned on having the right foot done this December but I don't think I can go thru it again so soon. The biggest problem after surgery was muscle spasms in my foot. They gave me muscle relaxers which help tremendously. If ypou have any specific questions please ask. I will help anyway I can. Oh, if you are wondering if I am happy that I had the surgery....the answer is yes. Also my insurance covered the entire surgery. Make sure you get a handicapped parking certificate. You will need it for a while.
Good luck and best wishes to you
Well I finally went ahead with the foot surgery to hopefully allow me to be pain free from my knees. I just had the surgery 2 days ago and it was pretty involved. I may not have all the terminology correct but he cut my calf to lengthen it, cracked my heel to realign it, and put two bone wedges on either side of my foot to create an arch. Today I went in to change out the soft cast for the hard cast and I was shocked how many incisions there were. There was a total of 6 different incisions with a screw and some staples later. The swelling is definitely significant at the moment and I am simply trying to keep the pain manageable. My scooter comes in tomorrow and I hope that will help. I am curious when I can expect to be somewhat mobile on the scooter without having to dope up so much. I realize I am only 2 days into the recovery but am curious if it should be within a few days or a few weeks.
Overall, the surgery went well and I am hopeful this procedure will help fix my knees and if so, the other foot will be next.
Well I am two weeks postop and so far so good. Pain is manageable and now have some uncomfortable burning where the incisions are. I go to get the stitches removed in a few days and get recasted. Hopefully that will help with the burning. I also get to see some postop xrays to see exactly what sort of hardware is in my foot and compare the arch with the preop xrays. While I thought I could go back to work full time 6 days after surgery, it ended up being 9 days after. The key was to get off the pain pills since they messed with my head (in a good and bad way). So now I am fully back to work with a knee scooter (must have) and am learning to be very resourceful. My wife has been great helping me but you can tell the added stress is getting to her. All in all, things are pretty good. Now I just hope the healing goes well and the time flies while I am in this cast.
Hi Pacsman, great to hear that things seem to be going well and your pain is manageable, and so soon! When I was post-op the first 2 weeks home from the hospital were just hell. I think they sent me home too soon. Also, in the hospital my body couldn't handle any of the IV drugs (morphine, dilaudid, etc.) and would cause me to vomit so all they could give me were Percocet pills. That was like taking an Advil basically and I was in such pain. Then when I went home, every time I stood up to go to the bathroom it felt like fluid was draining and my foot was on fire. Awful. So, I'm thrilled to hear that you're not only managing your pain, but you're also getting out of the house and functioning again! It's probably good that you've started work (esp. if it's not straining you) to get your mind off your foot for a while and focus on something else. Hope the months to come are just as great!
Last edited by ouchyfeetsies; 06-28-2010 at 09:58 AM.
It sounds like you are doing great! I'm very interested in hearing your progress and how your knees recover when you are done healing. I am 20 weeks post op and I am done with PT. I am the one who replied to your post because I had a chief complaint of knee pain too. I wanted to tell you that when I started to walk in PT I had a lot of trouble with my knee. It had trouble realigning to the new foot. My PT had to do a lot of deep muscle work to release some long standing adhesions in my calf and around my knee. It took about 4 sessions of therapy to release it and its been great since then. I am walking with a slight limp (getting better every day) and I have NO knee pain! My non-surgery side has stopped hurting too because it is under much less stress. My doctor says that my surgery side and my non-surgery side are each taking even weight now so there is less stress on my non-surgery knee.
Good luck and enjoy PT when you get there. It will feel good for you to finally use your knee in the proper alignment.
You made my day with your post! That continues to be in the back of my mind about if it was the right choice and will it actually reduce/eliminate my knee pain. Did you have the calf cutting procedure done like I did? I wonder if I will have the same alignment issue that you experienced in PT? Regardless, I will definitely keep that in mind when I start.
Thank you again for the big boost in confidence! I wish you the best and look forward to keeping in touch.
Sorry it is taking me so long to post back. Your msg got lost in my inbox. Yes I had the calf cutting. The calf has taken longer to heal than the foot it seems. I had a big knot under my 1" incision on my calf for about 4.5 months. I'm at 5 months now and the knot has disappeared and the calf is slowly stretching out. As it stretches out, my walking is getting smoother. I limp but I can force myself to walk without a limp if I walk slow with smaller deliberate steps (the way my PT told me to ) When I force myself to walk perfectly it really stretches out my calf and foot and even though it hurts a little, it feels like a rehab type pain and a neccessary thing for my calf. On the up side - NO KNEE instability AT ALL!! Once those muscle were kneaded deep especially around the head of the fibula and the calf, it's been great!