I am scheduled to have this done in january due to having a tarsal coalition, i have to have it done to both feet. I cant seem to get a straight answer from Dr's as to whether after recovery i will be able to go running again or not, or weightlifting, hiking etc.. I know it is a long recovery, somtimes up to a year, but i am nervous about taking such a drastic step.. i have pain walking now, although it is not severe all the time. i want to know if i am just getting rid of one pain and acquiring another if i have the surgery, or is it worth it. I have been runing at least 5 miles 5 days a week since high school, and dont want to have the surgery if it means no more running.. any advice? ALso since being diagnosed with this tarsal coalition i have been having pain in my hips too, could this just be becuase i am walking stragely now to avoid the foot pain? I am only 33 and am not looking forward to a life without lots of exercise...
The Following User Says Thank You to daxmargo For This Useful Post: Rock293 (08-29-2012)
Dax, you must be my doppleganger! I have had triple arthrodesis, and I am a runner. Emphasis on "am".
It is possible. But. Big BUT. IT is very very very very hard work, and surely the running will never be the same. What you say about trading one set of problems for another is somewhat true, and you will likely second guess yourself as you head out to try to run with ease and it doesn't happen all that often. Just remember that the surgery is not entirely a "choice". Sure, you could forego it, and just deal with the issues you have today. But ultimately the fusion is necessary, and because it is SO traumatic to your body, now is the best time to do it, while you are young and your body has more capacity to make the recovery a success. I did the fusion at 42, and could not imagine going through the efforts I had to go through if I were, say 52, or 62.
To give you a glimpse into my running evolution, I was an ultra-runner before surgery (albiet a slooooow ultra-runner). I had congenital defects in my right foot that caused aquinus, flat foot, club foot, crooked angularity. My pre-fusion running was weird and slow but didn't hurt until age 41. Then my foot started bloating up, and I was getting zaps of intense pain shooting up my leg that would catapult me up into the air as I did the misstep. One look at my xray and the doctor said I needed "the works". So I did the arthrodesis AND did an Achilles tendon lengthening AND a bunionectomy. The cast came off in 12 weeks, and I was able to shed the boot and the final crutch within 3 weeks of getting the hard cast off. I do remember, being the running addict that I am, gong for a "slog" IN BOOT about a week after the cast came off. Yes I was nuts, but I was told I could do weightbearing at my own pace, and that the bones were rock solid. It was only a matter of how much pain could I tolerate. So I did that slog (about a mile) just because I HAD TO KNOW. Would the running ever be there? And I could tell from the slog that I would get the running back eventually.
In the meantime: before and after surgery, I hit the gym very hard, building up my upper body strength, and also doing leg exercises as I could tolerate (swelling and edema for months will prevent you from really being able to do much with the casted leg). I made sure I stayed fit. I did my best to get off meds as soon as I could tolerate. I downed all vitamins and supplements daily, especially Bromelain (get this and TAKE IT it really works), and glucosamine. I ate high protein. I iced religiously. I stretched and twisted and poked and massaged and put pressure on my foot daily (after cast, not during cast). Here's an interesting thing I did - I went back to work. Right away. Another part of my insanity, but I was on a mission to overcome this. I missed 8 days of work, and hobbled back in, indeed with pain and swelling, but determined. I was allowed to go home at noon for the first week. I simply set an additional chair next to mine, laid a pillow on it, and propped my foot on the pillow. I have a desk job. When the pain got stronger, I just rasied my leg a little higher. And we have a gym in our building, so I hobbled to the gym every single day, if only to lie flat on a mat and rest, but usually to do weightlifting or try some concocted way to ride a stationary bike and actually get a sweat going (I admit getting a sweat was never really successful).
(Curious question to anyone who has been laid up - did you notice that when you began aerobic workouts again, that your body odor was FUN-KAY? I smelled like a pig pen for about 2 months. I wrote it off as toxins finally getting a chance to escape.)
Back to the running evolution - I think i truly began a running effort about 5 months after surgery. I didn't set a goal, I just jogged really really slow, almost a walk/run for a long time. I stayed on the treadmill because it is controlled, and softer, and I can stop when I need to stop and not be 3 miles from anywhere. My tips....do all your physical therapy regularly, even those parts that seem pointless. I made up my own therapy exercises over time, based on what I felt needed worked on. The one absolute life saving therapy for me, with respect to entering the realm of running, was walking backwards. If I made sure to walk backwards for 5 minutes, then walk forward for 5 - 10 minutes, then I could ease into a jog. Jogging from a cold start without grunts and groans did not happen to me for an entire year. After 3 months of treadmill, I took myself to the road. My progress focused on 3 separate goals - comfort and ease while running, speed, and distance. I had to separate the 3 ideas and decide which one I want to work on for any given day because they are pretty much mutually exclusive goals when all the bones in your foot are bolted together. It's been 16 months since my surgery, and I am now able to say that I am a "normal" runner. Normal is not like the old normal, but I no longer have to warm up with a walk. I no longer feel like a frankenstien, my normal running posture and gait are present. I feel loose and fluid at least 50% of the time. My only issues today are my calf strength, which causes slowness (which is attributable to the fact that with an un-dending foot you can not raise up on your toes and work your calf, so you have very little push strength). It's a significant issue, but I accept it. I am grateful to run. I will never do a marathon again, nor do I care to. But I can run 2 hours if I want to with very little consequence.
The bright side of post surgery running is that you have all new PR's to set! Don't try to compare before and after. It can be depressing. Think of it as a different type of sport - running with fusion. It's an elite group, we are!
Set your goals high - they can be accomplished if you plan and take action. Don't listen to the naysayers and those who tell you "well at least you didn't lose your foot". I suppose they have a point, but when you are down and crying because you have been pushing and the progress is painstakingly slow, people have a tendency, in their efforts to comfort you, convince you that "if it doesn't get any better than this you are still lucky". Accept their efforts to comfort and realize that it really is a signal to suck it up and give it another shot tomorrow. You will find joy and exuberance when you have break throughs.
Also - one thing I find necessary as time passes is that I have to look back in time to "what was my progress 6 months ago" to see clearly that where I am today is 1000 miles advanced. You will have progression for years. Thus, those new PR's are going to get better and better!
FYI - to give a mathematical reality check: my pre-surgery 5k PR was 25:30, at age 41. My best 5k effort 16 months after surgery is 27:30. I am SOOOOOOOOOO cool with that!!
Best of luck to you! You are not doing both feet together, I presume? Write anytime if you have specific running/therapy questions. I have tons of tips.
just re-read your questions...as for other activities, there isn't a single activity that I did before that I can not do now. I rock climb, rappell, weight tran, alpine ski, do adventure races, mountain bike (with clips!), swim.
(squats are sucky because it's hard to bend down far, but put your heels on a piece of wood to help that).
Funny - I couldn't dance before, and I still can't dance! Go figure
thanks for all the information, that makes me feel much better. I am just scared of surgery becuase i had a shoulder surgery about 2 years ago that was not so successful, and was worried that my foot might turn out the same. I have been postponing the arthrodesis for about three months now becuase i was worried, but finally se tthe date. I am not so worried about having no side to side movement because since i have a congenital tarsal coalition, i never had it anyway! which actuall ymay also be why even though i tried to dance i was pretty crappy at it.. and soccer as well. I just had been telling myself for months that even though i have pain and cant run, that maybe if i keep using anti inflammatories and the boot it would go away.. but no such luck, some days it feels good others bad, but as long as i will be able to run i will be happy. How do you find ways to stretch your calf now? is it true i wont be able to stand on tip toes to do it? Has your gate changed at all. Also this may sound strange.. i have started to have pain in my hip too that swells, do you think this could be becuase i am walking differently due to the pain.. my Dr wants to check me out for Rheumatoid arthritis,which kind of freaks me out.. did you ever have anything like that? yes i do have to do both feet, but my right is really much worse, so i am doing that first, then 1 year later my left.. so 2 years of surgery and recovery.. i will need to find a new way to deal with stress!
I normally ran 5 miles a day in about 40 min, so 8 miles an hour, 5 days a week.. if i can get back to that in a year then i will be very happy. Thanks again for all your advice and help.
I know what you mean about side to side movement. I had opposite problem as you; my ankle would rotate outward way way past normal (I could twist my ankle outward on the slightest thing, like a dime). I had to have my ligaments tightened as a result. All moot I suppose since the side to side is now fairly frozen. I can get a tiny bit of range of motion, but let's just say it doesn't feel "good".
to answer some of your questions - hmmmm. How do I stretch my calf? You tell me (just teasing). I can't get a stretch, plain and simple. It's physically impossible to lean forward enough on my rigth foot to get any kind of tension in my calf. It's a pathetic muscle, very noticable when I wear shorts. So there is a real downside. But for some reason, it doesn't affect my ability to run with pleasure and ease. It's the one part of my body that I am constantly tweaking, either trying to get a good calf squeeze while standing in line at the bank, or trying to do a toe raise while I stand and talk to someone. While runing, going up a steep hill can be frustrating. Downhill doesn't seem as bad, although you will still find that you can't point your foot forward with much confidence to take the weight of you body as you run downhill. You learn. Your other leg muscles will compensate and eventually you will find a stride and gait that works "okay". About the hips, I would bet money they hurt because you are not walking/running in a balanced manner. You favor the foot that hurts. Also, you very likely just have misalignment from your hips downward. If you have foot issues, you stand a good chance of having hip issues. I was born with dislocated hips, which were wired together when I was very little. I have always walked like a penguin, partly because of the foot, and partly because of my asymetrical hips. I have osteo arthritis. I hope you don't have RA!! They both suck to have, but I understand RA is the more debilitating one. I try to take my glucosamine every day, and the Bromelain. It is supposed to ward off further deterioration of your cartiledge. I've seen my hip xrays and they aren't pretty, but I am postponing any type of surgery (only help for me will be a hip replacement) because I hear that there is NO running with joint replacements. I will keep the originals until I am screaming in my sleep
To answer the speed/distance question, I wasn't even close to caring about distance for 9 months. I just wanted to feel comfortable and relaxed and re-teach my body the technical aspects of running. I would say the harder of the two to regain was speed. Once I broke through the 3 mile distance, it was not hard to get that up to 4, then 5, then 6. Btu getting to 3 was very very slow progress. Have a LOT of patience with your foot. Speed has neve been a big deal to me, since I was never fast to begin with. But it is VERY possible to do real speedwork. It actually is one of the best therapies I have found, because it really utilizes your foot. A slow jog can be done by hopping or throwing your weight, but speedwork requires your foot to get honest and kick in it's share of work. It hurt, but in a good way.
I have never felt the screw in my heel. But I can feel a staple on the top side of my foot where the subtalar is fused to the cuboid. It doesn't hurt, but it's a rather ***** feeling, similar to the way it feels to touch a scar.
PS - I am training for my first 5k race since surgery. I'll be honest with my results when it comes around. It's not until March 6. I have set a goal of 26:55, which is the finish time of the first 5k I ever trained for, 4 years ago. That would put me in the ballpark of "normal".
hmm i bet you are right about the hips. It is so strange though, this all started when i sprained my ankle by stepping in a pothole, and although the sprain healed, my foot just started feeling painful, which is when i got the ct scan that told me apparently i was a genetic freak and had this tarsal coalition .. then slowly the other foot started to give out too, as i went into the orthotic boot for the first foot, then now my hip.. and there is so much swelling in my feet.. i literally never had a foot problem unitl 3 months ago my whole life.. maybe i kept away from having the problems becuase i exercised so much before i dont know. Well i will look on the bright side and just think that at least i get a month off from work post surgically.. although for work i sell apartments in manhattan.. so it will be hard to go back to work, since my whole job is running around the city, and up and down those subway stairs. THat why i PRAY i dont have RA, becuase that would be even more debilitating, but it takes time i guess to get that diagnosis.. so one last question.. you mentioned that you could stand on your toes? or did you mean you could flex your toes upwards? Also someone told me i should try some SAM-e have you ever heard of that? for inflammation i think..
I do have SAM-e in my bin of assorted supplemtents. I don't take it as regularly as everything else, I guess because it's such a pain to take so many pills all day long. SAM-e is relatively expensive. I can't really say if it does anything. I should begin taking it daily and pay attention...
When I said I stand in line at the bank and try to stand on my toes, the key word is "try". No, I can not stand on my toes. The toes themselves bend in the normal fashion, as nothing up there was worked on. But the problem is a phsyics problem. Since the core of the foot is locked, the only way to get up on the toes is to leverage your body very far forward, way past the point of being able to do it without falling on your face! So, picture it: you can get on your toes if you have a rail or pole to hold onto, but you are at a very forward incline. There aren't too many other ways to get the calf muscle recruited. So I find myself leaning and toe-ing at odd opportunities.
Keep me posted when you get back from surgery. I'm sure you'll have plenty to talk about! The nice thing is, the drugs are so powerful during the first 48 hours of recovery that no matter how intense the pain, you are able to not remember it. I know intellectually that there were a few hours in there where I thought I was going to die. The meds were timed, so I had to suffer until the clock ticked by and my next dose was due. I remember the situation and I remember my agitation, but I don't remember the pain itself. It's not even like childbirth memory. With childbirth, you occasionally get a reminder of that pain when a bad cramp hits you. But fortunately, I am forgetfully ignorant about the first 2 days of foot pain, and there are no triggers to aid my amnesia, thankfully.
I am so glad I found this. I've scheduled a triple in the beginning of August. I'm going to Atlanta for the surgery. I'm flying in the day before. The surgery is on Thursday morning. Is it reasonable to expect to fly home (less than 2 hours) on Monday?
Both my feet suck, so we're doing the worser one first. Any ideas on how I can keep from totally destroying my *ha-ha* "good" foot while it is my sole weight bearing appendage?
Susan! Wow, I wish you well. Flying may be a not-so-pleasant excperience, due to the tremendous swelling you will have. But 2 hours is not that long. You will NOT be able to keep your foot below your heart for that amount of time though. The pressure wil be intolerable. You must try to arrange to have your foot elevated somehow on the plane. Very serious about that.
Thanks, Queeneev - this should be an interesting experience...("excuse me, sir, but do you mind if I rest my cast on your head for a bit. Thanks ever so...") It is bad enough flying - I'm 6' tall and mostly in my legs...Flying is ALWAYS a "not-so-pleasant" experience.
I called my old yoga instructor after I remembered she had had similar surgery (mine + ankle fusing). I had just left a message with my Dr. suggesting my getting a brace for the "good" leg. My Yoga instructor's first words were "I destroyed my other foot - I wish I had had it braced! So I'm waiting to hear from him about that. Meanwhile, I've had my first "personal training" session with a PT to build me up for the crutches. Sort of like Jobba the Hut doing weight lifting. Just don't have that upper body and ab strength.
I'm 21 and was diagnosed with tarsal coalition in my left foot when I was 14. I was advised not to bother with an operation, and was told I shouldn't do any high impact activities like running, or else I could shatter my shins (don't like the sound of that!)
Two years ago I sprained my ankle by walking quickly (over a period of a week). My ankle has been swollen ever since, and I've had varying degrees of pain with it, from 'crikey, I can't put any weight on this' to 'slight twinge'. I saw a physio for several months, who tried everything to get the swelling down, but eventually gave up and suggested it was all due to the coalition, and that I should go see an Orthopaedic consultant. After X-Rays and CT scans, they're basically saying it's a boney coalition, and the surrounding joints have already suffered some damage.
But here's my problem. One consultant said operations weren't that successful. Another said they were the only option. From what I've read on the Internet, either they work fine, or they cause even more problems, and require follow up operations to re-fuse the bones, which can go on to cause damage to the surrounding joints eventually. That's the problem I'm having now! I'm not in constant pain, though I can't walk quickly and if I over-do it then I'm limping. I want to improve this condition, but I don't want to go through a painful operation and weeks of recovery only to end up with exactly the same problem.
Please can people tell me their stories - if they had the operation or if they chose not to. No one will tell me what'll happen if I don't have it. I'm afriad of consultants who use surgery as their only option. But I'm also really frustrated that I'm 21 and find my ankle getting stiff in the mornings. My friends did a marathon a few weeks ago and it kills me that I can't do the same. Just walking without pain would be nice!
Any replies would be fab.
Hi, From what you have described you absolutely need to see a specialist who specializes in foot/ankle reconstruction. I have been down the road myself. I had 6 opinions and there are experts and then there are surgeons who see these problems once a year. Generally from my experience when a Dr says they could do something but it's not very successful it's your cue to find someone else who is confident and sees these all the time. Maybe in his particular hands it's not very successful. There are surgeons who only fix the worst and most challenging problems and I found one. What you and I have is not a very common disorder and not an easy surgery and it is so important to find someone who is known in foot circles as being "the guy". The 1st dr I saw said after the surgery I wouldn't really be any better and I would just get worse either way. The Dr who did my surgeries said I would be able to be more active AND walk without pain. He also said if I didn't have the problem fixed I would do enough damage to my ankles that I would need them fused as well and end up in a wheel chair. I had bilateral triple arthrodesis and my feet are amazing now. My ankles have been saved and are functional. It is a very long recovery and difficult - but sometimes that's what it takes. I'm only 30 and I had the same concerns as you. If I went with that first Dr I may not have been any better off. Take a look at my other posts - I have more info. Let me know if you have any questions - I like to help anyone I can because I know how hard it is to find the best dr.
thanks for replying. What was your condition? Did you have tarsal coalition too? I feel 'lucky' having it in only the one foot! I am concerned about my ankle, and from what the doctors have described, I can only think that things will get worse. He said the joints surrounding the fusion (I think it's my heel bone to some place in the middle) are wearing down because they're taking all the strain, and eventually the joints around them will start to suffer too. I think he said I already have some arthiritis in my ankle, and it certainly feels that way! What's annoying is I have a pair of shoes that I bought just after spraining my ankle, and I haven't been able to wear them because they press right into the swollen part. So far no doctor has really mentioned the swelling and just keep going on about surgery.
I'm waiting on the results from my scan (typically they 'lost' them when I went on Tuesday) and then they'll tell me what they think should be done. I'm in the UK, so I guess you can't reccommend any doctors over here?
How long did it take you to get back on your feet after the operation? Was it painful (stupid question!) I don't know anyone with this problem so it's really hard to find the answers - and really nice to find so many posts on this site from people in the same situation.
Hi everyone. I am new to the boards. I am very excited to see people who have had the same surgery as I have. I am 33 and have tarsal coalition in both feet. I have other deformities as well but that is the only defined one. I had a triple arthrodesis feb 2nd. It has been a long road. I am still in pain. the foot i had surgery on is still more painful than the one that hasn't been operated on yet. I don't know if this is normal or not. I have bad asthma and had an attack last month that put me on high doses of prednisone for a month, I dont know if this is slowing the process. The bones are fusing well though. I have to go back in to get the heel screws out because they hurt me when i walk.
Anyway I am hoping to share experiences with people who have had this surgery!
I had a triple arthrodesis two and a half years ago, and the results have been ok, but my Dr. didn't tell me anything about what to expect and he told me he didn't want me to have PT. I am just now able to walk with a tiny limp (used to be awful) and the new ortho I am going to tells me I need an ankle replacement. The pain before the triple A was so bad it was nauseating; I don't want to do any more surgery unless I get back to that pain level. About running: I cannot flex my foot far enough forward to run; I have absolutely no movement in my ankle. Am I missing something?
If you're had a triple arthrodesis, you should still be able to move your foot up and down, (dorsiflexion/plantarflexion) but not side to side.
Difficulty bending your foot up (can you walk down stairs?) would not be a result of the fusion, but of problems with the joint between the tibia, fibula, and talus, the true ankle joint.
Triple arthrodesis fuses the lower parts of the ankle joint, the ones that provide sideways movement.
The "side to side" joints are frozen, and an ankle replacement will not fix that. If you have joint replacement, you will be able to move the foot up and down freely and comfortably, but you will still have no side to side motion.
Running or doing high-impact sports on artificial joints is not recommended, although walking for exercise is good. The joint does wear out after a while, so if you are getting around reasonably well and having little pain now, it might be wiser to wait.
However, the recovery from replacement isn't quite as bad as from a fusion.
Thanks so much for that reply. Actually, my xray looks as though the tib-fib and foot are all one bone. There is absolutely no joint space at all. I am going to wait to get the ankle replacement; I am 57 and work full time as an RN so I am pretty active and want to get the most wear out of the replacement I can.
Ah. If you lack joint space between the tib/fib and talus, then the replacement might really help you out at some point.
From what I understand, when to get a replacement (on any joint) is a function of 2 things:
1) Don't do it too soon, because it is a major surgery and the replacement joint may not last as long as you do. Wait until it's clearly necessary, when arthritis seriously hampers work, daily activities, or getting enough exercise to stay healthy.
2) When it is clearly necessary, do it as soon as feasible, because aging and muscle atrophy due to inactivity will make the recovery harder. Also, prolonged inactivity leads to depression and a host of health problems.
Generally 60 is the "preferred" minimum age for ankle replacement.
So, kind of a balance there. No one can tell you where the right balance point lies for you.
Jane, I have to say I am immensely grateful for this board....had no idea there was such a thing for us feet-challenged.....
I just transferred to a new unit in my hospital. Right now I am able to manage the pain with Naproxen and tylenol, but I know it's just a matter of time. I think I'm going to get established in my new job and then do the ankle replacement. I have an incredibly high pain tolerance; I just don't want to wait too long (?maybe until the arthritis is so bad I can't have anything done?) ......
I love gardening and doing home improvements....yes, I'd love to collect a check every month for being disabled (I do believe a triple A qualifies for that) but that is not me. I have to be into everything around me. Guess I should mention I have ADD.....
Thanks for the kind folks who have responded to my posts. You are indeed friends. Considering that nobody on the planet knows what a triple arthodesis (and no joint space ) means, I am very grateful that there are people out there who can identify with me.