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Old 03-21-2010, 10:53 AM   #50
Join Date: May 2008
Location: Youngsville, NC, USA
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Re: Anybody use a cane? (2 months post-op calcaneal osteotomy/tendon transfer, PTTD)

I've got some catching up to do! Here goes:

Sally, the reason I asked how old your daughter was is because I recently came across one line in a long article about subtalar implants. It suggested that, in some cases, putting the implant in a child's foot (and then removing it when a young adult) might allow the foot to finish growing properly, without a flat foot and all the junk that goes along with it. I took notice because flat feet run in our family.

Kitty, yes my foot still hurts. No, it doesn't feel normal. Don't be discouraged by that, though. Personally, I needed the whole unvarnished truth--good and bad--when I was making my decisions, so I can't give you any less. My foot will never be perfect, but it is so much better than it was. I wish I hadn't waited so long to have the surgery.

On pain: What's weird is that my foot hurts in different ways on any given day. Mostly unpredictable, too. I do know when the weather's about to change though. That pain in some way reminds me of a tuning fork (I don't know any other way to describe it). I thought my titanium screws were hurting, but my PT, on palpating the site, said it was swelling pressing on the bursa. That was actually a relief--I didn't really want to sign up for any more cutting--those screws can stay right where they are as long as they aren't causing any trouble. Right after the surgery, and for really a long time, I'd get what felt like electric shocks zipping up my incisions. I've been told that's from nerves trying to connect, finding new pathways, and healing. Sometimes that still happens, even at almost 2 years out. But I do still have just general aching in my ankle a lot of the time. The improvement--and it is HUGE--is that before the surgery, walking even a half mile made me think I might just have to finish on my hands and knees. Now I can just walk as far as I need or want, as long as I'm wearing good motion control shoes. My surgeon wants me to wear my orthotics, but I found some shoes I like that seem to work better without them.

I mentioned earlier that my 76 year old mom is having an osteotomy and tendon transfer this month. I did an awful lot of research trying to find some other solution for her. My surgery took 4 hours. I think that's probably not a great idea for a 76 year old. Her stated goal is to not have pain and be able to wear pretty shoes again. I still have pain and I'm still not wearing pretty shoes (but maybe just because I'm too chicken to try).

My surgeon (an orthopod with a fellowship in foot and ankle) told me that I didn't have to have the repairs--people who are much less active than I get by with going in and out of the boot and wearing various orthotics. If you did nothing, though, eventually you might have to end up with having the ankle fused. But no one has put my mother in a boot or even made her a nice hefty hinged ankle/foot orthotic (it stays in your shoe and you slip your foot in from behind, then wrap the velcro strap around your calf to hold the shin-guard-looking part in place) which keeps your foot properly aligned. I wore one for quite a while. It's not terribly uncomfortable, it really helped prevent pain, and you couldn't see it as long as I wore pants. I'm frustrated that no one has offered these options to my mother.

I did a lot of reading about subtalar implants. I'd wanted that to be an option because the recovery is much easier, but I don't think she's a good candidate--among other things, your flat-foot must be flexible (meaning that there is some visible arch when you are not standing on it). Mom's feet are flat as flounders in any position you put them. I've read that the implant is not a good fix unless you have the tendon transfer as well (like getting new tires without aligning the car--the tires are not going to last long). But again, I saw one line in an article that mentioned what sounded like a much less invasive tendon fix. Apparently, some surgeons are "taking in" the loose posterior tendon in much the same fashion you'd take in a stretched out waist band. Since Mom's tendon has most likely come completely untethered (suggested by the fact that her pain level has actually gotten much less just lately), repairing it in that way is probably not an option.

But I gotta tell ya--a subtalar implant does sound intriguing. I'd like to consider it if I need to have the other foot fixed at some point. Some people who've had incomplete correction after the osteotomy and tendon transfer (I do still pronate) will finish-up and fine-tune with an implant. One problem lies in that podiatrists are the ones doing them. Orthopods don't believe in them. Personally, I'm uncomfortable with the idea of anyone but an orthopedic surgeon with a fellowship in foot and ankle cutting on my feet.

A little more on subtalar implants--

There are at least two kinds. One (Conical, Kalix, MBA, STA-Peg, STJ, Valenti are some of this type) has been called a "doorstop" to keep your foot from pronating. In the past, it has been done without fixing the posterior tendon problems, and so has been called a temporary fix. Adults seem to find them uncomfortable, and because of that, many people have had them removed.

The newer type (HyProCure is one) has a different mechanism, is put in a different spot in the foot, and some say it seems to be well-tolerated by both children and adults (including runners). Tendons are also now being repaired in this surgery by some surgeons.

It has been suggested that one find a surgeon who has a track-record with both kinds of implants if you wish to consider a subtalar implant. Orthopedic surgeons usually don't do implants. Podiatrists are doing most, if not all, of them.

Some interesting articles--

Assessing The Pros And Cons Of Subtalar Implants
Podiatry Today
Issue Number: 5
Author(s): By Donald Green, DPM, Mitzi Williams, DPM, and Chul Kim, PMS IV

Keys To Preventing Complications With Subtalar Joint Implants
Podiatry Today, VOLUME: 23 PUBLICATION DATE: Jan 01 2010
Issue Number: 1 January 2010
Author(s): Patrick A. DeHeer, DPM, FACFAS, and Eugenia Malenkos, DPM

Panda, I've noticed (and my PT agrees it's so) that when one part of my body gets out of whack, many other parts are going to be affected. I think it's interesting that my failed foot is the same one that had a bone spur on the big toe. I think favoring that foot may have had something to do with the posterior tibial tendon shredding, which then threw my gait off even more, which made my hip hurt, which caused back spasms, blah blah blah. Think dominoes (the little rectangles, not the big circle with cheese).

Kitty, Your arches gave out and your foot is collapsing and your ankle is going inward because the tendon is stretched. The tendon is what is supposed to hold the arch. You can baby the foot until the tendon heals, but it's going to be stretched out forever unless repaired. Because your foot is pronating, it's really easy to keep reinjuring the tendon.

Make it VERY clear to your surgeon that you want all repairs done at the same time. I had a bone spur that was supposed to be repaired during my foot surgery and wasn't. I had to do it later. He said he forgot. He said I "threw that in at the last minute." Hmmph (not so). I had no choice but to have it fixed because it was throwing my gait off. Doing it later significantly lengthened my recovery time. I was not happy about that.

Discuss your fear of a hard cast with your surgeon. I don't know what all surgeons do, but mine just put on a "splint," which is kind of like a cast that's only on the bottom of the leg and foot. Oh golly, I can't believe I can't remember exactly how it was applied! But in any case, it wasn't completely enclosed. My understanding is that they do that because they expect swelling.

Again, discuss with your surgeon the possibility of delaying for 8 months until you have a month of vacation. Maybe you can get by until then. One month of vacation will certainly go a long way in your recovery. I do know that many people (Emmie was one of them) went back to work very soon and managed just fine. But, if you've just had-it-up-to-there and are READY, then go for it right now.

I started a thread on this board to collect, in one place, everybody's best Tactics for coping while non-weight-bearing after foot surgery. Maybe some of the suggestions there will help you think through the logistics of getting back to work soon, and coping in general, even with very little help.

In spite of some lingering pain and swelling, I AM glad that I did it. If I had to do it again, I wouldn't drag my heels (no pun intended) as I did last time. It is all doable. You are stronger than you think you are. It just takes planning, and you can do that.

All the very best,