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  • Subtalar fusion & Achilles Lengthening

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    Old 02-01-2004, 01:43 AM   #1
    CrazyCatLady's Avatar
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    Subtalar fusion & Achilles Lengthening


    I'm trying to find out more about subtalar fusion and Achilles tendon lengthening.

    I'm almost 20 years old and have had pain and locking where the ankle meets the foot in the front for five or six years now. I ignored the pain and locking originally, but it has gotten progressively worse and almost impossible to ignore. I will get flare ups of locking and pain that are very bad and can last a few days to almost to weeks.

    I recently saw an ankle specialist who first took weightbearing x-rays and, after examining me, determined that my pain was due to a few things. Mainly the fact that my foot is structurally abnormal. My left heel is turning outwards. My foot looks skewed off to the left compared to the right foot. He explained that the heel turning out like that is causing the Achilles tendon to shorten. He held my foot, put my heel in the right place, and tried to bend my foot up and it basically didn't go anywhere and I had severe pain. He did that to demonstrate the Achilles tendon tightness and why a brace wouldn't fix that problem.

    My left foot looks like it's sinking or collapsing. The bone on the inside of the ankle is getting closer to the ground while my heel is turning out more. My mom had noticed the foot getting worse and worse just over the last few years. The dr says it's because I have severe ligamentous laxity. I asked him, if I didn't have any surgery done, would the foot continue to "sink" like this? and he said it probably would.

    He said that, if I did anything surgical for the foot, it would have to be soon, in the next six months to a year. He noticed severe changes of the ankle joint on the x-ray and, because the ankle is bowing in and the heel is turning out, it's causing all of the bones in my midfoot to shift down and back. He said that if my foot keeps up doing what it's been doing, it may be beyond repair in even 2 years. He's concerned about the arthritis that's already there becoming way worse and me needing a joint replacement, which they don't do for people my age.

    He's also concerned about circulation to the foot and the fact that it doesn't look like mine is very good in that left foot because of what's going on.

    In any event, he gave me two options, among other things that he said we could discuss later, just an Achilles lengthing with brace wear for the rest of my days or an Achilles lengthening with subtalar fusion and no long-term brace wear.

    His goal seems to be to correct the alignment of the heel and keep it that way. Either way, it would require the tendon lengthening. If I didn't get the fusion, I would have to wear the brace to keep the heel in a corrected position. This option sounded not so good because it seemed that it could mean the potential for more surgery. The lengthening with the fusion sounded like a much longer recovery, but less chance for more surgery later on.

    Also, the tendons on the inside and outside of the ankle dislocate very, very easily. He explained that, with either surgery, he may have to do something to anchor them anyway.

    I have not called him back about surgery yet. I only saw him on this past Wednesday. I do not know what to do.

    I'm afraid of leaving the foot be and having it get worse to the point of not being fixable. I'm afraid of going through with the surgery and coming out much worse or needing many subsequent surgeries.

    If I do have surgery, I'm looking at mid May. I'm in college and need to fonish out the semester first. I recently applied to get into the radiography program, which if I'm accepted, starts on October 1, 2004. If I do not get accepted, I'd be possibly looking at January of '05 at the four-year university here (for teaching, although I haven't totally written that in stone ).

    I dunno...May to October? May to January even? Would I be on crutches by then? I work at home as a medical transcriptionist. How long would I be out of that? How long would I be in the hospital? Yikes, I'm starting to ramble here.

    My mom seems keen on me having the surgery and she said that she was kind of glad that something more definitive than pain meds is being done. She thinks I'll be beter off and able to have more walking endurance. I can't even walk through the grocery store without having to get the weight off the foot/ankle. She just seems so keen on it and doesn't want to see the foot continue to get worse. I'm unsure about this whole thing.

    I apologize for this being so long. I'm just looking to reach out and connect with people who have either been through this or are facing it in the future. I'm having a hard time keeping it to myself and my friends don't have any experience with these things, even though they do cheer me up.

    Thanks for listening!

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    Old 02-03-2004, 07:02 AM   #2
    Ronk0747's Avatar
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    Re: Subtalar fusion & Achilles Lengthening

    Hi Crazycat,

    Unencumbered by the thought process, my feeling would be if you're going to go to all the trouble of having surgery and all the things that go with it, you don't want to then have to also wear a brace for the rest of your life. You also want to do all you can to not have to go through that again. Therefore, I would have to favor your having the fusion as well as the tendon lengthening. Longer recovery and therapy indeed but hopefully you'll be done with it after that!

    To give you a little background on myself, I had a similar problem with my arch collapsing but for a different reason. I had a medial sprain back in my teens which healed and I didn't think much of. Over the years, my posterior tibial tendon stretched and degenerated. I first noticed that my left foot was flatter than my right when I was around 17. I also noticed that my left shoe was wearing severely on the inside. But hey, I wasn't in any pain so I ignored it. Years passed and about 5 years ago at age 35, walking was becoming increasingly painful. I went to a podiatrist and got orthotics which helped tremendously -- for a while -- until about a year and a half ago. Last year, the pain became so bad that the orthotics no longer helped. I was told that at this point, the posterior tibial tendon and associated spring ligament were totally shot and no longer holding up the foot. I was basically like you, walking on the inside of my ankle. At this point, I was told by two different docs that surgery was the way to go. I was told that that the longer I waited, the harder it would be to treat and the more fusions would be necessary to reconstruct the arch. Not to mention that with the foot so misalligned, I would eventually get crippling arthritis from the bones rubbing and working each other in all the wrong ways. So I went for the surgery last September. Had the tendon and ligament replacement, metatarsal fusion to reconstruct the arch, a calcaneal osteotomy, lateral column lengthening and achilles allograft. I had to be non-weight bearing in a cast and crutches for 3 1/2 months. Now I am more than 4 months post-op and in a removable aircast and almost fully weight bearing but I still need one crutch.

    So what I my point to telling you all this. I somehow feel that if I had attacked this problem earlier, I might not have had to have such a complicated surgery (7 hours!) or such a long recovery. Not to mention that the older you get, the longer it takes to heal. My feeling in the past has always been, if it's not causing any pain, don't mess with it. I still think that is a good rule of thumb to go by. However, it sounds like you are not only having pain but the pain is greatly interfering with your life. Therefore, my feeling (now encumbered by the thought process, LOL), would be for you to do both the fusion and the tendon lengtheneing. Keep in mind that having the tendon lengthening alone probably will not hold up over the long term as none of these surgeries will bring you back to 100%. So these areas will always be a little weaker. Therefore, you need some help from the fusion which will give you a rigid arch to ease the strain on the other areas.

    All this being said, it is definitely a good idea to get a 2nd and even 3rd opinion on this. Also, I feel that an orthopedic surgeon is a much better route to go than a podiatrist. Podiatrists are not MD's and don't have nearly the amound of schooling and training that orthopedists do. Furthermore, make sure that you find an orthopedic surgeon that specializes in foot surgery and has done many of these types of operations, not one that only does one occasionally.

    I hope at least some of this is helpful. I wish you the best of luck!


    Old 02-03-2004, 10:45 PM   #3
    CrazyCatLady's Avatar
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    Re: Subtalar fusion & Achilles Lengthening


    Thank you so much for your responses! I'm feeling more like this is the right way to go mostly because if I don't, I will probably end up much worse in the long run.

    Ron: Basically, how you describe your foot is where mine is now and I'm only just coming up on my 20th birthday. Whatever tendon runs along the bottom of the foot is totally shot. The tendons on the inside and outside of the ankle move uncontrollably (because of very loose ligaments).

    This doctor is an orthopedist who specializes in foot and ankle surgery. I got orthotics a few years ago, which never really helped. Wearing shoes that come up high around the ankles helps to some extent, but it only keeps my foot from hyperextending; it doesn't fix the problem.

    Most doctors in the past just sent me on my merry way with some pain pills and really no explanation of what might be causing my pain. At least this doctor seems to know what's going on. I actually really liked him and felt comfortable with him. Now I just have to get up the nerve to call and commit to pursuing the surgery. It's a scary thought, but nobody's gonna do it for me.

    I have gotten second and even third opinions and it seems that surgery's the word. I've gotten the explanation a few times about why orthotics only work for a certain amount of time, if at all, and why braces will be ineffective in treating this.

    Like I said before, it sounded like the fusion and tendon lengthening are going to be part of what has to be done to my not-so-perfect foot. We haven't gotten into great detailed discussions about surgery yet because the doctor wanted me to talk to my family about it first and let him know. We only discussed things very briefly.

    I talked to my family and they seem to think that this will be beneficial for me, especially my mom, who has seen my foot collapse further and further just over the past 2 or 3 years.

    So now we're looking at the surgery in May...I just have to call the doctor back now before I get myself even more worked up over calling. That's my big goal for tomorrow: Call the doctor and tell him I'm interested in having surgery to fix my problem. Yeah, that's gonna be easy.

    Anyway, thank you both for responding. You've made me feel a lot better about this. I feel like I've gotten a bit more confirmation...or at least my head feels like it's on a bit more straight.

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