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14 weeks post-op flat foot reconstruction: problem extending big toe/tendonitis

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Old 07-13-2012, 10:19 AM   #1
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posttibtend HB User
14 weeks post-op flat foot reconstruction: problem extending big toe/tendonitis

Hello all,

I had flat foot reconstruction (due to stage 2A PTTD) on my right foot: FDL transfer tenodized to the navicular bone, debridement of the PTT tendon, and a double osteotomy by an excellent foot and ankle orthopedic surgeon on April 5, 2012.

The day of the final cast removal came on July 6th and my doctor took the cast off and put me in a removable air cast boot for another month. Although the fiberglass casts were changed periodically, I was in a cast for over 13 weeks. Both of my osteotomy sites, the medial displacement calcaneal osteotomy and the Evan's procedure (lateral column lengthening) with cadaver bone, were healing well (per x-ray reports). The tendon reconstructions seemed intact but difficult to see/demonstrate due to the atrophied muscles.

The doctor suggested I transfer out of the air cast into a shoe over the next month and so 95% of the time I'm in the boot and for 5% of the time I've been walking a few steps here and there bare foot or in a shoe which seems fairly easy to do (but a bit painful). I'm surprised at how sturdy my foot feels but it is still very swollen, stiff, weak and sore and the achilles tendon is soooo tight. So three and a half months post-op, I'd say I'm at about 20-25% of the way through the recovery process. I still need to elevate the foot every couple hours for about a half hour to an hour to keep the swelling down.

I haven't begun hypotherapy/contrast baths yet but now that I'm out of the cast, I may begin using ice and heat. Has anyone had much relief dunking their surgical foot in ice and hot water alternately (i.e. doing contrast baths)?

I had my initial PT intake appointment this past Thursday and I start PT on Tuesday of this week.

The only problem I have to report is that my big toe (the halux) seems to be very stiff/weak and there is tendinitis where the doctor attached the stump of the flexor halucis longus (FHL) tendon to the flexor digitorum longus (FDL) tendon. The remaining, longer part of the FDL tendon was transferred and tenodized to the navicular bone. Although all of my toes are now flexing from the use of the FHL muscle and tendon (since all 5 toes are now attached to this one tendon), it is painful at the suture point whenever I extend the big toe and secondarily, the little toes. My PT tells me that that pain may not go away and I may not be able to extend my big toe past a certain point anymore. Has anybody experienced this before? If so, did you do anything to recover the flexibility/extension in your big toe?

The internal rotation of both knees is still troubling and I would like to learn how I might strengthen muscles in my lower leg to change the gait and more externally rotate the knees. Hopefully the PT will address this. Has anyone else had this problem?

Thanks for all of your support and for reading this.
Any input or encouragement is welcome

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Old 07-14-2012, 05:42 PM   #2
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marble94 HB Usermarble94 HB Usermarble94 HB User
Re: 14 weeks post-op flat foot reconstruction: problem extending big toe/tendonitis


I am also 14 weeks post-op. My surgery was on April 6th for flat foot reconstruction, fdl tendon transfer, and calcaneal osteotomy. I had my cast removed in May and transitioned to a CAM boot. I am out of the CAM boot as of the end of June. I am now in a sneaker with a lace up brace.

I have been going to physical therapy since the end of May. I have been doing great! I have a wonderful therapist who is helping me develop range of motion and strength again (in my ankle, calf, and hip). Mind you, it does not feel 100% yet, but I would say I am about 60% there. I am going to start therapy next week with out the brace. A bit nervous but the progress is a great motivator.

I had problems with my toes too. My baby toe was turned before the surgery and is straight now, feels weird, and the rest of the toes felt stiff and really did not bend much at all. When I first started therapy I was doing a warm whirlpool, which helped to loosen the foot for the exercises I was about to do. I have noticed that the exercises from therapy have helped my toes. Especially once I got on the treadmill. It has allowed me to make sure I walk (very slowly 1 mph) heal to toe to stretch the whole foot. And that is exactly what my surgeon said to do.

I am now crutch free except times when I know I will be out of the house for a long time. My suggestion is to get a very good therapist you get along with. (My therapist and I get along great and I never met her before my treatments). Also, if they give you exercises to do at home, be very committed to do what they tell you. I make sure to get up a few minutes earlier to do them in the morning and just before bed at night. I see amazing progress.

Today I went out with my son and husband to get my son's hair cut and to another store after. I went with no crutches and just my brace. This was my first venture where I spent some time walking. I was shocked that I felt like I was walking "normal". I also noticed that after about an 90 minutes my foot told me to stop. Felt like it was swelling. I have swelling on the outside ankle that looks like a golf ball is there at the end of the day. It goes down at night thought. My therapist said that is normal because I am using the foot more and more and the body is trying to counter what I am doing. The bottom of my heel also feels odd from the screws for the osteotomy.

All in all, this is such a complex surgery the recovery time is crazy long. Be patient, take it slow, listen to what your foot says (it will know when you have done too much), and realize that swelling may take 6-9 months before it goes down completely. Total recovery time about a year.

I hope your recovery goes well!! Be patient and make sure to "lean" on friends/family for support. (oh, this board has also given me a ton of info and encouragement too)

Be Well!!! =)

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posttibtend (07-17-2012)
Old 07-15-2012, 12:40 PM   #3
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lindad1 HB User
Re: 14 weeks post-op flat foot reconstruction: problem extending big toe/tendonitis

I`m 5 months out from calcaneal & tendon transfer.I still have substantial swelling & pain when I have walked for about 2 hours.I was hoping to get back to playing golf,but it won`t be yet! This is one heck of a recovery,I`m just hoping thatthis time next year I`ll be bouncing around with no pain!
I do notice improvements though,I can actually walk down stairs normally now,albeit very slowly,but I`m not walking like a crab !

I don`t think a lot of people realise how brutal this surgery is & recovery is long.Even my GP said "Wow,you had extensive work done on your foot" & he wouldn`t want to have it done!
Good luck to all in your recoveries,I would love to get in my normal shoes again.

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posttibtend (07-17-2012)
Old 07-16-2012, 01:14 AM   #4
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Missyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB UserMissyluke HB User
Re: 14 weeks post-op flat foot reconstruction: problem extending big toe/tendonitis

I had flat foot reconstruction surgery in 8/2010. I do remember having some problems with my toe straightening and being really sore in the knees and hip areas. I had to "help" my toe straighten and did this as part of my home pt. When we have this surgery, there are so many changes to our feet that it takes a long time for our foot to adjust and figure out what it is suppose to do. It also took some time for my knees and hips to stop aching. But with some more time, you really will feel much better.

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posttibtend (07-17-2012)
Old 07-16-2012, 03:27 PM   #5
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Location: San Francisco, California, United States
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posttibtend HB User
Re: 14 weeks post-op flat foot reconstruction: problem extending big toe/tendonitis

Thanks so much for the replies. I really appreciate the helpful advice and stories. I have done so much research on this surgery but I still feel the frustrations and worries when the inevitable questions arise regarding whether the surgery worked or not or if I'm in the right stage of recovery. But of course the answers to those questions are such unknowns at this point and patience is the most important virtue to cultivate now.

I had my first real PT appointment this morning and my PT really warned me not to over do it and to stop any of the exercises that cause me pain (as opposed to fatigue) when I'm doing them. He knows my tendency is to do too much rather than too little or just the right amount. So I was happy for his advice. He had his FDL tendon severed as a child and told me it took him 5 years to learn how to curl his toes again properly.

I read him your message, Marble94, and I told him I'm no where near 60% (your surgery was exactly one day after mine). Your recovery is actually really impressive. You were out of a cast much earlier than I was. My PT told me that sometimes people heal much faster than others and where I am in my recovery is more of the norm. He said it could take a couple of years if not several years to recover. His emphasis was on patience. I think I'm much closer to your stage of recovery lindad1 and I just need to take it slowly and be satisfied with baby steps (literally : ) ).

And Thank you Missyluke for your continuing attention on the foot problems board. I think many people have benefited from your long term advice and service. Over and over the wise messages on the Healthboards are usually: be patient and listen to your body, hold out before making any rash decisions or acting out of fear that something is wrong (post-surgery).

By the way, I'm finding that daily contrast baths are very helpful (dunking the foot in ice water for 2 minutes and hot water for 4 minutes (for about 30 minutes total)).

I hope all of your recoveries are successful.
Be well,

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calcaneal osteotomy, evan's procedure, fdl tendon transfer, flat foot reconstruction, pttd

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