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Foot & Ankle Problems Message Board

Foot & Ankle Problems Board Index

Hi Antiremy,
Started responding last night and I got carried away with too much info. All I can tell you is you need to get a second opinion from a doctor that has very high credentials in foot and ankle surgery. I wasted 10yrs with a doctor, at a well know hospital, who missed diagnosed my condition and also told me a fusion was the last resort because it would limit my mobility. He was wrong and I glad I went for another opinion. This new doctor told me the a fusion was the only solution and that I would have minor side to side mobility loss. If it is not your ankle being fused but the bones directly below it (like Taminicole pointed out) you will not lose mobility. I had my surgery 19 months ago and it was the best solution for me and have no regrets. Do alot of research on the doctor you are going to see. Too bad you are not in the Boston area as I would highly recommend my doctor who was fantastic.
I feel your dilemma! I had flat foot pain as a kid too.

I had a Medial Calcaneal Osteotomy with FDL transfer two months ago. This is similar to what your doctor wants to do minus the gastrocnemius resection and navicular fusion. I definitely recommend surgery because, personally, painful flat feet only get worse with time and activity, and you are so young, you would heal faster than an older person, especially if you've tried everything else. I'm 41 and I'm glad I finally went through with it.

The hard part is the's long! Don't expect to go snowboarding this year. My doc says it will take a good year for my foot to feel 100% better. But after that, freedom! I was non weight bearing for the first 6 weeks, and I'm currently in a walking cast boot. At 7 weeks post op, I started working part time, mostly sitting down. So this operation is going to force you to be still for quite a while and you'll have to learn how to live basically as a handicap person. Don't get depressed, see it as a long vacation. You will get better and stronger with time.

Get a handicap placard for your car, so you can legally park'll need it. Your doc can write an order for a temp placard and you take it to the DMV. You may or may not have to pay a fee.
Equip your home with handicap devices like handles and a bench for the shower. Get a waterproof cast cover for bathing and extra padding for your crutches. If you live in a home with hard floors, use a rolling stool to move about in, it's convenient. After a month you might be interested in renting a knee stroller/walker at a medical device shop. It will help you move around faster and free up your hands, plus they are fun! The smaller stuff you can find at Walgreens or CVS.
Also get a back pack or travel sling. Your hands will be tied up in supporting your body, simple things like laundry and cooking become difficult.
Stay ahead of the pain. That means if the doc wants you to take hydrocodon every 4 hours, take them every 4 hours. Don't wait to be in a lot of pain to take a pill, it will be too late. For me, I gradually took my med every 4, 5, 6, 8 hours, until 2 weeks later I didn't need them. Also elevate your leg to at least heart level often. Because of that, I was never in excruciating pain.

Ok, now as to the mobility of your foot afterward. As long as your talus bone is not fused (aka, subtalar arthrodesis or triple arthrodesis) you should have full ankle movement. Yea! Navicular cuneiform fusions should not impair your ankle mobility, but this is a good question to ask your doc. Some people are born with a navicular coalition, where the navicular bone is still connected, partially or strongly, to one other neighboring bone. These bones are suppose to separate in early development, but in a few people they don't and may give people flat foot pain. The doc will either separate the bones surgically, remove a piece of bone, or fuse them completely. Sometimes a piece of bone is grafted usually in children.

Now I'm not a doctor, so definitely ask yours about this. Gastrocnemius resections are not usually done with this surgery because your calf muscle (that you're not using for a while) is going to shrink substantially under that cast. So you're cutting something to make it longer, only that it's going to shrink and possibly scar down. Don't worry, the shrinkage is temporary and it'll get stronger once your cast is off and your foot is using your Achilles tendon properly (flat footed people do not use their Achilles like everyone else, causing it to be shorter). However it is done on severe cases where the Achilles/gastrocnemius muscle even with physical therapy is not going to be strong, so definitely look into this. I'm not a doctor, please research this!

Evans osteotomies are different between children and adults, I'm assuming you are being treated as an adult. It is a powerful correction with a great success rate if done correctly. My biggest recommendation for you is to find an orthopedic foot surgeon with years of experience that you are comfortable with. Not a general orthopedic surgeon, not a podiatrist, a bona fide foot surgeon who did a fellowship in foot surgery and who only works on the foot all day long, 5 days a week. They have the most educational training and the most surgical experience out there. This 2 1/2 hour-ish surgery is complex despite what you might hear; you're reshaping the bones of your foot and repairing or replacing its pulleys, and possibly tightening ligaments. There is a reason it's a last resort fix. There are nerve bundles to avoid. There are areas that don't have the greatest blood supply, i.e. healing properties. Your foot carries the most bodily weight load of your body, so everything has to be strong. Angles have to be just right because an over correction can also be painful. Sorry, my foot is extremely important, and I'm sure there are good podiatrists out there, but I want the very best.

Best wishes to you!

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