Question
QUESTION: Hello Thank you in advance for the advice
I am 34 yr old women who has dealth with reoccuring back problems since 14yrs old. Having 3 children didnt help the problem so for many years i have worked towards keeping good core strength  Jan 2011 I hurt my back and upon investigation i have degentative probs bulging disk stenosis and 2 verterbray that has slipped  - back specialist adviced me multi level fusion was an option but didnt think it was the best given my age and lack of evidence to prove its worth it.  My prob is I for the last 18mths have also been dealing with a ruptured posterier tibial tendoin ~ causing me foot to collaspe and walking correctly impossible.  I also have 5/9 score on the bieghton criteria for Hypomobility syndrome.  So as a result of the back and foot i am also having lots of troubles with my left knee and right hip - SI Joint problems
My ortho specialist wants to perform fusion on my foot as she is concerned about the HMS causing too many complications and my questions is ~ should this be the similar approach i take with my back? Is HMS going to make it impossible for me to get my core that strong that i can get some relief from the pain i am now?  or should i be looking more serious at fusion ?
any advice you can offer would be greatly appreciated
Lyn

ANSWER: The age old question is what comes first, the chicken or the egg? A "bad back" which causes an altered gait eventually causes wear on the hip, knee, ankle, or foot resulting in additional problems. But, it's also true that a bad hip,knee, ankle, or foot that results in walking "funny" will eventually strain the back. It all works together and often to get the best result each of what seems to be a separate problem must be addressed together.

That said, I advise against doing anything permanent and irreversible such as a spinal fusion or ankle fusion until all more conservative measures have been exhausted. Permanent and irreversible means exactly that and there is no going back whether the result is good or bad. The worst that can be said about a conservative measure is that you tried it and it didn't work.

I hope that they have you in a boot for the ankle. My speciality is the spine, but this seems to be a good starting point. There are degrees of damage to any tendon - it could be simply inflamed from injury, overuse, or strain, it may be torn, or it may have separated (ruptured). If it is truly separated than only surgery is likely to mend it although this is more commonly called stapling, not fusion. Before agreeing to this be clear on the actual diagnosis and the proposed handling. If it is simply torn or inflamed a boot initially and later orthotics (special shoe inserts to support the bones of the foot) may be indicated.

In-so-far as the spine is concerned a fusion is the last resort. More conservative measures include specific home exercises, physical therapy, and chiropractic. If it is truly degenerated spinal decompression is recommended but degeneration too comes in various degrees and as young as you are physical therapy or chiropractic may be a less costly option worth trying before spinal decompression. Again, fusion is a desperate last resort.


AUTHOR BIOGRAPHY
Dr. Michael L. Hall, D.C. practices at Triangle Disc Care in Raleigh, North Carolina specializing in Spinal Decompression for the treatment of acute and chronic neck pain and back pain due to herniated, degenerated discs. This is a conservative procedure for patients suffering with bulging or herniated discs, degenerative disc disease, posterior facet syndrome, sciatica, failed back surgery syndrome, and non-specified mechanical low back or neck pain.

For more information call 919-571-2515, click on www.triangledisc.com or email [email protected]. Type "Free eBook - 101 Things I Need to Know about my Bad Back" into the subject line.


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QUESTION: Yes i have done physo.intensly for.many many years i.work.hard on.keeping my core.strength very hard ...which.when.checked.by a physo....is very good for.a person.with such problems.as.me.
yes i have been in a boot for 4 mths.now. & yes mri showed.complete rupture

Answer
Good. Then you certainly should have surgery to repair the tendon in your ankle, this is not the same as fusing the bones of your foot. Your orthopedist will have much more experience with ankles than I, but if the tendon has not healed in 4 months in a boot then it unlikely to heal. Anyone caring for 3 children all day everyday with a big boot on their foot is likely to develop hip, back, and knee problems. With your prior history it was nearly certain to exacerbate your condition and must be handled.