Question
I had a calcaneal osteotomy a tendon transfer and achceles tendon lengthing october 2009. because of hindfoot . it has been almost three years and  my root lookd deformed.. ankel swelling and the inside of my foof is swollen also, I am sorry this is my left foot.I have constant bone pain, nerve pain with twiching and burning. I have had two seccond opinions. first one said I needed my ankel fused, that the sugery failed, next was I have bone spurs in the ankel and he did not  understand why the surgeon did that procedure and if I fuse my ankel I will be in more pain. i am confused and tired oof being in pain. Woul wearing my casting boot help? Thank you for listening.  Sincerely: Michelle Brown.

Answer
Michelle, first I would like to say how sorry I am that you've experienced these complications after surgery.  No matter how much you or your surgeon prepare for surgery, post surgical complications can occur.  It sounds like you had a flatfoot reconstruction performed.  Swelling can sometimes be a permanent complication post operatively; however, the constant pain is not a "normal" complication.  

First, I would ask the surgeons if the bones are fully fused or healed from the original surgery.  Sometimes a CT (CAT) scan can be performed to determine whether the osteotomy actually fused.  Second, I have to wonder if maybe proper correction was maintained with the surgeries.  Sometimes, if you over or under correct moving bones or tendons during surgery, similar complications as yours can occur.  

As for having your ankle fused, I would say that should absolutely be your last resort.  Ask the surgeon to perform a diagnostic injection into that joint with anesthetic to determine if that truly is the source of the pain.  If you have relief with a diagnostic injection, then ankle surgery whether you choose to have a fusion or an ankle replacement may be appropriate.  If the injection provides no relief whatsoever, then most likely the ankle surgery would not be beneficial and could make things worse.

Wearing your casting boot may help temporarily but you can't stay in something like that forever.  I would consider buying a custom ankle foot orthosis before moving forward with an ankle surgery.  You can always try an ankle foot orthosis first and then if it fails to relieve any pain, ankle surgery may be the next step.  

Regardless, you should understand that if you have your ankle fused, you may not be pain-free aferwards.  When dealing with revisional surgery, I can tell you from personal experience as a surgeon it is RARE to be completely pain free when its all over.  Rather, if your pain is 9/10 or 10/10 on the pain scale, the goal is to decrease your pain to something that is tolerable such as a 4/10.  Anyone that ever says you will be pain-free after reconstructive surgeries such as flat foot reconstruction or ankle fusion is not in touch with reality, and I would caution having any surgery performed by him or her.

I hope this helps.  If you have any other questions, please feel free to ask.

Sincerely,

Dr. Leslie Johnston, DPM

Tampa, FL
Advanced Podiatry

http://www.thetampapodiatrist.com
http://tampafootandanklepain.blogspot.com/
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
Advanced Podiatry Facebook Page
http://www.facebook.com/profile.php?id=100000260088035