Question
QUESTION: I am a 56 year old female. My heel chords in both feet are extremely tight.  I am unable to get past -1 degrees with my leg straight or knee bent in either foot.  Initially, I had insertional Achilles tendonitis in my nonsurgical foot. After a month or so, I started to have pain along the ptt and into the arch and heel of my right foot.  I had successful flat foot surgery 18 months ago on my left foot.  I recently went through ptfor my feet.  While the pain has subsided, I still can not get to neutral and my heel chords feel tight.  I am stretching at home and also wear a night splint for an hour+ while watching TV.  Wearing the night splint when I sleep is pointless as I sleep with my knees bent which eliminates the stretch.  I wear custom orthotics in good shoes(Drew, PW minor, New Balance, Durea) and am within 10 lbs of my ideal weight. I am quite paranoid that my right foot will also end up needing flat foot reconstruction down the road.

One podiatrist said that the tightness most likely caused the surgical foot to "go south on me."  That foot had a prominent accessory navicular which became problematic about two years before my arch had completely collapsed and ankle starting to cave in towards the ground.  If I did not respond to PT, that doctor wants to do a gastroc release. He said that the tightness is a "serious condition" that will lead to PTTD in the nonsurgical foot.  I went to a different podiatrist for a second opinion.  The second opinion doctor said to continue to stretch at home and also put me on oral anti-inflamatories for a few weeks.  He is not suggesting surgery at this point at all.  The second podiatrist said that even though I have some pronation on the nonsurgical foot, he does not see any evidence of PTTD at this point.

Is it possible that I could continue to have bilateral tightness and my nonsurgical foot will never progress to the point that I require flat foot reconstruction? Is considering gastroc release at this point premature?

ANSWER: Hi Stacy,

Stretching and anti-inflammatories can only go so far for this condition.  Without seeing you for an exam, it would be difficult to know whether you will progression of the deformity.  I can tell you that the tightness in the Achilles will likely stay the same or get worse.

In my opinion, I would look at ankle foot orthoses such as a Ritchie or Arizona brace.  If you have enough pain or difficulty with normal activities, then I would consider thinking about surgery.

You can always get a 3rd or 4th opinion as well.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.thetampapodiatrist.com
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://painfoot.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
http://www.fixfootpain.com
Dr. Katz's Facebook Page
http://www.facebook.com/profile.php?id=100000260088035

DISCLAIMER: This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem. It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice. Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan. No doctor/patient relationship is created or established here and may not be inferred through answers on this site. The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site. The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.

---------- FOLLOW-UP ----------

QUESTION: After doing a lot of research about flat foot reconstruction surgery and speaking with a PT, I realized that the surgery does not have a very high success rate. I ended up having the flat foot surgery done by a surgeon at HSS who is actively involed in clinical studies and does two to four flat foot surgeries per week. I wanted to increase the chances of a good outcome. For the flat foot surgery, it was worth going out of network and driving 1 1/2 to two hours one way.

The combination of stretching and anti-inflamatory medication has resulted in a dramatic reduction of discomfort.  My heel chords are still very tight but I don't have insertional tendonitis, pain along the ptt or into the arch now.  I am able to make it throught a full day at work with no discomfort wearing orthotics and good shoes.

Dose lengthening of the achillese tendon have a high success rate in the hands of a competant surgeon or is it a proceedure that would require someone as specialized as the doctor that did my flat foot surgery?

Answer
Hi Stacy,

For Achilles lengthening, I would find someone that does them fairly often for the best result.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.thetampapodiatrist.com
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://painfoot.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
http://www.fixfootpain.com
Dr. Katz's Facebook Page
http://www.facebook.com/profile.php?id=100000260088035

DISCLAIMER: This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem. It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice. Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan. No doctor/patient relationship is created or established here and may not be inferred through answers on this site. The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site. The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.