Question
QUESTION: I had a modified kinder 11 months ago. Both the doctor and pt agreed that the tendon strength and function are good. However, I continue to have swelling by the surgical area. I can go a few days wearing good sneakers and my custom orthotics with minimal discomfort but as the week progresses, I end up with pain by the surgical site which is bad enough to force me to wear my custom ankle high gauntlet brace. Sometimes, if I am on my feet a lot - wearing my sneakers /orthotics, I end up with pain along the side of the foot extending into the arch which is reminiscent of my pre op pain.

Is this considered to be within "expected" recovery symptoms 11 months post op?

The doctor that did the surgery just says "wear the brace as needed." If the pain gets a lot worse or new symptoms develop, call. A second doctor said that the tendon function is good but if pain persisted, he would do a hyprocure and go back in to check the kinder. A third doctor took new xrays and felt that a calcaneal slide and going back in the check the kinder was indicated. No one gave me a definitve dx that would indicate the need for surgery to my satisfaction. I am not a doctor, but it makes no sense to go back in to "check the kinder" if the doctors all say that the function and strength are good and films show that the plastic anchor is in place. The three doctors are all well vetted surgical, board certified podiatrists. I am tempted to pay the $500 up front to see a foot and ankle orthopedist that specializes in posterior tibial dysfunction; however I question if a fourth opinion will just serve to further "muddy the water" and create more confusion.

Any insights would be appreciated.

ANSWER: Hi Amy,

It is not uncommon to have some discomfort for up to a year with a Kidner.  However, you are certainly there.  Hopefully you have some aggressive physical therapy, if not you should start now or try again.  The brace is helpful for a while but you should be able to get away from it by now. I agree that checking the Kidner sounds like a bad idea.  The main thing to examine is your foot function.  If you still have a significant flat foot deformity that will need to be addressed.  Without seeing your foot it would be a difficult call but I would consider the least invasive option which is the Hypocure.  But first have the surgeons tell you if the Kidner did not correct your deformity enough and what their procedure will do to correct the problem.  One more opinion may make it more complex.

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

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: I did go to the othopedic foot and ankle specialist. After the modified kinder, I did have pt from a fantastic physical therapist.  When the therapist first graduated 10 years ago, he worked for a foot and ankle ortho.  The pt contacted the ortho he had worked for to see what he knew about the ortho I saw.  His comment was "the ortho is extremely skilled and very very well regarded in the foot and ankle community."  He has only done foot and ankle reconstruction for 25 years, specializing in posterior tibial disfunction for the past 15 years. New xrays and an MRI were ordered.  The MRI showed that both my posterior tibial tendon and spring ligament were SEVERELY degenerated.  The ortho felt that the modified kinder did not address my foot allignment which is the reason it failed. The mri that was done before the kinder showed mild tearing by the insertion of the tendon. Now both the tendeon and spring ligament are in very bad shape. When I look at my foot, it actually looks different than the other foot.  When I look in a mirror, the ankle looks like it is starting to cave in and the ankle is now always mildly swollen.  This started to happen in the past few months. Even when I wear my Arizona style brace, my ankle starts to hurt as the day progresses. The foot and ankle ortho said that I need a calcaneal osteomy, posterior tibial tendon and spring ligament repair (most likely using tendon and ligament transfer due to the severity of the degeneration).  He also would lengthen the achilles tendon and possibly do a cotton osteomy depending what he finds when he gets in there.  I would be in the hospital for three days and then NWB for two months followed by two to three months in a boot or walking cast.  Of course I will have pt.  I am scheduled for surgery this week.

Answer
Hi Amy,

It sounds like you are on the right track.  As I mentioned, you likely did not have adequate joint alignment even after the Kidner procedure.  So it appears that this Dr has a clear understanding of the anatomy and methods to get you the proper alignment and function.  Good Luck and I hope you're able to get this fixed and behind you.

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

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.