Question
QUESTION: I had posted a few weeks ago.  I had a modified kinder 11 months ago.  Despite strength and function of the posterior tibial tendon being good, I continue to have post op pain.  Some days, the pain is minimal while other days it is problematic.  I have seen a total of three doctors (2 podiatrists) (1 foot/ankle ortho). All agree that the tendon's strength is good as is the function.  Two  doctors have suggested different surgical interventions if the pain continues through the end of June.  Neither really have provided me with a clear reason for the continued problems.  The Dr that did my surgery has had me wearing an Arizona style gauntlet brace the past three weeks whenever I am on my feet a lot.  For the most part, the brace has resulted in minimal or no pain. Sometimes, I do feel discomfort by the surgical area; however wearing the brace has resulted in a substantial reduction of pain along the side of the foot and into the arch.  

The doctor that did the original surgery did not talk about doing or NOT doing surgery yet.  He wants to see how I respond to the brace to try to figure out what is going on.  I have tried to schedule an appointment with a doctor at the hospital for special surgery NYC that specializes in posterior tibial tendon dysfunction but his earliest opening is August.  I am calling a few times a week to see if there is a cancellation.

In the mean time, I have an appointment with the doctor that did my surgery 11 months ago to discuss my response to the gauntlet.  

Do you have any suggestions for things for me to consider/ questions to ask going into this appointment?

ANSWER: It's great the the Arizona Brace is providing relief.

Ask about:
Length of procedure
Recovery time
Will you need to continue in the brace postop?  For how long? (if the answer is yes and forever, I'd not have surgery at this point, since the brace keeps you out of pain.)
What is the expected percentage of success with this procedure?

Hope this helps!
All the best,
Andrew Schneider, DPM

http://tanglewoodfootspecialists.com
http://www.houstonrundoc.com
http://www.facebook.com/houstonpodiatrist
http://www.twitter.com/houstonfootdoc

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

QUESTION: In a nut shell, I can wear my aravon sandles or naot shoes for a day at work or possibly two consecutive days but then I start to experience mild to moderate pain along the posterior tibial tendon/arch. I am finding that I then have to go back to the gauntlet brace in my sneakers for a few days before being able to wear my naots etc again.

I saw the Dr. today. He feels that I am doing VERY well. It sounds as if this is as good as it is going to get according to the doctor.  I am 54 years old and NOT matronly.  I absolutely expected to be able to return to pretty much normal after the surgery.  I would have no problem wearing normal shoes with orthotics; however I am unable to wear most shoes on the market. The vast majority of the shoes start to hurt by the surgical site as the day progresses...kind of a sensitivity.  Was my expectation to return to close to normal 11 months post op unreasonable?  Prior to surgery, I was told that I would most likely have to wear orthotics in my shoes post op....a gauntlet brace was never mentioned. Is this level of "recovery" almost a year after a modified kinder outside of the "normal curve?"  I absolutely do NOT want to have unecessary surgery which may potentially result in increased pain or other problems; however I never anticipated having to wear a gauntlet (even a few days a week) for the rest of my life.

If my current level of functioning is unusual, then I will absolutely see the Posterior tibial tendon dysfunction guru in NYC.  Of course you have not examined me, but I would appreciate your perspective on whether one should expect to need a brace on a semi-regular basis after undergoing a seamingly uncomplicated modified kinder.

Thank you very much for your input

Answer
It never hurts to get additional opinions, but I would hesitate at getting more surgery. You may be able to step down from the gauntlet brace to a hinged AFO (such as a Richie Brace) or even a very well made orthotic with deep heel cup and medial skive, but it'll be dependent on how much pain you may feel.  In most cases a brace isn't necessary, but every case is different and you have to do what makes you feel the best.

I know it's frustrating, but when it comes to the foot and ankle, you can't always predict results 100%.  

All the best,
Dr. Andrew Schneider

http://tanglewoodfootspecialists.com
http://www.houstonrundoc.com
http://www.facebook.com/HoustonPodiatrist
http://www.twitter.com/HoustonFootDoc