Question
QUESTION: For clarification, the physical therapist said that the talonavicular joint on the surgical foot is tighter than the other foot.  He feels that the restriction change the foot function and is actually contributing to stress by the surgical site. He is having me do light stretching, core strengthening (knees have grade 3-4 arthritis) and strenhthening of ankles.  The pt is doing manipulation by the talonavicular joint -not the surgical site and is doing graston where the hyprocure was removed to try to release scar tissue.  He told me to do the home exercise just to the point that I feel them, but not to where they cause pain.  The physical therapist agrees with the doctor that I should wear the brace when I will be on my feet a lot to settle things down and then gradually back of the brace. He wants me to continue to do the exercises so that I don't regress.

The third doctor is board certified in both foot and ankle surgery and rear foot surgery and is with a different practice from the doctor that did my surgery or his partner.  The third doctor was the one who felt that nothing surgical should be done for a year and that the osteomy was only a last resort.  I have an off the shelf deroyal element afo given to me by the doctor that did the surgery.  The problem is that it hurt by the surgical site.  The doctor from the new practice put cushioning in the modified kidner area of the brace which helped make it more comfortable.

In a nut shell, the doctor that did the surgery and the third doctor had similar advice; however the doctor that did the surgery keeps saying, things will be ok....don't worry.  When I ask him what will happen if things don't improve...he simply says things are ok and we don't have to think about that yet. The surgeons partner feels that due to the allignment of my heel, I will continue to have flare ups without an osteomy.  He wasn't pushing for immediate surgery but was definitely indicating that it would indicated i things didnt improve by the summer.

The doctor from a different practice feels that we should wait until one year post op before considering additional surgery.  He felt that the osteomoy was more invasive than needed at the present time.  He also took the time to explain what the next step would be if all else failed.

I feel that yet another opinion would just confuse things

Any feedback or insights would be appreciated

ANSWER: This Chicago & Elmhurst Podiatrist says.......

Dear Amy,
I agree you should wear the foot/ankle brace for a little while to give you a chance to think about all of this and try to strengthen the foot and leg.  The ankle brace should be worn in any activity or sport that causes pain or may injure the foot.
Don't worry about being weak or dependent with the ankle brace-just be smart! and exercise and strengthen in a way that will not re injure.
If the nerves are trapped by scar-no amount of massage will help.
Sometimes ultrasound quiets it down. Tincture of time quiets it down also.If the pain persists-you can have the nerve cauterized-also wait a year. Surgery to free the nerve in the ankle is about 35%-65% successful-depending on the injury and the skill of the podiatrist.
If you plan to be active,don't improve at @ one year, continue to re injure, and don't want to wear the brace-then the osteotomy is indicated.
Good Luck!

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.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: what is the overall success rate of an osteomy?  The doctor who recomended it said it would be a slide where the bone is taken from the side of the foot.  The partner of the surgeon who did my surgery (recommended the proceedure if I keep reinjuring) and the doctor from a different practice who said that it will take a year after the osteomy to not wonder why your ever did it are both board cerified in both foot and ankle surgery and hind foot surgery.


What is the difference between a board certified podiatrist and an ortho who is specializes in foot and ankle surgery?

I work in a school so if I were to consider surgery, it would have to be 10 1/2 months after the origional proceedure or wait an entire year. I guess that I have three months to make a decision.

Answer
This Chicago & Elmhurst Podiatrist says
Dear Amy,
Osteotomy healing success rates are high-due to the good blood supply to the calcaneus.
It will take a minimum of 4 months before it may feel "normal" and can take up to 9-10 months. The healing time will vary with physical therapy,the surgeon's skill and your ability to keep the osteotomy site free of movement.
Ask the doctor what his/her success rate is with the procedure,what can go wrong,and how will any complications be handled Pick the doctor who is humble & honest. No one has a 100% success rate.
The training difference between a podiatrist & orthopedist in the foot & ankle is HUGE. To be Board Certified in Surgery of the Foot & Ankle as a Podiatrist there are more than 75 cases sent in for the exam. The orthopedic surgeon may send in a Maximum of 12 case-usually less.
The orthopedic surgeon who has done a Foot & Ankle Fellowship has equivalent foot & ankle training as a board certified podiatrist. There are not many orthopedists who have had foot & ankle fellowships.

Hope This Helps
Good Luck!

Good Luck!

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.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