Question
QUESTION: --------------------------------------------------------------------------------

I had a modified kidner and removal of hyprocure implant that had backed out in August. I was still having pain by the the incision site and swelling which became worse throughout the day. The last four or five days, I have been feeling as if my ankle will give way. The posterior tibial tendon (along the edge of my foot and also my arch area have again started to become quite uncomfortable. The doctor that did the origional surgery was not in today so I saw one of the other doctors in the practice. He took new xrays and said that the the angle of the heel contributes to my flat foot. He said that because my foot is so flat, it will just continue to stress the tibial tendon. Right now, he has me wearing a laced ankle brace with my orthotics to take the stress off of the tendon. He said the two options I have is either to wear a brace for the rest of my life or have a calcaneal osteotomy. I am 54 and too young to wear a brace for the next 30 or so years. When I asked the doctor about the possible complications of the proceedure, he said that it is a very straight forward proceedure. The only complication he stated was infection.

The doctor that did the origional surgery kept saying, it sometimes takes awhile to heel after tendon work when I would complain about the ongoing pain by the incision. I am now 7 month post op. The doctor that I saw today watched me waIk, stand, looked at the new x-rays and felt that the only thing that will help is the calcaneal osteotomy.



What information could you give me about the proceedure? Any insights would be appreciated

ANSWER: These Chicago & Elmhurst Podiatrists say.......
I'm truly sorry to hear about the failed Modified Kidner and that you are still having foot pain

The only thing that would delay healing in this kind of surgery is being overweight or standing all day(also poor healing ability from Diabetes or other medical issues). Sometimes these kinds of pains may resolve with physical therapy consisting of ultrasound and bracing.

Continue to wear the ankle brace until you are able to find a second opinion.
All surgeries have Pros & Cons and possible complications. How would the foot and ankle surgeon handle a potential complication?
The foot & ankle surgeon should take the time to review these with you-so you can make what is known as an informed consent.
Did they inform you that the implant may fail?
There are more potential complications that just an infection with a calcaneal osteototomy.
All pros & cons need to be reviewed with you in language you can understand.

We are located just 45 minutes or less from both airports in Chicago and specialize in these kinds of revision surgeries-something to consider.

Go seek a consult from a Podiatrist who is Board Certified in Surgery and can claim to have done at least a dozen or more calcaneal osteotomies and can tell you the complications and how he/she would handle them.

Choose wisely Amy

Hope this helps!
Good Luck My Friend!

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: I am about 10 -15 lbs over weight.  For my job, I do a combination of walking (20%) and sitting.

After doing my own research, I see that non-union, nerve entrapment, incorrect placement of the bone etc can be complications. When I asked the doctor about non-union, he kind of down played it, telling me that I am healthy, don't smoke etc so it is highly unlikely that would be a problem.  He isn't suggesting surgery yet but put it out as a strong possibilty.  First he wants to see how I respond to the brace and continued PT.

The pt that is treating me feels that strenghtening my ankle could protect the tendon.

Both of the surgeons I saw from the practice are board certified and have good reputations. Some co workers were happy with the practice.  My primary doctor felt that the doctor was very good.  I also checked my state professional boards site to be sure that there were no complaints or restrictions placed on the doctors.

I absolutely plan to see a doctor not associated with the practice for another opinion.

In your experience, do you find that a modified kinder alone is effective in treating an adult aquired flexible flat foot?  Do you usually perform  the kidner as a stand alone proceedure or in combination with another proceedure?

When I first wake up, the area near the incision where the accessory navicular was removed feels fine but by the afternoon, the area begins to feel sore.

 Is this type of pain 5 months post op something that can happen with a successful surgery?  

A week ago I kind of stumbled and then my foot began to hurt by the tendon.  I iced my foot and within an hour or two, I felt much. About two days later, I started to feel as if my ankle suddenly became weak when I walk and now I sometimes get the pain by the tendon.  I still am doing pt but have backed off on the number of reps.  I am able to stand on the toes on the surgical foot and then slowly put the foot back down but after five or six reps, it starts to hurt.  In a successful surgery could a simple stumbuling result in a significant flare up?

Answer
This Chicago & Elmhurst Podiatrist says....

The fact that you wake up pain free and takes half a day for your foot to hurt is very encouraging and a very good sign!
Weight loss is tough. Believe it or not the 15 pounds is slowing down the healing. The 20% at work is acceptable.
Continue to work with your therapist and ask for ultrasound treatment around the surgery site and tendon.
The best strengthening for your condition is for your posterior and anterior tibial tendon and for your long flexors of the foot-The flexor hallucis longus and the flexor digitorum longus. You may also need stretching of your calf muscles. That will strengthen the foot mechanically-which is what you need for your condition-not necessarily just ankle strengthening.
I am sure the Doctors you have seen may be excellent surgeons with great reputations----but that still does not excuse them from not reviewing all Pros & Cons of all surgeries. That is today's standard of care-No if, ands or buts.
It's easy to be nonchalant when it's not your foot.
You may have torn some fibers when you stumbled.It is easy to flare up a weakened tendon or area post surgery in the foot or leg. Remember-you still use the foot all day long. As long as you feel you may be able to continue your toe standing and actually increase the reps-you will be heading in a good direction. If the pain stops you-then you need to have it reevaluated.
Unable to comment on the surgical procedure without ALL data(x-rays,chart,exam,etc)-to do so would be unprofessional of me.


Hope this helps you Amy!
And Good Luck Again!!!

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.