Question
QUESTION: Hi Mark  I wrote to you under "Bone out of place in foot" last answer you gave was dated Jan 5 2009, thankyou for the advice. You suggested getting an MRI & seeing a podiatrist but in the Ireland/ UK podiatrists don't do surgery.

I did have an MRI, please see report:
MRI scan report shows a small effusion in the tibio-talor joint, no osteochondral lesion on the talor done. There is some thickening of the dorsal talo-navicular capsule and early ostephyte formation. No subtalor or sinus tarsi abnormality. There is mild peroneal teno-synovitis. There is some marrow oedema on the calcaneus with mild posterior tibial tendonosus. The ligaments are intact. No evidence of Morton's neuroma. The overall findings appear to be mainly that of injury to the lateral ligaments and lateral peroneal tendon, but no evidence of any significant pathology that would warrant surgical treatment. Symptoms should normally respond to a physiotherapy programme, however if her symptoms continue to persist I would arrange a referral to a foot surgeon.

The orthopaedic surgeon is sending me to a foot surgeon but I would really like to get your opinion. My foot is still very swollen & I have been wearing the same pair of lace up shoes for 17 months now & without the arch supports as due to swelling I can't fit them in shoes. I feel pulling on the front of my leg near the ankle & pain in the ankle.  

I was in UK & saw a GP who explained the report in simple terms & said my foot has torn ligaments & I will need an operation to fix/ tighten ligaments & my body is attempting to heal itself by pumping fluid into the foot to make is supple.

ANSWER: Hi Sharon,

It sounds like you have several overuse type problems.  I would consider physical therapy and orthotic devices before surgery.  You may also consider a cast for 6-8 weeks to let the tendons and calcaneus heal.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.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: Hi again Marc

Thanks for your advice so far it has been of great benefit.  I have being seeing a chiropractor/ craniopath since May who has managed to even my leg length (they were slightly off) also I saw a foot & ankle surgeon who suggested physio therapy and a possible injection of hyaluronic acid if physio does not reduce swelling in foot.  The physio recommended exercises - calf stretches, up & down on toes, balancing on one foot & moving knee up & down balancing on one foot.  I find the exercises good but still have pain in my ankle & up my leg at times and have a lot of splaying in the foot - the 5th metatarsal has moved away from the rest of the toes & sometimes seems more splayed than others e.g. if I walk or stand a lot.

I have heard of a local woman having laser treatment in Dublin by a surgeon & having great success.  I also phoned a local laser clinic & the owner is trained as a physical therapist in Canada & does laser to speed up healing.

What do you suggest?  The physio says the splaying in my foot is due to it not being looked after at time of injury - she says it would have taken 6-8 weeks to heal but it has been going on nearly 2 years so will take several months & she thinks I may always have splaying in the foot, I hope not.  Also I was holding my foot one evening & maybe applying cream after washing my feet & the 5th metatarsal actually moved back into place - (it has been splayed out for at least a year) but I felt I wanted to 'stretch' my foot & when I did the 5th met moved out again.

ANSWER: HI

I have seen mixed results with laser treatment.  I don't imagine that it would make you worse and it would be a better option than surgery.  So, I would consider conservative treatment before surgery.

Good Luck.

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.facebook.com/markatz?ref=name#/profile.php?id=100000260088035&ref=nam

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: Thanks Marc I'm all for putting off surgery as long as possible.  Sorry for asking so soon again but do you think splaying in the foot can be healed/ improve with exercise in such an old injury as I have (Dec. '07 injured foot) or will I always have splaying?

Also what could be causing the swelling?  Sometimes my foot feels like it could burst my shoe other times it's ok.
Thanks for your time

Answer
Hi

Typically splaying of the foot will not change, however, the foot can be supported with an orthotic.  Following injuries exercise is always helpful.  Swelling can be longstanding following any injury.

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.facebook.com/markatz?ref=name#/profile.php?id=100000260088035&ref=nam

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.