Question
Hi, Dr. Katz.

I am writing to you on behalf of my nephew, Ryan.  He is approximately 25 years old, and was born with bilateral club feet.  These were corrected surgically when he was a toddler.  He grew up with consistent chronic foot pain.  He decided after 9/11 to join the Air Force as a fireman, and enlisted five years ago.  Part of the conditions for acceptance into basic training was to obtain clearance from the orthopedic surgeon who treated him as a child.  This clearance was given, with the understanding that he was to seek a desk job when one became available.  In the five years he has been an Air Force Fireman, Ryan has been on one short tour of duty to Kuwait, and has been promoted to Sergeant.  Unfortunately, he has been on "medical physical fitness" programs for the last few years.  His Unit runs.  He bike-rides.  Reason?  His feet can't handle the stress.  He wants to find a way to both manage the chronic pain (which is worsening as his active duty career continues), and to receive the proper medical treatment/surgical intervention that would allow him to stay in the Air Force.  He has been examined by two different orthopedic surgeons.  Both orthopods cite multiple medical problems with both feet; intervening in one area would apparently have a cascading effect on other areas.  The left foot is out of alignment more than the right one, and is causing him the most discomfort.  He is experiencing a degradation in the condition of the left foot due to the constant activity on it:  When he walks, the foot angles up on the inside and down on the inside.  The right foot has similar challenges, but to a lesser degree.  He has a flat talus, and has refused an ankle fusion surgery.  Current treatment consists of an orthotic insert in his left shoe as an attempt to straighten and flatten the foot.  

What he hopes to discover is what you would recommend in terms of treatment that would allow you to walk more comfortably and stay an active duty military fireman.

Ryan - and I - look forward to reading any advice or feedback you could give.

Thank you for your service.

Kit McKnight
Ryan Cooke


Answer
Hi Kit and Ryan,

I believe there are several options.  One is a device known as an ankle foot orthosis.  This is different than a regular orthotic.  It is a custom device that stabilizes the foot and ankle.  These are used as an alternative to having a fusion.  There are several types, one is a Ritchie brace and another is an Arizona brace.  However, even with this brace pain and deterioration can occur.  That is the nature of a clubfoot even following correction.

From a pain perspective there are several options.  One is a procedure known as cryosurgery which numbs some of the foot and ankle nerves and the other is a spinal cord stimulator.  The stimulator stops the pain impulse and can be dramatic in some cases.

So those are my thoughts.  Good Luck.

Sincerely,

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


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