July 22, 2007
Dear Dr. Zapf
I was reading your website.
It is very informative. I have a question. I am a 54 yr. old woman with
severely pronated, flexible feet. In the last year or two I have been
experiencing more and more pain in my ankle and also in my Achilles tendon. I
have worn custom casted orthotics since I was 30 and have been in nothing but
orthopedic shoes for the last 15 years.
Now I have been fitted with
AFO's but haven't worn them much as I haven't been able to find shoes to
accommodate them. My feet are 10AA without the braces, so I am trying to find
men's shoes in order to wear them.
Recently I met with a couple
of podiatrists who recommend fusing the bones in the back of my foot
and doing something to release the AT. I have had many surgeries:
bunionectomies, neuromas, hammer toes. Some of these were successful, a few not
as successful. I fear I will end up in a wheelchair as my feet seem to get
worse as the years go by. I have almost no fat pad and my feet are very
tender. I also have a 5th ray amputation on the right foot.
I am skeptical about this
surgery as it is so radical, but I don't want to pass up something that might
really help me. You mention this surgery on the website.
Any information or
advice would be very much appreciated.
Pam,
Oklahoma City
P. S. My feet have been
flat and pronated since birth but never really gave me any pain until age 30.
Dear
Pam,
Obviously
these are tough questions. Sometimes the feet are so flat that you will develop
excruciating arthritis of the bones of the feet and even develop calluses and
ulcers on the bottom of the foot where the arch has collapsed. Your choices, as
you know, are wearing in-shoe orthotics which help just a little, an
ankle-foot-orthoses which helps more but must be worn in a tennis shoe or
equivalent or surgery. The surgery is extensive and cumbersome but, ultimately,
successful in most cases.
You will likely be
in a non-weight bearing cast for two months and in a removable walking cast for
one month more and this will be followed up by a month or two of physical
therapy. You will be giving up almost half a year to the surgery – and this is
just for one foot. The upside is that your foot will more resemble a regular
foot and you can walk without the requirement for a brace, although it still
might be helpful.
Because you are
only 54 you are the best candidate for this surgery, assuming you are otherwise
healthy. You have many years of walking ahead of you. I know you are concerned
that things may go wrong with the surgery. But you know that the way your feet
are not will never improve on their own thus you will probably not be worse off.
I never advocate a surgery that is not truly needed, but yours seems quite
needed.
Finally, there
are many subtlety different ways to do this surgery so don’t be too concerned if
two doctors give you somewhat different approaches to the surgery. Make sure you
are comfortable with the surgeon. Also, make sure the surgeons you choose for
this procedure are Board Certified in Foot and Ankle Surgery. If they are
podiatrists, and many if not most doctors who are qualified to do this surgery
are probably podiatrists, ask them if they are “boarded in rearfoot” to assure
the highest quality.
Dr. Michael Zapf
