How to proceed with treating a side effect after 5 month post operative flat foot (PTTD) reconstruction?
Thank you in advance for answering my question. I had the all American Procedure performed on a stage 2A right flat foot due to moderate PTTD and a congenital flatfoot (that's my diagnosis). I also have internally rotated knees. The surgery included: a debridement of the posterior tibial tendon, an FDL transfer to the navicular bone, (both the FDL and PTT tendons were kept separate and not tenodesed to each other nor one replaced with the other)--so I now have two tendons controlling the midfoot (at the navicular), the Evan's procedure was also performed, and a medial displacement calcaneal osteotomy was performed. In addition the remaining stump of the FDL tendon at the forefoot was tenodesed to the FHL tendon. While the mid foot arch was corrected and the heel no longer in a valgus deformity, due to the rigid nature of my foot, the adverse effect of the surgery (primarily from the Evan's Procedure) was excessive pressure on the forefoot of the 5th metatarsal and some pressure on the 5th phalanx. In other words, after 5 months post-op, I feel excessive pain on the outside of the forefoot when walking on it. And there is decreased pressure on the 1st metatarsal and halux (on the medial side of the forefoot). So, my forefoot is now at a slight angle: the 1st metatarsal is slightly higher than the 5th metatarsal when weight-bearing -- this is slightly visible to the naked eye but felt very much internally, ie there is more pressure on the outside of the forefoot than the inside, and this hurts! It is not getting better and limits the amount of time I can walk. Also, in order to step on the foot across the 1st through the 5th metatarsals evenly, I now have to slightly internally rotate the knee. And the knee is hurting more now after the surgery than it did before. The internal rotation is also possibly due to femoral anteversion. My questions are: could a cotton wedge osteotomy help bring the 1st metatarsal down equal to the pressure of the 5th metatarsal when weight-bearing? If I try an orthotic and it doesn't work are there any other solutions you can think of? Have you ever seen this problem before with the Evan's Procedure not working correctly due to a more rigid foot?
Thank you for your time.
3250 day(s) ago