I met with a orthopedic surgeon today who specializes in foot and ankle surgery. For the first time I had a doctor talk to me about other procedures that need to be done besides just the subtalar fusion that had always been recommended to me.
One of my main concerns about the fusion surgery was that it may not correct the position of my heel. Doctors had always said something like "We'll just complete the fusion." This never sounded "corrective" to me.
It was explained to me today that, if it is possible, the coalition will be broken apart and the heel bone will be moved to a more optimal position before fusion. That made me feel a ton better. Hopefully that will prevent the twisting sensation I feel when I walk. If they cannot move the calcaneous (heel) bone, it will need to be cut in half and repositioned (a calcaneal osteotomy). Apparently there are lots of nerves and arteries under the subtalar joint that limit how far you can move the calcaneous. My surgeon referred to this as an area of "major badness." I'll take his word for it.
But there are some other things the surgeon will do. Apparently my forefoot has compensated for my heel being misaligned. Once the heel is repositioned, my forefoot will be twisted (supinated) which may require more surgery. In order to compensate, the surgeon is recommending a lateral column lengthening (involving the calcaneous bone) and also a Cotton Osteotomy on a cuneiform. These involve wedging a bone graft into strategic areas to move things into the proper position. The achilles tendon will receive a small incision below my calf muscle. This releases some tension here to compensate for any tightening resulting from the heel mocement.. This will all be done at the same time as the subtalar fusion. I think I counted a total of 4-6 separate incision points.
The subtalar fusion will be the same as you read about everywhere else. Bone grafts and screws. The doctor said I will be non-weight bearing (crutches) for at least six weeks. After that I will gradually start to put weight back on the foot.
Click image to enlarge.
If you have tarsal coalition and are considering surgery, try to find a foot and ankle specialist. I have been to a few orthopedic surgeons and they each told me they had done the surgery a "few" times, which scared me a little. When I asked the specialist today how familiar he was with this surgery, he said he makes these type of corrections "all the time." So don't be afraid to quiz your doctors.
2 comments:
Wow, wish I had found this awhile back... I have had tarsal coalition for 5 years and none of the doctors knew what it was, started when I was 10. We finally found a foot specialist but by then I have developed arthritis in my foot, my knees have bowed in, and my back has a mild case of scoliosis. Its interesting finding tons of people that have had the same problem, when for years we thought it was just some bizarre deformity. The surgery sure changed my life, just wish the doctors were a bit quicker.
How did your surgery go Chris?
Post a Comment