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Need input and advice...PLEASE

Posted by Debbie on 4/27/03 at 20:54 (117235)

I'm open to any comment...patients and docs...here's my post from the Ask the Doctors message board. Please comment...

I won't re-tell my story. Suffice to say I have been slow to recover from PF release late December. MRI had now revealed Posterior Tibial Tendon lenghtening(?) and displacement of the navicular(?). Does this sound right to any of you? I am in a cast (fiberglass) now for 4-6 weeks to totally immobilize my foot and ankle. No weight-bearing. My docs have conferred (my foot doc and knee orthopod...both in smae group) and there is some question about alignment of leg bones because I have had this challenge as well as suffer from severe patellofemoral syndrome in my right knee/same leg (have dealt with this for years). How does this all sound? Logical? Need someone to help explain this a little better...I am getting confused. Thanks!

Re: Need input and advice....ASAP

BGCPed on 4/28/03 at 00:18 (117248)

You prob have a ptti, or flat foot along with a genu valgum or knocked knee, the two can also create knee problems like pat/fem or lateral compartment arthritis, sometimes leads to total knee in bad cases.
A good orthotic and solid shoes should help when the cast comes off, it sounds like you have a bad case did they tell you if it was grade 2 or 3 ?

Going barefoot in the house or wearing weak shoes is bad for that condition. There is also an unloader knee brace that can help the knee when you are active. it has 3 to 5 degrees of varus load (it pushes your knee out) to unload the outside lateral compartment. In flat foot knock knee pt the outside knee often is painful as well.

Sometimes a debate on which to fix first the knee or the foot since they both have an affect on each other as well as the hip and back. It is a very common combination, usually found in females over 50. Also found in over weight pt, losing weight, if you need to can also help a great deal

Re: Need input and advice....ASAP

Debbie on 4/29/03 at 21:55 (117401)

Thank you to BGCPed for your response. I really am confused and perplexed, but what you say makes sense. Can you tell me more about what an unloader knee brace is? Maybe refer me to some examples online? Do I need to have my orthopodist order it? What exercises should I consider after the cast is off? What should I avoid? Advice on orthotic brands (custom?) and what do you mean by solid shoes? Thanks again for responding...

Re: Need input and advice...PLEASE

Ellen J. on 4/30/03 at 19:09 (117475)

I'm sorry to say I don't know about the surgery part, as I have not experienced surgery. I have had patello-femoral syndrome, however and it was in the leg opposite to the bad foot, oddly. From what I've read, it's due to a bad Q angle, in that the femur angles inward, causing the knee and lower leg to function differently. Sort of like that, anyway (not a good or accurate description). Anyway, re; the knee pain, I finally got rid of it by doing exercises to strengthen the Vastus Medialis muscle. I went to the gym and did VERY GENTLE leg extensions on the leg extension machine--at the lightest weight (10 pounds) and used both legs together, which divided the weight between the legs, at 5 lbs. per leg. I did the reps slowly and gently and never came all the way up with my feet nor all the way down. This doesn't get rid of the angle of the femur, of course, so the problem is always there and can come back if the exercises are not done. However, it got rid of my pain completely after having knee soreness for over a year. If you have not done this exercise, be very careful not to use heavy weights or you'll only aggravate the knee. I did as many reps as my knees allowed and if I felt even a twinge of pain I stopped for the day. I got up to 100 reps.
Hope you can get some good answers to your sore feet,
Ellen J.

Re: Need input and advice....ASAP

BGCPed on 4/30/03 at 23:43 (117506)

What area are you located, I may know who to refer you to. I like the donjoy defiance as an unloader brace. It is not worn all day long but more when you are active and wt bearing. They have a website, I would assume it is donjoy.com. Solid shoes meaning if you really have flat feet than a good motion control shoe meaning it is solid and firm with a rocker type sole would be best.

I know it is confusing, it is also not good to assume condition online. I was just giving you a plausible cause/solution. Seek out a good ortho foot person. Degeneration of the knee joint can, in some cases, be slowed down with proper treatment.