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Drs please weigh in - is this possible?

Posted by messed up foot on 6/13/05 at 17:11 (176701)

quick summary - Left peroneal tendon repair 12/04 (sural nerve is now numb), left TTS and partial plantar fasciectomy in Feb 05 (heel, toes and medial side of heel still numb). Ortho referred me to PT to evaluate why I cannot go up on toes on left foot and now right peroneals are swollen and sore. Ortho thinks that I can't do it because I was immobilized for 16 weeks over 4 months. He won't even consider the pain issue.

PT says that I have 'too many toes' on the left and marked pronation on the left but I think that it is about the same as pre-op. He noted that I have pain at the sinus tarsi region. He said my strength and flexibility are about the same between left and right.(all of which I regained without PT - just a lot of hard work) I asked about PTTD he said that the surgeon should have seen the tendon when he did the TTS surgery (I have an 14cm scar)and that PTTD wouldn't hurt where I feel pain.

PT says that he thinks that I have another nerve impingement. I could cry. Also says that right foot has too much laxity. He is puzzled that I have good strength and pain in the front of the ankle when I try to do a toe raise. I can walk with only a mild limp for 3-4 miles now but my ankle rolls over at least once/day on irregular surfaces.

What nerve could this be? Have any of you heard of this? I am so frustrated that I could scream. What else can be done to fix my foot surgical or non-surgical? While not being able to toe raise seems minor, it affects using ladders, stairs and even hills.

Re: Drs please weigh in - is this possible?

Ed Davis, DPM on 6/13/05 at 18:12 (176704)

The meain reason for not being able to get up on one's toes is tibialis posterior deficiency, that is, the tibialis posterior tendon is weak are damaged. A good non-surgical treatment is a Richie brace. The more I read your posts, the more I am convinced that a Richie brace is the best conservative treatment for you.

Keep in mind that a Richie brace is essentially an orhtotic with two double uprights -- you cannot roll in too much and you cannot roll out too much.

Also, keep in mind that with any orhtotic there is a wide variation in skill in the measurement, impression taking, ordering and manufacture of the device. As such, it is critical that the device be well made.

One trick is to work backwards; in other words, call the lab that makes good Richie braces and find out who their customers are in your area.
A lab that makes good Richie braces (or Richie type) braces is ProLab of NAPA, California. Paul Scherer is the owner of the lab so if you can talk to him, that would be ideal. He is hard to get a hold of since he teaches biomechanics at the California College of Podiatric Medicine and runs the lab, bouncing back and forth between the two. Dr. Larry Huppin of Seattle is the Northwest rep. of Prolab and would be a good person to talk to.


Re: Drs please weigh in - is this possible?

Ed Davis, DPM on 6/13/05 at 18:13 (176705)

ps There is a special modification I make ti the Richie brace for people with possible nerve entrapments -- Larry Huppin and and Paul Scherer would understand...

Re: Drs please weigh in - is this possible?

messed up foot on 6/13/05 at 18:55 (176713)

Thank you! I wish that you were in the Midwest. I have kid in California, this might mean a road trip!

Would the surgeon have been able to see the PTT while doing the TTS release?

Re: Drs please weigh in - is this possible?

Ed Davis, DPM on 6/13/05 at 21:15 (176722)

That is possible but I would not jump to the conclusion that you MUST have a TTS release -- remember the conservative options I have outlined.
I have a lot of patients who come to my office insisting on seeing me because I am in the minority of docs willing to offer patients a conservative treatment option to surgery for TTS.

You had indicated to me that you wanted to avoid further surgery so I outlined a non-surgical plan for you.

If you want surgery, my partner, Dr. Leonheart, one of the finest in posterior tibial repair in the country can repair your tibialis posterior while simultaneously releasing your posterior tibial nerve.

Re: Drs please weigh in - is this possible?

Robert B. on 6/14/05 at 09:10 (176749)

messed up,

I was fitted with a Richie Brace approx. a month and a half ago and WHAT A DIFFERENCE, very minimal pain or discomfort, each day brings more relief. My ortho has me in it for 4 months, we will see but I truly believe it is working. The only drawback is summers is here and ya feel a little dorky wearing it with shorts...........

Re: Drs please weigh in - is this possible?

messed up foot on 6/14/05 at 09:29 (176753)

I already had the TTS release in Feb. I want to avoid PTT surgery (or anything else on this poor foot!) I was wondering if the ortho surg who did the TTS surgery would have actually seen the PTT during surgery to know if it was suffering from any degeneration or inflamation. I seem to have a problem with tendonitis with the peronei on both feet and a wrist and elbow too.

I will approach the PT and surgeon about the brace. How it looks is meaningless at this point since I have really nasty looking scars and wear a Jobst stocking to control the edema. My goal is to walk without inversion problems and pain. The brace sounds wonderful at this point!

Thank you for your thoughtful answers. You are providing a wonderful service on this website!

Re: Drs please weigh in - is this possible?

Ed Davis, DPM on 6/14/05 at 15:07 (176771)

He may or may not have looked at the PT tendon, probably not. Please address further questions to me by email at (email removed) , thanks.