Dear All,

For the past 20 years, I have been a sufferer of plantar fasciitis. I am a 35 year old female (nickname, Larry) I have worn custom made orthotics for years and have had pain for years, even after seeing several podiatrists, orthopedists, and physical therapists.

I am ready to face my problems head-on, so I saw another podiatrist, who looked at my orthotics and said that he thought they were made quite well. Then, he looked at me stand on my feet and deemed me to be a severe overpronator. After recommending conservative treatments-- almost all which I have had-- he recommended surgery, wherein he would place implats near my ankles to act as hinges, prohibiting my foot to totally collapse on itself.

To hear that surgery was potentially on the horizon, I saw a podiatrist for a second opinion. She does not perform this particular surgery, but said that yes I was a severe pronator and that my foot was crazy flexible, causing it to truly collapse on itself every time I took a step.

She also said that my calves and achilles tendons were very tight and that if I did have surgery, she would inquire about having my Achilles tendon lengthened as well.

Has anyone out there had this type of surgery, and if so, what were the results? Recommendations for implant surgery, OR achilles tendon lengthening?

Please advise. Thank you.
Larry

The fact that you over pronate, must have placed extreme pressures on your feet and ankles. I am not familiar with any outcomes of the implants to help with the overpronation, but would believe that it would most likely provide you with some arch and as a result some comfort and stability. The Achilles tendon lengthening procedure is a commonly one done for patients with pronation as well as some childhood deformities such, as clubfoot. The result of this is less tension at the Achilled tendon as well as more motion available at the ankle. Many patients requiring a lengthening tend to have a tight Achilles tendon, which means limited ankle movement in the upward direction. I would ask your surgeon as many questions as possible. Also, maybe he/she could provide you with his patient outcomes post-surgery.

DOCTOR DNK

Hi Larry,
I know your problem well. I have been suffering with the same problem for 6 years. My doctor also suggested implants, although I don't have severe pronation. I don't know if I should try the ESTW first, it's so expensive.... but surgery is scary. Have you gotten anymore information you can pass on?
Allison

As far as conservative therapy, have your tried UCBL( an Orthosis thatcontrols the more than a custom arch support), Richy brace, SMO(super malalor Orthosis), AFO(Ankle Foot Orthosis), Arazona boot (an ankle gaunlet).

All these are proven orthotic devices that can help sever over pronation that do not involve surgery.

I have had several patients who have had calapsed feet to the point that they are weight bearing on their navicular or the base of their first's and was able to improve their foot position to where they were comfortable enough to turn to normal activity.

There are many orthotic devices available that can help to control the the mid foot hind foot and if necessary the ankle and when incorperated with proper shoe wear yeild satifactory results.

I must stress that unless there are other reasons and the success rate is high (well over 90%) try all consivative treatments first because I have had to make the same devices for people after surgery as I would have before and some times I have to go much more so to compensate for the surgical modifications.

Unfortunatly I don't see the successes of these operations I see the failures so I can only guess at their success rates.

Take care I hope you will feel better soon

Larry,
Although surgery is recommended for certain cases, I would avoid it at all cost. People are not aware of the pain and agony of recovery, as it is usually downplayed.

There is a direct relationship between tight calves and heel pain, as the tight calf inhibits the leg from passing over the foot. The foot then collapses to compensate causing microtears at the heel, or arch.
Have you tried a Dorsiflexion Night Splint? Steroid injections?

One of your doctors said that your orthotics were well made. Being an orthotic maker myself, I will tell you that seldom are orthotics made well, and often they do a poor job.
People that have a "crazy flexible" foot need an orthotic that rides up on the inside of their foot, preventing it from pronating as much. This aspect of an orthotic is called a "Medial Flange."

Do this: Put your orthotic on the floor and put your foot on it. If you cannot see your orthotic because your foot is covering it, then it is quite possible that your device is not properly enveloping your foot. Add a poor shoe to the equation, and you are asking for trouble.

For extreme pain, sometimes immobilizing the foot by wearing a CAM walker can help. It's a boot you might wear if you broke your ankle.
So, where does that leave us? I think that you have other options besides surgery.
I think you need another opinion about your orthotics, and should consider the night splint, and/or the CAM walking boot.



Best,
Spencer Weisbond, C.Ped.



PS I just noticed that the original post is 3 years old! I will leave my post up in case someone needs the info.