April 26th, 2015 – It has now been 6 more weeks since my last blog and I continue to improve my walking gait. For new readers to this blog please see my homepage for my entire medical journey or see my Short Leg Syndrome Category for the beginning of this subject. I am now 16 weeks total since my last surgery—Endoscopic Gastroc/Soleus Recession to cut the Aponeurosis(definition: a sheet of pearly-white fibrous tissue that takes the place of a tendon in sheetlike muscles having a wide area of attachment) allowing lengthening of my Achilles Tendon and to achieve a normal range of dorsiflexion of my ankle. Prior to this surgery, I was walking more on my mid and forefoot as my heel would not touch the ground and my ankle would not bend enough to have a normal gait.
My prior pain at my Achilles lateral insertion into my Calcaneus is gone. I was able to obtain a more pliable tendon after my Platelet Rich Plasma (PRP) injections were done at the 8-week post op mark as discussed in my last blog. I wear a 4mm foot lift inside my tennis shoes or boots of my left foot; I am now starting to wear 1 1/2 inch heels much more comfortably because I had 4 mm lifts put under my dress shoes by the shoe repair store. With the lift and my lengthened Achilles, I am now in balance for the first time of my life and I have progressively been reaping the benefits in such positive changes to my spine as I continue to walk.
Here is what I have been up to these last weeks while simultaneously going 6 weeks with my arm/wrist immobilized:
On March 31st, 2015 – I saw Dr. Soto of Spokane Spine Center for first time since before my surgery and he encouraged me on my goal of pursuing symmetry in my body even though we are dynamic creatures and some asymmetry is expected and normal. He also congratulated me on significant progress to date and for my active participation in my care.
On April 1st, 2015 – I revisited Christy Frazier, DPT at Apex Physical Therapy in North Spokane, WA as a follow up to her prior treatments before my Gastroc Surgery on my myofascial adhesions in my thighs. She also is a pelvic floor trained Physical Therapist. This was the first time she saw me and commented: ” Kim is demonstrating less difficulty maintaining neutral pelvis and gait pattern. I am pleased to see her enthusiasm for and focus on normalizing her gait pattern and appreciate her body awareness.” She did some Graston type tool techniques on my thighs to help break up myofascial adhesions and she mobilized my right diaphragm.
On April 7th, 2015 – I saw my local foot doctor, Dr. Alm, to discuss the pain under the lateral side of my foot involving my 5th metatarsal area. His impression: “Contusion plantar aspect 5th metatarsal shaft distally just proximal to the 5th metatarsal head. This could be an early stress fracture?” At this point I was to stay in a neutral foot bed, ice and elevate and come back in 2 weeks. If pain did not slowly dissipate then an MRI may be indicated to rule out stress fracture. I attribute the beginning of this problem before I had my surgery as I was constantly overloading that part of my foot with my toe walking.
April 8th, 2015 – I had a follow up phone consult with Dr. Gent, my foot and ankle surgeon, at Kitsap Foot and Ankle Clinic, Bremerton, WA. I shared Dr. Alm’s findings with him and he concurred to check back in a few weeks to see if my pain resolves or not in my foot and that he certainly had a concern to follow up also with an MRI if I didn’t get better. An MRI would show a possible stress fracture or any tendinitis issues remaining pertaining to my peroneal tendons. He had reviewed my prior blog of my walking demonstration and he was so pleased with my success.
I went out this day and bought a new pair of Asics Gel-Kayano tennis shoes since my old Asics from last year needed an update. I find these shoes to be a comfortable neutral shoe that does not supinate my foot like a lot of shoes do by over lifting the medial arch. I need normal healthy pronation as I walk. I had spent over an hour trying on shoes, walking back and forth with cheaper styles; then of course, my feet liked these more expensive ones in the $160 price range. The most important feature was how it felt to my arch and my ability to stay over my arch as trained into me by my therapist. These are important details in choosing the right pair of shoes. I just use the foot bed that comes with the shoe over my foot lift for my left foot. No orthotics.
April 19th, 2015 – Here is my YouTube video of me walking outside after church wearing a pair of 1 1/2 inch heeled sturdy dress shoes while having a moment with my horse as I haven’t been able to ride due to my left arm being splinted.
April 21st, 2015 – Here is my YouTube video of me walking on a treadmill at Pinnacle Physical Therapy. I was able to do a mile in 22 minutes starting out slow and peaking to 4% incline at 3.0 mph. Mark Bengtson, MPT did manual therapy on my foot which does make it feel better; yet, I am unable at this point to do single leg weight bearing specific exercises standing on this foot. The pain will increase as compared to just walking with both legs. My strength and control of my glutes is coming along very well and Mark is so pleased at my walking ability for the first time in working with me for 4 years straight through all my surgeries.
April 23rd, 2015 – My private physical therapy session in Lewiston, ID with Joanna Alford, MPT/ Yoga Instructor commentating on my YouTube Video.
She has been doing for several weeks extra mobilization on all parts of my left foot since my last doctor’s appointment to try and figure out what is causing my pain under what I call my lateral longitudinal arch/cuboid/fifth metatarsal region. She felt that there were some issues with my transverse arch. Before this video we had already walked 20 minutes on a treadmill and I did calf stretches and heel raises and she mobilized my foot into plantar flexion which is more difficult. I have tightness over the top of my foot from my big toe up through and over my medial ankle. Because of this, I struggle with a full heel raise on left foot/leg as I sense this tightness blocks me from coming up higher. The calf, however, is responding very well to contracting and scar tissue around the surgery sites has greatly diminished and the congestion of the calf is calming down. The muscle-tendinous junction below and near surgical area was the area that is now softening to give a smoother feel to the entire length of the calf muscles.
After my work out session with Joanna, I visited again with Dr. Alm, DPM my local foot doctor in Lewiston www.doctoralm.com as a follow up. His objective exam: “Exam reveals she has pinpoint discomfort 1cm proximal to the 5th metatarsal head plantarly, she is non-painful with lateral or dorsal palpation of the 5th metatarsal shaft. There is some swelling present, no warmth. There is a palpable mass in this area about 1cm in size in deeper structures. Is palpated from distal to proximal, not from side-to-side. She does have a plantar flexed 5th ray, at in range of motion is still not above the level of the adjacent 4th metatarsal head. A hyperkeratosis (thickening/callous) is noted of the 5th metatarsal head. She does have a rectus heel on weight bearing. Her subtalar joint range of motion is significant decreased as compared to her contralateral side.” His impression: “Lateral column overload, she has a plantar flexed 5th ray, the HyProCure has decreased her subtalar joint range of motion more than the contralateral side. She does have a soft tissue mass which could be inflammatory just proximal to the 5th metatarsal head plantarly, left.” His instructions: “She is going to continue physical therapy and massage therapy in shoes with neutral foot bed. I told her she could consider having a smaller HyProCure placed in the left foot to allow a little more pronation which would unload the lateral column. I direct her to talk to her surgeon, Dr. Gent, about that and I suggested an MRI for the soft tissue mass.”
In my case, the HyProCure stent on this left foot of mine was to eliminate the excessive lateral motion/subluxation with impingement following my prior Talus fracture. For most patients the stent is used for too flexible dropping arch/excessive pronation. My arch was flexible with some excessive pronation(not bad like my right foot) but my foot would end up supinated all the time when my Talus would sublux due to my horrible walking gait for years with the SI Dysfunction and Short Leg Syndrome. Hence, the HyProCure stent stabilized my Talus bone then the other foot/ankle pathology was able to be sorted out. This included my Arthrex Ankle TightRope Stabilization to end my chronic high ankle sprain and then my Achilles Tendon/Gastroc lengthening to end my Gastroc Equinus. Now that I can walk for sure with 100% improved form and function, the foot bio-mechanics are now in question. Am I being blocked by the stent in not having enough pronation during my gait causing some lateral column overload? Maybe the smaller stent would help tremendously? My right foot does not have this problem at all. I’ve talked to Dr. Alm and to my chiropractor, Dr. Sheldon, who is a www.solesupports.com orthotic provider. Neither doctors felt that orthotics were the answer at this point. Thank you Dr. Alm for your time and effort to exam my foot.
I left his office and spent the next hour standing to have my voice lesson and by bedtime my lateral foot was throbbing proximal to the 5th metatarsal below the cuboid. The standing still is worse for me than walking and moving around. I do feel better in the morning but the vicious cycle starts all over each day. However, I don’t let it stop me now. Compared to 2 years ago I could live like this if I have too. I can walk now with some pain, and before I had pain all the time. I didn’t even desire to walk because I’d end up in leg spasms, more pain and had swelling around my entire ankle. August 2013, I was walking on a fracture and I didn’t even know it and the story is in this prior blog. Now there is not any swelling at the ankle just the localized pain under lateral foot. The positive note is how wonderful my entire back feels and how its getting stronger with the walking on balanced even legs. I agree I need at least an MRI to make sure I’m not getting or have a stress fracture. The MRI will also rule in or out any tendon issues in this area of the foot such as the Peroneal Tendons.
April 25th, 2015 – So here I am writing and finishing this blog because I was released from the forearm sugar tong splint that went around my elbow to control all motion of my wrist. Now I’m in just a forearm wrist splint and I can get back to my typing. Before I sat down to type, I had been outside walking some in my Ariat Paddock Boots and did pretty well but realized that it is very tight over the dorsal medial part of my foot as my arch just does not flex down/pronate like my right foot. And the throbbing started again under my lateral mid foot while sitting here typing. I’m not complaining as it is a good day. Just stating the facts as they are in the moment.
April 26th, 2015 – A Glorious Day– I rode my horse today for the first time by myself with no help from my trainer. The only difficult part is lifting the saddle up on my tall horse with my wrist. Riding in the saddle felt wonderful with no problems for my legs/ankles/or feet whatsoever. I really haven’t missed a beat because all the walking that I’ve been doing has made me stronger which carries over to my abilities in the saddle. Being balanced from head to toe is very important because a horse can feel everything we do with our bodies while on their back. All the surgeries I’ve had these past 4 years have paid off for the first time in over 25 years of riding. This last surgery in lengthening my calf was truly the icing on the cake. My legs stretch evenly down to my stirrups and up until this last surgery I constantly felt like one leg was tighter and shorter. Words cannot express the joy I now feel in the saddle. Thank you Dr. Gent!
I certainly do not know what is up next except to plan a trip back to Dr. Gent at Kitsap Foot and Ankle Clinic, Bremerton, WA in a few weeks. In the meantime, he will see this blog and talk with me again by phone in a few days. I will keep my faith and hope for an answer because God, my Great Physician, cares about the details of my life. I am sure He will bestow wisdom to Dr. Gent on my behalf. Stay tuned for the continued foot story blog and my other blogs to be written about regarding my wrist. I sincerely appreciate all my website and YouTube Subscribers. You all give me motivation to continue writing my story. Thank you!
Here is link to finishing my post op recovery and diagnosis in my next recovery blog.