Surgical Flat Foot
PTTD/Flat Foot Repair
Dr. Rogers has diagnosed you with a flatfoot that is amenable to surgical repair. This may be due to the malfunction of the Posterior Tibial Tendon. The following is a brief handout on the probable surgical intervention that you will have performed along with the pre- and post-operative course that will probably take place.
1. Gastroc Recession: Incision on back of leg measuring approximately 3 inches in length there the muscle connecting to the Achilles tendon is lengthened. You will have a scar on the back of the leg, no screws/plates used.
2. Evans Calcaneal Osteotomy: On lateral side of foot, an incision is made. The tendons and soft tissue are moved up to the top of the foot and using a bone saw, a cut is made in the calcaneus (heel bone). A bone graft (bovine = COW) is then placed in the cut to lengthen the outside of the foot. The tendons then are moved back into place and skin is closed with stitches. THERE WILL BE A PIN on the top of the foot, through the skin and the bone graft. This will generally stay in for 5-6 weeks. This is removed in the office. No anesthesia is used when this pin is removed.
3. Talar-Navicular Fusion: Used to lift up the medial side of the foot to create an arch. This is accomplished with an incision on the medial side of the foot, retraction of the skin and a cut in both the talus and navicular. These bones are then placed in the correct position and a plate with screws is placed to hold the bones in place and allowed to heal. The plate and screws ARE NOT removed unless there is a problem. The skin is then stitched back together.
Post-operatively, you will be admitted to the hospital for a minimum of 23 hours. This is to ensure proper pain management and to start anticoagulation (thinning of the blood). You will be placed in a cast before you are discharged from the hospital. People who are immobilized in a cast are at a greater risk of developing a blood clot. We try to minimize this risk by giving Lovenox, an injectable anticoagulant that is given once a day. You or a family member will have to be taught how to administer this medication. The teaching will be started in the hospital and a visiting nurse may come to the house once or twice to ensure that the medication is being given correctly.
Several other things may also be done before surgery:
1. Pre-surgical testing: Blood will be drawn, and EKG may be performed. A urinalysis will be performed on all female patients. If you are female, of child bearing age, and have not undergone a hysterectomy, a pregnancy test will be performed the morning of surgery. If this test comes back positive, you will not be able to have surgery.
2. Dr. Rogers may opt to have a popliteal block performed before surgery. This is done by an anesthesiologist and involves the injection of numbing medication to the back of the knee. All the nerves to your foot and ankle run behind your knee. This block usually lasts for 12-24 hours and will keep you comfortable post-operatively.
Once you are admitted to the hospital, several things will occur. If you did not have x-rays taken in the recovery room, you will be brought down to the x-ray department and have these done. The nurse will elevate your leg and give you an ice pack (this is very, very important). The nurse will also give you an incentive spirometer. This is to help expand your lungs after surgery. You will have general anesthesia with a breathing tube during the procedure.
You will be seen by a "discharge planner". The discharge planner coordinates home teaching of Lovenox, the anticoagulant that you will be on for a few weeks. This is an injection that you or a family member will be administering. If you need home care, a wheelchair or anything else, this person will arrange for this.
Some patients do not have anyone at home who will be able to help them around the house while they recuperate. If you will not have anyone with you at home, it is advisable that you go to a nursing home or a rehabilitation center for a short time. If this is indeed the case, please let the staff know as soon as possible as this will give them a chance to coordinate this for you.
Plan to be off your feet for a minimum of 9 weeks. You will be in a cast for a minimum of 6 weeks and will need the anticoagulant Lovenox this entire time. If your home will accommodate a wheelchair, this is suggested as it ensures that there will be no pressure on your foot. Most people do not do well with crutches.
You will have a pre-operative appointment with Dr. Rogers prior to your surgery. During this time, you will sign your consent forms and have the opportunity to ask questions. We suggest that you bring in a list of questions (write them down).
You may need medical clearance from your medical doctor and clearance from any specialist that you may see, such as a renal doctor or cardiologist. If this is indeed the case, you, THE PATIENT, needs to arrange for the appointments with the specialist and need to get the clearance. It is not the responsibility of Dr. Rogers or the staff to acquire the proper clearance for your surgical procedure.
Should you have any questions, please feel free to contact the office or Dr. Rogers. The sooner you ask the questions, the faster we can try to iron out any problems that may arise.