Hello and welcome!
I started this blog as a way to record my journey through foot reconstruction surgery and reach others who have experienced similar surgeries. After countless hours of scouring the web for personal accounts of those who have undergone major foot and ankle operations, I came up largely empty-handed except for a few sporadic blogs on specific procedures.
A little background on me:
At the time of writing this post, I am 33 years old and live in Portland, Oregon with my husband Paul and our two poodles. Since I was a child I have always had very high arched feet. I never thought it posed a problem until recently when my feet started to not fit into "normal" shoes and my heels and lateral ankles started killing me nearly all the time. Granted, in my adulthood I had increased my physical activity levels. But never did I relate the multiple ankle sprains and "wobbly" ankle feelings I've had for years to my high arches.
I have pretty much always been active in sports, especially competitive swimming, In the last decade I also picked up hiking, dancing, running, and cycling, eventually competing in my first triathlon in July 2021 where I placed 7th out of 70 women. Besides the triathlon I also trained for and competed in several open water swim races as well as the Portland Half Marathon in 2021. Unfortunately as an athlete I am all too used to just pushing through the pain - which is not always beneficial.
The week after the marathon I was out for a run when I felt my right ankle give way for what seemed like the millionth time. This one somehow felt different than normal, though. I barely made it home 4 miles. I did the usual protocol of RICE for two weeks afterwards (Rest, Ice, Compression, Elevation), but even after two weeks my symptoms did not resolve. I'm still not sure exactly what I injured on that run, but I suspect some damage to my peroneal tendons occurred. Or maybe I just became acutely aware that my body was trying to tell me something was wrong.
Regardless, fast forward 6 more weeks and I was still in a whole lot of pain. A small and very painful bump had started to appear below my lateral malleolus. My ankle was still swollen and at my local Zoomcare I was misdiagnosed as having an ankle sprain - even scolded by the PA for not RICE-ing enough. I was given a naproxen prescription, which was a Band-Aid for my symptoms but did not really address the root cause of my pain - or what the "bump" was.
Three months down the road from the October injury, I was in so much pain I stopped being able to take my dogs for even short neighborhood walks. Going to the grocery store was next to impossible. I couldn't wear certain shoes or sit cross-legged because any pressure on the bump was excruciating. Driving hurt because it involved flexion of my right foot. At this point I was really starting to get depressed because I couldn't run or cycle anymore. I made an appointment at a local podiatrist's office, at which the doctor proclaimed what I had was "very unusual and extremely rare" and promptly placed me in a fracture boot until I was able to get an MRI.
Now, all of us Americans know how convoluted our healthcare system is, but I had never had a firsthand experience of it until this year. It took me weeks to be able to get the MRI cleared by my insurance, make an appointment, and get the results. In the mean time, thankfully, I was able to find a much better qualified foot and ankle orthopaedic surgeon who I wanted to work with, Dr. Bopha Chrea at OHSU.
At my first appointment, Dr. Chrea took a close look at my images, examined my foot, and was able to pinpoint my diagnosis on the spot. I should have just gone to her in the first place! I was diagnosed with severe cavovarus foot, peroneal tendon pathology, peroneal tenosynovitis, hypertrophy of the peroneal tubercle, and chronic lateral ankle instability (CAI). All of my pain started to make sense with these diagnoses. Dr. Chrea laid out a treatment plan: in order to permanently address my peroneal tendon problems, I also needed to concurrently address my cavovarus foot deformity (the medical term for a very high arched foot) and my CAI. The procedures she recommended were bony work in addition to soft tissue work. There would be a very high rate of failure if I just elected to get solely the tendon repair.
Hypertrophy of the peroneal tubercle is a rare disease and essentially means part of my calcaneus had overgrown due to excess friction from the peroneal tendons. This is what the bump was! There is a medical link between hypertrophy of the peroneal tubercle and tenosynovitis of the peroneal tendons: an inflammation of the tendon sheaths surrounding the tendons.
When it came down to it, the idea of having bony work honestly scared me, as a person who has never had surgery or broken a bone in their life. I trusted Dr. Chrea and wanted to take her medical advice since she presented her reasonings so clearly. She encouraged me to seek other doctors' opinions in the coming weeks because I had such a complex diagnosis. In the weeks before surgery I met with several other doctors who had no skin in the game. They all 100% agreed with Dr. Chrea's plan.
For the bony work, Dr. Chrea proposed a lateralizing calcaneal slide osteotomy as well as a 1st metatarsal dorsiflexing osteotomy. The chances of painful hardware and/or nonunion with the calcaneal slide were quite high even under the best circumstances, so I opted to only get the 1st metatarsal osteotomy, which lowers the arch of the foot. Having the calcaneal slide would make return to sports at a high level difficult if not impossible. On the other hand, there is typically a high success rate with the 1st metatarsal osteotomy making it likely for me to return to sport sooner. The middle ground I decided on was to get custom orthotics after my surgery to correct any remaining cavovarus alignment issues in my hindfoot.
The soft tissue work included a tenodesis of the peroneal longis tendon to peroneal brevis tendon. This involves suturing the two tendons together, essentially rerouting the deforming force on my foot. I also was going to get a Broström-Gould procedure, which tightens two ligaments in the ankle - the ATFL and the CFL - to remedy my CAI. Recovery from a surgery like this would be 6 weeks non-weightbearing (NWB) and 6 weeks partial weightbearing (PWB), ultimately looking at 6-12 months until full recovery.
All in all, at the end of March 2022 I had signed up for an absolutely massive surgery to take place on May 16th. Better start training for it!