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ankle My left ankle

Discussion in 'Other joint replacements' started by Celle, Apr 4, 2016.

  1. Pumpkln

    Pumpkln Forum Advisor

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    You are not alone, saw a neighbor on a walk, she has orthotics that do nothing but hurt her feet. I gave her the names of a couple of people to contact.
     
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    • Celle

      Celle Forum Advisor

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      I saw the orthotist this afternoon. He was very nice and he did his best to help. I get the feeling, though, that we are both on a learning curve with this orthotic.
      I explained to him, politely, that the orthotic has to fit inside my Mary-Jane shoes, as the sandals aren't strong enough to support it. If it can't fit, it will just be an expensive piece of junk.

      He has removed the toe wedge and almost straightened the foot bed (I told him (again nicely) that if he couldn't/wouldn't do it, I would get a chisel and do it myself. He has also cut down the outside edge, so that it no longer impinges on my little toe, but he said that he couldn't cut down the inside edge, as that would remove much of the support the orthotic gives.
      DSC04094 - Copy.JPG DSC04095 - Copy.JPG
      Before & After
      DSC04093 - Copy.JPG DSC04098 - Copy.JPG
      Before & After

      Well, that should have helped a lot, and it did. However, after I had worn the shoes with the orthotic inside, I discovered that the orthotic had moved inside the shoe.
      The lowered side on the lateral aspect and the unaltered side on the medial aspect had allowed the orthotic to rotate sideways inside the shoe, so that the lateral side had become even lower and the medial side even higher. I'm not sure how that can be fixed.

      I do want this orthotic to work, but honestly when I put my shoe on again, with its original foot bed in it, it felt much more comfortable and supportive than with the orthotic in place. The specification from my OS was for a "UCBL-type orthosis, with rigid heel cup and medial arch support". The shoe has good, firm support around the heel and Ziera makes its shoes with a comfortable foot bed that includes arch support.
      Maybe I'll just end up wearing Mary-Janes all year, and forget about sandals and bare feet.
       
    • KarriB

      KarriB Forum Advisor

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      Did the Vionics not work for you?
       
    • Jaycey

      Jaycey Moderator

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      @Celle if it were me I would go back and make the guy correct the orthotic. If it is shift as much as it is, it will not work. Sounds like he may need to start again with something more useful! It's your money - make sure it's something you can use on a regular basis.
       
    • Celle

      Celle Forum Advisor

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      The Vionics are good, Karri, but they are just to use as a slip-on for using around the house.
       
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      • Celle

        Celle Forum Advisor

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        Thanks, @Jaycey
        Yes, I'll be going back to the orthotist next week, to see what he can do. He has taken too much off one side and I agree that now he will probably have to start again.

        Unfortunately, I have a time constraint: I leave NZ in three and a half weeks, heading to England, and I shan't be back in NZ until the end of September. I would need to have another plaster cast made of my foot and ankle and then the orthotic has to be made in Auckland. The current orthotic took three weeks.

        At this stage, I'm ready to ditch the whole thing until I get back to NZ in September. I'll wear supportive shoes while i'm away and save my new sandals for special occasions.

        The orthotic itself cost around $900, but Accident Compensation Corporation (ACC) - part of our health service - is picking up the cost, thanks to my resurrected claim for a sprained ankle 10 years ago.
        This is thanks to what my OS wrote on the referral form ("post traumatic arthrosis left subtalar joint") and the evidence from the MRI, that I sustained damage when I sprained my ankle ("anterior and posterior talofibular ligaments are attenuated and indistinct, suggestive of partial tearing if there has been a history of trauma").
         
      • Jamie

        Jamie Administrator

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        How fortunate that you can get the cost of the orthotics covered! It's worth another try to get it right. Hope the second time works.
         
      • Celle

        Celle Forum Advisor

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        Well, I saw the orthotist again this afternoon and explained what is now happening with the rigid orthotic. He listened to me and agreed that it is now time to abandon that UCBL rigid orthotic. We've given it a good try and it just didn't work for me, so we are trying a different approach. Yay! :yes!::yay:

        Now I have a ready-made orthotic, with deep heel cup and good arch support. It only had to be modified slightly to make it comfortable, and it fits in my shoe. There's much more likelihood of me actually using this orthotic. I will be able to move it from shoe to shoe, too.

        Call me one happy old biddy!
         
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        • Pumpkln

          Pumpkln Forum Advisor

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          :yay: glad he listened to you and gave you something that will you will wear. Let us know how it is going after you have worn it for awhile.
           
        • Celle

          Celle Forum Advisor

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          Thank you, Chris. i wore the orthotic for the rest of the day and it didn't hurt me at all. It never moved inside my shoe, either.

          The orthotist is a nice man and he had done his best with the rigid orthotic.
          The ready-made orthotics come as a pair, so he also fitted the one for my right foot. I shan't wear that now, but I have felt the beginnings of the same symptoms in my right foot, so I could need that orthotic later on.
           
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          • Pumpkln

            Pumpkln Forum Advisor

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            Glad to hear the orthotics are comfortable. Be aware with out the orthotic in your right foot, you may have a little bit of difference in leg height. If you notice something off, a 1/8th inch lift should work.
             
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            • kmgraxy

              kmgraxy Member

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              I had a fusion of my left ankle in 1996. Unfortunately I had a non-union and it was fused again in 1997. I have had no further issues. In 2002 I had a triple arthrodesis of the same foot, which is a fusion of the subtalar, calcaneocuboid and talonavicular joints. Fusions are tough surgeries. A lot of initial pain and a long recovery of being non weight-bearing. I've had LTKR and LTHR and would say the fusions were more painful. That said, long term they give you great stability and pain relief. I do not have any range of motion in my ankle or most of my foot.

              Orthotics have been unsuccessful for me. I live in Alegria shoes. They have a slight rocker bottom in the sole that really helps mimic the motion I lack.

              If you decide to do a fusion at some point please feel free to message me if you have any questions or need support.
               
            • Celle

              Celle Forum Advisor

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              Thank you, @kmgraxy

              It's the triple arthrodesis of my left foot that I am trying to avoid. I don't fancy it at all. While I do have some arthritis in my ankle joint, it isn't as advanced as that in my foot.
              At almost 75, I feel I've had more than enough surgeries, but I do want to retain my mobility.

              Right now, the orthotic seems to be helping and my foot feels well supported when I'm using it. Using the orthotic does seem to lessen the pain.
              Last week, I started to feel some of the same symptoms in my right foot, so I've started using that orthotic as well.
               
            • ACDCJen

              ACDCJen Senior

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              I just had ankle surgery on June 8, 2016. I had several different procedures including removal of a huge Os Trigonum, Haglund's deformity removed, arthritis removed, debridement, and a scope to "clean things up." I had fractured my talus somehow and they talked about the subtalar fusion. Hopefully, there is something they can do other than that to address the arthritis, as they did for mine. I've had bad luck with my ankles too, spraining each of them at least 8-12 times. I just wanted to say good luck and hope that your pain goes away soon!
              Jen
               
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              • Celle

                Celle Forum Advisor

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                Thank you, Jen. For now, the orthotics seem to be helping. Fingers crossed that situation lasts a long time!
                 
              • Celle

                Celle Forum Advisor

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                The orthotics have definitely been helping, but I feel that the arthritis in both my feet is progressing.
                I have now reached the stage where I can feel the bones in my left mid-foot move, if I go barefooted. Then the ache begins again and my left foot adn ankle swell. It takes days to settle.
                So, I'm having to use the orthotics all day long. I did love going barefoot, too.

                When the foot and ankle are bad, I sometimes feel as if I need to use a stick to help with walking. Not thrilled about that, either.

                However, it hasn't reached the stage where I would contemplate surgery. My own OS doesn't do feet and ankles, and has said he would refer me to a colleague when that time comes - he's strictly a hips and knees man.
                 
              • Celle

                Celle Forum Advisor

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                Update on the foot and ankle:
                The orthotics gave me several months of activity that was almost pain free.

                However, the pain in my ankle has recurred and is becoming a nuisance. My ankle and foot are permanently swollen, no matter what I do. (Yes, I do ice and elevate, every evening.)

                If I sit for a while, I can hardly bear weight on my left ankle and foot for about five steps, then the pain gradually decreases and I can walk normally.

                I think it's time to go back to my OS and ask for that referral to his colleague, who specialises in ankles and feet. I'll discuss this with my GP at my routine visit on Wednesday - he has a post-grad diploma in orthopaedics, so he's quite clued up and also easy to talk to.

                I can't help feeling that the mid-foot arthritis is not the sole cause of my problem. I remember that 10 years ago, after my sprained ankle seemed otherwise healed, I had almost exactly the same problem, with severe pain on standing, after sitting for a while. It went away spontaneously, after a few months.
                I still think that pain is somehow related to the sprained ankle and I don't want to go through having a triple arthrodesis, only to find that it hasn't cured the ankle and foot pain. The original OS recommended orthotics and PT, and they didn't do a scrap of good.

                The MRI report (in Post #1) indicates that there is evidence of past damage to the talofibular ligaments and I feel much of the pain over the anterior talofibular ligament, as well as below the lateral malleolus (above the sinus tarsi), which my OS tells me is pain referred from the talonavicular joint.

                My husband massages my ankle and foot and he can get some of the swelling over the lateral malleolus to go down. It hurts when he presses there, though. Is there a bursa there?

                I'd be interested in your opinion, @Josephine .
                 
              • Pumpkln

                Pumpkln Forum Advisor

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                Find a PT, Chiro or other that has studied the Mulligan method. They have a unique way to tape the ankle, if it works you are right, it is the ligaments. If it doesn't work, keep looking for the source of your pain.
                This method was developed by Brian R Mulligan FNZSP (Hon), Dip MT, of New Zealand, so you should be able to locate someone.
                Here is a link to the website:
                http://bmulligan.com/about-us/founders-profile-history/
                 
              • Celle

                Celle Forum Advisor

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                Thanks for that suggestion, Chris. I'll start some research.

                I know that, if I wear an ankle support, the pain decreases, but my foot gets so swollen below the support that I can't wear it for long.
                I once strapped my ankle and foot, using that old-fashioned, three-inch wide Elastoplast that used to be applied to sprained ankles in the "old days" and it immediately felt a lot better.

                I really don't want any more surgery, but I'm losing fitness now, because I can't walk around as much as I'd like.
                 
              • Josephine

                Josephine NURSE DIRECTOR, BONESMART Administrator

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                It's often forgotten that the volume of the foot is actually quite small when compared to other areas such as the hip, knee and even the shoulder. Yet it has a much greater quantity of mechanics and structures in it. Your observation that the swelling extends past the ankle support suggests to me that you need to get one that includes the entire foot, like this

                support sock.jpg

                Or maybe even knee high supports
                 

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