Tarsal Resection Before and After X rays

Left Foot images. See area of resection circled. Left foot had a greater resection performed than the right foot. Before (left) After (right)

Right Foot images. See area of resection circled. Before (left) After (right)

Physical Therapy on Tarsal Resection

So it has been 10 1/2 weeks since my right foot surgery. I took a break from physical therapy while I had my left foot in a cast, but I got the cast off so I went back to PT. They started me on a Bone Stimulator to help the bones restore some density and hopefully reduce pain in the area of the resection. I used it for 20 minutes and it made my foot feel like there was a little bit of IcyHot on it. A very slight tingle, like my foot was being microwaved. Didn't feel different afterwards, but after a few weeks, getting this 2-3 times per week, it will hopefully have an impact.

Left foot image immediately after cast was removed. Similar symptoms to the right foot. Tender around the ankle, bruising in various places, weakness and stiffness all over.

Incision pictures

Right foot incision at 2 months

Right hip incision at 2 months                                        Left hip incision at 1 week

Post surgery timeline

Day 0 - surgery

Day 14 - cast removed. Partial weight bearing with walking boot. Begin physical therapy. 35% leg strength.

Day 30 - full weight bearing in walking boot. Foot incision completely closed/healed. 50% leg strength.

Day 45 - transition to normal foot wear. 65% leg strength.

Day 60 - first day of exercise with low impact. 80% leg strength.

Day 90 - first day of exercise with moderate impact. 100% leg strength.

Day 120 - earliest time at which surgery determined un/successful.

Surgery #2, june 9th.

I had my 2nd surgery on 9 june. It was just the same as my right foot surgery, with the same medications and recovery plan. I did have a CT scan the day prior since I had no (left foot) advanced imaging for preoperative records. I will continue to rehab my right foot while resting my left foot completely. Stitches and cast come off my left foot on 26 june.

Tarsal coalition surgery 2

So on june 9th I will have surgery on my left foot, exactly 8 weeks after my right foot. So far my right leg has regained a lot of strength with physical therapy, but has about 1~2 more months to go before returning to normal. Pain in my right foot seems like for the first time it could be less than my pre-surgery pain levels. I still have pain around my ankle and some stiffness with ankle eversion. I have normal feeling through my toes and no pain associated with the EDB muscle the doc had to cut during surgery. Wish me luck in a few days!

Incision at 6 weeks 4 days post op

Incision site. Still has a slightly numb tingling sensation when massaging.

Recovery timeline

Summary of dates and what I can expect from conversation with my Orthopedic Specialist.

14 April - Surgery
27 April - Stitches and cast remove
19 May - Drop crutches, start using knee walker
20 May - Follow up with Dr.

14 - 27 April, Crutches used regularly
28 April - 12 May, Only occasional crutch usage (too painful on the hands)
13 - 19 May, Crutches used majority of time
20 May, Began using knee walker/scooter

Expectations:
June/July - Absolutely no impact until this date (2-3 Months from surgery)
Mid-July/August - Point at which surgery will be deemed (un)successful (3-4 Months from Surgery)

After 5 1/2 weeks, my calf/foot strength is about 66% of its pre-surgery strength. I still have some pain around my ankle (2/10) but only when moving through a full range of motion. Standing pain is similar to pre-surgery still (5/10). It does take 5-10 minutes of standing to get to this level so I try to avoid that. The incision in my hip is rarely painful on any level.

I complete my physical therapy exercises about twice per day, and usually add some lunges or squats along with them to help my overall leg strength return after weeks on crutches.

Tarsal Coalition Web Links

These are some good web sites that explain the tarsal coalition well. Take the time to read and understand all you can about the condition, especially if it affects you.

http://www.footvitals.com/bones/tarsal-coalition.html

http://www.podiatrytoday.com/current-concepts-in-tarsal-coalition-surgery

http://www.orthopediatrics.com/docs/guides/tarsal_condition.html

http://www.podiatrytoday.com/keys-treating-tarsal-coalitions

http://orthoinfo.aaos.org/topic.cfm?topic=A00708

http://www.aapsm.org/ct0800.html

http://www.eorthopod.com/tarsal-coalition/topic/190

http://onmylastlegs.tumblr.com

http://www.wikimedz.com/topic/3d01f2a7dde62d440503d3d82c639d13

Ditch those crutches! Knee Walker/Scooter

If you have a bilateral coalition (in both feet) then you should definitely invest in a knee walker/scooter. It is 10x faster than crutches and doesnt destroy your hands, arms or shoulders. The pressure on the knee/shin isnt too bad. This one cost about $250 but is worth every penny. Crutching can cause you to put more pressure on the foot used to support your weight. It took about 3 weeks to get my knee scooter so make sure you ask your doctor or insurance folks about getting one as soon as you decide to have a surgery. Go fast!

4 weeks 4 days post op

Below is the incision after 4 weeks and 4 days. My foot is still bruised and the pain is similar to before surgery. I have my follow up next week and will figure out when I can get my other foot done.

Bone Model comparison

Above is my foot alongside a bone model. The area circled is the area of the coalition.

Incision at 3 weeks 3 days

Here is the incision site at 3 weeks and 3 days. Daily I sit near a sink with hot water running and a washcloth folded into a small square. I repeatedly soak the washcloth with hot water and gently massage the incision area to help with blood flow and to keep the area clean. There are some yellow areas all over (bruising) from me walking and the bones getting used to weight bearing again.

Walking Boot and physical therapy

Once I had the cast taken off I finally got a good look at the incision site. Aside from the incision, tarsal coalition resection and fat graft, they also had to cut some muscle out of the way just under the stitches in my foot, which was sewn back together after resection. This would be a primary cause of minor to moderate pain for a while.

The photo to the right is of my foot with stitches removed, a few hours after the cast and stitches were removed. The bruising is normal for a cast and much of the dark area on the incision is the surgical pen used to mark patients for surgery.

I stood up and walked around VERY carefully as soon as I got home. It was only slightly painful standing, and at this point I hadn't taken any pain killer of any kind in about 5 days, so things weren't looking too bad. It was painful to bend my ankle as I had lots of bruising, weakness and tender spots. For the majority of the time I moved around, I had to be in a walking boot, and even then my physical therapists told me to continue using crutches to move around.


At 3 weeks and 2 days post-op, My pain in my right foot (surgery foot) is beginning to feel better than my left foot (non-surgery foot), but its really hard to tell since I use my left foot far more, to ensure I allow my right foot time to fully recover.

Foot in a cast, crutches are terrible

If you have never had surgery, I am sure someone can fill you in on the process. I showed up for surgery on 14 April 2015. After a couple hours I woke from anesthesia with no more tarsal coalition in my right foot.

IMPORTANT - My tarsal coalition is a Calcaneonavicular coalition. It was not a complete bar, as in the bones hadn't grown completely together. There was tissue connecting the bones which was removed, and some bone was removed as well, but not much. I also had a fat graft taken from my hip area. I had almost no pain at all after surgery (except from the stitches in my hip area) and for the next 2 weeks I was in my 3/4 cast.

The cast was hard only about 3/4 of the way around my foot (the front/top was only gauze wrap), I assume to allow for swelling. I had lots of gauze wrap which I began trimming off since it was getting warm. I spent lots of time wiggling my toes and flexing my calf to try and keep blood moving through my leg, and hopefully help the healing process. After 2 weeks, the cast came off.

MRI and shots

Christmas of 2014, I have my bone scan recently done, which gave me no concrete diagnosis. After resting my feet throughout Christmas holidays, I returned to work, got a new doctor and an MRI scheduled. At this point, I had no idea what a tarsal coalition was, I had never heard of it. I had an MRI done of my right foot only, since the symptoms and onset were identical.

As you can see pointed out in the photo (my actual foot MRI) these two bones look strangely connected, and they became the only thing that could be identified as a problem.

To treat this issue I needed to first rest my feet, which at this time, I had stopped running and training for months, no change. Since the rest alone didn't help, I was given cortisone shots in each foot during the February to March timeframe, one at a time. The shots made a difference for a few days, but even then, then pain was only cut in half. I had initially scheduled a follow up appointment to get a cast for 6 weeks, but after careful consideration, I skipped the cast altogether and asked for the resection surgery.

Getting started

It has been difficult to find someone who has dealt with exactly the same issue I am dealing with; a Calcaneonavicular tarsal coalition. So, I am going to write some things about my experience so that others may hopefully benefit. If you are reading this, you probably have a similar problem, so I wont bore you with the basics of what a tarsal coalition is. I am a 30 year old male, with a calcaneonavicular fibrous coalition.

My coalition is bilateral and has been giving me problems for about a year and a half. With both feet in constant pain, life gets a little difficult. Prior to my diagnosis, many doctors thought it may be stress fractures or some sort of tendinitis. My symptoms include constant pain if my feet are on the ground, gradually increasing with the amount of pressure or length of time I am standing, walking, etc. If I get my feet off the ground, the pain dramatically reduces immediately, and eventually returns to no pain, depending on how long I was using my feet.

I am (was) very active and have been for my entire life and began having this issue after some intense training I was doing in 2013. I developed plantar fasciitis, but after about 6 months of treatment, I no longer had PF symptoms, specifically, but I did have regular foot pain from standing. After a long break I returned to normal activities and managed my pain levels, but eventually my pain was too much and I had to get it checked out again.

Fall of 2014 I had multiple sets of X-rays, physical therapy, dry needling, etc... but nothing worked. I eventually had a bone scan (seen below) that showed something going on in my feet, and specifically the bones of my feet.