#spastic flatfoot

So, I figure I'll probably run out of hilarious foot-related puns soon enough and be forced to put proper titles on these so I figured I should milk them while I can. 

Below you can see the photos that detail how my problem manifests itself in my joint. Talo-calcaneal tarsal coalitions (and indeed, any ankle coalition problems) usually become apparent in children. If the problems associated with tarsal coalitions aren't picked up in childhood or early teens it is quite common for them to lie dormant and asymptomatic for most of a persons life. In fact, the second surgeon I saw informed me that many of the tarsal coalitions that he sees are discovered when people join the army and are sent for thorough medical testing only to discover they have an abnormality they never knew of.

My tarsal coalitions had never caused me all that much trouble. I had played a lot of hockey in school and often suffered from sore ankles afterwards, this was usually put down to tendonitis and a course of physio normally helped me return to a pain-free state. I did sprain my ankles quite a lot as a young child and also, in my mid teens, would wake up with some stiffness in my ankle in the morning. Of course, when you're 16 and more concerned with whether or not a guy is going to put 39 x's at the end of his next text message you tend to ignore premature joint stiffness and go back to buying more unnecessary stationary. 

My only other signifier that all was not right internally was when I sprained my ankle at a céilí during my first year of university. Not only did I not get to dance with the guy I fancied but I subsequently couldn't walk properly for about a month. This sprain, by anyone's standards, was taking longer to heal than you would normally expect, but due to the fact that it didn't worsen it was left well enough alone.

Fast forward to 4 months after I became unable to walk unaided with high dose non-steroidal anti-inflammatories and I've reached an unfortunate grey area with how to proceed with treatment. At this point, I had received one cortisone injection into my joint to try and calm down the inflammation - this had not worked. I had been told by two different surgeons that a cortisone injection would be 1. perfectly suitable to attempt to fight this inflammation and 2. a total waste of time for this type of problem. Needless to say, when the second, ultrasound guided injection proved unsuccessful I was more than a little peeved.

There were two schools of thought when it came to dealing with my problem. One was that due to my age (22) I was too old to be considered for a coalition resection, and an arthrodesis (where they fuse the offending part of your joint, restricting movement) would be favourable. The argument against that was that in a young patient who uses their joints a considerable amount, fusing part of the ankle would no doubt lead to more problems in the long term.

The argument for resecting the joint was that, if successful, it would retain the joint's natural movement and prevent putting extra pressure on it resulting in early-onset arthritis. The downside was that at my age it was much less successful and failure would result in an arthrodesis regardless.

My personal take on the whole situation was very hard to identify for quite some time. I was told from many different angles and by different surgeons why I should try and take various options, and most were unwilling to operate unless absolutely necessary.

The point came that surgery was the only option when I was relying on increasingly higher doses of anti-inflammatory medication and was easily relegated to days in bed with the pain if I stood on anything uneven or had to run for a bus. Also, I spent 3 months in one of those new fangled Aircast Walker Boot casts to see if that would calm the inflammation down. While I didn't have to take medication during this time I looked 1. ridiculous and 2. my muscles slowly deteriorated from underuse and I suffered spasms and pain. I have fond memories of people looking at me horrified when I went to clubs wearing it though.

So surgery was the only option, and I was terrified at the thought of losing part of my joints mobility, losing months and months to a cast and rehabilitation and also leaving myself open to early-onset arthritis. I searched for as much information as possible but often found that no one had experienced my particular situation at this young age. Also, many people who had had an arthrodesis or similar operation had suffered ill effects and were using the internet to air their grievances. It was a rare thing that someone who had come out the other side, happy and healthy was checking in to reassure everyone.

So, in the end, after 3 surgical opinions - each conflicting - I met with a surgeon who is one of the most senior ankle surgeons in Ireland. He had agreed to see me as a favour and came to the very quick conclusion that due to my size (5'3) weight (56kg) and gender (female, had I mentioned that?) there was a good likelihood (70%) that I could benefit from tarsal resection surgery. So I had it.

What remains to be seen is whether or not he was right. Another surgeon told me my age was prohibitive against this small resection operation, yet another told me that the particular type of coalition that I had meant that a resection was possible but only because of this type. So basically, no one was backing each other up for the same reasons.

So, if you are looking for similar information and are in a similar age range or have experienced similar symptoms, maybe it will help you to know which route I have taken to better inform yourself.

That was an essay....but one last point, the joint itself has to be free from arthritic changes to be considered for anything less than an arthrodesis (or joint fusion).