Medical Questions > Conditions and Diseases > Orthopedics Forum

weird 1960's ankle repair surgery.

Hi I've been hunting for years to find out the name of the procedure that was done on my lower left leg and ankle when I was 3-4 years old. I am now 53.
I have a vertical ten inch scar on my lower leg that starts just below my knee. On my outer left ankle I have a 5 inch scar that slightly curves around the ball of the ankle.I remember being told the bone from my leg was going to be put in my ankle to keep it from rolling outward. I remember having casts on my leg for a very long time afterwards, the first one was up to the top of my thigh. I know I have no metal plates or screws in my leg or ankle.
I remember people always asking my mother if I had club foot when I was little. She would say no and demonstrate how I'd walk on the outside of my foot without the surgery and she'd say I'd inherited the problem from her. My mother died when I was very young so I can't ask her. My dad doesn't remember.
My ankle is still very unstable and I've sprained it more times than I can count. I had one physical therapist say I had a subtalar fusion and "wow, you can hardly tell you're fused" I had another doctor speculate I was born with an incomplete calcaneus . I still roll my foot outwards when I walk so much that I wear down the outer side of my shoes and they usually only last six months or less. Then the INSIDE of my left ankle starts to hurt and I have to buy new shoes.
I'd really appreciate it if someone could identify this procedure and birth defect I had. Links welcome to, I don't care if they are very technical.
Thanks.
PS. I wore expensive, ugly orthopedic shoe until i was in 6th grade.
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replied February 17th, 2013
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cookiebun,

Unfortunately, it is not really possible to tell what you had done (exactly) from just your description.

If you have x-rays of your leg and ankle, it would probably be possible to determine what was done from them.

Though you say that you did not have club foot, the fact that you walked with your foot extremely inverted (so that you walked on the lateral border of the foot), would lead one to suspect that you did indeed have club foot. The "club foot" deformity (talipes equinovarus - TEV) is, of course, a spectrum. It can go from the very significantly involved foot, which is completely turned inward, to the very mild deformity, where the child has just a minimal inversion (but the foot can still be brought into a plantargrade position).

Since TEV is a spectrum, there is also a huge spectrum of surgeries that were done to correct it. Most of the time, TEV surgery is done while the child is still quite young, preferably before he/she starts to pull up and stand a lot. So, we like to wait till the child is big enough to withstand surgery, and the structures being operated upon are big enough to manipulate, but before the child is weight bearing on the feet.

So, to wait till you were three is not the usual timing for correction of a congenital problem (one you were born with). However, it is possible, that the pediatric orthopedic surgeons who were taking care of you wanted to see if bracing, casting, custom shoes, etc would take care of the problem. Often, in mild to moderate deformities, the nonoperative techniques would be attempted first. Then, if it become apparent that the deformity was just not going to respond well to the treatment, surgery would be done.

Again, there are just so many surgical procedures that could have been done, it is not really possible to know what you had done. You do give a fairly good description, of taking what sounds like a piece of the fibula out, to use in the foot.

However, it is interesting that your scar is on the lateral aspect of the ankle, yet your deformity was one of walking on the outside border of the foot (inversion). Usually, when patients walk on the lateral border of the foot, the structures on the medial side are tight (contracted). Thus, these tight structures would have to be released, so that the foot could be brought back into a plantargrade (foot flat) position. So, for the surgery to be on the lateral aspect of the foot just goes contrary to what you describe (inversion of the ankle/foot).

Again, it would be very interesting to see what your x-rays look like. That would probably be the easiest way to determine what you had done.

Another option is to try to contact the hospital where you had the surgery done, and see if you can get the operative report. If you had surgery at one of the childrens hospitals (such as the Shriners system), they keep patients records forever, and you can just sign a release to get the records. Many other hospitals (if it is still in existence) also archive records. It usually takes some time to retrieve records from these facilities, but it is still possible.


You also state that you still have some problems with wearing out your shoes quickly. You need to make sure that the shoes you buy have very good heel counters in them. The heel counter is sort of a cup that is built into the shoe, to grasp and cup the heel, so that it is held in the proper position. When you are selecting a pair of shoes, you should check the heel counter. Grasp the back of the shoe, where the heel would be cupped. You should not be able to squeeze the heel of the shoe very much at all. If you can, then the heel counter is too weak. You should not purchase that pair of shoes.

Also, if you are having problems with your ankle rolling a lot (inversion ankle sprains), you may need to have a very small lateral heel wedge added to the outside of your shoes. This would have to be done by a medical cobbler or prosthestisit/orthoticist who does the ugly orthopedic shoes. A small lateral heel wedge would have to evert the ankle/foot just slightly, so that you do not wear your shoes abnormally and dont roll your ankle. A small lateral wedge would not be noticeable to other people, and can be put on just about any flat foot gear (no high heels).


Again, sorry, that further information could not be given to you on what procedure you had done. The subtalar fusion is a possibility, but you would usually have pretty significant loss of motion in the hind foot. The calcaneous lengthening is also a possibility. But, there are also other procedures that could have been done.

If you have x-rays, even if they are old, if you can upload them, it may be possible to tell you what you had done.


Good luck. Wishing you the best.
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replied February 17th, 2013
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cookiebun,

Unfortunately, it is not really possible to tell what you had done (exactly) from just your description.

If you have x-rays of your leg and ankle, it would probably be possible to determine what was done from them.

Though you say that you did not have club foot, the fact that you walked with your foot extremely inverted (so that you walked on the lateral border of the foot), would lead one to suspect that you did indeed have club foot. The "club foot" deformity (talipes equinovarus - TEV) is, of course, a spectrum. It can go from the very significantly involved foot, which is completely turned inward, to the very mild deformity, where the child has just a minimal inversion (but the foot can still be brought into a plantargrade position).

Since TEV is a spectrum, there is also a huge spectrum of surgeries that were done to correct it. Most of the time, TEV surgery is done while the child is still quite young, preferably before he/she starts to pull up and stand a lot. So, we like to wait till the child is big enough to withstand surgery, and the structures being operated upon are big enough to manipulate, but before the child is weight bearing on the feet.

So, to wait till you were three is not the usual timing for correction of a congenital problem (one you were born with). However, it is possible, that the pediatric orthopedic surgeons who were taking care of you wanted to see if bracing, casting, custom shoes, etc would take care of the problem. Often, in mild to moderate deformities, the nonoperative techniques would be attempted first. Then, if it become apparent that the deformity was just not going to respond well to the treatment, surgery would be done.

Again, there are just so many surgical procedures that could have been done, it is not really possible to know what you had done. You do give a fairly good description, of taking what sounds like a piece of the fibula out, to use in the foot.

However, it is interesting that your scar is on the lateral aspect of the ankle, yet your deformity was one of walking on the outside border of the foot (inversion). Usually, when patients walk on the lateral border of the foot, the structures on the medial side are tight (contracted). Thus, these tight structures would have to be released, so that the foot could be brought back into a plantargrade (foot flat) position. So, for the surgery to be on the lateral aspect of the foot just goes contrary to what you describe (inversion of the ankle/foot).

Again, it would be very interesting to see what your x-rays look like. That would probably be the easiest way to determine what you had done.

Another option is to try to contact the hospital where you had the surgery done, and see if you can get the operative report. If you had surgery at one of the childrens hospitals (such as the Shriners system), they keep patients records forever, and you can just sign a release to get the records. Many other hospitals (if it is still in existence) also archive records. It usually takes some time to retrieve records from these facilities, but it is still possible.


You also state that you still have some problems with wearing out your shoes quickly. You need to make sure that the shoes you buy have very good heel counters in them. The heel counter is sort of a cup that is built into the shoe, to grasp and cup the heel, so that it is held in the proper position. When you are selecting a pair of shoes, you should check the heel counter. Grasp the back of the shoe, where the heel would be cupped. You should not be able to squeeze the heel of the shoe very much at all. If you can, then the heel counter is too weak. You should not purchase that pair of shoes.

Also, if you are having problems with your ankle rolling a lot (inversion ankle sprains), you may need to have a very small lateral heel wedge added to the outside of your shoes. This would have to be done by a medical cobbler or prosthestisit/orthoticist who does the ugly orthopedic shoes. A small lateral heel wedge would have to evert the ankle/foot just slightly, so that you do not wear your shoes abnormally and dont roll your ankle. A small lateral wedge would not be noticeable to other people, and can be put on just about any flat foot gear (no high heels).


Again, sorry, that further information could not be given to you on what procedure you had done. The subtalar fusion is a possibility, but you would usually have pretty significant loss of motion in the hind foot. The calcaneous lengthening is also a possibility. But, there are also other procedures that could have been done.

If you have x-rays, even if they are old, if you can upload them, it may be possible to tell you what you had done.


Good luck. Wishing you the best.
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replied February 17th, 2013
1) No, I don't have any x-rays
2) The scar on my ankle is on THE OUTSIDE, of my ankle, not on the inside opposite my other ankle AND I roll my foot OUT in the direction of the scar, NOT INWARDS toward my other leg.

3) The last time something was added to the heel of my shoe
to prevent my foot from ROLLING OUTWARD I ended up with a broken leg.
4)Are you actually a physician? If not how do I contact one.
5) Club foot is a problem of muscles and tendons. I am missing and/or have boney deformities.
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replied February 17th, 2013
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cookiebun,

That makes much more sense. When you stated that your mother would describe how you walked, walking on the outside of the foot, that usually means to a physician that the patient is walking with the sole turned inward, bearing weight on the lateral border of the foot. Thus, my confusion.

So, again, this makes a lot more sense.

It would not be club foot (TEV). With the foot everting, usually the underlying problem is one of the lateral malleoulus (the outside ankle bone - the distal end of the fibula).

There is a condition called fibular hemimelia, where the outer ankle bone does not form correctly. As such, there is nothing to support that side of the ankle mortise. The ankle mortise is just like a mortise made for carpentry. It is basically a three sided structure with a fourth piece acting as a joint (ie the ankle).

Again, this disorder is a spectrum, from just a very small outer ankle bone all the way to a very short overall limb. And, as such the treatment varies.

One of the treatments for the type where the limb is basically the full length, but the foot turns to the outside, is to reconstruct the lateral malleolus (outer ankle bone). One way is to transfer some bone from the upper fibula to the lower fibula, to reconstruct the mortise.

But, again, it would take some investigation and imaging studies to know exactly what was done. There are a lot of foot and ankle deformities that this could have been, and thus many procedures.


As to the heel wedge, since you evert the foot, it would need to be placed on the medial side (inside, towards the other foot). It does not have to be very large, just enough so that you get some proprioceptive effect from it. You do not want to over correct. The heel counter in the shoes is still a needed thing for anyone with eversion/inversion or pronation problems of the hindfoot and midfoot. A very good longitudinal arch support is also a good idea.


As to seeing someone, it depends upon where you are (what country). But, in any case, you have a very complex problem. It would be best to see an orthopedic surgeon who is fellowship trained in foot and ankle disorders. Most countries have a national orthopedic organization. You could contact the one in your country and find out where the closest foot and ankle orthopedist is to you.


Good luck. Wishing you the best.
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replied February 18th, 2013
Hi, thanks for the reply.
I'd found this paper:
http://www.limblengtheningdoc.org/files/fi bular_hemimelia_FAQs.pdf
by searching "subtalar fusion" and was wondering if I had a very mild case of fibular hemimelia.
If you look at the second page of the pdf near the bottom it pretty much describes most of the problems I have. I've always thought of my problem being my talus and calcaneus. It never occurred to me before I found this paper that my problem was because of the lower end of my fibula. I found the diagrams here helpful:
http://en.wikipedia.org/wiki/Fibula

I do have some orthotics right now and they do make my feet far more comfortable. They were very expensive (more than $800) but my old insurance paid for most of it. Still, they are actually just glorified arch supports. About 15 years ago I had some very good orthotics that actually countered my ankle roll. Unfortunately I'm in the U.S. and I'd have to pay a lot of money out of pocket now to get another set of those orthotics. My insurance now is not very good at all.

Thanks for taking the time to read my question and reply. I'm a lot more informed now.
"lateral malleolus " gives me a lot more to go on.
Thanks again.
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replied February 20th, 2013
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cookiebun,

No problem.

It is possible that you do indeed have a mild case of fibular hemimelia. Again, it is a spectrum, from the very mild to the very involved.

If you are developing more problems with your foot and ankle, you will most likely need to see a foot and ankle specialist.

In the US, you can contact the AAOS (American Academy of Orthopedic Surgeons) and see if there are any fellowship trained foot and ankle surgeons in your area.

If you don't mind traveling, then you might want to go to one of the tertiary centers, such as the Mayo Clinic or Johns Hopkins. They would be able to do imaging studies, and of course examine your foot/ankle, then determine what exactly is going on.

Also, if you know what hospital did your surgery, you might contact its medical records section. Many times, surgical reports are archieved, especially the ones done on children. It might be worth a try.


Good luck.
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