Neglected Congenital Hindfoot Valgus - What to do about it?

[Haisook]

Hello all.

Glad I found this forum.

I was born with a valgus deformity of my left hindfoot. However, it must have been less evident in my childhood as, although my parents noticed it, they didn't think it was anything serious as I had been a very active athlete at the time and never complained from it, until 2 years ago. After knowing that it's a progressive condition (if left untreated), I'm not surprised of what it has become now.

I'm now a 23 year-old medical student, and I've had a lot constant pain/tingling for 2 years. After a lot of doctor visits, an orthopedic surgeon diagnosed my condition, and described it as a 'severe' valgus deformity of the hindfoot. He also noticed that it's pretty stiff at the ankle area and suggested physiotherapy. I also went to a rheumatologist because I'd had heel pain for 2 months, and he told me I had plantar fasciitis, and suggested stretching exercises.

My main symptoms now are:

- constant tingling/vibration -not painful, but extremely annoying- sensation around the ankle (this makes me guess the deformity is compressing a nerve or could it because of plantar fasciitis?).
- a sense of tightness/stiffness at the back of the heel.
- heel pain (obviously due to plantar fasciitis).

So my question is, what type of exercises I can do at home for the valgus condition to loosen up the stiffness and decrease this annoying tingling? I've read about the stretching exercises for plantar fasciitis, but I had no luck finding any material about physiotherapy techniques for hindfoot valgus.

As to plantar fasciitis stretching exercise, I do a lot of stretching on a can, going back and forth on it, and I do the ladder stand exercise. Are these enough?

I'd appreciate you help very much.
Thank you.

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[gcoe]

Hi Haisook

Just from what you said

- constant tingling/vibration -not painful, but extremely annoying- sensation around the ankle (this makes me guess the deformity is compressing a nerve or could it because of plantar fasciitis?).
- a sense of tightness/stiffness at the back of the heel.
- heel pain (obviously due to plantar fasciitis).

* That sounds quite likely that you have a neural component, based on those symptoms.
*Wherever possible it is best to apply Ockhams Razor with the diagnosis- try to find one diagnosis that fits all the symptoms and not just one symptom. Plantar fasciitis would only explain the heel pain. Stiffness and pain is often worst on first mobilising but the pain isn't usually at the back of the heel - rather deep at the front of the calcaneum. There are also other causes of heel pain and other reasons for posterior heel stiffness. Of course I don't know how the rheumatologist arrived at the diagnosis.
*Given a long standing deformity for instance the symptoms could arise from articular pathology.


I think this is too hard to sort out by the internet. Are you happy with the diagnosis? Given your young age and how long that foot has got to last you, I would really see if you can get a good diagnosis. Have you had an MRI or high resolution ultrasound scan? of the hindfoot?

On the treatment side: if it is plantar fasciitis there is evidence for physiotherapy using: for night splints, orthotics, extracorporeal shock wave treatment, and stretching. if there is more of something like an articular problem I would go and see a specialist musculoskeletal physio about it. A podiatrist may be able to help you with the orthotics if the physio can't.

[Haisook]

Thank you, gcoe, for your reply.

Yes, I've had 2 Nerve Conduction Studies; they were a year apart, an EMG to rule out any muscular problem, lumbar spine MRI to rule out any prolapsed discs or tumors pressing on a nerve root (as I noticed my left leg girth is smaller than the right), and a foot/ankle MRI. All these tests did not show any abnormality. I've had 2 x-rays as well to rule out tarsal coalition or heel spurs.

It's worth saying that this tingling sensation is most prominent when I'm sitting down. And when I raise my foot of the ground, it disappears. When I'm lying down on bed, it's not there. This makes me think it's a direct result of the deformity itself; when I press on the ground with my foot, the deformity leads to compression of a nerve. I'm wearing the orthotics at home, and I think it alleviates the condition a little.

I've had all the investigations I could have, and I visited a neurologist, 2 rheumatologists, and 2 orthopedic doctors. I know my condition is confusing, and I've tried almost everything. So now I think what's going to really help me is rehabilitation i.e. physiotherapy. At least I haven't tried this. And because I have no time for physiotherapy sessions at a clinic (my exams start in a month), I want to try it at home, if possible.

So my question is clear (I hope); if someone with a valgus deformity of the hindfoot visited you in the clinic, and complained of stiffness in the ankle and in the back of the heel, what type of exercises would you suggest to him?

Thank you.

[eramses]

hydrogen peroxide works really well for me

[Haisook]

hydrogen peroxide works really well for me

I'm not sure what you mean by this.
Could you please elaborate?

Thank you.

[Haisook]

If we were to assume that I have Tarsal Tunnel Syndrome, a very common condition with valgus deformity, what excercises/massage techniques I can do at home??