Mom is Pain, Please help, I am desperate

[MominPain]

The history is that I had ACL reconstruction in May of 2006 and also had chondral debridement of Lateral femoral condyle in September. Ever since the chondral debridement, when I went back to walking again, my gait seemed altered. I had a piece of articular cartilage removed that was wedged in the back corner of my knee which made me walk on more on my toe for about a year. Once the piece came out I gained full hyperextension. I was happy and relieved, but unfortunately....

During my rehab, I developed severe foot pain in both of my feet. It is now so bad I can't stand up for more than a minute.

I definitely stretched something and have been diagnosed with Turf Toe. I definitely pronate and I have been wearing orthotics which do not seem to be helping.

My problem is my gait is really whacked out and that is causing me to walk on the inside of my arch.

Here is a big clue but no one seems to get it. When I sit in a chair with my knees at 90 degrees my right foot does NOT sit flat on the floor. It cannot. The arch is raised up and my foot rests on the outside of the foot. Something is WRONG.

The area of the arch is so tight but I think it has something to do with my knee. Do you think the graft placement (allograft) could be wrong and it is pulling my leg wrong?

I also have a rotation in my tibia about 20 degrees when I walk. If I put my kneecap straight ahead my foot points 20 degrees out.

I noticed right after my injury and before any surgery, that when I extend my legs at the final 20 degrees my tibia on my bad leg will rotate 20 degrees to the outside. I cannot put my ankles together when standing or when extending my legs out in front.

I know this is a complex problem believe me. I have spent countless hours trying to find the answer. Can you believe I am seen by one of the best OS's in the country and even though I have complained about this, he tells me that I am better off than I think.

I have 2 small children and it is so difficult these days as I cannot stand up for more than a few minutes because I feel like my arches are going to collapse.

I am 40 years old and I was so active before this, I did everything, now I can barely walk to the bathroom.

If you don't know what is wrong, could you please just point me in the right direction as to who can best get to the ROOT of this problem. I am seeing a podiatrist and he is excellent but he is only treating the symptoms of my bad feet now. But I just know the problem is in my knee.

What do you do with people who have crooked legs after injury? My hip and ankle line up but my knee will go knock kneed so strength exercise is very difficult.

Please anyone help! Thank you in advance, I really appreciate it.

MominPain

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[physiobob]

Here is a big clue but no one seems to get it. When I sit in a chair with my knees at 90 degrees my right foot does NOT sit flat on the floor. It cannot. The arch is raised up and my foot rests on the outside of the foot. Something is WRONG.

The area of the arch is so tight but I think it has something to do with my knee. Do you think the graft placement (allograft) could be wrong and it is pulling my leg wrong?

This doesn't really seem like anything out of the ordinary. You say you walked on your toes for a long time so now that yo have a change to have a heal-toe gait all sorts of foot pains will present due to soft tissue contractures being stretched out over time. On intermediate remedy will be to wear running shoe style trainers with a high heal, or even healed shoes until you ankle regains its full dorsiflexion (bend).

You physio should be able to test the scenario of the knee being involved by looking a the amount of bend your ankle has with different amounts of knee flexion. Perhaps by sitting you on the plinth and looking at the heals ability to sit flat with varying heights of the bed. You might simply have a tight soleus (part of the calf muscle) and so the deeper you knee flexes in sitting the more then ankle is forced to flex to compensate. Again restriction here is normal from what your history says.

As for the posterolateral instability, well that's perhaps par for the course. This is likely to be the ACL injury but you are noticing it now as you have regained full rotation. One might like confirmation that the graft is in place.

Overall it sounds like to are panicking prematurely and perhaps because your therapist has not fully investigated the situation with you and explained what's going on. Also a graded return to flat shows would be recommended with more or a healed shoe in the early months. Also get some deep tissue work done on the deep calf and peroneal muscles on that side plus some firm through range of motion ankle joint mobilisations.

Good luck

[MominPain]

Thank you so much for responding. You are my angel today. I did have my graft checked by my surgeon last week and it is A-okay. He also performed dial tests and said it's okay. I wish our physios were as good as you seem to be. I have been to 3 offices already and worked with about 7 of them. They are so nice, but don't seem to look at the entire picture/history like you did. Thanks again for your response.