I have a tear of my peroneus longus but I did not sprain or injure it. My orthopedist recommends this:
1.Repair peroneus longus with possible tenodesis to peroneus brevis because the tear is fairly large.
2.Realignment of cavovarus foot with:
a.Calcaneal osteotomy which would correct the crooked heel.
b.First metatarsal osteotomy to lower the arch of my foot.
c.Possible removal of the accessory ossicle in the peroneum.
AND he would do all these procedures at the same time.
What would the recovery period be for these procedures? He failed to mention that the osteotomy means breaking/sawing apart the biggest bones in my foot and putting it back together with pins and screws. I can walk reasonably well with a Donjoy Velocity brace. Doctor said I MIGHT be able to drive in two months and that is best case scenario. I suspect I would be on crutches for many months and MAYBE (?) recover in a year? This recovery period is not realistic and I have torn cartilage in my left knee. I can’t risk blowing out the left knee and being unable to walk at all.
How long will the non-surgical treatment work? Will the tendon finally snap completely? Can’t I have tendon repair and wear a stability brace to keep it from happening again? Help! Thanks for any suggestions or input from anybody!

Hi jan and welcome.

Let me first ask, do the peroneal tendons hurt? Have you been a chronic ankle sprainer? And has the varus foot type (high arch) bothered you over the past several years?

Jeff

Dr. Jeff,
Thanks so much for your reply. The answer to all your questions is no - at this time. I wore a knee-length orthopedic boot for 4 weeks in July/Aug. which finally took the weight off the foot and helped the pain. The velocity brace for past 10 days has really helped keep it stable. And no, strangely enough, I have never sprained my ankle or had problems with my high arches until suddenly this past April. The ankle specialist said the tendon tear is a repetitive stress injury because the right foot is so supernated.

Gosh, not to meddle, but do you think that all of that work is really necessary? I can see in a theoretical world that what has been discussed is reasonable, but if it doesn't hurt? That's a tough call.

Jeff

My thinking exactly. The Dr. wants to fix everything so it stays fixed which is a nice thought but not realistic. He claims the tendon will tear again if he doesn't reconfigure my foot. It took 53 years for it to tear the first time - would it really tear so fast the second time? The osteotomies are a non-starter. They might cause more problems than I had before. I only hope the extreme pain I had in April doesn't come back. I was beyond limping, I was actually dragging my leg for 3 weeks because I couldn't put weight on it. The worst pain tapered off but the improvement plateaued after 6-7 weeks. By then I was just limping, not dragging. I'm going to wait and see if this improvement lasts for awhile. I am relatively pain-free (with the brace) but I'm nowhere near my previous level of activity and I have to think about every step I take. I've lost a lot of strength in my foot because of the tendon tear - I'm afraid long-term brace-wearing will make my ankle atrophy. I don't want to maintain such a low level of activity forever. What do you think? Thanks so much for your feedback.

OK - I can tell you what I had done the first week of June and we are kinda similar. First week of June was about 11 weeks ago. I had the Dwyer thing done to my heel, Brostrom for ligaments, exotosid of fibula because it was shredding my longus peroneal and repair of the brevis....took 3.5 hours or so. The longus was not repairable so he sewed the longus and brevis together up high.

6 weeks non weight bearing and then 6 weeks in an aircast - my total 12 weeks is up next week. My therapy guy gave me permission to walk around the house for this coming week and I have attended 6 therapy sessions. I did have a little problem for abotu week making the transition from NWB cast to the Aircast - I thoghth I could walk right away but took a little time to make the transition.

Hindsight - the surgery was not all that bad in all honesty. I walk around the house now with no limp and no pain except some soreness after a rehab session of standing on the sore foot and doing al their tricks. Soreness but no pain. Soreness welcome because it means I am getting back to normal.

My rage of motion is now normal. I can hold the therapist's grip in all directions at maximum except to the outside where I am at about half strength which is great considering I had nothing before. All this at 11 weeks post-op. I am amazed at the difference and I must have tolerated and compensated a lot. Stil have a sensitivity along the incision site where it hurts some to touch but that should go away eventually and I keep rubbing it to desensitize. But I am so happy I just got this done and over with. And super happy about results so far.

I have a ways to go with rehab but I am already better than before surgery with the power I need in my foot. I say bite the bullet and get it all done. I was shocked then the DR told me all he planned to do, but hey -- it's done and great results.

Thanks for telling me your experiences. It's helpful to find someone with similar foot issues.

jan1515,

YOu are very welcome. Of course I know people who have had problems from reading cases here. I am over 50 years old and figured I would not do well but could not live in a brace and the instability anymore and not be able to walk comfortably or ride bike, etc. I also have serious knee arthritis in the knee of same leg my surgery was performed on my foot. I think it is ALL related. Over the years the foot instability aggravated the knee problem and when I went thru the last tear in my peroneals at the gym, my knee pain increased markedly. My reason for going for it all was to get the total alignment done with hopes of easing the degeneration of my knee. That I cannot report on yet but it has to be a help overall down the road. Walking in an aircast irritated my knee but walking around the house now in bare tootsies, I can say that my knee does not seem to be as irritated. And I realize I have not limped as I have for years. I'm hoping I have two good legs now to take me the rest of my life.

I'm still torn (so to speak) about what procedures to do and when. I will be 54 next month and the longer I wait recovery will be harder. The ankle feels fine now that I'm wearing a brace full-time and I have deluded myself into thinking that it is OK. My Dr. doesn't think long-term brace wearing is a great choice. I need to get another opinion about the raft of procedures he recommends. Did you have your arch lowered with a metatarsal osteotomy or anything? I looked up the Dwyer procedure so now I will know what to ask when I see a Dr. again. My decision is tough because right now the pain is controlled with a brace. But my longus tear is pretty big and I don't know if it could just snap and make the whole thing harder to fix. Having heel and metatarsal surgery on top of the tendon repair really makes me nervous. When were you able to get out and go back to work? Can you drive yet? If I have this done I need to find a way to get back to work in 6 weeks or so. I have a knee issue too but on the opposite leg from my bad foot. Unfortunately, the bad foot is on what used to be my good leg. When I was in the knee-length boot for a month my ankle improved but my knee started flaring up. I agree, lower extremity issues are all interconnected. A friend finally had his big toe fused and the toe is now fine. But he limped for so long with foot pain that he messed up a disc in his back. So now he will have back surgery! It's always something!

Jan1515,
We are same age so we are talking same age perceived difficulties. These are only my experiences that follow.

I wore an ankle brace since Aug 2006 but it does not fix the problem. Surgery fixed the problem although I want to wear an ankle brace for a little bit to feel mentally comfortable after I get "officially" out of cast on Fri.

I did not have an arch lowering procedure. I did have the Dwywer thing done where they straighten out the heel bone. I have two screws in my heel for that procedure and those screws will only come out if I have a problem and right now, I feel perfect with no problems whatsoever.

I was in a hard NWB cast for 6 weeks. If you are motivated, you can go to work whenever. I was not motivated and had ample sick leave so have only recently returned to work. I mean, you can go back at 2 weeks but I did not because I had no need.

I drove after 3 weeks in hard cast! If you can try to learn to drive left - footed like I did - it was really weird at first, but now it feels sooo natural. I almost prefer driving with left foot, BUT once I got out of the hard cast (when I say hard cast I mean NWB), I was allowed to drive, I just did not want to fool with putting a shoe on my foot each time I got in the car - so I was comfortable with left-foot driving and still do.

Only in my opinion, the brace helps and it did for me, but it does not fix the problem. But you need to feel the sensation of total freedom and confidence in bare feet. THAT is when you know you are fixed. And by golly, I feel this now and am so glad i made the decision to get this all done at once.

AND as I said I have severe knee arthritis. MY knee surgeon is the one who told me "your foot is too mangled and you need a foot specialist". You need to be sure you have a good foot specialist. I had one of two recommended in my area. Just be sure you have a specialist with a history of satisfied patients.