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Thursday, August 8, 2013

Post Calcaneal Fracture: Email Advice

Hi Dr. Blake,

     You helped me once before with advice regarding Neuro Eze cream for my feet.  If you don't mind, I had a question about peroneal tendons/muscles.  I broke both my heels 7 years ago and had plates/pins installed.  Over the years my feet have gradually become more and more supinated, to an extreme point where management with orthotics is impossible on my left foot.  I'm 5'6" and weigh 145 lbs.  It's occurred to me that I'm sore right where the peroneal tendons run, and I can't put my big toe on the ground.  I didn't start out this supinated.  Is it possible that I have a peroneal injury from the plate or accident that is making me more supinated?
Dr Blake's comment: Thanks for the email. Since the supination is on both sides, you have to think first of mechanical causes. The most common is gradually peroneal weakening since the surgery somehow disrupted their normal function. You could have peroneal nerve problems, originating from your back, since you are supinating too much. Supination is one of the biggest causes of low back dysfunction. The plates also can be loosening up around the lateral side of your foot irritating the tendons, shutting them off from normal function. 

    On my left foot, there's a 3/4" inch gap between the big toe and the ground.  I've seen a lot of podiatrists and orthopods, and no one has mentioned the peroneals.  They've suggested options like calcaneal osteotomy and/or plantar flexory first ray osteotomy.  Do you have any other ideas for treatment?  (I used to bicycle a lot but can't use a cycling shoe now.)  Thanks so much for any advice.


Dr Blake's comment: Please have someone tell us if you can get your heel straight to the ground. This video below may help you understand this.

I would not consider a surgery unless the peroneal tendon function is evaluated by a physiatrist/neurologist  and a physical therapist. The MDs will perform a Nerve Conduction Test with EMG (muscle test) and the PT will be more practical about muscle strength and function. A bone scan or MRI should be done if there is questions about loosening of the plate on the lateral side of your foot. Any surgery like this should be pre investigated with a fine tooth comb to understand why this is happening, not just how to fix it. The fix may be simple, and have nothing to do with surgery. I hope this is in your case. And, I hope this helps you. Rich

PS Please review all my posts on excessive supination, one of my most favorite topics, to get a strong handle on some of the conservative options, but also so you can ask those treating you the best questions. 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.