Chronic Pain From Club Foot

My wife was born with a club foot that was initially treated (rebroken) but subsequently neglected when she was a child (“absent mother” would be putting it lightly). We’ve seen two orthopedic surgeons that have looked at her foot and seen x-rays and have concluded that things have healed and progressed about as well as you could expect from her situation.

I’m no expert in any sense, and I’m not going to argue with professionals concerning what is or isn’t a positive outcome, but she began having discomfort on the leg when she was 18, and twenty years later, she spends many days in crippling pain. She has virtually no capacity for dorsiflexion on her smaller leg, and the soleus/gastroc have almost totally atrophied. From what I can find, atrophy of those muscles is fairly normal with a club foot, but I’m not sure that the pain she’s experiencing is typical. If she walks a bit too much or tries to ride her bike too much (which she loves more than anything), she can’t walk the next day - or sometimes, the next week.

She’s hitting a point where I’m sure a lot of people going through chronic pain hit - the “whatever, this is just the way life is” phase, and she sort of seems to want to give up on finding some treatment. We went to a podiatrist, as I had horrible tendonitis when I was a kid and orthotics really helped me to be able to walk and corrected my arch, and the orthotics she got have helped a bit, but clearly more needs to be done to strengthen her weak areas.

Here’s a front picture:


You can see the right leg is clearly smaller, and you can see how the ankle is shifting inwards.

Here is a side picture of the right leg:

The red highlighted area is what hurts her the most, and it radiates outwards from there.

The last picture is a rear view and it’s the most obvious. The ankle kind of shifting medially, and the sheer size difference between her R leg and her other calf. The heel on her right foot gives her a ton of discomfort too, which is probably bad tendonitis as well.
IMG_0364

@Dr_Grove_Higgins wondered if you could point us in the right direction or have any suggestions.

Lot of smart people on here as well - would love some help here. My wife can find it hard to accept help sometimes. I did ask her permission to make this post and post these pictures and she was quite receptive to it, so it’s an encouraging sign and I’m hoping her willingness to put herself out there and ask for help can yield some much-needed relief for her. She’s a super positive and fun person in spite of all this - I just want her to hurt less.

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Where are you located? I may have a referral.

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I’m 100% not qualified to make this post.

It looks like your wife’s foot is Pronated. Or turned “Pinkie Toe Up.” Like the opposite of Supinated or “Pinkie Toe Turned Under.”

It looks like maybe her foot is so pronated that her leg bone is knocking into her foot bone.

Dr Higgins posted this video last month. It wasn’t specifically for an ankle, but at about 45 seconds in he shows/cues how to pronate and supinate the foot. He calls it mobilizing the arch or something.

Maybe she could practice supinating her foot to clear more space between her leg bone at foot bone. Or to like shift the ankle outwards?

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Central Virginia.

Thanks for the input dude!

Her orthotics are custom made by a podiatrist, and they essentially do just that - they supinate her foot to lift everything up and stop the bones from shifting medially. It’s helped for sure, and she tries to work on it outside of that, but I think the tightness of the tendons and the lack of musculature keeps shifting things in the wrong direction.

Maybe there’s a more permanent way of addressing things than just an orthotic that she wears in her sneaker, though!

Thanks again for the thoughts, man - much appreciated.

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My original recommendation is 9 hours away from you, unfortunately. I’ll see if they know anyone closer.

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Check this post: Foot Compensation Patterns – ZacCupples.com

Might be a bit tough to parse due to the language used but there are some good tips and exercises to try in there. FYI Zac (the PT who wrote that blog) does offer online “movement consultations” that may be of interest to you. It is always difficult when structures have been changed by surgery, but I can vouch for his approach generally. May be worth a shot if other interventions have failed.

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OK!

After the supination/pronation Doc goes on to show how those motions are connected to the way your whole lower leg moves. And how the tibia is supposed to rotate. He mentions the Tibialus Anterior, which I guess is the muscle supinates the foot. And the different heads of the hamstring which rotate the tibia.

I THINK that maybe the answer for your wife might be learning to feel the tension and use these non-ankle muscles better.

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Thanks for the heads up - I’d like to check the rotation of the tibia, and I also agree that maybe she needs to learn to actively put her foot in the right position instead of relying on a passive “brace-like” prop to put her foot there.

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And then if the tibia rotates, the femur may be in a different position, and the way the glutes work might feel different.

Like maybe the limited ankle caused some compensation by the hip.

This stuff gets complicated quick.

The guys Trevor mentioned have some pretty neat techniques to connect breathing and hips and feet. That stuff can seem overwhelming though!

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If you are comfortable checking hip internal and external rotation on both sides that may provide more useful information.

EDIT: I’m not a medical professional btw. Worked in the fitness industry for more than a decade while specializing in post-rehab, chronic injury, and “active aging” populations. But no medical credentials at all.

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Wow, what a great husband! I know this has to be challenging for both of you in trying to support her. I can only imagine how loved and supported she must feel knowing you are going to great lengths to try to help her. Good job @flappinit !

As is evident by the replies you have received, in this forum, many knowledgeable and compassionate people genuinely want to help. Your wife can be assured of learning something that will help and be cheered by knowing so many are thinking of her. Good job, everyone! It is incredible to be surrounded and counted in the number of such a great crowd of individuals!

Here is how I go about thinking about issues like this.

She was born with a congenital issue and developed her movement patterning through every stage of her growth with an asymmetrical issue (not existing equally on both sides). This means that her movement patterns are such that, even though she has had corrective surgery, some compensations and patterns are hard to break without those most fundamental patterns being correctly developed.

So, I literally take people back to the beginning of movement pattern development. This means learning to roll, sit up, crawl, sit to squat to stand, and such. These “little” movements develop in windows that set up the development of the next movement that opens into the next developmental window. The great part is that these can be trained and retrained even into adulthood.

This even happens to individuals who do not come from an athletic background and don’t develop proper movement simply because they sat so much as a child and never learned to squat or run. Yet, all their movement from that time forward can be seen in their repetitive motion injuries I get to help them fix in my clinic. Also, people who have had injuries that mess with their fundamental patterns oftentimes need to be relearned.

So, here is what I would like to do. I will post week by week a series of movement training for her and everyone interested in working on it. In doing so, I’d love to get feedback on what people find is easy, what they find is hard, and what improves if something does.

The photos you provided are very helpful. But, what may be most beneficial is an evaluation. So, I will send a private message to you, and we can talk one-on-one about other strategies.

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For anyone interested, @Dr_Grove_Higgins messaged me with a method of getting him some more pictures and videos of my wife to help with an evaluation. Just an awesome response overall.

I did send the pictures and videos - I’m sure you’re quite busy but let me know if you got them / are getting my messages. Thanks again!

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