How Would You Treat An Active Hiker With Bilateral Foot Pain?

I want to start off the new year with a bang. Educating fellows and residents daily is often challenging and rewarding altogether. Our program has come together to provide real-world situations and highlight management of various pathologies.

The purpose of this DPM Blog is to broaden the scope of education in the foot and ankle space, and bring all of those struggling on a day-to-day basis up to speed. We will start off with a case and my next “episode” will discuss the outcome, intraoperative pearls, postoperative protocol and discussion.

The idea is that we can all discuss a variety of cases and complexities (forefoot, hindfoot and ankle), and take something back to your practice. 

Please use the comment functionality at the bottom of the page to describe your feedback, your experience and outcomes.

A Closer Look At The Patient Presentation

We present a 35-year-old healthy male with bilateral foot (not ankle) pain. His pain is primarily in the left forefoot. He is an active hiker and former military sniper. He has no diagnosis of any neuromuscular disease or collagen or elastic tissue disorder.

The patient has a history of more than five procedures on both feet including calcaneal osteotomies, subsequent hardware removal and midtarsal osteotomies. His gait is mildly antalgic but he presents with tennis shoes and custom-molded orthoses.

Upon clinical examination, he has isolated gastrocnemius equinus, a negative anterior drawer and talar tilt. His hindfoot position is visible in the clinical photos. His ankle and subtalar joint range of motion are relatively normal. His midfoot is very rigid with an obvious cavus foot type. No digital deformities are present. Manual muscle testing of all associated tendons in the foot and ankle is normal. He has a normal neurologic exam.

His goals are to reduce left forefoot pressure and pain so he can hike again without pain.

Please provide your operative plan and your experience with this type of patient if any. Perioperative pearls are helpful as well.