Post-Surgery Challenges: Managing Clubfoot Rehabilitation and Pain

Many years after bunion surgery?

Hello Doctor: I am a patient who has undergone surgery for clubfoot (this term is from my health check-up report).
I am not familiar with what clubfoot is; I only know that I had a right foot inversion as a child and underwent surgery, but I do not remember the details since it was done when I was very young.
Most of this information comes from my parents and relatives.
My main concern now is that I have difficulty performing a standard squat; the sole of my right foot naturally arches up, creating a concave shape, and I experience tightness and pain.
My body weight tends to lean towards my left foot, which has not undergone surgery, so after squatting for a while, my left foot becomes very sore because I cannot put weight on my right foot.
Additionally, there is a noticeable size difference between my buttocks and right foot, and I walk unsteadily, swaying back and forth.
Is there a way to relax the tight muscles in my right foot? How can I walk without the inward rotation and instability? What can I do to make my legs appear more symmetrical?

J, 20~29 year old female. Ask Date: 2002/12/17

Dr. Pan Yingda reply Rehabilitation

To respond effectively, the focus should be on stretching and strength training.
1.
Is there any pain? This needs to be addressed first.
2.
Stretching; stretch the areas that are tight.
If there is a joint locking issue, it may be more challenging.
3.
Muscles are used or lost; if you don't exert them, they will naturally atrophy.
Strength training involves leg lifts, targeting different angles to train various muscle groups.
Adding weights, such as sandbags, can increase resistance, especially for the thighs and glutes, which should not be allowed to atrophy.
4.
Regarding gait, attention should be focused on walking posture, progressing slowly, much like how a baby learns to walk, essentially relearning.
5.
It is advisable to consult a professional in person for specific training methods.
Take care.

Reply Date: 2002/12/17

More Info

Post-surgery rehabilitation for clubfoot can be a challenging process, especially when dealing with issues such as pain, muscle tightness, and functional limitations. Based on your description, it seems that you are experiencing significant discomfort and instability in your right foot, which has undergone surgery in the past. Here are some insights and recommendations that may help you manage your rehabilitation and pain effectively.

Understanding Clubfoot and Its Treatment
Clubfoot, or congenital talipes equinovarus, is a condition where a baby's foot is twisted out of shape or position. Surgical intervention is often required to correct the deformity, and while many patients achieve good outcomes, some may experience residual issues, such as tightness in the muscles and tendons, uneven leg length, and difficulty with certain movements like squatting.

Addressing Pain and Tightness
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can assess your specific needs and develop a tailored exercise regimen that focuses on stretching and strengthening the muscles in your right foot and leg. This may include exercises to improve flexibility in the calf muscles and the Achilles tendon, which are often tight in individuals with clubfoot.

2. Stretching Exercises: Regular stretching can help alleviate tightness. Focus on calf stretches, toe stretches, and ankle mobility exercises. For example, standing with your hands against a wall, place one foot behind the other and gently press the heel of the back foot into the ground while bending the front knee. Hold for 15-30 seconds and repeat several times.

3. Strengthening Exercises: Strengthening the muscles in your foot and leg can improve stability and function. Exercises like toe raises, heel raises, and resistance band exercises can be beneficial. Your therapist can guide you on the appropriate techniques and repetitions.

4. Footwear and Orthotics: Proper footwear is essential for individuals with a history of clubfoot. Shoes that provide adequate support and cushioning can help reduce pain and improve walking stability. In some cases, custom orthotics may be recommended to correct alignment issues and provide additional support.

Improving Gait and Stability
1. Gait Training: Working with a physical therapist on gait training can help you develop a more stable walking pattern. This may involve practicing walking on different surfaces, using balance exercises, and focusing on proper foot placement.

2. Balance Exercises: Incorporating balance exercises into your routine can enhance stability. Simple activities like standing on one leg, using a balance board, or practicing yoga can improve your proprioception and coordination.

3. Gradual Progression: As you work on your rehabilitation, it’s important to progress gradually. Start with low-impact activities and slowly increase intensity as your strength and flexibility improve. Listen to your body and avoid pushing through pain, as this can lead to further complications.

Monitoring Progress and Seeking Help
1. Regular Follow-ups: Keep in touch with your healthcare provider or orthopedic specialist. Regular check-ups can help monitor your progress and make necessary adjustments to your rehabilitation plan.

2. Pain Management: If you experience persistent pain, discuss pain management options with your doctor. This may include over-the-counter pain relievers, topical treatments, or other modalities like heat or cold therapy.

3. Emotional Support: Dealing with chronic pain and functional limitations can be emotionally taxing. Consider seeking support from friends, family, or support groups for individuals with similar experiences.

Conclusion
Rehabilitation after clubfoot surgery can be a lengthy process, but with the right approach, you can improve your function and reduce pain. Focus on a combination of physical therapy, stretching, strengthening exercises, and proper footwear. Remember to be patient with yourself and celebrate small victories along the way. If you have any concerns or experience worsening symptoms, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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