Back Area Impairment: Insights on Treatment and Surgery

Back area obstruction

Hello Doctor, I previously asked about my foot drop issue...
I indeed have a left ankle dorsiflexion impairment (inability to lift the sole of my foot upwards), not an issue with knee extension.
I apologize for my poor writing, which may have caused misunderstanding.
Although I have seen many doctors, most do not recommend undergoing lengthening surgery again and only offer comforting words, suggesting I practice on my own.
However, this leads me to walk on my toes unconsciously, resulting in an awkward gait that my friends often notice and question.
While I can walk with my heels down like a normal person, it requires a lot of effort and feels very unnatural, which truly bothers me and has caused some psychological distress.
I understand that I had surgery when I was 6 or 7 years old, and my condition improved significantly, but I am not willing to live my life like this.
Recently, I visited the Tri-Service General Hospital, and the doctor there initially seemed skeptical, believing my condition was acceptable.
However, upon expressing my strong desire for treatment, the doctor agreed to perform surgery, which I am scheduled for next month.
He did mention that the outcomes might not be as favorable.
I have read previous articles and understand that excessive lengthening can lead to muscle weakness.
I know that the difference between my left and right ankle is not significant, but I am afraid the doctor might inadvertently lengthen the tendon too much.
If such a situation occurs post-surgery, is there any remedy? What should I do if this happens? I hesitate to ask the doctor directly, fearing he might think I am questioning his skills.
I would like to ask how the decision is made regarding how much to lengthen the tendon before the surgery.
Is this determined beforehand, or is it assessed during the surgery once the incision is made? What is the likelihood of excessive lengthening leading to muscle weakness? Should this issue be categorized under pediatric orthopedics (congenital deformities)? Although the doctor is an orthopedic surgeon, he specializes in trauma and not pediatric orthopedics.
Could this lead to a lack of expertise in this type of surgery? Is this considered a basic orthopedic procedure that every orthopedic surgeon should learn?
Do you have any advice for me, Doctor? I apologize for asking so many questions and causing you trouble, and I appreciate your guidance.

KK, 20~29 year old female. Ask Date: 2004/09/05

Dr. Shi Guozheng reply Orthopedics

The extent to which a tendon needs to be lengthened sometimes depends on the conditions observed during surgery.
The issue of tightness or looseness is usually carefully considered by the physician.
It is preferable for pediatric orthopedic surgeons to perform the surgery, but orthopedic surgeons with relevant experience will also be capable of performing the procedure.
If you decide to undergo surgery, you should trust that the physician will do their utmost to achieve the best outcome.

Reply Date: 2004/09/05

More Info

Understanding back area impairment, particularly in the context of congenital conditions such as your left ankle dorsiflexion limitation, is crucial for determining the appropriate treatment and surgical options. It seems you have been through a lot already, and your concerns about your walking posture and the psychological impact of your condition are completely valid.

Firstly, it's important to clarify what you mean by "背曲障礙" (back curve impairment) and how it relates to your ankle's inability to dorsiflex. Dorsiflexion is the movement that brings the top of your foot closer to your shin, and limitations in this movement can lead to compensatory gait patterns, such as walking on your toes. This can indeed affect not only your physical health but also your mental well-being, as you have described.

Regarding your upcoming surgery, it’s understandable to have concerns about the potential outcomes and the risks involved. Surgical procedures, especially those involving tendon lengthening or adjustments, require careful planning. The decision on how much to lengthen a tendon is typically made based on preoperative assessments, including physical examinations and imaging studies. However, the final adjustments often occur during the surgery itself, as the surgeon evaluates the actual condition of the tendon and surrounding structures.

Your concern about the possibility of over-lengthening the tendon leading to muscle weakness is valid. Over-lengthening can indeed result in a loss of muscle function, which is why it’s crucial to have a surgeon who is experienced in this specific type of procedure. While all orthopedic surgeons receive training in various surgical techniques, not all may have the same level of expertise in pediatric orthopedic conditions or congenital deformities. It’s essential to ensure that your surgeon has experience with similar cases, as this can significantly influence the outcome.

If you are feeling uncertain about the surgeon's expertise, it might be worth seeking a second opinion from a pediatric orthopedic specialist. These specialists focus on musculoskeletal issues in children and adolescents, and they may provide insights that are more tailored to your specific condition.

In terms of postoperative care, rehabilitation is critical. After surgery, physical therapy will likely be necessary to help you regain strength and improve your range of motion. Your therapist can work with you to develop a personalized rehabilitation program that addresses your specific needs and helps you achieve a more natural walking pattern.

If you do experience any complications post-surgery, such as muscle weakness or persistent discomfort, it’s important to communicate these issues with your healthcare provider immediately. They can assess the situation and determine the best course of action, which may include additional therapies or interventions.

In conclusion, while surgery may offer a potential solution to improve your ankle function and walking posture, it’s essential to approach it with thorough preparation and understanding. Engage openly with your healthcare team, express your concerns, and ensure that you are comfortable with the surgical plan. Remember, your quality of life and mental well-being are just as important as the physical aspects of your condition. Don’t hesitate to advocate for yourself and seek the best possible care.

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