right club foot with diabetes

by William
(Fourmile, Ky)

My right foot is twisted inward and ive walked on the right side of my foot my entire life. My current surgeon {smart guy just young and not enough experience} told me that when walking ppl use their heel and big toe so removing digits 4 and 5 would not effect the way I walked. Because I was clubbed foot you can see how this has effected me. After the removal of digits 4 and 5. the bones running up my foot that was connected to toes (4 and 5) started to work out the right side of my foot until they eventually did. Now I have(try to imagine) 3 toes with bones connected to a heal, but I still walk on the right side of that foot. If you look at it from the bottom it looks like im just walking on the bottom plate of my foot and because of the way my foot is twisted my big toe and the two others don't touch the ground when i walk (the pain is beyond belief). My question is , is it possible to somehow correct the angle of that foot to where my heel and big to are touching first when i take a step. My diabetes has been under 125 without medication, through diet and exercise for over a year now and ive build up plenty of strength. I have plenty of feeling in my foot and i can wiggle all my toes. Im even ticklish if a feather is moved down my foot. Im willing to do anything. (i would imagine) breaking my foot and realigning it in the correct position and then using metal pins to keep it straight, im desperate and i will try anything. I do not want to loose my foot witch has already been suggested. Please respond to this asap i will greatly appreciate any and all advice.

RESPONSE

Hi William,

The first question I have is why were your fourth and fifth toes surgically removed in the first place? Were they painful when you walked because of the fact that your foot twists inward as a result of clubbing or had the toes become infected and perhaps gangrenous? I am stating the obvious when I say that unless they were bothering you in some manner, they should have never been amputated.

I wish I knew how old you are as that would be helpful in offering some insight into your predicament.

As you rightfully point out, your diabetes can be an issue in any further surgery. What I do know is that you obviously had adequate circulation so that your two toes were amputated and apparently there were no surgical complications as a result of inadequate circulation.

In general, in a normal foot people can get by and lead a normal life without their lesser toes (all but the big toe), as I have seen this over the years. We use the big toe to "propel" the foot off the ground as we walk.

So the problem for you is that you have a clubfoot and are minus the last two toes and apparently this is giving you much difficulty and pain when walking.

You have two options here. The first would be to try a custom made shoe that makes up for the deficiencies in your right foot in terms of structure and function. A special shoe can be made to allow more even distribution of body weight on your foot in a more "normal" fashion. I cannot give you specifics as I do not have the luxury of actually examining you.

The second option is that of reconstructive surgery. Again I cannot give specifics as I have not examined you. Assuming your blood sugars are controlled, your circulation is adequate and your neurological sensitivities in the foot are intact, (and you do not smoke), you may be a candidate for extensive reconstructive surgery.

Your foot complaints would have to be evaluated according to the type of foot structure you have and then a determination could be made as to what procedure(s) would be the most helpful for you.

The best piece of advice I could give you is to choose an experienced surgeon who has performed major reconstructive surgery on an ongoing basis. In general you may find this type of surgeon at a large university teaching hospital. This may require some travel on your part, but it will be well worth it. The problem here is that you are taking an abnormal foot and trying to make it more normal. In general you only get one chance at this. You do not want to become that person who keeps undergoing repeated surgeries to correct problems with the previous surgery. This rarely works out well for the patient.

Marc Mitnick DPM
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