Mark Goff, a 33-year-old accountant from London, was born with a tarsal coalition, which is the fusion of two or more tarsal bones, located in the hindfoot.
In this condition, two bones which would normally form a joint are joined together and can cause stiffness and pain and is often associated with a flat foot. The two commonest coalitions are between the talus and calcaneus or the navicular and the calcaneum. In teenagers with pain, the bone bridge can be removed if it is small but in adults, the surgical procedure to address the pain is to carry out a total fusion of the joint and correct the deformity at the same time.
Describe your ankle problem
I always played a lot of sport and was aware that my left ankle didn’t move as much as other children’s. My left foot would always be sore the day after I had played sport, but I didn’t think much of it. I continued to play a lot of sport and got my Oxford blue in football.
Why did you choose ankle fusion surgery?
During my twenties, my foot started to stiffen up and by the time I reached the age of 30, I was in a lot of pain. It got to the stage when it was painful simply walking down the street or standing for half an hour.
I knew that I would need treatment and Mark Davies was recommended as the best foot and ankle surgeon. Mark wanted to try more conservative approaches before considering surgery, so I saw a podiatrist and wore an Aircast boot to see whether the problem would settle.
But it became progressively worse and it was clear that surgery would be necessary. I knew it would involve a long period of recovery but I felt confident in Mark and was at a point when I couldn’t play football or even manage a round of golf. I had my operation on August 21, 2007.
How did you feel straight after surgery?
My first day was fine – much better than I had anticipated. I’d had a painkilling injection and the whole of my left leg felt numb. There was more pain on the second day as the injection wore off and by the third day I went home.
The first two weeks
I spent the first two weeks literally doing nothing other than lying on the sofa at home. The hospital team had explained that the first two weeks are very important and because I rested, keeping my foot elevated, the swelling went down substantially. I was comfortable – the pain was controlled by the painkillers I was taking. Mark said I wouldn’t suffer much pain and before surgery, I found that hard to believe, but he was right.
The first three months post-surgery
At two weeks post-op, my leg was put into a plaster cast for two months. Once it was in the cast, my foot felt very secure. My company gave me eight weeks off work, so I rested, spending a lot of time with my leg elevated. Happily, this coincided with the Rugby World Cup and I saw every minute of every game.
Three to six months: physiotherapy and weight bearing
My plaster cast came off at ten weeks post-op and I was given an Aircast. At 12 weeks, I started a little weight bearing. You work gradually down to Aircast boot and one crutch, then no Aircast and one crutch before fully weight bearing. The scariest thing was going on the underground because people didn’t see that I had an injury or offer me a seat if I was standing. It took a couple of weeks getting used to the action of walking again. Your muscles have been wasting away because you haven’t used them to walk for three months. As soon as I could, I started swimming and cycling.
Six months and beyond
By six months, I could walk on the treadmill in the gym. At about eight months, I was able to do a gentle jog, which was a real joy. I was doing cycling, swimming and spin classes, feeling so much better for being able to exercise.
My first major landmark was climbing Snowdon in May 2008. My foot coped really well with the uneven ground and I felt a massive sense of achievement reaching the top. At the end of that month, I completed the cycle leg of a triathlon as part of my family team.
Finally, on August 17, almost the anniversary of my surgery, I did a sprint triathlon. On Sunday night, after doing a 400 metre swim, 20km cycle and 5km run, I had no pain, just an amazing sense of what I was now able to do.
What would your advice be to anyone considering subtalar fusion surgery?
Follow the advice of your medical team very carefully and be prepared to put in the work doing your exercises and building up strength. The support of my family and friends was very important, especially in the first couple of weeks when you are basically incapacitated. You will need to be patient.
For me, surgery was the only option and I am now free from thinking about my ankle all the time, as soon as I got out of bed. I don’t have to constantly reach for the chair and am able to fully participate in all the sports that I love. I had fantastic medical support at the London Foot and Ankle Centre – from the surgeon to the physiotherapist to the podiatrist, the standard of treatment and care was excellent.
