Flat feet, accessory navicular, severe overpronation and hypermobility - now what?!

Hi all,

It's now getting to the stage where - in the summer heat (UK) - I can barely walk. My ankles and feet are swollen (not super puffy but clearly swollen) and stiff. In the winter they are just stiff but less swollen. The ache when I wake up is getting worse. Pain when walking is getting worse. Pain after walking is getting worse.

History

• Accessory navicular, over-pronation and flat feet diagnosed at age 12. Over-pronation was made worse by walking with my feet pointing outwards.
• Physiotherapy and prescribed orthotic insoles. Hypermobility identified.
• Feet and ankles set in plaster for 2 weeks, with the rear of the casts then used as splints - aged 14.
• Physiotherapy and prescribed orthotic insoles until age 20 - changed location.
• Kidner procedure on right foot aged 20, followed by physiotherapy. (Original hospital had been unwilling to operate due to "growing up and the foot changing as you grow up.")
• Kidner procedure on left foot aged 22, followed by physiotherapy. (Done at the original hospital...)
• Orthotics used following surgeries/physio.
• Orthotics collapse (I used them less as they were incredibly painful and every time I had an appointment, I saw a different orthotist - there was never any consistency.)

Feet continue to get worse but the nature of my job until aged 28 (present) meant it was very difficult to get time off work for hospital appointments.

Foot pain continued to worsen.

I went to the GP a couple of weeks ago and was referred for X-rays. When I called the GP to enquire why I hadn't heard anything back, the receptionist told me that the X-rays were labelled as "abnormal but expected."

I was unable to get an appointment with the GP.

I have now found out - via text message - that I have been booked for an appointment with an orthotics person at a hospital local to me.

1.) The GP has done no physical examination.

2.) The GP has not shown any real understanding of my feet (sounds odd, haha) - when I was asked to describe where the pain was, she was shocked that I was able to describe its location using the names of the bones... and she still argued with me about where the pain was!

3.) I don't believe orthotics will fix the problem. At best, they will mitigate some of the biomechanical errors (my leg comes into the foot at completely the wrong angle these days) At worst, they will just cause more pain.

Given life expectancies, and the rate at which my mobility is now declining due to these issues, I can't see much point in an orthotic that won't fix the issue - I honestly don't see myself walking past 35 at this point, let alone 50/60/70/80 etc.

I currently use over-the-counter pain medication - I've been unable to get a prescription due to moving house/GP and then Covid - so have made to with the highest strength Codiene I can get over the counter... Unfortunately I don't particularly like the use of opiate based medication - I was on a lot of Codiene for a long time after each surgery and had to be weened off... and it really impaired my ability to work.

Therefore:

1.) Can I demand a referral to an orthopaedic consultant?

2.) Can I demand some other form of treatment?

3.) Can I ask her to justify her decisions?

What sort of options are realistically open to me?

• Ankle replacement?
• Realignment?

It's getting to the stage where I feel like proposing to the Dr that they just amputate each ankle - after all, it'll cost them and me less in the long run! (NHS, so no real financial cost to me, just the pain etc.)

Ultimately, I need some form of solution - I've just left teaching and am trying to change career. My ankles aren't bad enough to click the disabled box... I really need a job but can't do the physically demanding ones - I can't stand or walk for long enough any more! It's doing my nut.

Any thoughts really appreciated.

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