The 56 Year Old Female
A couple of years ago in our clinic, a rotating 29-year-old female orthopaedic resident started to present a new patient to me out in the hall, and before she could get much out, I interrupted her and said, "Let me guess, a 56-year-old female?". She reacted a bit like I was patient profiling, which I was, making such a bold statement with little if any, information. She responded as politely as possible in her heavy Tennessee accent, "Now, Dr. AO, how can you say something like that?". "Because I am probably right," I responded. She then had to reluctantly admit that the patient on the other side of that door was indeed a 55-year-old female.
"...in her heavy Tennessee accent 'now Dr. AO, how can you say something like that?''
Fast forward, after this same resident has been around for a couple of weeks in my world and back in the same hallway with another new patient. I ask, "What do you have?" referring to the patient on the other side of the door. She responded with a resigning attitude, "Another 56-year-old female!".
BOOM, told ya!
The scientific evidence has existed for years and is mounting by the day that the isolated gastrocnemius contracture (AKA, equinus) is here, and it is real, and it is causing the majority of non-traumatic acquired foot and ankle pathology we see. This is the very thing I have promoted for all 30 years of my practice as well as on this site. But I digress. Back to the 56-year-old.
Not to sound creepy, but I could make and sustain a busy orthopaedic practice by seeing only women in their fifties and sixties. Why? Around our mid twenties and increasingly thereafter is when the cumulative effects of long-standing and increasing isolated gastrocnemius contractures start to become noticeable and symptomatic in many forms, more in women than men, in general. And 56 seems to be the perfect age.
The two most common problems I see in the 56 year-old female, without question, are second MTP synovitis and midfoot arthritis. Other problems in all ages resulting from an isolated gastrocnemius contracture, and in general, are start-up pain and stiffness, plantar fasciitis, Sever's disease, shin splints, posterior tibialis tendon rupture (PTTR) acquired flatfoot deformity, second MTP synovitis which leads to plantar plate rupture and ultimately a hammer toe, Morton's neuroma, insertional Achilles tendinosis/Haglund's deformity, Achilles tendinitis, musculotendinous Achilles ruptures, calf cramps at night/Charley horse, anterior ankle spurs, Jones/Fifth MT stress fracture, diabetic Charcot arthropathy, diabetic malperforans ulcer formation, and lesser metatarsal stress fractures.
Here is the problem. People, including the majority of my doctor colleagues, either don't know or don't believe or don't care if they do know, even though the evidence is there and is solid. It is too bad because the secondary foot or ankle problem naturally becomes the focus of treatment, which might make a person feel somewhat better, but it will not fix the primary problem, the isolated gastrocnemius contracture. Ever wonder why plantar fasciitis seems to just linger on or mysteriously returns when you have "tried everything"?
Let me be clear on the next point: WE ARE TREATING THE WRONG THING. And it is wasting loads of money and time for all of you out there suffering. No wonder there are so many lost souls out there searching in Facebook Groups.
“WE ARE TREATING THE WRONG THING”
On a final note, of my few colleagues who get that the isolated gastrocnemius contracture is the problem, want to guess what their solution is? Surgery to lengthen the Achilles or the gastrocnemius, of course. Don’t get me wrong, I surgically lengthen the gastrocnemius as well, but only after clear-cut failure of dedicated daily gastrocnemius stretching, which works just fine almost always.
Why would somebody take on the expense and obvious risk of any surgery when it can be avoided in most cases? All it takes is ONE simple exercise, daily calf stretching, and some patience.
This is for all you lovely 56-year-olds. I love ya. Now stretch!
Be a believer,
AO
Current Conversation
Add your questions, thoughts, and commentary to our current conversation below, I dare ya!
Sara on March 17, 2022 at 11:16 pm
Hi AO,
I have a question about equinus. Is it still possible to have it if you have normal ankle dorsiflexion? I’m not a 56-year old female, I’m a 43-year old female with an 8-year history of debilitating foot pain. It seems to help a lot to release my calves with a lacrosse ball (“calf smash”), but I’m not having as much luck with stretching. I tried your calf stretch on a stair, very carefully following the instructions (e.g. putting the arch on the edge of the step), and couldn’t even feel a stretch in one of my legs, and in the other leg there was barely anything. Plus I have good ankle…
Tracy on January 26, 2022 at 9:31 pm
Wow! Hi AO – maybe I have stumbled across the solution after countless hours searching the internet for answers! I am a 55yo female and my feel got horribly sore about six months ago and then got worse. I can barely hobble in the mornings and eat painkillers to get about my busy life. I’ve been to a podiatrist, two doctors, a surgeon (told him there would be nothing being cut) and a orthotic person who sold me expensive titanium plates that are too hard and painful to walk on. Oh and now a physio guy. I have had xrays and ultrasounds, they don’t think it’s arthritis but nobody seems to knows what…
Barb on March 17, 2020 at 8:58 am
I am so excited you saw my comment and responded! Thank you! My podiatrist only spent 20 seconds with me and sent me home with a boot. I’m thinking I may need to get a second opinion on what kind of stress fracture/if it truly is one or see if I can get her to spend a bit more time with me. I do have a physical therapist who is very much into calf stretching and looking above the foot for issues. That is good. She was very reassuring to me yesterday and thought the boot might be overkill, although she said she can’t say because she’s not a doctor. If I get…
Barb on March 10, 2020 at 12:20 pm
I came across this blog and I am a 58 year old female who in the past four months has developed feet problems! First diagnosis was Metatarsalgia with no imaging. Then Morton’s neuroma after an ultrasound. Still limping so after an MRI dx with bone edema and microstress fracture of Fifth Metatarsal. I was given a CAM boot yesterday and am miserable. Already have back and hip issues. Anyway, I don’t want to waste your time but didn’t find a search function for your site. It looks like you’re still answering comments so if you could direct me to anything you’ve already written on stress fractures I’d appreciate it! I have been in…
Cindy Turner on December 28, 2019 at 1:45 pm
I have been struggling with metatarsalgia for about 3 months in both feet. My toes have tingling sensations and my pads are bulky feeling. So far I have had a vitamin B injection in each foot through my Osteopath. It did provide some relief in 1 foot. I later went to the podiatrist who diagnosed me with the metatarsalgia. He didn’t provide any realistic help. He just said that Asics are good tennis shoes to get. He wasn’t impressed with the custom orthotic I got through my chiropractor, but he didn’t say I should stop using them. The X-rays he took looked fine. I like the orthotics in the heel and arch…