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

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