Saw the orthopedic surgeon this morning. He's a very nice man who took over an hour to explain all the things he wants to do and to answer all my "silly" questions.
The result is I am going to go ahead with it and I'm feeling pretty confident that I can manage this, although it's not going to be easy.
He want's to do quite a few things
1. Detach the rectus muscle at the pelvis, it will then pull back into the leg by about 4cms and will grow back and reattach at the normal point, but as we'll be stretching it as it heals it will be longer and that will mean my pelvis should sit back where it should be and my hamstrings will not be under constant load which is limiting their function
2. Inject botox into the hamstrings to make sure they relax during the healing
3. Release the fascia on the calf muscle so that it's longer and I get more range in dorsiflexion, he can't give me full range as that will weaken the calf too much.
4. sightly lengthen the tendon in the tibpost muscle
5. Split the tendon that attaches on the right side of my left foot and reattach half of it on the left side of the foot. this will rebalance the foot and let me lift it flat.
The end result of all this is supposed to be better knee flexion and pelvis location plus normal foot positioning without the current eversion under flexion. Which with retraining should allow an almost normal gait. I may have to go back into an AFO if the foot drop still happens(likely as the brain hasn't been able to do this fr the last 5 years), but as the muscles will no longer be fighting with the AFO that should be easy and pain free.
It's all keyhole stuff but because he's moving the tendon I will be in a half leg cast for 7 - 8 weeks however I can be weight bearing on it as soon as I want to be. I may need to use a crutch for the first couple of weeks, but he's organising for in patient rehab placement after the initial hospital stay to make sure I have the balance etc. working before I go home.
The hardest part will be that the cast is not allowed to get wet so setting up for showering with only one useful hand is going to be a bit of a challenge.
As I no longer have a neurologist, I am going to need to find one and get a risk assessment done prior to the surgery so they can adjust and plan for any issues. I assume this will mean doing another MRI. The main risk is DVT which should be minimal as he wants me back up and about within 24 hours anyway.
So now I need to plan for being out of the office for a couple of weeks.