One taste of Big Bend National Park and David White was hooked, already planning a return trip.
Tackling the long-distance hikes and rugged terrain was a dream come true for the 68-year-old retiree just months after recovering from ankle replacement.
“Two years ago, I wouldn’t have been able to enjoy that trip,” said David. “I owe my new ability and confidence to Dr. McGarvey.”
Finding answers
David was referred to William C. McGarvey, MD, an orthopedic surgeon with UT Physicians Orthopedics – Katy, after five prior surgeries failed to relieve pain and instability in both his feet and ankles.
“When he first came to me, he was wearing braces on both feet,” said McGarvey, a professor in the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston. “He could walk and stand, but it took a lot of effort.”
Foot pain wasn’t new for David. Doctors diagnosed him with caved arches at 12 years old, which progressed over time to cavovarus foot deformity.
“My parents noticed that my shoes wore out on the inside of the ball and the outside of the heel,” said David. “My toes never touched the ground when I was barefoot.”
McGarvey helped narrow down additional diagnoses: arthritis and chronic inflammatory demyelinating polyneuropathy (CIDP), which is a rare, autoimmune disorder that can lead to weakness and loss of sensation.
CIDP meant David’s nervous system was slow to signal the muscles in his legs and feet, which left him prone to losing balance, tripping, and falling. The arthritis in his ankles caused them to bend, exacerbating his instability, and the cavovarus foot progression was increasingly painful.
“By the time I found Dr. McGarvey in 2023, my feet hurt all the time, even to the point where I would wake up in the middle of the night in pain,” said David.
Altogether, David presented a rare and complex case.
“He was dealing with a vicious cycle of repetitive negative consequences of each condition feeding the other and making it worse,” explained McGarvey.
Walking is freedom
Growing up on a small farm, David never let an irregular stride keep him inside. He joined the marching band in junior high and high school, which led to a full scholarship in college.
“If I couldn’t do something, I never used my feet as an excuse,” said David.
That was a mental attitude rooted within him as he developed a professional career, spending the better part of 45 years on his feet, first in a machine shop, then construction, followed by 22 years with a major airline.
Even at his final job in downtown Houston, he used lunch breaks to walk up to 2 miles, crisscrossing city blocks.
“I would rather walk 8 miles than run 8 feet,” David said through a laugh. “It gives me a sense of freedom and accomplishment without having to run races.”
But that freedom was shrinking as his feet and ankles began deteriorating in retirement.
Using advanced imaging to forecast a foot repair
With a focus on David’s right foot, McGarvey opted to complete a foot reconstruction and ankle replacement, requiring two surgeries.
“My priority in the first surgery was to get his foot flat on the ground,” said McGarvey.
Mapping out the surgery included advanced imaging from CT scans and an MRI. McGarvey also used a fluoroscopy machine to capture an X-ray video, called a live X-ray.
“You can do manipulations to see what kind of correction can be obtained by positioning his foot and ankle in certain ways,” explained McGarvey. “The machine captures his X-rays in a video and shows us what his foot has the potential to do.”
Treatment in two surgeries: Reorientation and total ankle replacement
The first surgery was successful, reorienting his foot so it was flat on the ground.
Recovery meant eight weeks without using that foot. David went through physical and aquatic therapy to assist with the recovery.
About nine months after his first surgery, McGarvey completed the second surgery, a total ankle replacement, on the same leg.
Surgery went well, and David’s foot and ankle are aligned together for the first time in a decade.
“He is substantially more functional, stable, and pain-free than he had been in years,” said McGarvey.
The second surgery was also followed by physical therapy to strengthen his foot muscles and regain mobility.
Today, he walks a minimum of 2 miles a day.
“I can stand for a much longer period of time with less difficulty,” said David.
Big Bend celebration
In celebration of his regained mobility, David and his wife headed for Big Bend National Park.
“We climbed as much of the mountains and all the steps that I could do, wherever we could,” said David. “There were just two trails that I couldn’t finish due to the incline.”
Just four months after the ankle replacement surgery, David was handling the uneven surfaces and tricky topography through days of hiking.
“From a surgical standpoint, his recovery is a huge win,” said McGarvey.
“Completing this trip made me feel like I was 25 years younger,” said David.
Quality care for long-term relief
After years of progressive foot pain, David found comfort and reprieve under the care of McGarvey and his team.
“I trusted Dr. McGarvey from the very beginning because he didn’t rush into surgery with me,” explained David. “He took his time to examine my ankle and foot, then took the time to put together a comprehensive plan.”
“My role here is to try to improve his quality of life,” said McGarvey. “We took the time to examine every detail to understand the potential for his foot and ankle.”
Evaluating David’s left foot and ankle is likely to come, but for now, David is enjoying pain-free nights and more balance as he walks during the day.
“I went to Dr. McGarvey for long-term relief, and I found it,” said David.
