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Posterior Tibial Tendon Dysfunction

Discussion in 'Ask your questions here' started by Unregistered, Dec 22, 2008.

  1. Foot Doc

    Foot Doc Guest


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    There is no one-best method. It is possible that you may require surgery.

    FOOT DOC
     
  2. Unregistered

    Unregistered Guest

    Reply to person wanting more info. on platelet rich plasma injections for posterior tibial dysfunction. I had the injection for posterior tibial tendonitis/tear last April. Tendon ruptured ( I now know) within 2 days of injection, but Dr. failed to recognize it and reassured me for next 6 mos. was healing well, though by 4 mos. I was questioning. Am now scheduled for surgery and major repair. From what I'm gathering, not much info. on this treatment for this PTTD- my Surgeon won't confirm injection caused rupture, but I told him no question of when it happened. He also said he is not aware of this treatment for this problem, and he doesn't think it will prove effective for this problem. So beware-if you have significant tendonitis- be aware that purpose of treatment is to INCREASE infllammation to get healing 'cascade' going. Seems like that would only make rupture more likely. I was supposed to have treatment on L. foot- thankfully I held off. I would never do that treatment now. Hope this helps. Good luck.
     
  3. mictim

    mictim New Member

    Hello ! I feel for you i had the tendonitis for 2.5 yrs i wore cam boots off and on i had orhotics and injections it never went away ! Did you have an MRI !! I was sent to a foot and ankle surgeon in Boston and h ad surgery !! it was very long and painful recovery but i am better !! Thank god !! Go to a different MD if you don;t get any help !! good luck !
     
  4. Unregistered

    Unregistered Guest

    I also went through about a year of conservative treatments for posterior tibial tendonitis. Despite treatments including imobilization, pt, orthotics in good shoes and bracing, my foot progressed to stage 2b flexible flat foot. An MRI revealed profound degeneration of the ptt and severe degeneration of the spring ligament. I went to the foot and ankle dept of a top ranked orthapedic hospital where I had extensive flat foot reconstruction surgery about 6 months ago. The recovery is long and difficult but in my case, so far things are going very well. For the most part, I am now pain free with the exception of some occasional twinges. As with any surgery, no one can guarentee the outcome and each person is different. If all conservative treatments fail, and you are a canditate for surgery, then I would strongly suggest that you get more than one opionion and be sure to use a surgeon who has a lot of experience with posterior tibial tendon disfunction.

    Good luck
     
  5. I went through almost the exact same scenario as you. Had the surgery Nov 11, 2010 and am on the road to recovery. Had the surgery at Hospital for Special Surgery. Would like to know more about your experience.
     
  6. Unregistered

    Unregistered Guest

    amf214

    My surgery was also at the Hospital for Special Surgery. I can not believe that 6 months post op, I am for the most part pain free considering that prior to surgery after taking 9 or 10 steps wearing an afo brace I got sharp pains along the posterior tibial tenon and into the arch. Now, for the most part, I forget that I ever had surgery except when I get a twinge here or there. I am still following my surgeons directions and NOT doing high impact activities, activities that involve twisting the foot or placing the foot in an incline position. My physical therapist can not believe that I am basically pain free. We are now working on increasing the range of motion in my toes, particularly great toe and strengthening the supporting structures in the foot to protest my spring ligament and posterior tibial tendon. My experience at the hospital was very good. I was in the hospital for three days and everyone was very kind and attentive.
     
  7. limping

    limping New Member

    I was diagnosed with stage 2 PTTD. of the left foot. I thought I had sprained my ankle but couldn't remember doing it. The orthopedist had me stand on my tip toes which I could do with both feet but when using just one foot at a time was unable to do so with the left foot. He currently has me doing PT stretches and using rubber bands to strengthen my foot(?)
    I also 100 % of the time wear the Aircast for PTTD. What experiences have you had with treatment or surgery. I am near Duke and UNC Chapel Hill so surgeons are top notch but is it possible at stage 2 to improve w/o surgery? Anyone had this experience or had a patient that improved w/o surgical intervention?
     
  8. limping

    limping New Member

    Also I worry if I have surgery and NWB for 8 weeks+ that I will gain weight. Any kind of exercise machine recommendations? Elliptical??
     
  9. lindalillian

    lindalillian New Member

    Re: Posterior Tibial Tendon Dysfunction-- shockwave therapy

    Did you try the Arizona boot? I did..helps a little. Havin hind foot fusion soon.
    I had same problem at night...use walker to get to bathroom.
     
  10. jocko

    jocko New Member

    I have had and recoverd from PTTD. It sucked. I ignored this injury (very similar symptoms to the first post, i.e. mild pain, then sudden bouts of sharp pain for no apparent reason) for about 6 months to a year. Then one of the "sharp" pain bouts was the last straw - I had ignored it until I experienced a partial tear in the PTT. So, I let a minor injury/partial tear evolve into a surgery-required PTT tear. Bummer. MAJOR bummer.

    I required surgery and the Ortho Surg performed an FHD transfer (i.e. harvested big toe tendon to repair the PTT - also an option is the FHL transfer, and I think that is the normal route, but the Doc said my FHD was simpler in this case for some reason - note FHD transfer will result in you not being able to flex your big toe up any more. I don't miss it and I would not stress about this little detail). Painful recovery, many weeks on crutches and then a boot. The doc also cut the heel off at aprrox a 45 deg angle and moved it inboard to create an "artificial" arch. This turned out to be a very smart thing to do in the long run as it keeps the tension off the PTT that a lower arch would have retained (or that a falling arch induces - this is why an ignored PTT problem self-exacerbates - as it starts to tear, the arch is lowered, which in turn causes a larger tensile load on the PTT, and the arch gets lower, which in turn.... yada yada, you get the idea - this is why when you have a full PTT tear, the arch "falls" - nothing is holding it up anymore).

    Today, that foot is healthy and the structure of the foot does not promote a re-tear of the PTT.

    So a couple notes from someone who made it through this nightmare eventually:

    1. Don't ignore the injury - PTT tear or dysf is one of those injuries that once it starts, will continue to worsen if you don't take a positive step to correct it becasue the natural motion of the foot/bones in the foot and tendon mechanical structure will continue to stress the PTT. I have high arches. Had I gotten aggressive orthotics for support AND employed crutches/walking boot at the first sign, I could very well have avoided all this in the first place. But I felt I didn't have the time to deal with it (active duty mil and at an important phase of training). Was I ever wrong - it will NEVER be convenient to have crutches or wear a boot - but if you gotta fix something, better earlier than post-surgery.

    2. Go to your family doc if needed to get a referral, but know that you will need to see an ortho or podiatrist soon thereafter. This is a very specialized injury and you really need an expert to see it. I went the orth route, a professional at Bethesda and he was a very good doc. I was fortunate.

    3. X-ray will only (maybe) rule out a broken bone that can cause similar pain. Only an MRI or CT scan can truly dx a PTT tear. I know they cost money, but I'm not there to see the Dr to save imaging dye... This is why I have insurance, so don't screw around guessing for a month, get the MRI sooner than later.

    4. While this is a great forum - make sure you educate yourself so that you can converse with the Dr. and, more importantly, understand what he is telling you. In other words, don't just run with a single source of info (this or any other site - but also don't rely solely on your Dr., he or she is only human). In the end, take respopnsibility in your treatment and work WITH the doc, but don't follow him, or any single source blindly. Know and understand your options by educating yourself.

    Bottom line - treat it early with professional help and you may be able to avoid surgery. If surgery is required, get it done sooner than later and don't rush the recovery (but getting into a walking boot asap will help you get on with life). Personally, once able to bear the weight in a walking boot, it was the key to my recovery.
     
    Last edited: Feb 24, 2011
  11. Unregistered

    Unregistered Guest

    Ok but what if you have no tear but the doc does an MRI says tendons look good however you have the too many toes sign and the arch is falling? If you wear orthotics (false arch support)then are you postponing the inevitable or preventing it? Does PTTD ever improve? I am also a stage 2 with no tear according to MRI. Do I wear an aircast forever or does it truly calm down with rest and then no surgery?
     
  12. jocko

    jocko New Member

    Dear Guest,
    If MRI shows no tear, then I'm not certain what the actual cause of the pain is. Tendonitis only maybe? (which can be painful). What is your doc saying the pain is caused by? As for orthotics - it's not preventing the inevitable, it can prevent the inevitable. PTTD can improve, but in my personal experience, it won't unless you intervene - i.e. arch supports, etc. If you can get it to calm down with rest and aircast (how long have you had the air cast?) then you you may be able to avoid surgery if the symptoms are gone or greatly reduced - but do note that you will likely need orthotics for life. That is the case for ME - please note I'm only speaking from my own experience, I'm not a Doctor. I didn't like that little comment from my Doc (orthotics for life) but I've come to accept it. And when the symptoms go away, you will have a little more flexibility. But if you had high arches, then going without orthotics will cause increased tension on the PTT, possibly causing your symptoms to flare up again or promote a partial tear, etc. Not sure the how this all works if you have naturally LOW arches, but people with low arches can develop PTT dys also.

    One note I neglected - my situation did not arise naturally, it was casued (in the long run) by a prior surgery for a heel spur. The Doc did a plantar fascia release and cut the arch tissue about 1/2 to 3/4 of the way across to allow it to heal back together and "naturally" lower the arch to help avoid the recurrence of the heel spur. This caused the additional stretch on my PTT that started the whole process toward the tear (about 15 years elapsed between the plantar fascia release and the PTT tear, for ref). This plantar fascia release process was done about 20 years ago and today the process is different. They don't cut across the fascia any more for this very reason - it can cause PTT problems later in life. I'm living proof. The Ortho doc in Bethesda was kinda pissed off that a Navy podiatrist did this plantar fascia release on me this way, but what can you do? Anyway, just wanted to explain how my problem started. Don't want to mess with what mother nature gave you to start with as a kid, because changes in structure and geomety of the foot can cause problems later in life. If you're like me, and are already "later in life", then screw it, you gotta do what you gotta do to get rid of the pain and symptoms that you have today. My 2 cents.
     
    Last edited: Feb 24, 2011
  13. Unregistered

    Unregistered Guest

    I have had PTTD for over a year now. I have done PT, mostly doing gait modification. I have had some success understanding the biomechanics of my PTTD. I had ankle reconstruction in the past and my PT thinks that this has contributed to my problem because the doctor harvested the tendon on the outside of my ankle to replace some torn tendons of my ankle. I also tore the lateral meniscus of my knee a few years after the ankle reconstruction because I had limited dorsiflexion. So it goes on and on. My pttd started after I re-injured my knee dancing (which I should not have been doing!!) Anyway when I do PT for my pttd, I have a hard time keeping my knee in the correct position and that leads to knee pain. If I don't walk exactly as I have been trained to do (which I find very diffictult or impossible) then my foot pain is so severe I can put weight on my foot. So every day I have some level of pain mostly after walking and resting and then trying to stand. Mostly this is temporary but last night it started again and the pain was so bad that I have it even when I'm sitting. Again I don't know what precipitated this latest problem except that I held a 20 lb baby and walked around the block and I noticed my back was hurting me while doing this. I may have also altered my gait to compensate. My knee also hurts more this morning. I had an MRI a few years ago which did not show that my posterior tendon was torn. My doctor thinks I need a total knee replacement and at that time he would straighten by tibia so that it is aligned properly. He said this might help the pttd but if not, then he recommends the fusion surgery on my foot. I really don't know anything about this surgery. I do have chronic pain on the other side from my knee and pttd which I believe would get worse with surgery. I really don't think I can handle the pain and rehab of surgery without feeling like it was really going to work. So right now I'm just in a ton of pain and may not be able to go on a trip I had planned. Very sad!
     
  14. Smokey

    Smokey Guest

    Are you suggesting that the plasma therapy caused the rupture? This doesn't make sense to me since plasma is a component of blood. Usually a cortisone injection leads to rupture.
     
  15. Unregistered

    Unregistered Guest

    Hey guys... I read everyone's post here... and it sounds like most of you have let the injury linger for a while until it got worse?

    2 weeks and 2 days ago I landed on my ankle hard... felt a sharp pain... I went home... did RICE... and it gradually got better... but little twinges in the inner ankle when I walked. 2 days after the injury I did a crazy bike/eliptical/weights/swim workout... and 5 days after.. I resumed my kickboxing classes...The following wed and thurs.. I strated running again. I am training for a half marathon(may 1st)....Believing that running made the pain go away... I said the hell with it... and did 11 miles this past weekend... I also went to my grappling class monday night.... tuesday I woke up in pain.. with swelling that wasnt there before... now I not only feel pain in that inner ankle area.. under that bone that pops out... but I also feel pain in the upper arch.. in the instep area... its also swollen... but you have to look closely to see it... its not obvious swelling.... I went to a doc.. he said rest for 2 weeks and go back to him......

    based on your posts... possibly I am in stage 1? I dn. I have kind of accepted that I prob wont run in this half marathon May 1st... but do you think I have a fighting chance to be able to resume normal activities soon.. with no pain???
     
  16. NervousStepMom

    NervousStepMom New Member

    I never noticed it before until tonight...step son and hubby were walking in front of me and i looked at step sons feet... he was walking on the inside of his foot bad and he was walking weird...i asked him if he was ok...you look like your in pain the way your walking he said it hurt a little...i looked up Posterior Tibial Dysfunction and he has the level 3... hubby is gonna make him appointment for it....does anyone know of a good doctor in the Tampa Florida area?? i am new to the step mom business....i cant believe no one has noticed that before...i feel so sorry for him... :(
     
  17. Unregistered

    Unregistered Guest

    I had a good PT who told me to stop doing anything that put pressure on the tendon, no running, no kickboxing, NO ELLIPTICAL! Got some ultrasound, friction rub and iontophresis treatments from the PT. I could walk for 5 min a day only without pain and gradually built on it to 10 min etc. Did ankle strengthening exercises, hip strengthening excercises, and glutes on the left side. Started getting more into Spin for cardio, biking outside instead of walking, doing yoga, pilates, weight lifiting....taking ANTI INFLAMMATORY herbal remedies and diet...ie no sugar, no fried food, and turmeric, Evening Primrose Oil, and Bromelein. After this diet and exercise I lost 20 pounds. Bought the most expensive shoes for work from Aravon(New Balance) and Top of the line running shoes for support from Mizuno with inserts. After time it went away completely and I can walk for hours. But if I try to run, jump, and do crazy things...forget it...it wasn't meant to be..ICE right away and i'm ok. I don't know why I will never be able to run and it's not fair, but who knows, it's a mystery.
     
  18. Unregistered

    Unregistered Guest

    I've read alot of posts here and my impression is that many people are expecting a relatively quick improvement with the treatment protocols. The truth is, this condition ( I have it and have been getting treatment) is most often degenerative unless it is the result of a sudden, acute injury. It is very hard to treat because tendons don't have alot of blood flow
    (low vascularity) and the structure of tendon tissue is still being studied by many researchers. Even with study participants, it has been found that a significant portion of people DON'T FOLLOW THEIR TREATMENT PLANS AS THEY ARE INSTRUCTED. There is no quick fix, and studies also show that Functional Orthotics can improve symptoms and slow the deterioration of the tendon. Yes, they are expensive, and it's wrong that insurance doesn't cover them. There are things you can do to help yourself even if you can't "fix" the foot 100%. If you are overweight, trim down. Improve your conditioning and strengthen the muscles in your leg to help maintain function and take some of the load off the tendon.
    I do many exercises on a mat or sitting, so I don't have as much pain and I can be in better
    shape. This condition is fairly common with middle aged people, but more so in women.
    Early diagnosis and treatment is KEY. Don't leave it until your arch falls and you need bones fused permanently. The longer you wait, the worse the surgical choices can be.
    Swimming is a good non-loading exercise with many health benefits. The point is, you must try and help yourself. There is no magic bullet for PTTD.
     
  19. limping

    limping New Member

    UPDATE!!!!
    I went to an orthopedic doctor who said he used to always do the surgery until he tried a protoocol for people suffering but with their tendons intact. Mine is not torn (yet!) Initially was put on 10 days of prednisone. As soon as that ended started Celebrex and 3Xweek PT. Used Voltaren gel on area every 4 hours. Consistently wore my aircast (air in the arch area for PTTD) About 2 weeks ago on a whim I tried to get up on my toes which I could not do at all for months. I was able to do so w/o assistence from the other foot. I wear only shoes like Finn Comfort for the arch support. Orthaheel is good as well as Naot. For now the doc says I am good but if it "flares up " to ice it and start the celebrex again. Two surgoens said surgery was the only way. I am glad I listened to this guy here in GSO. He is a doc that also has this problem. I do have custom orthodics in my athletic shoes. He wears them all the time because he is on his feet alot. I tend to trust someone that is actually living the same issue.
     
  20. Robby

    Robby New Member

    Today I had my cast removed! Xrays were taken and everything was perfect! The surgeon had a compression stocking put over the foot up to the knee. The walking boot was fitted and put over the stocking. I was instructed to get up and walk out on both feet and two crutches!!! He wants me walking without any crutches on Monday. I have 14+ weeks of grueling PT twice /week starting next Tuesday. I need to wear the boot except to sleep and I can shower without it. No baths or pools or soaking for four weeks. I think I had the most awesome surgeon from Duke Hospital in Durham, NC! My positive attitude and loving wife of 40 years are what made this what it is!
     
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