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Posterior Tibial Tendon Dysfunction

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  #1  
Old 22nd December 2008, 04:05 AM
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Default Posterior Tibial Tendon Dysfunction

About three years ago, I hurt my left foot while walking on the treadmill. From then on, I have had mild pain come and go in my foot, depending on how much I was walking or what shoes I was wearing. About a year ago, I started having pain, stiffness and cracking noises coming from the top of my foot. This fall, I finally went to get a physical with my family doctor's office and was sent to physical therapy when I mentioned my problem. They made everything worse! After realizing that they couldn't do anything for me, I was referred to an orthopedic doctor. I had to wait another 1 1/2 months for the appointment. The day before the appointment, I woke up with such EXTREME pain in my foot, I thought something was broken. I was on my feet much of the day prior. When I went to the doctor, he took an x-ray of my foot and diagnosed me with Posterior Tibial Tendon Dysfunction and arthritis in the top of my foot.

Did my arch actually fall the night before, or had it started when I walked on the treadmill three years prior?

Ever since the appointment, I have had constant pain in my arch area, and top of my foot. The doctor told me that the only way to treat PTTD, was to wear UCB inserts (hard plastic) in both feet to prevent the tendon from tearing and prevent any damage to my other foot. I am afraid that these won't work because I have had problems wearing shoes and inserts all my life.

Can I use over the counter cushioned arch supports or are UCB inserts the only way to prevent tearing of the tendon?

I am so scared to be in pain for the rest of my life. I am only 35 years old. I've gained 30 pounds since this problem began. I know I probably have to lose weight, but how can I if I can't put pressure on my foot?

Is there anything else I can do other than wear UCB inserts to help my condition?
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  #2  
Old 22nd December 2008, 02:58 PM
FootDoc FootDoc is offline
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Default Re: Posterior Tibial Tendon Dysfunction

PTTD, unless cause by a sudden and obvious injury, is generally a condition which takes a great deal of time to eventuate, and so, I think it unreasonable to suppose that your arch "fell" over night. But if I can take the account of how your diagnosis was made as being accurate, and if it was based primarily on an x-ray as you imply, I would have to question such a criteria as being sufficient. Medicine is as much art as science, and each condition must be evaluated on its own merits. Accordingly, it is of little use to comment on any individual's treatment without having intimate knowledge of the nuances presented, and the only comments that can be responsibly offered are general in nature, and should not be taken as necessarily applicable to your or anyone else's individual case.

PTTD, is treated in many fashions, both conservatively and surgically. Conservative management would include rest, analgesia, casting, physical therapy and various types of external stabilization and support, including various types of foot and ankle orthothoses. In severe and unremitting cases, various surgeries, both soft tissue and osseous, sometimes concomitantly employed, might be considered. But to recommend a specific alternative for your individual case would simply be shooting from the hip. Any good foot and ankle specialist should be aware of the range of treatment and be able to select the most appropriate for any individual case. Certainly, if one is overweight, weight reduction can be a significant aid to symptomatic relief.
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  #3  
Old 30th January 2009, 07:52 PM
ce2two ce2two is offline
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Default Re: Posterior Tibial Tendon Dysfunction

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Originally Posted by FootDoc View Post
PTTD, unless cause by a sudden and obvious injury, is generally a condition which takes a great deal of time to eventuate, and so, I think it unreasonable to suppose that your arch "fell" over night. But if I can take the account of how your diagnosis was made as being accurate, and if it was based primarily on an x-ray as you imply, I would have to question such a criteria as being sufficient. Medicine is as much art as science, and each condition must be evaluated on its own merits. Accordingly, it is of little use to comment on any individual's treatment without having intimate knowledge of the nuances presented, and the only comments that can be responsibly offered are general in nature, and should not be taken as necessarily applicable to your or anyone else's individual case.

PTTD, is treated in many fashions, both conservatively and surgically. Conservative management would include rest, analgesia, casting, physical therapy and various types of external stabilization and support, including various types of foot and ankle orthothoses. In severe and unremitting cases, various surgeries, both soft tissue and osseous, sometimes concomitantly employed, might be considered. But to recommend a specific alternative for your individual case would simply be shooting from the hip. Any good foot and ankle specialist should be aware of the range of treatment and be able to select the most appropriate for any individual case. Certainly, if one is overweight, weight reduction can be a significant aid to symptomatic relief.
I have the same problem ,as described,same pain , exactly ....been casted , rested, now walking , pain shoots from ankle bone on inside of foot up close to knee ,pain in arch yes .....both feet ...yes.....where p/t goes from tendon to muscle i have pain , certainly i would rather be dead then deal with this for the rest of my life .....suicide has been on my mind ...no job , alot pain why live....getting close to jumping off a bridge head first ....no more pain
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  #4  
Old 16th July 2009, 04:51 AM
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Angry Re: Posterior Tibial Tendon Dysfunction

dont even consider jumpin over anything...there must be a way to fix this without simply having to buy 500 dollar orthotics and getting a kick in the ass out of the docs office till they mail you and urge you to come back for another pair one year later. These docs are crooked scum...we should sort them out in a jiffy! I think one is better off wearing one of those elastics by wrapping it around their arch and just above the ankle. I for sure have PTTD. I had an accident 5 years ago, now my right food doesnt look like my left anymore. I am aware that nobody (or hardly anybody) is perfectly symmetrical but this is showing its toll. I can't walk without pain, cant run for 2 minutes without having inflammation for the next two days. My family doc, freakin imbecile, sent me to a rheumatologist who farted while looking at my foot and told me i have no problem. This is Toronto Canada...f****** garbage health care. I took myself to a sports clinic and have been receiving physio with no benefit at all (80 dollars/hour). So i quit the physio. It seems we are alone when it comes to real treatment. Wearing orthotics does not remove the problem, it does not even ameliorate it!!! I would not suggest orthotics because they dont do jack s*it. I've had them for 5 years and my condition is worsening. Please help us somebody
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  #5  
Old 9th October 2009, 12:01 AM
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Thumbs up Re: Posterior Tibial Tendon Dysfunction

Hi...I have PTTD. Just went through Plasma Rich Platelet Treatments and am in Physcial Therapy. Am definitely getting better; but not healed yet. I know it will take time. Also had an amazing massage session today at the advice of a pt I worked with for 5 years, it was very specific to PTTD. I can feel the difference, it helped release the pull on the tendon from the surrounding muscles. WIll keep you informed if you are interested!

http://www.runresearchjunkie.com/pos...on-in-runners/
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Old 1st November 2009, 09:39 PM
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Default Re: Posterior Tibial Tendon Dysfunction

I would like more info from the person that had the Plasma therapy. I was diagnosed with PTTD over two years ago. Had a cast on for 6 wks., then this molded brace which I still wear. I still have pain after all this time. Went to another dr. for a second opinion. Same as first opinion. Surgery is not an option for me at this time. This new foot and ankle dr. I recently saw gave me literature on the Plasma therapy. I am very interested to learn all I can about it. I searched everything I could find on-line, but would like to hear from someone that actually had it done. I am tired of living in pain. It is bad enough that I can't wear just any old shoes because of the brace but my #1 complaint is the pain.
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  #7  
Old 21st November 2009, 11:04 PM
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Cool Re: Posterior Tibial Tendon Dysfunction

Sorry you have suffered for so long. Just found your thread. If I could I would suggest a couple of places for information. The foot is a very complex set of joints and only until recently have plausible answers been found. Here are some links to get you started.
http://ezinearticles.com/?My-Back-Hu...elp&id=2876236
instepfootandankle.com on the front page, two hyperlinks are highlighted --HyProCure and Solesupports. Click on the links and watch the videos. Given what you have been through and progressive deformity you are experiencing, these are not always the answer, but in my experience, they have been a pathway for many of my patients to get relief. Either way it gives some insight as to how the foot works and what options are available and are giving rise to new options to foot ailments. As for the Platelet therapy, I enjoy using the procedure. I has lots of applications, but only if something is being done to address the biomechanics/insult/injury, that caused the problem in the first place. It may work this time, but there is definitely a possibility of it coming back
Paul Clint Jones, DPM
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  #8  
Old 24th November 2009, 10:56 PM
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Unhappy Re: Posterior Tibial Tendon Dysfunction

Hi! I was just diagnosed with Posterior Tibial Tendon Dysfunction last week -- the "dx" was made by my physical therapist. I began PT earlier in the year for a knee problem and as I became more active, I started to have foot pain. The DPM sent me to an orthopedic surgeon and he said that I had a collapsing arch, gave me some protocols to give to my DPM and recommended insoles. Everything was fine for several months. I continued to walk and jog as tolerated. JUST SIGNED UP FOR MY 1st HALF MARATHON and WHAM! Pain when I walk. Over the last week, I've experienced slight swelling at the ankle and pain from inside the arch all the way up to my knee. My DPM has banned me from walking/running/elliptical -- only stationary bike and some hamstring & quad exercises/stretches.

I am getting so worried that I will not be able to walk or run competitively anymore. I will have to miss a race this Thursday for the 1st time ever. : ( I am very concerned. Any advice? Has anyone used custom orthotics? I believe my insurance would pay a good portion of the cost if it would alleviate my pain. And the pain is no longer "just" when I'm exercising. It's when I wear ANY shoes, and 1st thing in the morning. I am taping my foot for arch support and icing it as often as I can during the day.

Advice please!

Julie
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  #9  
Old 24th November 2009, 11:23 PM
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Default Re: Posterior Tibial Tendon Dysfunction

DISCLAIMER:
THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
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I do not know enough about either your symptoms or whatever examination and tests you might have had leading to a diagnosis of PTTD, and am not convinced that two doctors failed to diagnose you as such but a PT was able to. Each case of PTTD, if that's what you have, is treated on its merits, but conservative treatment generally includes rest, NSAIDS and frequently several weeks in a BK cast. Orthotics are generally employed after a successful stint in a cast or resolution of symptoms by other means. But, as usual, I cannot and will not speak to any individual case. Has either of your doctors confirmed the PT's diagnosis and what is their prognosis?
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  #10  
Old 28th January 2010, 01:21 PM
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Default Re: Posterior Tibial Tendon Dysfunction-- shockwave therapy

Hi -- Just completed third and final session of shockwave therapy for recently diagnosed PTTD through podiatrist. Has anyone else had this? It seems to be my only hope. Painful, yes, but doc is promising that I will experience relief within three weeks. Also wearing brace at night as pain is worse in the morning and that is helping a lot
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  #11  
Old 12th March 2010, 12:40 AM
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Default Re: Posterior Tibial Tendon Dysfunction

Hi;

I have PTTD for a year now. Have tried ultrasound, 6 sessions at $1500 of shockwave therapy, (which didn't work so save your $$) left it tears after treatments, orthotics(3 pair) hundreds of dollars spent on physio treatments, massage therapy, chiropractic treatments and running shoes. Still no further ahead. Now I am wearing a brace all day to aleviate the pain. I am pretty well convince that I will never run again. Rest, ice and capsicum ointment helps with the pain but then it's back... SAD
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Old 16th March 2010, 10:44 PM
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Smile Re: Posterior Tibial Tendon Dysfunction

4 years ago I was diagnosed with pttd. I had the surgery where they fuse your foot with cadaver bones and insert 4 titanium screws for permanent stability. It was a tough surgery and even tougher recovery; but, after being in a cast for 8 weeks and on crutches; no weight bearing at all; I went to P/T and worked diligently and was able to play golf after 4 months from surgery. Long walks are tough, but I am able to exercise on the elliptical; but no treadmill. I was fitted with orthotics, but found them unnecessary on the surgically repaired foot because now it's perfect. I still needed one on my other foot because it's flat so I have an orthotic for that foot. I have found that sneakers are best along with tie shoes, not loafers. Anyway, good luck. Allenz1349@gmail.com
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  #13  
Old 20th March 2010, 04:46 PM
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Default Re: Posterior Tibial Tendon Dysfunction

Quote:
Originally Posted by Julie2009 View Post
Hi! I was just diagnosed with Posterior Tibial Tendon Dysfunction last week -- the "dx" was made by my physical therapist. I began PT earlier in the year for a knee problem and as I became more active, I started to have foot pain. The DPM sent me to an orthopedic surgeon and he said that I had a collapsing arch, gave me some protocols to give to my DPM and recommended insoles. Everything was fine for several months. I continued to walk and jog as tolerated. JUST SIGNED UP FOR MY 1st HALF MARATHON and WHAM! Pain when I walk. Over the last week, I've experienced slight swelling at the ankle and pain from inside the arch all the way up to my knee. My DPM has banned me from walking/running/elliptical -- only stationary bike and some hamstring & quad exercises/stretches.

I am getting so worried that I will not be able to walk or run competitively anymore. I will have to miss a race this Thursday for the 1st time ever. : ( I am very concerned. Any advice? Has anyone used custom orthotics? I believe my insurance would pay a good portion of the cost if it would alleviate my pain. And the pain is no longer "just" when I'm exercising. It's when I wear ANY shoes, and 1st thing in the morning. I am taping my foot for arch support and icing it as often as I can during the day.

Advice please!

Julie

JULIE did you ever get help??? I have the same situation and my mrathon is in may 2 2010 My pain is just starting to sit me out! HHHEEELLPP
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Old 7th May 2010, 10:31 PM
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Default Re: Posterior Tibial Tendon Dysfunction-- shockwave therapy

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Hi -- Just completed third and final session of shockwave therapy for recently diagnosed PTTD through podiatrist. Has anyone else had this? It seems to be my only hope. Painful, yes, but doc is promising that I will experience relief within three weeks. Also wearing brace at night as pain is worse in the morning and that is helping a lot
I was diagnosed with PTTD about 2 years ago. I'm going back to physio next week as the pain is still pretty consistent with walking or weight bearing. I was having terrible pain trying to stand on my foot first thing in the morning, and had to limp around for several minutes until it subsided. I wondered if the weight of the comforter was causing this, so started turning it up at the bottom and loosening the sheet so that my feet were not weighted and could move freely. Since then I have not had this excrutiating pain in the morning, although the general symptoms still remain. Sounds simplistic, but thought I would pass this along. My PTTD originally developed while I was receiving physio for an injury to my Achiles area, so I am a bit worried about going to physio again, but I don't know what else to do, as orthotics alone have not helped.
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Old 11th May 2010, 03:10 PM
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Default Re: Posterior Tibial Tendon Dysfunction

After 3 years of constant right ankle pain and swelling, MRI results showed Phase 2 (partial tear) of tibialis tendon. 2 years later and after numerous techniques to relieve the pain ( drugs, exercise, rest, braces) I have found a formula that has significantly reduced the pain and swelling. I went to a foot doctor who prescribed good orthotics. It is essential not to fool around with a lot of the "Mickey Mouse" orthotics out there. Go to a good podiatrist who knows what tibialis tendon symptons are and get a pair of AGGRESSIVE orthotics. That means they are mostly rigid and provide a LARGE arch support. Any time your foot rolls in due to the tendon deficiency, the ankle is suffering trauma and the pain and swelling results, so you must try to prevent as much as possible the foot rolling in. Along with the good orthotics get a pair of training shoes that provide maximum stability control, and wear them constantly inside and outside the house. Do not participate in any sports that require prolonged pounding of the feet (long running, squash, tennis), but keep exercising. I found that shortly after doing these things, my pain and swelling were significantly reduced.
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Old 7th October 2010, 06:17 PM
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Default Re: Posterior Tibial Tendon Dysfunction

After multiple doctor visits (of varying opinions, I get the impression that none actually seemed to be that familiar with PTTD or what to do about it), resting, taking a multivitamen & flaxseed oil, and then using some semi-rigid orthotics that one doc prescribed) I still have slight pain in my left ankle one full year later now. It seems to slowly be getting better after having stopped hiking altogether and wearing an "orthoticlike" getup (described below) - but it is still a year later and I'm worried it will never heal.

After tons of hours of research online (as an aside, thanks to many posters here for helping me understand issues related to PTTD) I am pretty sure that I have some early stage PTTD. Initial onset was from aggressive hilly trail running, too much/too soon from couch. Bottom line is, I think I need more aggressive orthotics. The "Footlevelers" I have just don't seem to adequately stop my foot from overpronating. The best makeshift shoe/orthotic combo seems to be a motion control New Balance 850 running shoe I have with superfeet green inserts (high arches, firm material). This seems to control my overpronation that any other combo I've tried, including the footlevers. But I would like something even better that is made directly for my feet. Pain is not severe enough to make me think about surgery, but then again it has changed my life (I can't run or hike without annoying pain and probably making the condition worse) I want to hike again one day...

My question is this: Where do I look in Upstate South Carolina (Greenville-Spartanburg), Columbia, or Charlotte for a doctor familiar with PTTD and how best to treat it. Any advice at all on a specific practice or just general advice on how to look for such a practice would be greatly appreciated!
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Old 13th October 2010, 06:13 AM
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Default Re: Posterior Tibial Tendon Dysfunction

Glad for your good outcome. What was it like non wt. bearing??? Did you have enought strength to get up and down from toilet and chairs with only one leg to use???
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Old 30th October 2010, 02:10 AM
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Unhappy Re: Posterior Tibial Tendon Dysfunction

I need some advice from someone who understands how frustrating PPTD is. I had tendonitis following a dance injury and spent 5 months in a boot doing conservative treamtments trying not to have surgery. After 9 months following the injury I had a debridement and it helped greatly. My MRI was normal but the surgeon said what should have taken 45 minutes took over 2 hours because of the damage. This was in 2002.

Fast forward to one month ago. I had two ankle sprains one inversion and one eversion (sp). I rested a bit and it was sore but did not seek medical attention. I was in my kitchen two days after the last ankle sprain when I went on tip toe to grab a plate and when I cam down I felt this terrible pop and it hurt immensly. Since then I have had nothing but problems. I went to my doctor who put me in a boot with crutches. I cannot rise on my heel, my foot is turned inward and I can feel the bones in the bottom of my fott when I put weight on it. The doctor thought for sure I ruptured it based on how it presented. I saw him today and he said my MRI was totally normal. How can this be with all the pain and swelling. Now he wrote me off, said go to physio and I can wear the boot only if I want to. I still can't raise on my heel and I have very bad pain. What on earth to do now?
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Old 30th October 2010, 08:04 PM
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Default Re: Posterior Tibial Tendon Dysfunction

What is the best way to treat pttd besides an orthodic and keep it from getting worse?
Quote:
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The following is offered gratis as general information only, and, as such, may not be applicable to the specific questioner and/or his/her problem. It is clearly not based on actual knowledge and/or examination of the questioner or his/her medical history, and it can not and should not be relied upon as definitive medical opinion or advice. Only through hands-on physical contact with the actual patient can accurate medical diagnosis be established and specific advice be given. No doctor/patient relationship is created or established or may be inferred. The questioner and/or reader is instructed to consult his or her own doctor before proceeding with any suggestions contained herein, and to act only upon his/her own doctor’s orders and recommendations. By the reading of my posting which follows, the reader stipulates and confirms that he/she fully understands this disclaimer and holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are admonished to read no further.
************************************************** *********
i do not know enough about either your symptoms or whatever examination and tests you might have had leading to a diagnosis of pttd, and am not convinced that two doctors failed to diagnose you as such but a pt was able to. Each case of pttd, if that's what you have, is treated on its merits, but conservative treatment generally includes rest, nsaids and frequently several weeks in a bk cast. Orthotics are generally employed after a successful stint in a cast or resolution of symptoms by other means. But, as usual, i cannot and will not speak to any individual case. Has either of your doctors confirmed the pt's diagnosis and what is their prognosis?
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Old 30th October 2010, 08:10 PM
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Default Re: Posterior Tibial Tendon Dysfunction

My dr. After looking at my feet and reviewing x-rays confirmed the pttd and proscribed an orthodic without casting my foot. I have myasthenia gravis and have been on pregnasone (60 mg) i am now on 2.5 mg trying to get off it. I started pt yesterday and it seems to help.
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Old 30th October 2010, 11:54 PM
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Default Re: Posterior Tibial Tendon Dysfunction

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What is the best way to treat pttd besides an orthodic and keep it from getting worse?
There is no one-best method. It is possible that you may require surgery.

FOOT DOC
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Old 12th January 2011, 09:12 AM
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Default Re: Posterior Tibial Tendon Dysfunction

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I would like more info from the person that had the Plasma therapy. I was diagnosed with PTTD over two years ago. Had a cast on for 6 wks., then this molded brace which I still wear. I still have pain after all this time. Went to another dr. for a second opinion. Same as first opinion. Surgery is not an option for me at this time. This new foot and ankle dr. I recently saw gave me literature on the Plasma therapy. I am very interested to learn all I can about it. I searched everything I could find on-line, but would like to hear from someone that actually had it done. I am tired of living in pain. It is bad enough that I can't wear just any old shoes because of the brace but my #1 complaint is the pain.
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.
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Old 17th January 2011, 03:05 AM
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Default Re: Posterior Tibial Tendon Dysfunction

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 !
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Old 17th January 2011, 03:30 AM
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Default Re: Posterior Tibial Tendon Dysfunction

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
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  #25  
Old 6th February 2011, 02:58 PM
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Default Re: Posterior Tibial Tendon Dysfunction

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.
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Old 6th February 2011, 05:13 PM
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Default Re: Posterior Tibial Tendon Dysfunction

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.
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Old 13th February 2011, 08:00 PM
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Default Re: Posterior Tibial Tendon Dysfunction

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?
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  #28  
Old 13th February 2011, 08:05 PM
limping limping is offline
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Default Re: Posterior Tibial Tendon Dysfunction

Also I worry if I have surgery and NWB for 8 weeks+ that I will gain weight. Any kind of exercise machine recommendations? Elliptical??
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Old 24th February 2011, 03:59 PM
lindalillian lindalillian is offline
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Default 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.
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Old 24th February 2011, 05:40 PM
jocko jocko is offline
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Default Re: Posterior Tibial Tendon Dysfunction

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 by jocko; 24th February 2011 at 05:45 PM.
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