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Posterior Tibial Tendon Dysfunction

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  #61  
Old 11th October 2011, 05:59 AM
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Question Re: Posterior Tibial Tendon Dysfunction

I also have PTTD.
Mine started when I began walking 5 miles 2@ day with my Mom. She had just been diagnosed as a Type II diabetic and the exercise was helping her level her sugar levels.
After 3 months of pain, seeing my GP, and having been told it was 'just a stone bruise'.
I went for a second opinion. Imagine my surprise when the foot doctor looked at my foot
and said "Lady, there's not a thing I can do for you"." Your arch is shot, your ankle has shifted forward and your foot is turning to the side." Also a couple of my toes are numb, which I have been told is possibly due to nerve damage when the arch collapsed.
He had an Orthopedic Doctor come in and they sent me straight to X-ray.
When I was done, I was placed under the Ortho's care, who immediately put me into
a cast to my knee. Pain was gone! I thought WOW! ok, this will be fixed.
Little did I know, the pain was only relieved when I was in the cast. Once it was off, I was back to hobbling around, trying not to put weight on this foot.
Had orthotics for my shoes, a plastic brace, expensive corrected shoes, Nada.. the only thing that has helped so far, is a lace up brace/boot similar to what a wrestler wears.
Due to the fact I am also now a Type II diabetic, I've decided that surgery is not a good option for me. My last ortho visit ( who no longer will see me as I won't agree to surgery) has me restricted to standing or walking no more then 30 mins in a 8 hour stretch.
It was also suggested that maybe someday a ankle reconstruction possibly including an artificial ankle joint ( when & if they get around to them) might be my best option.
It's now been at least 8 years since anyone has suggested anything that might help. Came here to see if possibly there is some news on a new treatment.
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  #62  
Old 7th December 2011, 01:50 PM
richard r golden md
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Default Re: Posterior Tibial Tendon Dysfunction

i have had pttd diagnosed about four years ago. was treated for acute event with casting. I was offered ubs by ortho but told him I wanted an arizona boot. It was paid for by medicare. I have been wearing it for four years, now, about half the day, and have had no pain nor any advancement of my disease. i also had a shot of prp { platelets ) by local ortho. there are other things like streching and excercise for pttd but the arizona boot is the best non surgical treatment for this disease
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  #63  
Old 18th January 2012, 02:44 AM
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Default Re: Posterior Tibial Tendon Dysfunction

Hi, I have had PTTD for many years. I can't afford to be out of work or unable to drive because I am a caregiver for my husband. The last episode I had left me unable to walk for quite a few hours, then only with lots of pain.
I eventually found relief in two ways: my primary physician prescribed 400 mg of ibuprofen 2-3 times a day. This was after visiting a podiatrist for "water therapy" and electrical stimulation at $75 a visit for several visits that didn't really help the situation.
Several years ago I purchased arches at Good Feet and almost threw them away, thinking they were a ripoff and a huge waste of money. I pulled them out of the closet in desperation after the podiatrist told me I needed to update my very old orthotics with a new $500 pair. I started wearing the Good Feet arches a few hours a day in the house, then gradually increased wearing time to all day outside the house. I also took out the New Balance arches in my shoes and bought a pair of arch supports from Dick's for $39.00. The Good Feet supports go in the bottom and are not as long as orthotics.
So far - after several months, I can walk a reasonable distance on pavement and haven't had any episodes that require cortisone shots or other treatment. I think the Good Feet arches are doing most of the job - but I'm still taking the ibuprofen.
Hope this helps someone.
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  #64  
Old 13th February 2012, 08:21 PM
Casey
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Default Re: Posterior Tibial Tendon Dysfunction

I had PTTD in 2010, and yes it is extremly painful. Went to my family doctor who gave me an injection which did not help at all. He then ordered and x-ray which did not show any problems. Sent me to a Podiatrist who ordered a MRI. This showed that there were minute tears throughout the tendon. He tried more injections however told me before that they would probably not help. He told me surgery probably would not help and that if you had the best surgeon in the world and the surgery went perfectly there was only about a 40% that it would help. Next step was Orthdotics which were molded to fit my foot and an Arizona Brace. The brace helped stabilize my foot but could walk only a short distance before the pain was unbearable. He told me that my foot would probably never be well. My son, a RN, told me about PROLO THERAPY which is injections but not the usual kind almost all doctors would use. I started the treatments and with each treatment my foot improved a little. After eleven treatments I had no more pain, discarded the Arizona Brace and haven't had any more problems. I walk up to three miles a day. The injections are somewhat painful but well worth it. Neither my health insurance or Medicare would pay for the treatment. Google "Prolo Therapy" and educate yourself about this procedure. For me it was a miracle but that doesn't mean it would heal everone.
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  #65  
Old 16th February 2012, 07:17 PM
jpkoto jpkoto is offline
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Default Re: Posterior Tibial Tendon Dysfunction

I need advice. I am almost 50 years old and have been active all of my life but just started running seriously in May of 2011. I used the C25k program and tried to follow it but then I started pushing myself and was running too much too soon. I noticed a knot on the back of my ankle/heel area but there was no real pain so I kept running. Finally, I started having the burning pain and horrible stiffness and pain in the morning. Ice really made it burn more. At this point I did stop running because it was way too painful. Even had to stop the long walks. Finally, after a few months of pain, I talked to my family dr. who referred me to PT. The physical therapist was wonderful but it did not help. So, I finally went to an orthopaedist who specializes in foot/ankle issues. (at this point I had had the xray and MRI which didn't show any obvious tears). He said it was degenerative and put me in the aircast. I have been wearing the aircast for several months now with NO improvement, however, if I put enough air in it then I do have some relief when wearing it (I am a teacher so I am on my feet all day).

I went back to him yesterday and now he is suggesting the blood shots (answer: no) and possibly ultrasound. Neither appeal to me so he has written a script to return to PT and for an Arizona brace. I have been looking around and it appears that the Arizona brace is very expensive. I am waiting to hear whether my insurance will cover it. Has anyone tried the AZ brace and, if so, how did it work? Were you able to exercise while wearing it?

Also, I am considering finding another orthopaedist as this one looks at my heel for about 30 seconds, talks to me for another 2-3 minutes and seems to want to do the blood injections, which I will not do.

Any thoughts would be greatly appreciated. This is the most annoying, drawn out process I have ever experienced, not to mention the altered lifestyle and pain!! It has been about 8 months since my initial injury and there is NO PROGRESS! My family doctor suggested that I try acupuncture. Anyone have any experience with this?

Thanks!
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  #66  
Old 16th February 2012, 08:00 PM
jpkoto jpkoto is offline
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Default Re: Posterior Tibial Tendon Dysfunction

wrong thread, sorry!
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  #67  
Old 17th February 2012, 12:46 AM
LGR LGR is offline
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Default Re: Posterior Tibial Tendon Dysfunction

I have struggled with PTTD for 10 years. I always wear orthotics in firm shoes or cork sandals such as Birkenstocks or Mephistos. But at the first sign of a flare up, which has happened many times, I turn to higher heels to take the stress off the tendon. This applies only to women, but as I understand it, women are most often afflicted by PTTD. It sounds counter-intuitive and no doctor has ever suggested it, but my own experience bears it out. Since the posterior tibial tendon is responsible for push off, I think, heel elevation (1 1/2 inches) means that the tendon doesn't have to work so hard. The result is temporary immobilization or partial immobilization to allow for healing. Even when I am not experiencing inflammation, I feel safer with some heel. No Uggs for me. Even in running shoes I need orthotics with heel postings/ lifts. I have found that this advice has been mentioned on only one website. I don't understand why it is not mentioned more often.
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  #68  
Old 18th February 2012, 07:07 PM
Casey
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Default Re: Posterior Tibial Tendon Dysfunction

Quote:
Originally Posted by jpkoto View Post
I need advice. I am almost 50 years old and have been active all of my life but just started running seriously in May of 2011. I used the C25k program and tried to follow it but then I started pushing myself and was running too much too soon. I noticed a knot on the back of my ankle/heel area but there was no real pain so I kept running. Finally, I started having the burning pain and horrible stiffness and pain in the morning. Ice really made it burn more. At this point I did stop running because it was way too painful. Even had to stop the long walks. Finally, after a few months of pain, I talked to my family dr. who referred me to PT. The physical therapist was wonderful but it did not help. So, I finally went to an orthopaedist who specializes in foot/ankle issues. (at this point I had had the xray and MRI which didn't show any obvious tears). He said it was degenerative and put me in the aircast. I have been wearing the aircast for several months now with NO improvement, however, if I put enough air in it then I do have some relief when wearing it (I am a teacher so I am on my feet all day).

I went back to him yesterday and now he is suggesting the blood shots (answer: no) and possibly ultrasound. Neither appeal to me so he has written a script to return to PT and for an Arizona brace. I have been looking around and it appears that the Arizona brace is very expensive. I am waiting to hear whether my insurance will cover it. Has anyone tried the AZ brace and, if so, how did it work? Were you able to exercise while wearing it?

Also, I am considering finding another orthopaedist as this one looks at my heel for about 30 seconds, talks to me for another 2-3 minutes and seems to want to do the blood injections, which I will not do.

Any thoughts would be greatly appreciated. This is the most annoying, drawn out process I have ever experienced, not to mention the altered lifestyle and pain!! It has been about 8 months since my initial injury and there is NO PROGRESS! My family doctor suggested that I try acupuncture. Anyone have any experience with this?

Thanks!
Raather than finding another Orthopaedist may I suggest that you go to a Podiatrist instead. Additionally, get a second opinion on the MRI. I beleive that a very specific diagnosis is necessary before the problem can be treated successfully. As indicated in my 13 Feb. Post an Arizona Brace did stabilize my foot, it was turning out, but did not do away with the pain or promote any healing. My Arizona Brace cast $800.00 but I was fortunate that Medicare and my insurance paid for it. I haven't heard of anyone that tried acupuncture for this condition. None of the three doctors that I saw suggested it. Hoping that you find an answer to your problem.
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  #69  
Old 27th March 2012, 12:29 AM
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Default Re: Posterior Tibial Tendon Dysfunction

Quote:
Originally Posted by Hope I can Help View Post
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!
I too do not seem to be getting better.. The first couldn't,t help after one month so he sent me to a foot specialist who diagnosed pttd stage 2 and put me in a foot brace, I also asked about platlets but she did not recommend them. later she was no longer practicing and sent me to another who recommended p t where I have been going for 6 weeks. I still do not see Improvementt. Please, some opinions and options. Thanks
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  #70  
Old 11th May 2012, 10:14 PM
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Default Re: Posterior Tibial Tendon Dysfunction

Non of you make me feel very optimistic. I'm 52, love playing tennis, basketball, soccer. I've had the MRI and was told that the PTT is "pretty shredded". Am wearing the aircast for 4 weeks then will have a reevaluation. If all is good, 3 more weeks in the cast then PT. My question is, how do they know if it's healing? Can they really tell w/o another MRI? Has anyone out there actually had their PTT heal to the point of full sports again? I'm Ok with the orthotics, I've had those off and on for years.
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  #71  
Old 1st June 2012, 09:39 PM
A..dam A..dam is offline
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Default Re: Posterior Tibial Tendon Dysfunction

I have PTTD for 8 years now.
Looking for a surgery option now.
Live in Ottawa, Canada.
Any recommendations for surgery in Canada?
What about Cambie Clinic in Vancouver?
Willing to pay for the surgery if needed so looking into US as well.
The most commonly mentioned US hospital is HSS.
Any other leads, for example, in Boston area?
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  #72  
Old 16th August 2012, 07:28 PM
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Quote:
Originally Posted by LGR View Post
I have struggled with PTTD for 10 years. I always wear orthotics in firm shoes or cork sandals such as Birkenstocks or Mephistos. But at the first sign of a flare up, which has happened many times, I turn to higher heels to take the stress off the tendon. This applies only to women, but as I understand it, women are most often afflicted by PTTD. It sounds counter-intuitive and no doctor has ever suggested it, but my own experience bears it out. Since the posterior tibial tendon is responsible for push off, I think, heel elevation (1 1/2 inches) means that the tendon doesn't have to work so hard. The result is temporary immobilization or partial immobilization to allow for healing. Even when I am not experiencing inflammation, I feel safer with some heel. No Uggs for me. Even in running shoes I need orthotics with heel postings/ lifts. I have found that this advice has been mentioned on only one website. I don't understand why it is not mentioned more often.
LGR, You're absolutely correct. I too have struggled with PTTD in both feet for 25 years from the date it started when I was 47, I'm female. I went to an Orthopedic doctor in Ft. Lauderdale who was referred by my PT and he saw me come in in boots like Granny boots which had had the heel removed and a newly designed wooden one put on (it was rectangular about 1 1/2" to fit the shape of the shoe at the back with a flared piece added on the bottom of that heel, less than 1/2" high.) I still wear these boots today when I go 'dancing' or somewhere I need to be really dressed up. I wear cork arch supports in them. Anyway this doctor looked at my feet and was quite concerned about the PTTD and suggested I wear the boots every day instead of the athletic type shoes I was wearing with arch supports and buttresses on the side of the arch. He said they were ugly and he was right. He liked the boots because they had a heel and explained why they would work better than a shoe without heels. Your description, LGR, was very accurate. At any rate it's impossible I think to wear the boots on a daily basis all day because the toes are pinched in such a narrow shaped boot at the front. So what I wear is a PW Minor shoe with a heel that flares out slightly and that gives you balance. I've 'corrected' every shoe I've had with buttresses on the arch side and in one case an orthotist added firm 'foam' maybe' wrapped around the heel of the shoe and it made it so comfortable and stopped the foot from rolling over at all. It feels wonderful and with the arch supports my foot has been comfortable for years. No pain whatsoever. But I'm told we shouldn't be walking because the foot can get worse in time.
So anyone who was a runner or dancer or even just loved to walk miles a day, from what I'm told by doctors and orthotists, probably shouldn't be doing it anymore. I was a dancer and when this happened to me it was the worst thing I could imagine and I lost my spirit and felt life had come to an end. Since then I left work (I was a secretary mainly sitting down all day), do things sitting down at my computer, and have hobbies at home. We can still work out so that's good and need to to support the back or else that starts to change over time. I didn't opt for surgery because at the time they didn't have one that was a definite fix and then I found a solution that seemed to get me by and I no longer thought about anything but just buying good orthopedic shoes and having someone make good orthotics. I thought the older I got the more I'd look like I fit into my orthopedic shoes. Then when I did get older I still felt young so my theory only half worked. But today I am just happy I can walk and I'm told there are many many people out there who did not do anything about their PTTD when it first appeared to be a problem and as a result they are much worse off today than I am after 25 years. So go through the struggle to find what works for you and when the pain stops you'll know you found an answer. I wore an air brace for a few weeks on the worst foot and I tried SAS shoes that were too soft and I tried many soft arch supports that were too low and I tried higher cork ones that worked well and I tried UCBLs that about killed me because I have a very bony foot and couldn't tolerate the hard plastic (where others can). My pain continued and swelling for maybe a year or two until I found the right arch support and more than that, a good firm orthopedic lace up shoe to put it in and a good Orthotist who you can work with and has patience.
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  #73  
Old 17th August 2012, 02:10 PM
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Default Re: Posterior Tibial Tendon Dysfunction

Quote:
Originally Posted by A..dam View Post
I have PTTD for 8 years now.
Looking for a surgery option now.
Live in Ottawa, Canada.
Any recommendations for surgery in Canada?
What about Cambie Clinic in Vancouver?
Willing to pay for the surgery if needed so looking into US as well.
The most commonly mentioned US hospital is HSS.
Any other leads, for example, in Boston area?
I'm in Ottawa and had PTTD surgery a couple of years ago. Mine was the result of a sports injury. Dr. Jaques Brunet did mine at the General Hospital.
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  #74  
Old 2nd August 2013, 04:27 AM
HungryHeart HungryHeart is offline
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Default Re: Posterior Tibial Tendon Dysfunction

To the people who had their PTTD surgery done at Hospital for Special Surgery, would you mind sharing the name of your surgeon? Thanks.
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  #75  
Old 17th January 2014, 02:20 AM
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Default Re: Posterior Tibial Tendon Dysfunction

Has anyone heard of a richie brace? it is what my dr is recommending but it comes with a nice pricetag of $950. I realy cant afford that and am hoping I can find a decent cheaper alternative. But I am wanting to hear from anyone that has had a richie brace.
thank you in advance!!
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  #76  
Old 20th January 2014, 12:30 AM
Craig Payne Craig Payne is offline
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Default Re: Posterior Tibial Tendon Dysfunction

Quote:
Originally Posted by Unregistered View Post
Has anyone heard of a richie brace? it is what my dr is recommending but it comes with a nice pricetag of $950. I realy cant afford that and am hoping I can find a decent cheaper alternative. But I am wanting to hear from anyone that has had a richie brace.
thank you in advance!!
I have no doubt that a Richie Brace is often one of the better options for a PTTD that has gone beyond what a typical foot orthotics can do and has not yet reached the stage of needing surgery. Yes, it is expensive, but that is because it is custom made from a plaster cast. There are cheaper alternatives that can often work as well, but some or all of the components are not custom made..... its going to be one of trade offs.
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  #77  
Old 30th January 2014, 08:30 PM
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Default Re: Posterior Tibial Tendon Dysfunction

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Originally Posted by HungryHeart View Post
To the people who had their PTTD surgery done at Hospital for Special Surgery, would you mind sharing the name of your surgeon? Thanks.
yes i did ..on dec 10 2013 in hospital of special surgery with dr david levine he was wonderful..
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  #78  
Old 23rd September 2014, 08:19 PM
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Default Re: Posterior Tibial Tendon Dysfunction

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LGR, You're absolutely correct. I too have struggled with PTTD in both feet for 25 years from the date it started when I was 47, I'm female. I went to an Orthopedic doctor in Ft. Lauderdale who was referred by my PT and he saw me come in in boots like Granny boots which had had the heel removed and a newly designed wooden one put on (it was rectangular about 1 1/2" to fit the shape of the shoe at the back with a flared piece added on the bottom of that heel, less than 1/2" high.) I still wear these boots today when I go 'dancing' or somewhere I need to be really dressed up. I wear cork arch supports in them. Anyway this doctor looked at my feet and was quite concerned about the PTTD and suggested I wear the boots every day instead of the athletic type shoes I was wearing with arch supports and buttresses on the side of the arch. He said they were ugly and he was right. He liked the boots because they had a heel and explained why they would work better than a shoe without heels. Your description, LGR, was very accurate. At any rate it's impossible I think to wear the boots on a daily basis all day because the toes are pinched in such a narrow shaped boot at the front. So what I wear is a PW Minor shoe with a heel that flares out slightly and that gives you balance. I've 'corrected' every shoe I've had with buttresses on the arch side and in one case an orthotist added firm 'foam' maybe' wrapped around the heel of the shoe and it made it so comfortable and stopped the foot from rolling over at all. It feels wonderful and with the arch supports my foot has been comfortable for years. No pain whatsoever. But I'm told we shouldn't be walking because the foot can get worse in time.
So anyone who was a runner or dancer or even just loved to walk miles a day, from what I'm told by doctors and orthotists, probably shouldn't be doing it anymore. I was a dancer and when this happened to me it was the worst thing I could imagine and I lost my spirit and felt life had come to an end. Since then I left work (I was a secretary mainly sitting down all day), do things sitting down at my computer, and have hobbies at home. We can still work out so that's good and need to to support the back or else that starts to change over time. I didn't opt for surgery because at the time they didn't have one that was a definite fix and then I found a solution that seemed to get me by and I no longer thought about anything but just buying good orthopedic shoes and having someone make good orthotics. I thought the older I got the more I'd look like I fit into my orthopedic shoes. Then when I did get older I still felt young so my theory only half worked. But today I am just happy I can walk and I'm told there are many many people out there who did not do anything about their PTTD when it first appeared to be a problem and as a result they are much worse off today than I am after 25 years. So go through the struggle to find what works for you and when the pain stops you'll know you found an answer. I wore an air brace for a few weeks on the worst foot and I tried SAS shoes that were too soft and I tried many soft arch supports that were too low and I tried higher cork ones that worked well and I tried UCBLs that about killed me because I have a very bony foot and couldn't tolerate the hard plastic (where others can). My pain continued and swelling for maybe a year or two until I found the right arch support and more than that, a good firm orthopedic lace up shoe to put it in and a good Orthotist who you can work with and has patience.
I just saw this post from two years ago. I'm so glad to get some confirmation for what I have discovered. It is good to dispel some of the stereotypical views of what people with foot problems need. For example, softness can be really bad. Shoes that are safe for PTTD aren't necessarily comfortable: high heels of 2 inches can pinch the toes and be generally uncomfortable for walking; but they are not likely to aggravate the PT tendon (because they supinate the foot.) Granny tie up boots with a moderate heel are the best. I hope they stay in style. I have found that shoe sales people, physiotherapists, podiatrists , chiropodist and even some orthopaedic doctors are woefully ignorant of the needs of PTTD sufferers.

However, I disagree with anyone who says PTTD sufferers shouldn't be walking. I have had this problem for 13 years and have had some relapsing flare ups, which I have had to deal with. But as long as you understand what is going on with the foot and try to protect it from pronation or anything that stresses the tendon, you can walk long distances. If my foot is not properly supported, I don't dare walk even for a short block.

This winter I fell and sprained my bad foot. I iced it and rested it, but by the 2nd or 3rd day I was bearing weight with my version of a "cast": a pair of old granny boots with a 1 and 1/2 inch blocky heel, orthotics and thick socks to keep the foot stable. In 5 or 6 days I was good to go.

But it is constant trial and error. Certain orthotics fit into certain shoes. I have 17 year old hard orthotics that still work in some shoes. I have purchased about 6 pairs of orthotics over the years. Some work in certain shoes and not in others. Summers can be a bummer. Mephisto sandals (e.g. Helen) with their cork arch supports sometimes work. For the past two summers I have worn Wolky (Jewel style) sandals fitted with custom orthotics (with heel postings). They have been working for me. But they are a little too wide. I have a narrow foot, and so many "comfort shoes" are made in wide widths. Just putting orthotics in any shoe is not the answer. Height, firmness, close fit and shock absorption come into play, and it is a fine balance.
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