Options for a falling PTTD

Hi Doc,

I know you're busy, but I have been having a problem for several years and I would really appreciate it if you could help me out.

A couple years go i injured my PTTD (I believe). I wore very high heels daily for a few months and got a bunion. I immediately switched to flats and began exercising at the same time. I think this was too much for my PTTD which was probably very weak from all that high heel wearing. One day when trying to go up on tippy toe, I pulled something BAD. For a YEAR I was in excruciating pain- to the point where I could not even walk a block. I wore over the counter orthodics and flats and it took a little over a year, but the site has stopped hurting as much. The site by the way is the inside of my ankle and I can even see a puffy part right below my ankle that isn't on my other foot. I went to doctors about it at the time and they all told me that I had a very strong foot, low arches, wear the over the counter orthodics, and I'll be cured in no time at all.

My problem is that while the foot has "healed", it still hurts when I stand. I can't even take a shower standing up for more than 10-15 mins, and forget about standing and cooking in the kitchen! What's very odd is that my foot feels best in heels, or when I wear sneakers and stuff them with the $10 arch supports. I can't ever walk bare foot because my foot gets so tired. I'm told I have a limp, and I do notice that my right knee and hip hurt if I walk walk more than a mile. All this being said, please keep in mind that this is leaps and bounds better than it used to be when I first injured it.

I would very much like to see a doctor about it again but I'm a little hesitant since the first time around they were so wrong. It didn't "heal in no time at all", and I took it "easy" like they recommended. I used to be a gymnast and a dancer. Both of those activities are done either barefoot with split heel jazz shoes- which means no arch support. These activities seem so foreign to me now. I'm only 25 and I've been living with this since I was 23.

I know my arch on my right foot is lower than my left foot, and I think that all the reliance on my left foot has started to squash that arch too- although there's no pain thank goodness. I am wondering if you could tell my how invasive surgery would be- I am otherwise healthy, young and I am definitely willing to spend the 1-2 years recovering from this. Do you know if everyone who has surgery has to wear orthodics for the rest of their life? Are all arch surgeries very, very invasive? Or can some be quicker to heal from with better rates of success?

I feel like my foot problems aren't as far along as some of the other people on this website but I know that PTTD is a degenerative disease, and I'm wondering if my preemptively doing something now if I would be saving myself some trouble down the road. I know surgery is never the first option, but if you see this through my eyes, I've been living with this for a while, have tried different options, and I just can't imagine living the next 50-70 years of my life like this.

Also, I live in the US and use Kaiser. Although I'm willing to switch if there's a better surgeon/clinic in the Portland OR metro area.

I've done my best to answer all the questions you require, but if there's anything else I can explain in more detail, please let me know

Thank you for your time

[FootDoc]

What you are asking for is advice as to the type, appropriateness and prognosis of surgery for a condition for which I hear no clear diagnosis having been offered. You have made clear that your statements are not based on any recent conclusions by a qualified doctor, and that you deemed your past professional medical experiences non-productive. Having no ability to examine you or in any why confirm the conclusions which you have thus far drawn through your personal findings, I could have no idea what your specific diagnosis might be or whether or what surgery or other treatment might be a viable option. The place to start with all of this is a definitive diagnosis, not just a "thought" which you "believe" to be at the center of your complaints. Instead of starting from the beginning, you seem to want instead to be jumping on a moving cart headed in no particular direction. This is fraught with much danger. I would recommend that you spend time making a good doctor selection and put your foot in his/her hands.

No. I am not asking for the "type", "appropriateness" and "prognosis" for surgery. My question clearly asked how invasive foot surgery tends to be and whether everyone who has surgery for their PTTD needs to wear orthotics for the rest of their life. I also asked if some types of surgery for the arch had better rates of success than others.

Nowhere in my (extremely detailed) question did I ask you for a prognosis of ME. I simply gave you details involving my background to give you a better understanding of where I'm coming from.

I understand that this is free advice, and you get what you pay for, but you don't need to be rude and condescending. I've already booked an appointment with a specialist but it's three weeks out. I only wanted some information to think about or research until then so I would be prepared for my office visit.

[FootDoc]

I can work only with the words of the questioner, and I cannot imagine what you might have meant by "I am wondering if you could tell my how invasive surgery would be" other than that you were asking PRECISELY about the TYPE of surgery, the APPROPRIATENSS of the surgery and its PROGNOSIS. What else might one expect in answer to such a request other than the very topics which you now claim you were not asking? Furthermore, I stand by my statement that you have offered no clear diagnosis other than what appears to be your personal, lay conclusions, beliefs and feelings about what is causing your symptoms. You went on to assert that your previous doctors were all wrong about your case, so, in essence, you offered nothing on which a responsible professional here could comment. If pointing that out to you, advising that attempting to obtain answers to problems which are yet to be properly diagnosed and upon which you might act is fraught with danger and recommending that you see a good doctor for a real examination and diagnosis is thought by you to be either rude or condescending, then I guess you didn't really come here for information other than what you already wanted to hear. Your job, when you actually see that doctor, is to tell your story in a clear and cogent manner, and not to come prepared with diagnoses of your own and treatments expectations based on those diagnoses. You will be paying a doctor for that, so it would have been better for you to have spent your research time in picking a good doctor rather than preparing to come in with a diagnosis of your own. Otherwise, you'll probably conclude that he/she is also rude and condescending.

Quite the contrary, I thought my doctors were perfectly nice people who unfortunately, could not fix what was wrong at the time. However, you seem to be of the opinion that anyone who says anything I don't want to hear is rude and condescending.

Instead of actually answering the questions asked- for the second time, you continue to further comment on what you interpret my original questions were. This is a waste of time for everyone involved.

My "personal" diagnosis aside, do you actually know the answers to the following questions:

1) Do the majority of people who undergo arch surgery need to wear orthodics for the rest of their lives?

2) Do different types of surgeries for the arch have different success rates?

For all you, or I know, it may never come to this for me, but this is something I am curious about regardless.

If you don't know the answers, it's okay to just say that.

[FootDoc]

How nice your doctors were is irrelevant. One does not go to a doctor for "nice." One goes to be relieved of whatever ails him/her. What you said was,

"I would very much like to see a doctor about it again but I'm a little hesitant since the first time around they were so wrong."

Obviously their being "nice" was not what you were looking for. Being "right" WAS. But because they were "so wrong," you have no diagnosis on which to then base your question regarding surgeries. Thus, the issue and the reason that your questions cannot be answered is that you are asking about an undefined diagnosis and an undefined surgical procedure. If you had asked about a specific type of surgery in question 1 and a specific diagnosis in question 2, perhaps you could be offered an answer. But you didn't and I can't.

I didn't say that I think that anyone who says something you don't want to hear should be termed rude and condescending, I said that YOU apparently think that. Why else would you have accuse me of being rude and condescending simply because I didn't supply you with the answer you desired, but instead told you why I could not?

The lesson to be learned if you chose to is that questions that cannot be answered get no answer other than for an explanation as to why they cannot be answered. No one could know the answer to your question unless one presupposes what your question is. So, not that I or anyone else knows all the answers, but in THIS case. I don't know the answer because I don't know what your question is.

Can we end this now or do you want to beat a dead horse?

Well, like I said earlier- you get what you pay for.

It's clear why you don't charge anyone- you would actually have to provide some value for that. Your "bedside" manner for lack of a better term makes it clear why you advise people on the internet and not in person.

If nothing else, I'm very much looking forward to my appointment with a real doctor. Maybe he'll figure out what's wrong and maybe he won't, but at least I can count on him to not spend my entire visit psychoanalyzing questions and being a complete waste of time.

[FootDoc]

You are misinformed if you think that forums such as this are replacements for actual doctor visits. Many folks . . you are one of them . . post here because they have been not satisfied with the ability of their chosen doctor(s) to cure them. In many of those cases, based on the dearth of cogent information offered here, I can suspect that at least part of the reason for their doctor's failure may have been the complainant's lack of good patient skills in defining his or her problem and offering accurate feedback. Somehow, you have unreasonable expectations that a doctor reading a sketchy description of a failed treatment, especially as often mis-remembered or mis-characterized by the writer can somehow, without examination, offer accurate specific advise as to what might be done. In YOUR case, you offered a supposed diagnosis, of which you in no way offered professional confirmation, and then went on to ask about some supposed but unidentified surgery which you simply identified as "invasive surgery" (what surgery is other than invasive?). And now, as before, you are displease with the results. I'll bet that this scenario will be repeated, whether with a doctor in person or online, and that others will no doubt receive your unwarranted disdain. Seems to me that whether you paid for care or not had and probably will have no bearing on your satisfaction. I think you need to develop some good patient skills, as the doctor/patient relationship is a two-way street which requires participation on both ends. Learn to do YOUR part and perhaps your doctors will better function to satisfy your needs.

Please do not take my disdain for you as a disdain for all doctors.

You asked for very specific questions:
* where does it hurt
* how long has it hurt for
* how bad is the pain
* what where you doing when it started
* what have you done for it so far
* anything relieve it
* what have you been told about it so far
* is it affecting your ability to work or play sport
* do you have any other sorts of symptoms
* what country you are in (different countries have different health systems; different scopes of practice of different disciplines; access to care might be different)

As such, I DID my job in answering these to the best of my knowledge. Maybe you should do YOUR job. Oh wait- you don't actually have a job, you just volunteer on a forum board.

No where did you ask for my personal doctor's opinion, so please don't get your panties all bunched up because I didn't provide one. Additionally, you should probably stop assuming that the way people on this forum treat you is how they treat their doctors in person. People who actually practice with clinics and hospitals are qualified, competent and get straight to the point. They don't waste time assuming personality traits of their patients. But then I'm not your patient- no one on this forum is.

I'm not saying you don't necessarily know what you're doing, but I am saying that there is probably a reason you are on the internet and not in an actual clinic. And it has nothing to do with my (or any) forum writer's so called "disdain" of their doctors.

And don't flatter yourself, everyone on here understands this is no substitute for a doctor's visit. Especially when the most useful thing you suggest IS an actual doctor's visit.

Finally, maybe you should do YOUR part in outlining exactly what you want before people waste their time writing to you. It would save you a temper tantrum down the road when people don't write exactly what you want to hear in their questions.

[FootDoc]

WOW . . . How'd you get to be such an angry lady in only 25 years. I feel assured that I am neither the first nor the last doctor, or person for that matter, with whom you have had such issues.

The list of questions to be asked were posted by the Administrator, not me. I ask only for a lucid explanation of a problem and a clear question to which a response can reasonably be offered based on the information given. As I have previously stated, you made a diagnostic assumption and used terms about which you apparently know little. To wit: You stated that you BELIEVE that you injured your PTTP and you titled your post "Options for a falling PTTD," seemingly not knowning that PTTD stands for Posterior Tibial Tendon Dysfunction, and you can't injure a dysfunction, nor can a dysfunction fall. Furthermore, you have not established any scenario outside of your "belief" that you do indeed have PTTD. You went on to state that you saw a doctor and that he said that you have "very strong feet" whatever THAT means, and low arches, and recommended store-bought in-shoe support. Sorry Charlie . . but I did not seem to hear a diagnosis of PTTD. But what the hell . . . You're gonna stick with your "belief" anyhow . . . and you expect. . . nay DEMAND that I will buy into it. Then you say you feel best in heels, but that you wear sneakers, which, in case you have never noticed, have no substantive heel raise. Then, out of no where you say, "I was wonder if you could tell me how invasive surgery would be." Where did THAT come from? The most diagnosis you have from a doctor is that you have low arches and "very strong feet," Who mentioned surgery and what kind of surgery was mentioned? I'll bet you made THAT one up too, so I suppose I need to be clairvoyant to respond to THAT one. So then you tell me that you are hesitant to see a doctor because the last one was totally wrong . . but you liked him anyhow. Young lady . . . perhaps YOU can make some sense out of what you're saying, but I can't and I bet the doctor who was totally wrong couldn't either.

Finally, I have no idea of where you get the idea that in general folks in this forum respond other than positively to my help. Over the years, I've given about 5000 responses including those on the predecessor to this version of the forum . . . the overwhelming majority having been well receive. Sure I run into a few such as you who come here with overblown expectation and a chip on their shoulder which is easily revealed when they don't get exactly what they want. Frankly, I think you need more help than a podiatrist is qualified to offer you . . maybe some anger management for those occasions when you don't get what you want. You can continue to rant if you like, but I, for one, am finished with you. Go annoy some other doctor.

You can feel "rest assured" about whatever you want, you're still an internet "doctor" at best. But it's a free country and even you have the right to believe whatever you want. I've already stated multiple times I have no issues with my doctors- only you. Yet....you've said it was irrelevant how I feel about my doctors..... Clearly, it doesn't count that I like my personal doctors, only that I dislike you.

And to clarify you're point about my contradictory statements- I wrote that I feel better when I wear sneakers with arch supports- so yes Einstein, that does raise my heel. Either you're blind to what people write or have a poor grasp of the English language- both of these points seemed to sail by you.

I've never had issue with you saying that I should see a doctor. Regardless of how hesitant I am, that's common sense. But the way you respond was completely uncalled for, like what was I thinking having an opinion of my own?? That's only something a licensed doctor can do! Well, I don't need a medical degree to know a hack when I see one.

And your record of posts and replies speak from themselves. I've read through some of your "thousands" of replies and guess how many of them are conversations just like this? I am just one person online who writes in occasionally. You're a so-called doctor who has spent a ridiculous amount of time replying to everyone who doesn't like what you have to say or puts you down. Does anyone else see a blatant self esteem issue here? The fact that you take the time to respond to every individual who disagrees with you is kind of sad. Real doctors are busy. I'm just a grad student that's interning, so I have time on my hands- what's your excuse?

Oh an in regards to the questions that the "Admin" posted, here's your reply:

Thank you, Admin. I hope that your pleas will fall on less deaf ears than have mine. Unfortunately, the same sort of lack of preparation and thought is often seen even when patients come to the office, but at least professionals are being paid there for their patience with such patients and most of us actually receive far less guff and annoyance from those who so fail in their preparation and subsequently often receive less than optimum service. That guff and annoyance is then frequently expressed here when they haven't gotten what they paid for, and even more so when they are told here in no uncertain terms that their presentations are inadequate. I guess that's just part of the fun in my participating here.

A little bitter, are we? Maybe if you had a real clinic and real patients, you could take your annoyance out on them? Just a thought...unless the real reason you're on here is because you've had your license taken away already and have no other outlet to "practice".

Typical foot doc response. Refuses to provide any answers other than see your doctor, becomes enraged if any dare challenge him, insults the "questioner" by then saying things like "WOW . . . How'd you get to be such an angry lady in only 25 years. I feel assured that I am neither the first nor the last doctor, or person for that matter, with whom you have had such issues." Predictable, predictable, predictable. Also the incessant reminders of how he is providing "free" advice as if everyone should bow in his honor. He's obviously equally rude in his real world work because HE has A CHIP ON HIS SHOULDER about "nice" doctors. That's telling...any time someone says their dr is nice, he asserts that they can't be competent and nice at the same time.
Well it's obvious that this dude gets his jollies by insulting people through a computer and in fact spends most of his free time doing so. He thoroughly enjoys arguing with people. This poster followed the posting instructions yet still got grief. Why the administrators would want to manage a site and allow this pompous podiatrist to post is the real question.

I agree. I thought it was interesting he was surprised I was so angry at "only 25 years of age"...like there's some magical age threshold you need to surpass before becoming angry.

People generally become angry when dealing with fools.

The so-called foot doctor is NOT a credit to his profession.

Gotta disagree with you KGirl. Been following this one and the Foot Doc is right to have a beef with you. Sounds like you made up a condition to me too and you want the doctor to comment on some surgery that wasn't even prescribed for you and you don't know what it is. I don't know what you want from the guy but I've read many of his other answers where people wrote in with real fact and he seems to give what sound like inteligent answers to me. You had no call to get nasty with him and you deserved to get back from him. So stop complaining and move on if you don't like what you got. Go find another doctor who you like but then complain that he didn't help you. BTW, you do sound kinda angry for someone still wet behind the ears. I guess now you'll be mouthing off to me too. Takes all kinds I guess. You just need to grow up and stop thinking everybody owes you. They don't.

Hank

Hank you sound a lot like your friend the foot doctor....are you sure you're not one and the same?

Originally Posted by Spacks

Hank you sound a lot like your friend the foot doctor....are you sure you're not one and the same?

lol...yes another TYPICAL foot doc behavior--always writes a post which agrees or compliments himself. BIZZARE behaviour

It's obvious to me that you have pttd i've had it years and my knee and hip hurt on the other side too.
I can't walk far and have the same swelling.
there's two types of surgery for this i've had the first and now i'm awaiting the second which rebuilds the foot with a tendon transfer.
my ankle is so weak but i have bought a brace from amazon that helps

facebook.com/PosteriorTibialTendonExerciseDevice

Huh??????

What is going on here? I have PTTD diagnosed by 2 different Drs an Xray and MRI and I dialed into this site thinking I might get some advice.

This thread looks like some kind of online service for people who want to have an on line argument (J Alfred Proofrocks - "Tedious argument of insidious intent") sort of an odd twist on the dating service.