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PTTD - I lost the thread

Posted by Dr. Marlene Reid on 1/21/01 at 22:46 (037044)

To Nancy and Wendyn,

I lost track of where the previous comments were. I just wanted to say a few things, in general. First of all, I don't mean to direct treatment, it would be irresponsible of my to recommend treatment without actually examining. Wendyn, are you sure you were diagnosed with progressive flat feet and not flexible flat feet. Progressive flat feet is usually diagnosed when you are in your 40's (it goes with the 3 f's: forty, female, fat). PTTD has to do more with excessive wear and tear of the tendon. Nancy, the early symptoms will be general and vague. It may be possible to identify if the tendon is involved with a thourough examination. I did look up location #8 and it was referenced to the plantar of the foot and not the ankle. PTTD affects the ankle, behind the ankle bone which is where the tendon courses and up onto the medial side of the foot. (I do like discussing these things with you all because you are so much better educated in the foot than my average patient- I guess that is what a chronic problem does).

If diagnosed with flat feet at age 11, the treatment choices at that age would include conservative and surgical. After 20 years, you have to ask yourself if any symptoms have progressed (NOT JUST PAIN). Symptoms such as tiredness, increased in the flatness and more importantly, progressive X-ray changes. Personally, I would rather treat a young person surgically rather then wait until painful arthritis sets in. Most orthopedic surgeons will do fusions of the joints, even at an early age. Most of my colleagues in the American College of Foot and Ankle Surgeons would prefer to correct the structures (reconstruction) and attempt to save the joint from becoming arthritic. It sounds like the advice you got regarding 'reconstrive surgery' is to wait until later and would likely involve fusions. Remember, fusion means no more motion at that joint. Very often, other joints are forced to pick up the extra motion and then later become a problem!

Now that I've confused you all even more....

Re: PTTD - I lost the thread

wendyn on 1/21/01 at 23:17 (037045)

It's okay. Hmmm -

I just checked for an update before I went off to bed. Looks like I checked at the right time. I have definately been having problems since age 11. Although between 13 and 19 not much happened. Then I developed a dorsal bunion - rt foot. Had it removed at 23. A couple episodes of PF a few years later, then all hell broke loose about 2 years ago. I've been diagnosed with all kinds of stuff - but everything seems to centre around Post tib tendonitis/TTS/and Pes Planus. I can't find the last write up from my surgeon but I do recall the following phrases from various letters - pardon any spelling errors.

Forefoot varus
Tibial tortion
Pes planus deformities
dorsolateral sublaxation (big word isn't it!?)
gastroc equinus contracture
hypermobile medial column

and he definately said 'progressive deformity' or maybe 'condition'. When I stand barefoot I consciously hold my arches up - otherwise I'd be rollin right in. I've been doing this a long time. My pain level is certainly much greater than 3 years ago. I had a massage last week, masseuase said that the metatarsal bones in my right foot do not line up the way they do in my left foot.

Bottom line?

I have really sore feet.

And I appreciate all the advice I can get!

Re: PTTD - I lost the thread

wendyn on 1/21/01 at 23:18 (037046)

Oh - and I don't have the 'F's - I weigh 112 lbs..there's a picture of me on the social support pages under frequent visitors.

Re: To Dr. Reid

Pauline on 1/22/01 at 19:49 (037110)

Please don't object to my jumping in and asking you a question. Dr. Reid
just what is done for Progressive Flat Feet with recurring plantar fasciitis?
Thank You

Re: To Dr. Reid

Dr. Marlene Reid on 1/24/01 at 12:03 (037217)

Hi Pauline,

Posterior tibialis tendon dysfunction occurs when the posterior tibialis tendon is weakened, inflammed or partially torn (and each of these things contributes to the other two) and can not do its job in holding up the arch.

Several things can be attempted: orthotics (usually do not work), physical therapy to strengthen (can really work with a good therapist once any inflammation has subsided) and helping get rid of the contributing factors: excess weight, pronation (orthotics and shoes with excellent heel support will help the pronation even in they don't fully help the PTTD) and a whole slew of surgical options.

If inflammation is the only problem, cast immobilization or crutches usually work and then PT may work. If there are multiple tears, surgery may eventually be necessary.

Re: To Dr. Reid

matt on 1/24/01 at 12:38 (037222)

About how long would it take for immobilzation to work, before being able to try pt?

Re: To Dr. Reid

Dr. Marlene Reid on 1/24/01 at 14:30 (037228)

Matt, I would try an initial period of 3 to 4 weeks. It could be in a removable cast. I also didn't comment on injecting steriods to the tendon sheath before. Its really hard to inject just the sheath and not the tendon itself so I usually don't inject unless I know for sure there are no tears. I wouldn't go more than 4 weeks in a regular cast. A removable cast could be worn longer and some therapy could be started before full muscle strengthening began.

Re: PTTD - I lost the thread

wendyn on 1/21/01 at 23:17 (037045)

It's okay. Hmmm -

I just checked for an update before I went off to bed. Looks like I checked at the right time. I have definately been having problems since age 11. Although between 13 and 19 not much happened. Then I developed a dorsal bunion - rt foot. Had it removed at 23. A couple episodes of PF a few years later, then all hell broke loose about 2 years ago. I've been diagnosed with all kinds of stuff - but everything seems to centre around Post tib tendonitis/TTS/and Pes Planus. I can't find the last write up from my surgeon but I do recall the following phrases from various letters - pardon any spelling errors.

Forefoot varus
Tibial tortion
Pes planus deformities
dorsolateral sublaxation (big word isn't it!?)
gastroc equinus contracture
hypermobile medial column

and he definately said 'progressive deformity' or maybe 'condition'. When I stand barefoot I consciously hold my arches up - otherwise I'd be rollin right in. I've been doing this a long time. My pain level is certainly much greater than 3 years ago. I had a massage last week, masseuase said that the metatarsal bones in my right foot do not line up the way they do in my left foot.

Bottom line?

I have really sore feet.

And I appreciate all the advice I can get!

Re: PTTD - I lost the thread

wendyn on 1/21/01 at 23:18 (037046)

Oh - and I don't have the 'F's - I weigh 112 lbs..there's a picture of me on the social support pages under frequent visitors.

Re: To Dr. Reid

Pauline on 1/22/01 at 19:49 (037110)

Please don't object to my jumping in and asking you a question. Dr. Reid
just what is done for Progressive Flat Feet with recurring plantar fasciitis?
Thank You

Re: To Dr. Reid

Dr. Marlene Reid on 1/24/01 at 12:03 (037217)

Hi Pauline,

Posterior tibialis tendon dysfunction occurs when the posterior tibialis tendon is weakened, inflammed or partially torn (and each of these things contributes to the other two) and can not do its job in holding up the arch.

Several things can be attempted: orthotics (usually do not work), physical therapy to strengthen (can really work with a good therapist once any inflammation has subsided) and helping get rid of the contributing factors: excess weight, pronation (orthotics and shoes with excellent heel support will help the pronation even in they don't fully help the PTTD) and a whole slew of surgical options.

If inflammation is the only problem, cast immobilization or crutches usually work and then PT may work. If there are multiple tears, surgery may eventually be necessary.

Re: To Dr. Reid

matt on 1/24/01 at 12:38 (037222)

About how long would it take for immobilzation to work, before being able to try pt?

Re: To Dr. Reid

Dr. Marlene Reid on 1/24/01 at 14:30 (037228)

Matt, I would try an initial period of 3 to 4 weeks. It could be in a removable cast. I also didn't comment on injecting steriods to the tendon sheath before. Its really hard to inject just the sheath and not the tendon itself so I usually don't inject unless I know for sure there are no tears. I wouldn't go more than 4 weeks in a regular cast. A removable cast could be worn longer and some therapy could be started before full muscle strengthening began.