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thanks lis and an exception:posterior tibial tendon dysfuncion

Posted by paula on 1/05/02 at 16:26 (068848)

thank you for all your effort to make us aware of these machines and the excellent results. here is a possible exception to the use of them. i have severe pttd (posterior tibial tendon dysfuncion). as i understand it from the cazillion doctors i saw if this tendon doesn't hold up the arch then pf is the result, gotta make tendon stronger and compensate with afo devices. just healing the soft tissue won't be a lasting cure for me. i wonder how many with pf here have some level of pttd. docs, any opinion? till recently they just did drastic hideous surgery that fused bones and sounds to me like it left folks with a painful stump to hobble on for life. but lately there are doctors and physical therapists and orthotists who have developed methods of actually rehabbing severe pttd for some folks. takes a long hard time but i am lucky to have found a team of these guys. well lucky might be a bit of a stretch.

Re: thanks lis and an exception:posterior tibial tendon dysfuncion

Dr. David S. Wander on 1/05/02 at 16:48 (068853)

Posterior tibial dysfunction treatment depends on the severity and 'stage' fo the problem. (The condition has 'stages', depending on the severity). If the problem is not too severe therapy can be of benefit as well as supportive devices such as an AFO or orthoses. In severe cases, the tendon is attenuated (stretched out) and will no longer support the arch of the foot. In these patients it is very difficult if not impossible to raise up on the toes of the affected foot. There are surgical procedures that 'tighten' up the tendon or use other tendons that are transferred to perform the function of the posterior tibial tendon. However, once bony adaptation has occurred, the only really effective procedure is a fusion. Although it is a drastic procedure, it usually provides excellent long term results. There is a device that is almost a hybrid between an AFO, ankle brace and custom orthoses called a RICHIE BRACE. You may want to ask your medical professional about this device. It was designed specifically for PTT dysfunction. There is a correlation between posterior tibial dysfunction and plantar fasciitis, simply because there is increased pronation with PTT dysfunction, therefore causing increased stress upon the plantar fascia. Ask your doctor about the RICHIE BRACE. It may be helpful for your condition.

Re: thanks lis and an exception:posterior tibial tendon dysfuncion

wendyn on 1/05/02 at 18:02 (068862)

Paula, I have had problems with my post tib tendon since I was 11. I am 33.

Re: thanks lis and an exception:posterior tibial tendon dysfuncion

BG CPed on 1/05/02 at 18:31 (068864)

Paula, That is a very common condition unfortunatly. If you have exausted all other conservative measures surg may be indicated. I noted you said you worried that it would leave you 'with a hideous lump of a foot'. One of the Doctors that refers to me does a procedure he calls an 'all american' that is very effective.

There are many variations and degree of procedures for this condition but if the foot is that bad and you have tried all conservative treatments you may want to consider. There are some that will just fuse it and some that will reconstruct the whole foot and try to maintain or regain more normal function. The Doctors that do the heavy recon and do it well are specialized and not located in every city.

There are ways to locate or ask around for one that specializes in this, you dont want to just take the first opinion since there are variations on that procedure. It is human nature to want to pick the easiest, fastest less complicated procedure but the simple fusion is not always the best choice. More complex reconstructiion may sound worse but if it results in a more normal functioning foot you may be better in long run.

Be picky in your choice of Doctors. You can have a guy that builds garages all day and one that does fine finish work, they are both carpenters but you want the right one for the job. You may mention tour location and some of the Docs on here may be able to steer you in the right direction

Re: What are these different stages of PTTD?

Beverly on 1/07/02 at 14:20 (069079)

I have PF and PTTD. I got the PTTD almost healed over the summer until I had a near fall in late Oct. and relaspsed. I'm wearing an ASO Ankle Stabilizer, and it seems to be helping. At least I'm not in constant pain anymore, and my massage therapist says my ankle looks and feels better. What I like about this particular brace is that it doesn't take up so much room in my shoe. I am being a very good girl and staying off my feet most of the time.

I have no idea what stage my PTTD is. That is something I didn't know about until it was mentioned on the Board this week. How are the different stages classified?
Thanks,
Beverly

Re: thanks lis and an exception:posterior tibial tendon dysfuncion

Dr. David S. Wander on 1/05/02 at 16:48 (068853)

Posterior tibial dysfunction treatment depends on the severity and 'stage' fo the problem. (The condition has 'stages', depending on the severity). If the problem is not too severe therapy can be of benefit as well as supportive devices such as an AFO or orthoses. In severe cases, the tendon is attenuated (stretched out) and will no longer support the arch of the foot. In these patients it is very difficult if not impossible to raise up on the toes of the affected foot. There are surgical procedures that 'tighten' up the tendon or use other tendons that are transferred to perform the function of the posterior tibial tendon. However, once bony adaptation has occurred, the only really effective procedure is a fusion. Although it is a drastic procedure, it usually provides excellent long term results. There is a device that is almost a hybrid between an AFO, ankle brace and custom orthoses called a RICHIE BRACE. You may want to ask your medical professional about this device. It was designed specifically for PTT dysfunction. There is a correlation between posterior tibial dysfunction and plantar fasciitis, simply because there is increased pronation with PTT dysfunction, therefore causing increased stress upon the plantar fascia. Ask your doctor about the RICHIE BRACE. It may be helpful for your condition.

Re: thanks lis and an exception:posterior tibial tendon dysfuncion

wendyn on 1/05/02 at 18:02 (068862)

Paula, I have had problems with my post tib tendon since I was 11. I am 33.

Re: thanks lis and an exception:posterior tibial tendon dysfuncion

BG CPed on 1/05/02 at 18:31 (068864)

Paula, That is a very common condition unfortunatly. If you have exausted all other conservative measures surg may be indicated. I noted you said you worried that it would leave you 'with a hideous lump of a foot'. One of the Doctors that refers to me does a procedure he calls an 'all american' that is very effective.

There are many variations and degree of procedures for this condition but if the foot is that bad and you have tried all conservative treatments you may want to consider. There are some that will just fuse it and some that will reconstruct the whole foot and try to maintain or regain more normal function. The Doctors that do the heavy recon and do it well are specialized and not located in every city.

There are ways to locate or ask around for one that specializes in this, you dont want to just take the first opinion since there are variations on that procedure. It is human nature to want to pick the easiest, fastest less complicated procedure but the simple fusion is not always the best choice. More complex reconstructiion may sound worse but if it results in a more normal functioning foot you may be better in long run.

Be picky in your choice of Doctors. You can have a guy that builds garages all day and one that does fine finish work, they are both carpenters but you want the right one for the job. You may mention tour location and some of the Docs on here may be able to steer you in the right direction

Re: What are these different stages of PTTD?

Beverly on 1/07/02 at 14:20 (069079)

I have PF and PTTD. I got the PTTD almost healed over the summer until I had a near fall in late Oct. and relaspsed. I'm wearing an ASO Ankle Stabilizer, and it seems to be helping. At least I'm not in constant pain anymore, and my massage therapist says my ankle looks and feels better. What I like about this particular brace is that it doesn't take up so much room in my shoe. I am being a very good girl and staying off my feet most of the time.

I have no idea what stage my PTTD is. That is something I didn't know about until it was mentioned on the Board this week. How are the different stages classified?
Thanks,
Beverly