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PTTD and Surgery

Posted by Charles C on 1/20/02 at 12:15 (070655)

I have been having pain and swelling around the ankle joint and bone for about a year. In December my podiatrist diagnosed PTTD and recommended immediate surgery, a tendon transfer, Achilles tendon lengthening, and a bone transfer. (This after viewing x-rays and MRIs.) Since this would involve cutting all three major tendons in the foot, not to mention cutting up bone, I am getting a second opinion from a foot and ankle orthopedic surgeon. I am also trying to get all the information from the web as possible. That is part of my problem.

I am familiar with the three stages and I do have noticeable pronation in the left foot, BUT, I can do a single heel lift with no pain at all if the foot is 'warmed up' after stretching and exercise. There is slight pain if I do a single heel lift from a cold start, like sleeping. In fact I can do repetitive heel lifts with no problems. The problem is in pain and swelling after resting - it's a stiffness type problem. After warming up, there is only the swelling and tenderness in the area above and below the ankle joint.

Since diagnosis I have been using the Alznner othodics daily with stiff soled shoes. I have also changed my workout routine significantly (which I think exacerbated the problem). I used to jog 60 flights of stairs in the morning and 72 flights of stairs in the afternoon, 5 days a week. I stopped and went to a low impact 30 minute elliptical in a gym in the afternoon and a 25 minute fast walk around the neighborhood in the morning.

In the 3 weeks since starting this routine, the swelling is much less, the stiffness is less and the pain is much much less. Not gone, but not bad either.

I believe the swelling was primarily due to the pronation pushing the ankle bone against a low rise exercise shoe side wall. My stiff sole hiking boots and Wellingtons, with the alznner orthodics, feel great. I actually have hours of zero pain during the day. Since I can do single heel rises, I can't believe the tendon is gone. In fact the greatest pain I have is after getting up in bare feet, both the Achilles and PT tendons feel so tight that it hurts to walk until they stretch out a bit. I even curl my left foot a bit to walk on the outside to give the tendons time to stretch out. After 4-6 steps I can walk normally in bare feet with minor discomfort. After putting shoes on, there is hardly any pain at all.

Any comments or suggestions?

Re: PTTD and Surgery

wendyn on 1/20/02 at 16:25 (070672)

Charles, I am not a doctor...and you probably won't want to hear what I'm going to suggest.

Your change in workout is probably a great improvement from what you were doing...but is there any chance of convincing you to switch to biking and/or swimming at least for a while?

Cross training is great for working different muscle groups, and it sounds like you really need to give your feet a break. At least until after you get your second opinion.

Re: PTTD and Surgery

Ed Davis, DPM on 1/21/02 at 14:57 (070780)

Surgery generally is not advisable with stage 1 PTTD and often not with early stage 2.

Physical therapy may be needed to stretch the tight achilles. Custom orthotics can help progression of PTTD especially if severe overpronation is present. A prefabricated orthotic may feel more comfortable due to its' relative softness and flexibility but may not provide the desired relief of tension on the PT tendon.
Ed

Re: PTTD and Surgery

paula on 1/21/02 at 18:52 (070804)

hi there i'm not a doc but was diagnosed with severe pttd. the doc who wanted to do a bone fusion said i'm in stage 6 wich is rich cause there arn't that many stages. he said i must have fusion right away. next doc said physical therapy and afos would probably get me out of this. so i'm going with that. it is good to get more than one opinion i think. keep us posted on what is working for you please.

Re: PTTD and Surgery

Charles C on 1/22/02 at 18:15 (070908)

wendyn - I wish I could swim, but here the pools are few and far between and I will try a bit more biking in the gym.

Thanks for all the responses. We switched insurances this year so I have to go through a new referral process and won't be able to see my 2nd opinion until the end of Feb.

The ankle feels better and better all the time. The more I use the elliptical in the gym, the more flexible it feels. I've started wearing my hiking boots, very stiff sole, and the alznners all the time instead of athletic shoes. The swelling is also much less.

I'll keep everyone up to date as it goes.

Re: PTTD and Surgery

paula on 1/22/02 at 19:10 (070913)

i forgot to say i also do ice massge on my tendon swelling as well. it seems to help. i think a pod here told me about that or maybe my physical therapist

Re: PTTD and Surgery

Ed Davis, DPM on 1/24/02 at 16:49 (071154)

The second opinion sounds like a good idea.
Ed

Re: PTTD and Surgery

wendyn on 1/20/02 at 16:25 (070672)

Charles, I am not a doctor...and you probably won't want to hear what I'm going to suggest.

Your change in workout is probably a great improvement from what you were doing...but is there any chance of convincing you to switch to biking and/or swimming at least for a while?

Cross training is great for working different muscle groups, and it sounds like you really need to give your feet a break. At least until after you get your second opinion.

Re: PTTD and Surgery

Ed Davis, DPM on 1/21/02 at 14:57 (070780)

Surgery generally is not advisable with stage 1 PTTD and often not with early stage 2.

Physical therapy may be needed to stretch the tight achilles. Custom orthotics can help progression of PTTD especially if severe overpronation is present. A prefabricated orthotic may feel more comfortable due to its' relative softness and flexibility but may not provide the desired relief of tension on the PT tendon.
Ed

Re: PTTD and Surgery

paula on 1/21/02 at 18:52 (070804)

hi there i'm not a doc but was diagnosed with severe pttd. the doc who wanted to do a bone fusion said i'm in stage 6 wich is rich cause there arn't that many stages. he said i must have fusion right away. next doc said physical therapy and afos would probably get me out of this. so i'm going with that. it is good to get more than one opinion i think. keep us posted on what is working for you please.

Re: PTTD and Surgery

Charles C on 1/22/02 at 18:15 (070908)

wendyn - I wish I could swim, but here the pools are few and far between and I will try a bit more biking in the gym.

Thanks for all the responses. We switched insurances this year so I have to go through a new referral process and won't be able to see my 2nd opinion until the end of Feb.

The ankle feels better and better all the time. The more I use the elliptical in the gym, the more flexible it feels. I've started wearing my hiking boots, very stiff sole, and the alznners all the time instead of athletic shoes. The swelling is also much less.

I'll keep everyone up to date as it goes.

Re: PTTD and Surgery

paula on 1/22/02 at 19:10 (070913)

i forgot to say i also do ice massge on my tendon swelling as well. it seems to help. i think a pod here told me about that or maybe my physical therapist

Re: PTTD and Surgery

Ed Davis, DPM on 1/24/02 at 16:49 (071154)

The second opinion sounds like a good idea.
Ed