Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Posterior tibial tendon dysfunction

Posted by Anne K on 11/13/02 at 08:02 (100001)

I am considering surgery for my torn tendon and am looking for feedback from individuals who have had the surgery.

Re: Posterior tibial tendon dysfunction

Dr. Zuckerman on 11/15/02 at 14:40 (100294)

What specific questions do you have ?

Re: Posterior tibial tendon dysfunction

Anne K on 11/27/02 at 06:54 (101239)

Has the surgery been successful and were the individuals glad that they went through it? I understand the recovery is a minimum of 2-2 1/2 months.
Also, after recovery were they back to their normal physical activities prior to the tear? I am/was a runner and would like to be able to walk without limping and pain as I have now.
Thank you,

Re: Posterior tibial tendon dysfunction

edith t on 12/01/02 at 13:20 (101557)

Hello there,
I too was just diagnoised with pttd, right now i'm in a boot for four weeks
and after that he said some kind of brace?, and then orthotics.my question is does this ever heal without surgery?
HELP!

Re: Posterior tibial tendon dysfunction

Anne K on 12/05/02 at 21:49 (101912)

Sounds like you are lucky, Mine is a complete tear and the only way to heal it is surgery. 6-8 weeks in non weight bearing cast and 3-4 in walking cast! Not sure if I am going to go that route or not, Have scheduled an appointment with an orthopedic surgeon and consult with a Physical Therapist. Good luck keep in touch and let me know how you turn out.

Re: Posterior tibial tendon dysfunction

edith t on 12/07/02 at 12:50 (102097)

ANNE,
LET ME KNOW WHAT THE SURGEON HAS TO SAY? I DIDNT KNOW THAT P.T. WOULD HELP. THIS IS LIKE A REAL NITEMARE,ISN'T IT?

THEY FINALLY TOOK ME OUT OF THE BOOT,I AM GRADUALLY GETTING INTO MY SHOES.
ON THURS. I HAVE AN APPT. TO HAVE SOME SORT OF BRACE MADE.THIS IS ABOUT IT UNTIL THURS. YOU TAKE CARE! AND TAKE IT EASY.

Re: Posterior tibial tendon dysfunction

Anne K on 12/11/02 at 07:27 (102675)

I went to the Orthopedic surgeon only to find out his specialty is shoulders and arms! He referred me to someone who specializes in foot and ankle. Can't get in until January 10! I do have an appointment with the Physical Therapist on Monday 12/16 she will check me over and see if there is a chance I could get relief with an orthodic and looking at surgery as a last resort. Is yours a complete tear? My understanding is that a complete tear will not heal and the only thing that will make it better is surgery. Are you a runner? I ran for 20 yrs and it was devastating when they told me I couldn't run anymore! But it hurts when I walk fast and for exercise.
Well, I am off to the club to lift weights! Have a great day and please stay in touch! Good luck...
Anne

Re: Posterior tibial tendon dysfunction

matts on 12/12/02 at 22:12 (102865)

Over the past couple of years I have tried boot, cast, pt and other things for posterier tibial tendon problem. Last year got a brace, also called an afo and got a lot of relief while wearing it for 8 months. I would sure try it. It did not cure the tendon for me and a recent mri shows more fluid and possible damage to tendon than 15 months ago. I am now scheduled for surgery to work on the ptt in January. I have a different tendon, on outside of foot, pereoneal brevus that is torn and has to be repaired now too, it hurts as bad as ptt or worse now most of the time. The orthopedic foot and ankle dr thought something else was wrong since brace did not allow healing of ptt, so we checked on arthrtits andthen the mri showed cause of pain this time. Good luck to you maybe the brace will work, my dr really thought it would help and it did relieve alot of pain for a long time.

Re: Posterior tibial tendon dysfunction

edith t on 12/13/02 at 07:10 (102889)

ANNE,
SORRY TO HEAR THAT YOUR HAVING ALL THIS PROBLEM TRYING TO GET AN APPT.
I KNOW THE FIRST THING THEY DID FOR ME WAS A BOOT CAST. I WENT YESTERDAY AND WAS FITTED FOR A ARIZONA AFO,AND HOPEFULLY AN ORTHOTIC AFTER THAT.
NO, I ONLY HAD A LOW GRADE TEAR AND NO, I DO NOT RUN.
I PRAY ALL THE ABOVE WORK, I'M CERTAINLY NOT LOOKING FORWARD TO SURGERY!
I HOPE ALL GOES WELL WITH YOU! YOU SOUND LIKE YOUR ACTIVE...TRY NOT TO DO TO MUCH UNTIL YOU SEE THE DOC. KEEP IN TOUCH.

Re: Posterior tibial tendon dysfunction

edith t on 12/13/02 at 07:15 (102890)

IT'S GOOD TO HEAR OTHER PEOPLES INPUT
WHATS YOUR NEXT OPTION? HOPE ALL GOES WELL.

Re: Posterior tibial tendon dysfunction

pala on 12/13/02 at 17:42 (102981)

can you tell us who you are getting the arizona from and where. some of us may want to try that if they live near there.

Re: Posterior tibial tendon dysfunction

edith t on 12/14/02 at 12:54 (103099)

YES THE WEB SITE IS CUSTOMFOOTWEAR.COM
THEY ARE LOCATED IN ARIZONA,AND ALSO THE PITTSBURGH AREA.HOWEVER ONE WILL NEED A SCRIPT FROM THEIR DOCTOR AND I'M SURE HE IS AWARE OF THE ARIZONA AFO-

Re: Posterior tibial tendon dysfunction

Dr. Zuckerman on 11/15/02 at 14:40 (100294)

What specific questions do you have ?

Re: Posterior tibial tendon dysfunction

Anne K on 11/27/02 at 06:54 (101239)

Has the surgery been successful and were the individuals glad that they went through it? I understand the recovery is a minimum of 2-2 1/2 months.
Also, after recovery were they back to their normal physical activities prior to the tear? I am/was a runner and would like to be able to walk without limping and pain as I have now.
Thank you,

Re: Posterior tibial tendon dysfunction

edith t on 12/01/02 at 13:20 (101557)

Hello there,
I too was just diagnoised with pttd, right now i'm in a boot for four weeks
and after that he said some kind of brace?, and then orthotics.my question is does this ever heal without surgery?
HELP!

Re: Posterior tibial tendon dysfunction

Anne K on 12/05/02 at 21:49 (101912)

Sounds like you are lucky, Mine is a complete tear and the only way to heal it is surgery. 6-8 weeks in non weight bearing cast and 3-4 in walking cast! Not sure if I am going to go that route or not, Have scheduled an appointment with an orthopedic surgeon and consult with a Physical Therapist. Good luck keep in touch and let me know how you turn out.

Re: Posterior tibial tendon dysfunction

edith t on 12/07/02 at 12:50 (102097)

ANNE,
LET ME KNOW WHAT THE SURGEON HAS TO SAY? I DIDNT KNOW THAT P.T. WOULD HELP. THIS IS LIKE A REAL NITEMARE,ISN'T IT?

THEY FINALLY TOOK ME OUT OF THE BOOT,I AM GRADUALLY GETTING INTO MY SHOES.
ON THURS. I HAVE AN APPT. TO HAVE SOME SORT OF BRACE MADE.THIS IS ABOUT IT UNTIL THURS. YOU TAKE CARE! AND TAKE IT EASY.

Re: Posterior tibial tendon dysfunction

Anne K on 12/11/02 at 07:27 (102675)

I went to the Orthopedic surgeon only to find out his specialty is shoulders and arms! He referred me to someone who specializes in foot and ankle. Can't get in until January 10! I do have an appointment with the Physical Therapist on Monday 12/16 she will check me over and see if there is a chance I could get relief with an orthodic and looking at surgery as a last resort. Is yours a complete tear? My understanding is that a complete tear will not heal and the only thing that will make it better is surgery. Are you a runner? I ran for 20 yrs and it was devastating when they told me I couldn't run anymore! But it hurts when I walk fast and for exercise.
Well, I am off to the club to lift weights! Have a great day and please stay in touch! Good luck...
Anne

Re: Posterior tibial tendon dysfunction

matts on 12/12/02 at 22:12 (102865)

Over the past couple of years I have tried boot, cast, pt and other things for posterier tibial tendon problem. Last year got a brace, also called an afo and got a lot of relief while wearing it for 8 months. I would sure try it. It did not cure the tendon for me and a recent mri shows more fluid and possible damage to tendon than 15 months ago. I am now scheduled for surgery to work on the ptt in January. I have a different tendon, on outside of foot, pereoneal brevus that is torn and has to be repaired now too, it hurts as bad as ptt or worse now most of the time. The orthopedic foot and ankle dr thought something else was wrong since brace did not allow healing of ptt, so we checked on arthrtits andthen the mri showed cause of pain this time. Good luck to you maybe the brace will work, my dr really thought it would help and it did relieve alot of pain for a long time.

Re: Posterior tibial tendon dysfunction

edith t on 12/13/02 at 07:10 (102889)

ANNE,
SORRY TO HEAR THAT YOUR HAVING ALL THIS PROBLEM TRYING TO GET AN APPT.
I KNOW THE FIRST THING THEY DID FOR ME WAS A BOOT CAST. I WENT YESTERDAY AND WAS FITTED FOR A ARIZONA AFO,AND HOPEFULLY AN ORTHOTIC AFTER THAT.
NO, I ONLY HAD A LOW GRADE TEAR AND NO, I DO NOT RUN.
I PRAY ALL THE ABOVE WORK, I'M CERTAINLY NOT LOOKING FORWARD TO SURGERY!
I HOPE ALL GOES WELL WITH YOU! YOU SOUND LIKE YOUR ACTIVE...TRY NOT TO DO TO MUCH UNTIL YOU SEE THE DOC. KEEP IN TOUCH.

Re: Posterior tibial tendon dysfunction

edith t on 12/13/02 at 07:15 (102890)

IT'S GOOD TO HEAR OTHER PEOPLES INPUT
WHATS YOUR NEXT OPTION? HOPE ALL GOES WELL.

Re: Posterior tibial tendon dysfunction

pala on 12/13/02 at 17:42 (102981)

can you tell us who you are getting the arizona from and where. some of us may want to try that if they live near there.

Re: Posterior tibial tendon dysfunction

edith t on 12/14/02 at 12:54 (103099)

YES THE WEB SITE IS CUSTOMFOOTWEAR.COM
THEY ARE LOCATED IN ARIZONA,AND ALSO THE PITTSBURGH AREA.HOWEVER ONE WILL NEED A SCRIPT FROM THEIR DOCTOR AND I'M SURE HE IS AWARE OF THE ARIZONA AFO-

Re: Posterior tibial tendon dysfunction

Connie A. on 3/12/03 at 18:40 (112691)

Hello!

I just found this threaded discussion, several months after it was over, so don't know if anyone will read or reply to this. But it can't hurt to try. I am curious to know what progress you have made in the last months. I just had an MRI done and learned that the foot pain I've had for the last six months is due to a partial tendon tear (don't know yet if its the tibial tendon). I'll learn more tomorrow when I see the doctor and he looks at the film. I'm hoping that a boot or cast will be the answer, since I'm very wary about surgery.

I don't run either, but did run one day in September, which is when the problem began. I used to do a lot of swing dancing, and walking, and hope I will be able to again someday. It would be good to know what your experience is, since you wrote that you did not have a full tear either.

Thanks!

--Connie

Re: Posterior tibial tendon dysfunction

Anne K on 3/13/03 at 08:10 (112725)

I do have a complete tear. I have seen 3 different Orthopedic surgeons and finally came to the conclusion I am not going to have surgery. For me and my situation it would be a tendon transfer and they would have to break my heel bone and that would mean being in a cast with my toes straight out for 10 weeks! Right now I am seeing a Physical Therapist and she has given me some exercises to do to strenghten the other muscles and I will be seeing the orthopedic surgeon in April, he wants to keep an eye on the status of the ankle/arch. My running days are over, but if I can at least walk and exercise without pain that is what is important to me.
Good luck with your appointment and let me know how things develop.

Re: Posterior tibial tendon dysfunction

Connie A. on 3/17/03 at 17:00 (113240)

I think my situation might be similar to yours: partial tear, not a runner, wary of surgery. Your last posting on the threaded discussion was several months ago (in December). How are things going with your treatment? I very much hope that the conservative methods, brace, afo (?) have worked for you.

I just learned that if the arch supports that two different doctors have recommnended don't work, the next step would be to try a brace. Did you try customized arch supports at any point in your treatment?

Thank you in advance for any further insights you can give me on this condition, from your experiences with it thus far!

--Connie

Re: Posterior tibial tendon dysfunction

sue s. on 4/10/03 at 06:20 (115825)

Hello to anyone with pttd-I have a partial tear in my posterior tibial tendon and tendonitis in my achilles tendon. I have been in orthotics for a month and have had physical therapy. My foot swells after I have been on it for an hour or so. Have pains around my ankle and arch. Am going to see my foot and ankle specialist tomorrow. This has been going on since Ded,. If anyone is in my situation, I would appreciate it if you would let me know. Have you had surgery? My life seems to have come to a halt. I am even being treated for depression.
Any replies welcom.

Re: Customized orthotics, PTTD

Connie A. on 6/15/03 at 13:45 (121924)

Hello Anne,

I'm still grappling with the PTTD, and thought I might try to find out how you're doing with it, since it's been a couple of months since our email exchange! Customized orthotics have had mixed effects for me. Since they gave me a bad knee (in the other leg), I couldn't wear them for a long time, till that had cleared up (it's still there, but more bearable, I had that orthotic adjusted twice). I'm interested in knowing what your experience has been with orthotics, how fast they helped, whether you're still using them, what they are like (do they have a cork heel post, for each foot, as mine do?) . . .

On another, related topic, have you heard anything about the possibility that NSAIDS, non-steroid anti-inflammatory drugs (like Ibuprofen) actually impeding the healing process for tendons, especially in cases of chronic pain (rather than after the initial trauma)? Have you taken, do you take any medication, or have the orthotics eliminated all of the pain?

Do you know other people who have this condition ('know' as in email connection or more directly)? I find it very helpful to know about other people's experiences, but haven't been able to find many people (contactable), on-line or otherwise, with this problem (aside from someone who works nearby who cut her PTT with a shard of glass in a freak accident. She had surgery to reconnect the tendon and is healing very well).

Hoping to hear from you!

--Connie

Re: Posterior tibial tendon dysfunction

Connie A. on 6/20/03 at 16:21 (122471)

Hello Edith,

It's been a while, I know, since you were in this on-line discussion (nearly 7 months), but I thought it was worth asking how things have turned out for you with PTTD. Did you get orthotics and did they work for you? I have been wearing orthotics for about a month now, and I just reinjured the tendon, by doing an exercise the physical therapist gave me, which didn't hurt. If I had remembered a piece of advice that Anne K. had sent me earlier, then I would have known to stop BEFORE the pain begins . . .
I think it is really important for people who have this condition to be in touch with others going through it too, or who have gone through it. We CAN help each other!

Re: Posterior tibial tendon dysfunction

Rich on 3/17/07 at 19:59 (225345)

I am also a runner for many years. My PTT is partially torn and after wasting about 6 months in a boot, brace, taking it easy etc., the tendon is still useless for running -- although I can walk pretty well.

My surgery is in two days. I wold be very interested inknowing what happened to you and for how long was it before you could walk and then run.
Thanks,
Rich

Re: Posterior tibial tendon dysfunction

Anne K on 3/18/07 at 19:38 (225405)

I have not run for 4 years, I walk a lot. I was told not to run. I did not have surgery and faithfully wear an orthodic in my shoes. I have very little pain. About 6 months I saw my orthopaedic surgeon and he was surprised that I have not had to have surgery. Good luck with your surgery and let me know how you do. I guess I have just resigned myself to not running, which was really hard after running for 20 years.

Re: Posterior tibial tendon dysfunction

Mary A on 3/26/07 at 23:30 (226045)

I was also a runner and need surgery now, but I got two different opinions from two surgeons. One wants to do a reconstruction with a tendon transfer. The other wants to do a triple arthrodesis, with three joint fusions. I would be interested in anyone's experience with these surgeries.

Re: Posterior tibial tendon dysfunction

Brandon W on 4/16/07 at 15:37 (227890)

I had an injury while playing roller hockey 7 years ago that caused my partial tear. Stupid me, I kept playing on it resting it only a week or so. Over the years it has worsened to where I now wear a custom made orthodic. It has caused some knee and hip pain in the same leg. I have seen a surgeon a couple of times over the years and each time he did not recommend surgery due to the massive recovery time and risk in the procedure causing other complications like a stiff foot or infection. Also as a sales rep I need to be able to drive (it is my right foot) and could never take off that much time. I have tried two other things that have helped. One is prolotherapy to the tendons surrounding the posterior and to the posterior itself. This is a procedure where they inject a solution that actually reinjures where the tendons and ligaments connect to your bones (as that is normally where the partial tear or damage occurs. The reinjury promotes additional healing to occur and actually make the tendons or ligaments stronger. This has helped with the tendons/ligaments in the inner part of my ankle creating a stronger support structure for this ankle since the PTTD is stretched to the point of not functioning normally. Check it out on the web for a doctor near you who will do it.

Also - check out the book 'Pain Free' by Pete Egoscue. It is available for like $10 on Amazon .com It has some really good and unique excercises (that the physical therapist did not have) that help keep the muscles surrounding my ankles strong.

I would still possibly be interested in the surgery if I could find a doctor that would do it as I am only 31 and active in sports and would like to get the thing back to normal. How has the surgery gone for anybody out there who has had it. Is it worth it.

Brandon

Re: Posterior tibial tendon dysfunction

Mary Lou S. on 5/06/07 at 12:51 (229191)

Brandon--I appreciated your post re prolotherapy and the book recommendation. I have just been diagnosed with PTTD and my recent MRI shows a complete tear of the posterior tibial tendon. I am being fitted for an Arizona brace as conservative treatment, but wondered if you knew if prolotherapy works on tendons that are completely torn. I will see the one surgeon in our area that performs prolotherapy in about two weeks. Also, I was interested in the kind of physical therapy exercises that you found to be helpful for this condition. Thanks for sharing your experiences. I will post information that may help you and others as I work through this uncomfortable situation. Who would have guessed????? --Mary Lou S.

Re: Posterior tibial tendon dysfunction

Dorothy on 5/06/07 at 14:42 (229198)

Mary Lou S -

Forgive me for intruding into your comments to Brandon for a moment but I am also considering prolotherapy and am gathering information. Here is a website that you might want to take a look at:
http://www.prolotherapy.org/

Rick R, another poster on this website, responded to my general question about this procedure not too long ago so you might want to do a message search under his name. He reported that it did not help him for PF, that it was painful and expensive. Another person I know reported that her physician used it for his own parent's back pain with no success. I am considering it for knee problems but am wary because of the inconsistency of the results, the expense and other factors.

As you no doubt know, former US Surgeon General C. Edward Koop, is a great proponent of prolotherapy. He had great success it for his own back and (I think) shoulder pain and also uses it himself on his own patients. There are many other 'testimonials' about successful outcomes. So it's apparently quite a mixed bag.

I hope you find help and healing whatever you decide. If you decide to try prolotherapy, I hope you will report here, as I will do too, if I try it. Best wishes.

Re: Posterior tibial tendon dysfunction

Dorothy on 5/06/07 at 15:35 (229200)

My error - I think his name is C.Everett Koop. Sorry.

Re: Posterior tibial tendon dysfunction

Susan K on 5/30/07 at 23:34 (230840)

Hello,

I have had both procedures; a triple artrhrodesis on my left foot seven years ago and the subtalar fusion and tendon transfer on my right foot last July. For me, it depended on the severity of injury and other symptoms. The same surgeon did both surgeries. I think I needed the more major operation on the left foot because the condition had been going on for several years and I had a failed tendon reconstruction prior to the big operation. The second foot, we caught the tear very quickly and moved quickly to surgery.

As to post op pain, recovery, physical therapy and outcome, I would rate both procedures equally.

There is also a procedure that involves tendon transfer and reconstruction but not fusion of the calcaneous. I think your best bet is to ask each surgeon why he or she made the recommendation. I hope this helps.

Re: Posterior tibial tendon dysfunction

Bobbie W. on 6/03/07 at 11:03 (231007)

Just found this site and also have been diagnosed with PTTD Stage 3. Am older and not an athlete so don't want the pain, inconvenience, and time involved with surgery. I need some 'encouragement' about non-invasive approaches to handling this problem. Any advice? Bobbie W.

Re: Posterior tibial tendon dysfunction

Susan K on 6/03/07 at 11:22 (231009)

In my experience, with PTTD stage 3 and stage 2+, there are really no non-invasive ways to deal with this problem. If you want to be able to walk and just do the activities of daily life, at stage 3+ I believe surgery is the only option. I had stage 3+ and without surgery I am sure I would not be walking today. The same is true of stage 2+, which I had in my other foot. I don't know what you mean by 'older' but I was 56 when I had my second surgery.

I am sorry, but personally I cannot be encouraging about non-invasive approaches with PTTD at this advanced stage. What does your doctor say?

Susan K

Re: Posterior tibial tendon dysfunction

Julie on 6/03/07 at 14:46 (231029)

Bobbie, you've posted your message on a very ancient thread. You should re-post it as a new post on the Ask the Doctors message board, where you will get professional advice. If you don't know how to do that, go to the home page, where it should be clear. I have no idea whether the one response you've had is correct - you should post your question where it can be read and responded to by the doctors who contribute here.
.

Re: Posterior tibial tendon dysfunction

denise e on 6/11/07 at 17:42 (231402)

i had a triple arthrodesis back in dec of 07 i just had two screws removed june 4th does the pain ever go away this is my fourth surgery

Re: Posterior tibial tendon dysfunction

Susan K on 6/11/07 at 21:09 (231413)

The pain does eventually go away but you need to give it at least a year. I had one in 2000 and it took that long to feel right again, but once I felt right again, I was very happy that I'd had the surgery.

Re: Posterior tibial tendon dysfunction

Gail S on 6/13/07 at 22:02 (231528)

Glad to hear someone speak of happy results post surgery. I see the ortho doc tomorrow to schedule surgery for a high grade possible complete tear....Tried the orthodics and physical therapy....neither helped so I'm ready to go! For anyone interested something I will be doing is electro magnetic treatment a few days after surgery to speed the healing and shorten my overall recovery time. Luckily I am the Clinic Director of a facility that does this treatment,,,,,heres the website for others interested in what I'm going to be doing to heal quicker....www.amri-mi.com

Re: Posterior tibial tendon dysfunction

Elaine L on 6/19/07 at 15:01 (231832)

I just had a total right knee replacement 10 weeks ago. I need the other knee done too. First I must have reconstructive surgery for posterior tibial tendon dysfunction on the right foot first so it won't throw out the alignment of the new knee. Does anyone else have any experience with knee and foot connection? I have worn orthotics for 30 years, so this is not a new thing. Foot is very pronated and heel out of place.
I am not looking forward to the two foot reconstructions and then another knee replacment. Because of arthritis in my joint, I cannot do the bone fusion thecnique.

I had a lot of problem with pain from the knee replacement so am wondering how long I can put off the foot surgery. Anyone have any experience or knowledge about this? I just found this site and am thankful for a place to share information.

Re: Posterior tibial tendon dysfunction

stu p on 6/20/07 at 11:12 (231855)

Had calcaneal osteotemy gastronemicus ressession and fdl tendon transfer on june 5th placed in hard cast june 15 and having a boot put on july 5th...how long till im walking without crutches and how long to resume normal activities im 50 and in real good shape

Re: Posterior tibial tendon dysfunction

Gee S on 7/20/07 at 21:39 (233287)

Hi Elaine,
The proble I have is similar to yours. I have pronated foot ( I wasn't using any orthitics until now), with very large navicular bone and an accessory bone. I am 26 now and my job required lots of running around. Six months back I got MRi done for both the foot and got to know I have torn posterior tibial tendon of both the foot. It was grade one tear, But still dortors are suggesting me to undergo flat foot reconstruction surgery in both the foot , one after another... quite scary. I have been put under ankle brace for 4 months now... had to resign my job... My life has come to a halt...I am seeing some improvement, but not significant.
I am thankful to fine this site to share information.
Wish You good luck with your leg treatment... and get well soon.
Thanks for sharing information.

Re: Posterior tibial tendon dysfunction

shristi s on 8/04/07 at 07:51 (233948)

HEllo, you are probably the first person I have come across who has a knee and ankle(pttd) problem symultaneously. I am in the early stages of my problem(3 months in). Looks like this is a long term thing. Has any one mentioned to you/ have you found out why the two could occur simultaneously? how did your problem start?

Re: Posterior tibial tendon dysfunction

Susan K on 8/05/07 at 14:42 (233975)

These two conditions are both due, at least in part, to my hereditary flat feet. My knee had been injured three times and operated on twice, and eventually the damage from the previous injuries just got to the point that it needed to be replaced. I have always been knock kneed, from my flat feet. My guess is that when I got the new knee, and that part of my leg was properly aligned, that the ptt, clearly already weak, was stressed by the new leg alignment and tore as a result. My doctors basically concur with this assessment.

My problems clearly stem from my hereditary flat feet. The knee injuries were from a direct fall as a child, patellar tendinitis from running in my youth, and torn cartilege from just walking down stairs.

As to this being along term thing, the knee problems built over time. And then the foot just happened. It is now a year since both procedures and I am excellent.

I hope this answers your questions.

Re: Posterior tibial tendon dysfunction

Elaine L on 8/05/07 at 19:02 (233983)

I haven't checked this site for awhile and was pleased to find anyone that had the same problems with knee and feet. I first had the foot problems since after my 2nd child was born. I think the knee problems were partially because of the flat feet and pronation because the inside of my knees were the worst bone on bone. It cause my bone to bow. This was corrected with the total knee replacement. I am to see my foot surgeon this week to ask how long I can wait to have the foot surgery without it pulling the new knee out of alignment. I am not ready for another major surgery. However, my feet are in pain when walking, and I know I face the two foot surgeries and another total knee replacement.
I will write again after I visit the surgeon. I am 61. I also have osteoarthritis in knees and feet. Thanks for writing. I was beginning to think I was alone.

Re: Posterior tibial tendon dysfunction

Elaine L on 8/05/07 at 19:10 (233984)

Can you tell me how far apart you had the knee replacement and the foot surgery? Also exactly what procedures did you have done to your foot?
I am curious as to the recuperation and pain. I had my tkr in April and I will see the foot surgeon this week to determine how long I can wait to have the foot surgery. Thanks for writing and good luck.

Re: Posterior tibial tendon dysfunction

Charlotte M on 12/23/07 at 23:02 (241202)

I was diagnosed with PTTD last year and am now in an Arizona Brace.
It doesn't always help. I have significant heel pain.
I also have flat feet and a partial drop foot on that side.
I have consulted two feet surgeons and I don't even know what stage I am in.
How do I know if I have a tear? I had an MRI, but don't nothing was mentioned.

I just know even with the brace my heel is very painful.
Surgeon's have wanted to do a fusion but I was told by both it would be non weight bearing for 6 months. I can't do that. I live alone.
I am 55 and need help in understanding these stages and what is a tendon transfer involve.
I would appreciate anyone who can assist me.
Thank you. Please write me at the below address.

Thank you!
Charlotte in PA.
philylady at hotmail.com

Re: Posterior tibial tendon dysfunction

Robert M. on 1/09/08 at 11:25 (241742)

I also suffer extreme pain in my right foot (stage III PTTD).My Doctor is pushing surgery which I would like to avoid. I am curruntly wearing a prescribed brace and am taking celebrex on Drs. orders.Also, I work on my feet 10 hours a day. Any positive advise would be greatly appreciated. Thank You.

Re: Posterior tibial tendon dysfunction

Dr. Wedemeyer on 1/09/08 at 21:58 (241778)

Robert what type of surgery is your doctor opting for? What type of brace are you wearing (Arizona type-solid ankle boot or Richie brace-foot plate with upright straps)?

You should post this in the ask the doctors section as this thread is very old, you will probably get more responses.

Re: Customized orthotics, PTTD

william r on 2/13/08 at 11:29 (243161)

I am waiting , waiting on our nation's wonderful health care system to decide whether I am worthy enough for a custon-made brace. I don't know if I have stage 2, 2 1/2, or 3. Who can afford 3 months (or more) off of work for surgery?

Re: Posterior tibial tendon dysfunction

John on 2/13/08 at 22:53 (243186)

Hey Philly lady you might want to try a Dr. Rudloph in Bethlehem Pa, I think he is in the OGG building. Really good ankle only doctor.

Re: Posterior tibial tendon dysfunction

Marie on 2/16/08 at 20:48 (243274)

Hello, I just had the surgery in Dec. 11, 2007 for PttD. I am depresssed and tired of this cast and everything. I had to wear the cast for 2 months and now I am in a boot-I have to wear it until March the 3rd. I dont know what the dr. is going to do next. I was diagnosed and then I tried to go without the surgery but I couldn't because it hurts to me. I hope that my foot heals properly-it has been doing very well. I am just ready to walk again. I could not stand the cast on my leg so they had to split the cast and use ace bandage to help hold it on my leg. I hope to be walking soon. I am in the boot and using 25% of my body weight on the foot right now, I am suppose to increase to 50% and so on until I am walking pretty good without my walker. I hope you success-if you have the surgery and I will respond back with any questions.

Re: Customized orthotics, PTTD

Marie on 2/16/08 at 20:51 (243275)

Please read my post.It is on the board somewhere. I just had this surgery.
marie

Re: Posterior tibial tendon dysfunction

Donna E on 2/22/08 at 09:43 (243516)

I have been dealing with p.t.t.tear, and tendonisis in both feet, wore boot cast on foot for 8 weeks, and was basicly off of feet most of the time trying to heel,also do ice and moist heat 3x a day, take an anti-inflamitory, had orthodics made that support flat foot and hold up side of foot, am now doing theropy 3x week for 6 weeks, and find all is helping, still have pain but, much better, and am able to be on feet more, and walk for longer periods of time.I recommend sports medicine theropy. Theropy has strenghtened me, along with ultra sound, deep tissue massage, mild stretching-hang in there it isn't easy but, beats surgery I hope to avoid that. I will always have to be careful, and know I can't do all I want to but, have to learn your limitations. Along with this I also have arthritis,and fibromylgia. Dr. has recommended richie brace but,I really don't want that, its hard enough getting orthodics in shoes. Theropist recommended motion control sneakers by brooks, as he said, they take getting use to like the orthodics did but, are very helpful.I was born with flat feet have had pain for several years and am thankful to be at the place I'm at now. I am 60 years old but, have dealt with all this a long time.I will continue exercises at home when theropy is completed which is only 4 more sessions.

Re: Posterior tibial tendon dysfunction

Stuart W. on 2/22/08 at 17:39 (243540)

I have suffered with PTTD in both ankles now for about 10 years. I didn't know what it was until diagnosed about 1 year ago. I went for my first pair of custom orthotics about 7 years ago and that really helped for about 2-3 years, then it came back even worse. I won't reiterate what so many have said here, we all know this is an insidious problem. I have considered surgery but honestly can't get myself to do it...yet.

I have tried the custom orthotics, like the Arizona ones, but haven't really put in the time or effort necessary to see if they really help. They are large and bulky, hard to get on and don't fit well in my shoes. One of these days I will really give them a true test. I have tried assorted ankles braces and other types of stabilizing wraps and devices, none have helped. I think, like what probably happens to many of us, I just don't walk a lot and sit whenever I don't have to stand. Compensation I guess.

I have tried as many types of shoes and sneakers as I could find with little noticeable effect. The pain of walking persists. I have one slim ray of hope and I would like to share it. I have read this forum several times and did not participate until now since I really had nothing to offer. Here goes...

Among my many tries to find a shoe that would help I ran across MBT's: http://www.swissmasaius.com/

I went to Zappos.com, and searched the web, for reviews. The theory behind these shoes, which you can read about on their web site, sounded so ridiculous and hokey that I almost didn't order them. I am very pleased that I did. I was very intrigued by the many people who swore by these shoes. I could not find anyone who suffered from PTTD who tried them but still I liked what they were saying. I consulted with my foot doctor, who happened to also recently learn of these (in fact he was wearing a pair) and so I took the plunge. I have been so disappointed and disheartened by my previous attempts that I just figured this was another leap of faith. I'll get to the point. I have found a measure of relief with these funky shoes. They are ugly, heavy and bizarre but I have tested them thoroughly and can state that they are helpful. I find I can walk with them, on a concrete or tile floor, for about twice as long as I could before. This is not to say my ankles do not hurt, just takes longer. These are not a miracle shoe, but they did help me and I wanted to pass that along. They feel strange and walking in them is a bit unsettling at first. One down side to these shoes are in trying to stand still. I know that sounds ridiculous but due to the rounded heel and toe you must constantly rock back and forth to remain stationary. This becomes rather annoying. I find myself holding on to walls, chairs, anything available to steady myself. Don't let this stop you, for walking they are very good and do offer significant help with my PTTD.

I wish all of us luck and hope that I have contributed something to help any of you with your pain.

Stuart

Re: Posterior tibial tendon dysfunction

Dr. Wedemeyer on 2/22/08 at 18:42 (243542)

Word of caution here regarding MBT's for PTTD. This shoe is nothing more than a retail version of a simple heel-to-toe rocker sole and NOT indicated for PTTD whatsoever.

Stuart may find that due to the increasing pathology in his PTT that this type of shoe actually accelerates the progression of PTT dysfunction and puts added stress on the Achilles tendon. I have witnessed a number of cases of people with no prior history of PTT or Achilles dysfunction prior to wearing the MBT.

A rocker sole modification is only beneficial for PTTD when using a solid ankle AFO such as the AZ brace wwhere dorsiflexion is fixed at 90 degrees.

Re: Posterior tibial tendon dysfunction

karen c on 2/23/08 at 09:35 (243583)

I am just going through the consultation process for pttd relief but have found Accupuncture realy good at relieving my pain. I highly reccomend it

Re: Posterior tibial tendon dysfunction

Stuart W. on 2/23/08 at 20:09 (243608)

I would surely not want to cause anyone, including myself, any more pain then we are already experiencing. As for the MBT's I honestly think it is the thick soft cushioning in the sole that has helped me, not the 'heel-to-toe' construction. I have always found that walking on carpet feels much better then a hard surface. The MBT's have a 'spongy' cushion in the sole that I cannot find in any sneaker or shoe. You feel less impact when walking.

I am not a physician and have no medical knowledge. I have worn the MBT's on and off now for about 6 month's. I will report back if I feel any changes in my condition. I do know this; no matter what shoe I wear my ankles hurt very quickly, with the MBT's I can walk longer before the pain becomes too severe. They are not a panacea, they just feel better to me. More then that I do not know.

PS: I do wear them with my regular custom orthotics in place of the inner shoe pad. I don't believe they are wide enough to accommodate a large orthotic like the AZ brace.

Re: Posterior tibial tendon dysfunction

Dr. Wedemeyer on 2/23/08 at 22:19 (243623)

Stuart I did not mean to suggest that you would or that you intended anything but to help.

In early PTTD a well designed custom orthosis and good shoes can effectively control progression of the problem initially. Often though the problem progresses and a shoe of this type is not indicated nor is an in-shoe orthosis.

Rocker soles were created to offload plantar pressures (and aid in propulsion when deficits exist), so what you have in essence is a retail device that does effectively help people with quite a few problems in the foot in a clinical setting.

Among the conditions that I would not suggest this shoe are PTTD and equinus due to a short or tight heel cord (Achilles).

Re: Posterior tibial tendon dysfunction

Stuart W. on 2/24/08 at 12:56 (243641)

Dr. Wedemeyer, thank you for the information, much appreciated. To the best of your knowledge are there any shoes you would recommend for PTTD sufferers? Do you feel that PTTD can ever be resolved without surgery?

Lastly, are you saying that a conventional in-shoe orthosis is not recommended for PTTD? Should I no longer wear mine?

Than you,

Stuart

Re: Posterior tibial tendon dysfunction

Dr. Wedemeyer on 2/24/08 at 16:08 (243653)

Stuart as I stated previously early PTTD can and does fare well with the appropriate footwear and an well designed in-shoe orthosis. A UCBL device is particularly suited for this type of pathology. Along with physical therapy patients often find relief with this regimen although further progression is possible and likely.

PTTD is graded in stages I-IV and a further distinction is made between early and late stage II. From late stage II on the foot defect becomes more pronounced and the subtalar joint becomes more rigid. Conservative care in these stages is typically a brace such as the Richie or a solid ankle gauntlet such as the Arizona AFO.

I have had great success with some very tragic and painful cases of late PTTD with these orthoses, others become so inflexible and painful that the doctors choose fusion surgery (triple arthrodesis). Either way the supportive shoe and possible modifications are a large part of the success with orthotics, bracing or post-surgically.

Stuart unfortunately an MBT is not my first choice (if ever) for this type of pathology unless you are in a fixed ankle gauntlet brace and even then I can list numerous shoes that are of a better construction and that are a better choice than that shoe. The list of possible manufacturers is just too lengthy to address here. A certified pedorthist in your area is a great first step and your doctor may have a referral for you.

You should ask your physician his/her opinion and always take their advice, especially over any advice from the internet. I am almost certain that your doctor did not suggest this shoe for your PTTD.

Re: Posterior tibial tendon dysfunction

Deb H on 3/14/08 at 17:53 (244562)

My 77 year old mother in Alabama has been diagnosed with PTTD by an orthopedic surgeon. After many tests, experimenting with a brace, etc. surgery involving a tendon replacement is scheduled for the end of next week. She is in relatively good health, not very active, and has dad to take care of her during the recovery. However, I would like to hear from somebody else that this is a wise move for someone her age before she goes throught with it i.e. that the total ordeal will most probably improve her quality of living. (The person her doctor recommended for her to talk with about the operation and recovery is considerably younger.) My mom cannot walk now without pain and is, to her credit, willing to go through with the procedure as a last resort. Thanks for any feedback.

Re: Posterior tibial tendon dysfunction

Dr. Ed on 3/14/08 at 19:08 (244572)

Deb:

I would generally tend to utilize conservative treatment for a person of your mother's age. Although there are 77 years old who are active and athletic so we would need to know more about your mother. Please explain what you mean by 'experimenting with a brace?' Devices used to treat PTTD range from custom molded orthotics for stage 1 PTTD to Ritchie braces for stage 2 to ankle gauntlets like the Arizona brace for stage 3.

Dr. Ed

Re: Posterior tibial tendon dysfunction

Lynn J. on 3/19/08 at 16:25 (244760)

Has anyone ever tried a chiropractor for treatment?

Re: Posterior tibial tendon dysfunction

Dr. Wedemeyer on 3/19/08 at 18:56 (244769)

Lynn

I would see an MD (foot & ankle orthopedist) or DPM prior to seeking chiropractic care for PTTD.

Early PTTD can be helped with PT and orthoses. There are issues involved in PTTD that most chiropractors have never assessed or treated, not the least of which is prescribing an appropriate orthosis for PTTD.

There are DC's with lower extremity and orthotic training but they are not the norm.

Re: Posterior tibial tendon dysfunction

Lynn J. on 3/19/08 at 22:10 (244780)

Thank you Dr. for your response. I am currently under the care of a podiatrist who has me in custom orthodics. I guess I was wondering if a chiroprator would be able to help with massage therapy. I am set to start physical therapy for 6 weeks to see if that helps. I would love to be able to run again (let alone do calf raises at the gym.) I was born with cursed flat-feet and never had problems until my mid-30's. Already had a case of plantar fasciitis (hurt like heck).

Re: Posterior tibial tendon dysfunction

Dr. Wedemeyer on 3/20/08 at 10:24 (244787)

PT is indicated for PTTD, massage is not. Massage in fact is not medically necessary for any condition that I am aware of, although there are specific soft-tissue techniques that are medically necessary when performed by a DC or a PT.

Re: Posterior tibial tendon dysfunction

mballing on 3/27/08 at 23:42 (245201)

Hello,

I am 32 and a mom of a 3 year old and 8 month old. I have PTTD, I believe stage III and am having surgery next month. I have someone coming into the house to help me 10 hours a day for 6 weeks until I can bear weight on my foot. Does 6 weeks seem long enough?

I have 3 questions I am hoping anyone can help answer:

1) I am nursing my baby. What types of medication do they usually prescribe? I am trying to determine if I need to wean.

2) I have severe hip pain on my right side. I am in an Arizona brace currently, but previous to the brace I had a hard cast and walking cast and which is when my hip pain started (exactly one year ago). Is this common? It almost feels like my hip is popping out of socket.

3) Can I do other excersizes that are not weight bearing? For example, sit ups, etc. I am so afraid of gaining excess weight after the surgery.

Any input is appreciated! Thanks in advance.

Maxine

Re: Posterior tibial tendon dysfunction

mballing on 3/27/08 at 23:46 (245202)

I realized after my post, my hip pain is on the opposite side of my foot diagnosed with PTTD. PTTD is on left foot, hip pain is in right hip.

Re: Posterior tibial tendon dysfunction

CarolH on 4/03/08 at 09:54 (245452)

Hi I ruptured my post tibial tendon in my left foor Jan. 2003 and had the surgery to repair Sept 2004. I would not change a thing a did. Yes it wasa very long recovery, daily activities very hard as simple as getting to the bathroom and bathing.I saw probally a total of 5 dr's before I found the most amazing Dr who did not want to fuse bones together. Now 4 years later my foot is completely healed and great No pain at all. But when the Dr. says 2 years for it to heal completely it really is 2 years till you are pain free. I caution do not use just any dr it is a very complicated procedure

Re: Posterior tibial tendon dysfunction

Ruben on 4/14/08 at 09:51 (245819)

Hi Carol thanks for the post.

My Dr. as well has sugested surgery. I am not sure what stage i am in
I was diagnosed with PTTD in Feb. I have been in the boot for about
3 weeks. Things seem to be progressing, with rest, ice, and PT. I recently had the orthotic made, I dont want surgery, can't afford the time off but my job requires me to be on my feet for 12+ hours. What was your deciding factor for surgery, why did you take so long from the time you were diagnosed to the time you actually had surgery. What kind of surgery did you have and where is your dr located.

Re: Posterior tibial tendon dysfunction

Becca r on 4/16/08 at 00:09 (245903)

hi im 16 yrs old i got told i have posterior tibial tendon 2 yrs ago i have gone back 2 my podiatrist because its getting worse. i have to take anti imflammaty pills and buy new shoes and hav physco therapy wat do u think will happen after that, what do you think i should do??? i have othodics. i use to be a runner and that

Re: Posterior tibial tendon dysfunction

Ruben on 4/16/08 at 12:36 (245920)

PTTD is very serious condition if not acted upon quickly. What did the podiatrist say. Are you able to walk. I was diagagnosed early this year i currently have a boot and orthotic to my left foot and using crutches. for arly stages Most important for PTTD is the 'RICE' method for ealy stages of PTTD. Rest, Ice, Compression,and Elevate.

Re: Posterior tibial tendon dysfunction

becca r on 4/16/08 at 14:27 (245931)

she said we will try physio therapy to stretch the muscles and exercise them. um yer i can walk just wen im walking and doing sport at school i get like a pitching pain and wen im standing to long its sore 2 sorry its not alot of information ae i got physio 2day so ill c wat happens and wat they say
thanks

Re: Posterior tibial tendon dysfunction

becca r on 4/16/08 at 20:16 (245955)

hi i went 2 mi physio therapy 2day and got told i have something wrong with the tibial nerve in mi left leg. i hav 2 do exercises. so i dont no if it is pttd but i think it is. um he said on the left side of mi sphine its stiff and the right its springy.

Re: Posterior tibial tendon dysfunction

Ruben on 4/17/08 at 10:47 (245972)

hi becca if you are having foot pain during normal walking and exercise, i would ask the doc for a note to restrict u to no physical activity until u know exactly what u have. I just got back from PT myself. hope u feel better. take it easy & rest.

Re: Posterior tibial tendon dysfunction

becca r on 4/18/08 at 03:24 (246009)

ok thanks for the info ill just tell mi physical education teacher wats happening she should understand. im gonna c how PT goes and if it hasnt got beta after 2 or 3 months ill go c a orthapedic surgeon.

Re: Posterior tibial tendon dysfunction

Ruben on 4/22/08 at 07:44 (246187)

hi carol, what type of surgery did you have. tendon replacements transfers or what? who is your dr. where is he located. I have 3 torn tendons. what do you think your dr would suggest.

Re: Posterior tibial tendon dysfunction

Dee M. on 9/21/08 at 15:24 (250382)

Hi,

Maybe you could tell all of us what the exercise that re-injured the tendon was so the rest of us don't do it? I hope you are feeling better as your message is several years old.

My experience is a failed tendon transfer surgery for PTTD. It lasted 7 years and now the tendon is not functioning which means the muscle is not functioning either. This also translates to constant pain on the outer side from the ankle on up the leg. I am currently waiting for an Arizona Brace to wear the rest of my life - a true fashion statement with whatever kind of oversized sneaker or orthopedic shoe I can find to fit over it - but hey I at least will be able to walk which I can't do right now.

My questions: Will this reduce most of the pain and will I be able to walk almost normally and for pretty good distances? I used to walk pretty fast and could go for 2-3 miles without a problem - am wondering how this will change.

Any help any experienced Arizona brace users can give me is welcome. Thank you all.
Dee

Re: Posterior tibial tendon dysfunction

renee.c on 9/23/08 at 13:16 (250430)

I had an extra nevicular bone that was removed last august, they had to re-attach my ticial tendon, 2 months later it ruptured, my surgeon repaired it after having to shorten it now I am dealing with a torn tendon and was told I would need a bone fusion, has anyone had this? I have 3 children and it is very hard to be laid up after foot surgery however at this time I cant walk on my left foot without severe pain.

Re: Posterior tibial tendon dysfunction

Judy Bard on 6/06/09 at 12:20 (257992)

A few years ago, the space between my right ankle and heel started to hurt real bad when I would go for long walks. I've been walking for years. Went to see a specialist and he told me I had a tear in the tendon. Also have osteo-arthritis in the foot, because of previous breaks in that foot years ago. My right foot is also flat and have a fallen arch. My foot is a mess - bunion and hammertoe in also present. The doctor wants to do surgery on my bunion and hammertoe in the fall, and also check out the tendon tear and it's progress, since he has me wearing orthotics until I see him in Sept. I also do home therapy 4 or 5 times a days, as my foot is very stiff. I am leary of surgery, too, as I hate to be down for 6 or 7 weeks. I'd also like to hear from people who has had the surgery and it's outcome.

Re: Posterior tibial tendon dysfunction

TERRI on 7/12/09 at 22:48 (258813)

Hello,
I have read the post and I too have PTTD and been like this since Dec. I have tried a walker boot for eight months and know awating surgery. My foot Doctor says I have micro tears in my postier tibial tendon area and still have swelling along with pain in my right foot.

Re: Posterior tibial tendon dysfunction

brian on 9/19/09 at 21:00 (260710)

i run with my brace