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Old 03-05-2007, 01:25 PM   #1
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Question Posterior Tibial Tendon Surgery

I know there is a long thread below about PTT surgery. I wanted to start another thread as that one is so long and the surgery I'm having includes more work than what it seems like the other posters have gone through.

Next Tuesday, the 13th is the surgery.

My problem is that I have stage 2 posterior tibial tendon dysfunction. The MRI showed tendinitis and tendinosis in the tendon. My doctor first put me in a Cam Walker boot and that did help alleviate the severe pain I was in. But in my line of work I'm on my feet 8 hours a day... and the condition wasn't improving. So he put me on 1/2 time work and still no improvement (and going to physical therapy 3x per week the whole time). So in December he took me off work completely and now surgery is looming.

But I have times when I doubt myself and my doctor as the pain is not as severe or constant as it was a few months ago. I guess it needs to be done; I am off my feet most of the time and realistically, I would likely be in a lot of pain if I were on my feet more.

Upon seeing my x-rays, the doctor also saw that my navicular bone and medial cuneiform bone (joint) is badly out of alignment.

So, the prescribed surgery is as follows:

1) repair damaged PT tendon with FDL tendon transfer, secured through a drilled hole in the navicular bone

2) calcaneal osteotomy using the Evans procedure/column lengthening not the sliding one where they move the bone over and secure it with screws - this one uses a wedge-shaped bone graft inserted into the outside of the calcaneus

3) fusing the navicular/cuneiform joint by using another bone graft and two screws

He says I'll be in a non-weight bearing cast for 6-8 weeks, then into another walker-boot for about another 6 weeks while I begin to bear weight and start physical therapy.

I know there will be a significant amount of pain and recovery will be slow.

I'm just wondering from those of you who have had this surgery done if there is anything you didn't expect, how you're doing now, and any other advice you'd care to share.

I live in a small apartment, so I'll be hobbling around on crutches - but I'm wondering how I'll complete daily tasks without any weight bearing. I bought a shower chair and a shower/hose attachment. Must look into a bag type thing to keep the cast dry... I have a walker and regular wheelchair that I borrowed from a friend. Anything else I need to look into?

Thanks for any advice or words of wisdom. I'm getting nervous!!

~Debbie~

 
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Old 03-08-2007, 08:00 PM   #2
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Re: Posterior Tibial Tendon Surgery

Quote:
Originally Posted by debincalif View Post
I know there is a long thread below about PTT surgery. I wanted to start another thread as that one is so long and the surgery I'm having includes more work than what it seems like the other posters have gone through.

Next Tuesday, the 13th is the surgery.

My problem is that I have stage 2 posterior tibial tendon dysfunction. The MRI showed tendinitis and tendinosis in the tendon. My doctor first put me in a Cam Walker boot and that did help alleviate the severe pain I was in. But in my line of work I'm on my feet 8 hours a day... and the condition wasn't improving. So he put me on 1/2 time work and still no improvement (and going to physical therapy 3x per week the whole time). So in December he took me off work completely and now surgery is looming.

But I have times when I doubt myself and my doctor as the pain is not as severe or constant as it was a few months ago. I guess it needs to be done; I am off my feet most of the time and realistically, I would likely be in a lot of pain if I were on my feet more.

Upon seeing my x-rays, the doctor also saw that my navicular bone and medial cuneiform bone (joint) is badly out of alignment.

So, the prescribed surgery is as follows:

1) repair damaged PT tendon with FDL tendon transfer, secured through a drilled hole in the navicular bone

2) calcaneal osteotomy using the Evans procedure/column lengthening not the sliding one where they move the bone over and secure it with screws - this one uses a wedge-shaped bone graft inserted into the outside of the calcaneus

3) fusing the navicular/cuneiform joint by using another bone graft and two screws

He says I'll be in a non-weight bearing cast for 6-8 weeks, then into another walker-boot for about another 6 weeks while I begin to bear weight and start physical therapy.

I know there will be a significant amount of pain and recovery will be slow.

I'm just wondering from those of you who have had this surgery done if there is anything you didn't expect, how you're doing now, and any other advice you'd care to share.

I live in a small apartment, so I'll be hobbling around on crutches - but I'm wondering how I'll complete daily tasks without any weight bearing. I bought a shower chair and a shower/hose attachment. Must look into a bag type thing to keep the cast dry... I have a walker and regular wheelchair that I borrowed from a friend. Anything else I need to look into?

Thanks for any advice or words of wisdom. I'm getting nervous!!

~Debbie~
You will need help the first weeks. I had FT help. I also suggest etting one of those gadgets that grab things. Keep all things you use a lot, like contact lens stuff, hand cream, pain meds right next to your bed. If you have a cell phone, keep the charger near you. If you have high step in tub, like I do, you will find it hrd, if not impossible to get into so get wash clothes to sponge bath for the first weeks. Ask youe dr if you will need multi doses of Ibuprofen. I went through that so fast. Have extra pillows for under your feet to keep them elevated. FILL the fridge with easy to cook stuff.

Best of luck.

 
Old 03-09-2007, 01:48 PM   #3
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Re: Posterior Tibial Tendon Surgery

Thanks for the advice... a couple of those are things I didn't think of.

I went for my pre-op appointment at the hospital this morning and everything is ready to go. I'm getting nervous, but anxious to get on with the healing process.

~Deb~

 
Old 03-10-2007, 07:11 AM   #4
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Re: Posterior Tibial Tendon Surgery

First, Good Luck and positive vibes on your upcoming surgery. After having had 2 surgeries 6 months apart I have learned a few tricks that may help you.

Go to your local Bath, Bed type store and pick up a suction cup mounted rack for your bath supplies (soap, razor, shampoo etc). You can mount it sitting level height in the middle wall of the tub for ease of grbbing stuff. Sure beats getting the floor wet or chasing your soap around the tub Mine coats $12 and has been a Godsend.

Get a footstool for the outside of the tub. You can sit on it and then slide over onto the tubseat/showerchair. A lot safer and less tiring.

A "cast sock" is great, but they do not fit over most CAM cast boots. I put a rubber placemat on the tub edge and rest my leg on that (it keeps it from sliding off the edge and into/out of the tub. I keep a hand towel on the footstool to catch any stray shower head spray.

Get a rubber bath mat or latex backed tub rug so you don't slip once you are out and attempt to stand.

OK, this sounds weird but I need it because I have to blow dry my hair (it's long and takes a while to dry). Get an extension cord for the dryer. I sit on the footstool, prop my leg on the toilet (it hurts and swells if left down) then I can see the mirror and dry and fix my hair.

My husband mounted a hook 1/2 way up the bathroom door so I could reach my towel quickly before I dripped everywhere.

Get a second (or more) cam boot liner sock. They stink up quick and need to be washed just like socks. After the swelling went down I bought mens tube socks. They work superbly as a boot liner/sock. A six pack (12 socks) cost $5. My PT and OS thought it was a good idea and now suggest it to folks.

A roll-a-bout is a great invention. You can web search it or go to the local DME/med supply store. You can rent or purchase them, some insurance companies will cover them if doctor certifies need.

If you have a laptop get a router so you can be wirelessly online while in bed or proped up on your recliner/sofa. Buy a few cheap, firm pillows to prop up your leg (3 is what I needed). Remeber to put them under you knee and leg- not just under your foot. A back rest pillow is also fabulous, as is a bed lap table

Get a handicapped parking form from DMV and give it ot doctor BEFORE surgery. You will want it even if you yourself can't drive. Get the jang tag (not plates) so you can take in a friends car if you go out shopping, MD appointments etc.

I should have gotten these things done before surgery as the last thing you will want to do, or have the stamina for, is running about and standing in line afterwards.

The other suggestions are also wonderful. Again, good luck! Hope some of my tips will help.

jane

 
Old 03-10-2007, 12:22 PM   #5
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Re: Posterior Tibial Tendon Surgery

Jane - FABULOUS tidbits!! Thanks so much.

I was just at Linens-n-Things this morning getting a stand-up mirror so I can do my hair, etc. in bed or lying on the couch... also got a "body pillow" to fold up and elevate my foot. I wish I would have seen your post to get a suction cup shower basket. I may have to run back and get one of those.

My husband thinks I'm getting slightly obsessive/compulsive about things - but I don't care! Last night I practiced with my shower chair until I could get on and off and in and out on one foot. I also borrowed a walker which I'm finding will be SUPER to help with bathroom maneuvering. I've even found it nearly impossible to get off the potty on one foot! So having that walker is wonderful.

I've got my handicapped plackard already... wheelchair, walker, shower chair, hand-held shower head w/6 ft. hose, pain & nausea meds, extra pillows for propping, lap desk... I'm feeling better about all of that right now. And what a relief to know I can get around in the bathroom because that was really bothering me.

I've seen those roll about foot walkers, but haven't seen anywhere to rent them. Pretty pricey to purchase... I may have to do without that.

Surgery is Tuesday, and while I'm excited to get ON with LIFE, I'm also nervous if that makes sense.

Thanks so much for the advice,
~Debbie~

 
Old 03-11-2007, 03:09 PM   #6
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Re: Posterior Tibial Tendon Surgery

I ren ted the Roll - About. I rented mine for 30.00 week I think. You can do a search for the product online as they won't let me name the site here.

Also, as for the potty issue, I know what you mean so I got a potty 'lift' thingie. I don't know what it is called but go to a medical supply store and get it. It's not expensive and fits on the toilet seat acting as a seat but 6 or 12 inches or so higher. It's good so you don't have to bend down as much and when you get up, it isn't far to the standing position. This was a lifesaver for this surery and my other knee and back surgeries.

I second having a stool for the bathroom. You will be surprised how many different things you will use it for.

Last edited by Lynn1991NY; 03-11-2007 at 03:12 PM.

 
Old 03-11-2007, 04:18 PM   #7
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Re: Posterior Tibial Tendon Surgery

hey all...

i have been diagnosed with pttd and have been using orthotics and going to pt for the past six weeks. nothing seems to be working. i am a teacher and am on my feet for 8 hours a day. i actually tracked my walking and i average about 2 miles a day. my pain actually began about 3 years ago, but i didn't feel it was severe enough to warrant a visit to the os.

the doc did mention the surgery many of you have had. he told me if i was any older (i'm 31) he would do the surgery immediately. i see him again on the 19th.

i am wondering how long you were in the hospital and off of work? also, how long was recovery? if i get some info from all of you, i am sure i will be able to make a more informed decision about what to do.

thanks for your help!

 
Old 03-11-2007, 06:26 PM   #8
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Re: Posterior Tibial Tendon Surgery

Hi teacher,

I am a cook and was on my feet 8 hours a day averaging 5-6 miles. My pain started gradually, and by the time I went to my primary care doc it was severe. Of course they have to go through their "standard" fixes... so I was instructed to get new shoes, new orthotics (I already wore orthotics because of previous plantar faciitis), and take ibuprofen and ice.

I did this for a month with the pain increasing to the point of me chomping down 12-15 ibuprofen per day and coming home from work in tears. After a month my primary care doc sent me for x-rays, which revealed a heel spur.

From my previous experience with plantar faciitis, I knew that bone spurs are related to that, and these symptoms were not even remotely like the pain I had with plantar faciitis. But with the bone spur diagnosis, she sent me off to a foot/ankle pain specialist (he's a DPM, not OS). He immediately came up with the correct diagnosis of PTTD.

At that point, he put me in a Cam Walker boot, gave me 2 cortisone injections along the tendon, and started physical therapy. He told me that healing of this tendon would be slow; up to 6 months in the boot to let it heal. The boot did give me some immediate relief from the pain, but not all of it.

After three months of the boot, 2 more cortisone injections, and 2 months of therapy, I was showing no signs of improvement, so my DMP sent me for an MRI which revealed both tendinitis and tendinosis of the PTT. That was in September, and he put me on 1/2 time work.

We followed this course until December, when there was still no improvement. As a last-ditch effort, he put me on full disability and I went back to physical therapy and received iontophoresis cortisone treatments. At the end of December we decided that surgery was inevitable, as there was no improvement - even downhill again.

My DPM explained that the tendon is in a way a symptom of a malaligned foot. Many people with PTTD go and have the tendon repaired, but down the road find recurring problems. He said it's like if your car is out of alignment, and your tires have worn, so you go buy new tires. Yes, your tires are "fixed", but only until they wear out again. Therefore, for full recovery you need to address the bone structures of the foot. In my case, he is doing a calcaneal osteotomy (Evans procedure). Upon examining more x-rays he has also found a joint in my forefoot that is very out of line and unstable, so he will be adding a bone graft and fusing that joint as well.

I will be in a non-weight bearing cast for about 8 weeks, then back into a boot and intensive physical therapy (basically learning how to walk again on my new foot). I am off work until September.

To sum up the time-frame, I was on half-time work from September through November, then since December I have been completely out... and will continue to be out through September. For me, this has been a long journey.

My surgery is this Tuesday and I'm really looking forward to the end result.

Hope this has been somewhat helpful,
~Debbie~

 
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Old 03-11-2007, 06:29 PM   #9
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Re: Posterior Tibial Tendon Surgery

Oh - also, I'm wondering why he said if you were any *older* he'd do the surgery. I'm 39, and my doc was just the opposite. He said if I had one foot in the grave and another foot on a banana peel, he'd give me heavy pain meds and tell me to enjoy life as best as I could. But being "young", he said I deserved a better quality of life as soon as possible.

Just food for thought...
~Deb~

 
Old 03-11-2007, 07:56 PM   #10
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Re: Posterior Tibial Tendon Surgery

Debbie,
this helps a great deal.
my doc said he had read new research that younger adults with this diagnosis could benefit from orthotics and pt without surgery. he wanted to make sure we took this route first, though he made it clear that it may not work...which it hasn't. i am more inclined to agree with your doc. i believe i can heal much faster at a younger age and would like to have a better quality of life.
good luck on your surgery...please keep me posted on how you are doing!!!!

 
Old 03-21-2007, 11:20 AM   #11
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Re: Posterior Tibial Tendon Surgery

Had my surgery last week, still mostly in bed at this point. I never imagined how hard it would be to get around and how TIRED I would be after the surgery.

The pain is manageable, although I'm on heavy meds... night time is the worst.

The doc said all went well and he's extremely pleased with the outcome. He ended up not having to fuse the navicular/cubeiform joint, so that was a bonus. He said the osteotomy took care of the instability of that joint. I saw him yesterday and they did an x-ray... even though it was hard to see thru the cast, I could see the osteotomy site and compare the angles of the bones in my foot - truly a huge difference!

Looking forward to being in less pain and able to be more mobile soon.

Hope all is well with everyone.

~Debbie~

 
Old 03-23-2007, 01:12 PM   #12
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Re: Posterior Tibial Tendon Surgery

Debbie...
Keep me posted on your progress. I went ahead and scheduled my surgery for April 24. I am having a post tibial tendon reconstruction and a calcaneal osteotomy. Let me know about those things that I need to prepare for now! Stay well!!!

 
Old 03-24-2007, 10:00 PM   #13
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Re: Posterior Tibial Tendon Surgery

Do you know which osteotomy you're having done? Mine was the Evans procedure. The post-op x-rays looked like a whole new foot!

It's still pretty hard for me to spend much time being "vertical" vs. "horizontal". But I'll take some time over the next week or two to share my experience with you as well as what has helped, what I was prepared for and what came as a total shock.

Good luck on your surgery!

~Deb~

 
Old 04-02-2007, 10:05 PM   #14
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Re: Posterior Tibial Tendon Surgery

Tchr, your surgery is coming up pretty soon! I've thought of several things that might be helpful for you - unfortunately, it's still hard for me to spend much time on the computer (too much swelling when foot is down).

A couple things you might want to think about:

1) For me, it's difficult to use crutches around the house as my pain meds make me very unsteady, esp. the first week. A walker was invaluable as it's much more stable than crutches.

2) See if you can get up & down from both your bed & potty on only one foot. You may want to look into a commode.

3) Find either a wedge or big pillow you can use to elevate your foot and to keep comfortable while sleeping at night. I found a "body pillow" works well and can be folded several ways - quite versatile.

4) Someone here suggested a suction cup basket to use at bathtime. It's been great! I also use a shower chair. There's no way I could bathe without it. To keep my cast dry, I take a kitchen trash bag and tuck it in all around the cast, then take a second bag and tie it off at the knee. Works well.

5) My tv tray is my best friend... I also have a basket I keep things in that I use often (meds, chapstick, books, kleenex, lotion, etc) and keep that near me by the couch.

6) I'm usually cold... but since the surgery I've been roasting! Not a fever; perhaps it's the meds or cast? Anyway, be prepared to have a variety of comfy clothes available.

7) Be patient... I was SO unprepared for how helpless I've been and how much I need to rely on other people. I also wasn't prepared for how sore arms, hands, back, and good leg would be. I've also been so very tired.

That's all I can think of now... I'll post anything else I can think of.

I'm going on week #3 post-op and am feeling stronger and less sore. I still need help getting off the couch, but am more mobile than a week ago. The pain has gotten less annoying... almost overnight... but swelling is still a problem, so most of my time is spent on the couch with the foot elevated.

Next week I get this cast off and stitches out... but then they'll put another cast on for 4 more weeks. Slow healing process, but the end is in sight!

Let me know if you have any specific questios I can help you with!

~Deb~

 
Old 04-05-2007, 10:30 AM   #15
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Re: Posterior Tibial Tendon Surgery

Hi, I've never used any site like this before.... so please be patient with me. I've had a posterior tibial tendon surgery that's gone bad I'm afraid... the osteotomy appears to have failed and I have bone fragments causing trouble, as well as a few other things I'm still sorting out in the Cat Scan report. I'd love to talk to some people who've been through this surgery before. Where to start? I guess at the beginning..... I notice some of you say that age is a concern to some of your doctors. I am a 49-year-old woman in good physical shape, and my doctor told me right fromt he start that he was not used to seeing patients with this problem who are as young as I am. He said that typically patients are a little bit older, overweight, and maybe even have diabetes.

Last edited by hey19; 04-05-2007 at 10:34 AM. Reason: wording

 
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