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Old 01-23-2008, 06:50 AM   #1
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Unhappy Posterior tibial tendonitis ???

Hi! I am new to the boards so I will give a little back ground first. I am 36 and the mother of 5 kids. When I was 10 I had the first surgery on my right foot. I had an accessory navicular bone the was going to be shaved down and chips from it removed. It didn't go they way they said it would and wound up having to have a second surgery when I was 16. That did bring much relief. Since then because of very flat feet and pronation I have always had some pain and never really paid much attention to it until this summer. It started bothering me more an more and in the middle of December it got to the point I couldn't walk without limping. Went to the ortho and was told it was Posterior tibial tendonitis . I was in a walking boot for 3 weeks and finally got my MRI last saturday.. Went to the Dr. yesterday and he gave me a cortisone shot and wound up putting me in a cast. I have to be in the cast for the next 6 weeks! I guess my question is am I doing all of this all in vain? I let him give me the shot even though I have heard that they can cause rupture with this problem and at least in the cast it isn't rubbing on the navicular they way it was in the boot. I know there is a tear at the navicular just the way the Dr. thought there would be. Anyone gone through the cast , back in boot, physical therapy, and not need the surgery with a tear? I am just wondering if I should get a second opinion at this point.. With 5 kids and being a stay home mom I can't afford to spend 6 - 9 weeks like this and then surgery on top of it! Also VERY frustrated that all this has started up again all because of that first surgery! To make matters worse this is the right foot so the cast is making it very hard to drive! Sorry for the long post!

 
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Old 01-24-2008, 09:01 PM   #2
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Re: Posterior tibial tendonitis ???

It might not be a bad idea to have it checked out by another foot/ankle orthopedic surgeon or podiatrist. I know the first dr I saw was going to do the cortisone injection and am aware that it is contraindicated. I am now seeing another orthopedist who specializes in foot/ankle issues. I did the boot for a good month, part of it NWB, PT, orthotics, Celebrex, then had surgery in May (tendon repair and Evans osteotomy). I am having the same problem with my other foot and will have surgery late in Feb. I had some small tears and an area of degeneration near the navicular in my surgery foot. It is pretty hard for the tendon to heal...did your dr say he was hoping it would? Is the tear small? It's a hard injury and recovery...nobody realizes how important the feet are until unable to use one. And with 5 kids...it was so hard being NWB and just taking care of me! Good luck...let us know how things go!

 
Old 01-25-2008, 07:09 AM   #3
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Re: Posterior tibial tendonitis ???

Thanks for the reply.
He did say that he thinks with the cast, shot and PT that the tear will heal on it's own. I got his notes in the mail yesterday and the MRI report says that there was swelling and high signal in the posterior tibialis tendon and linear signal noted within the tendon, represntative of an intrasubstance tear (so small tear) and tenosynovitis. I understand some of that from reading these boards and the internet searches I have done. I just really doubt that this is going to heal on it's own and even if it does that it won't just tear again once I start walking around without the cam boot. With that said I am still not sure if this is serious enough to have surgery on.but don't want to let it go and have it get worse that it already is especially since he says that all of this is because of the accessory navicular surgery that I had years ago.

 
Old 01-25-2008, 12:01 PM   #4
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Re: Posterior tibial tendonitis ???

Some background on me... 21 yr old female, and have always had foot problems due to flat feet (thanks to my dad), and have always been a very competitive athlete. When I was 12/13 I had bad heel pain. Saw a Sports Dr and was told it was Severs which is common growth "disorder" for young athletes, and was given a Cortizone shot. It worked great for about 6 weeks, and I wanted another, but my pediatrician said no more. Fast forward, when I was 19 I tore my arch while playing college soccer. Though in EXTREME pain, I played the rest of the season before seeing a doctor. After an MRI was told I had a significant tear in the Plantar Fascia, and a small one in the PTT from not letting it heal. I wanted another Cortizone shot so I could keep playing but they said it was too likely to cause it to rupture. I was put in a boot for 6 weeks, which helped until I became active again. I saw a number of different specialists, and just recently had a new procedure called TOPAZ, for work on the plantar fascia. Since the tear in the PTT isnt too bad yet, we're going to wait. Was told that the only fix would be the same as if the tendon was completely torn, which is a major surgery involving replacing the tendon. (Sorry that was so long).

Now back to you. I dont really understand the point of doing the cortizone shot if he was going to be putting you in a cast anyways. The shots are usually done in order for the person to continue their activities, such as athletes continuing to compete. Besides making it more likely to tear... cortizone shots arent really good because they hide the pain. Pain is the ways body of telling you something isnt right, and to stop... but with the shot you may be doing more damage by "ignoring" the pain.

I think the cast is a good idea, but I would most definitely get a second opinion, if not more. You'd be amazed at how different surgeon's opinions can be!!! I saw 5 specialists before my procedure, and each one had a different opinion, and not just on treatments, but on diagnosis. Everything from "Nothing is wrong with you" all the way to "You need major surgery as soon as possible."

 
Old 01-30-2008, 07:34 PM   #5
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Re: Posterior tibial tendonitis ???

Hello. I am new to the boards also. I feel your pain. Its so frustrating to go through all this and still may need surgery. In your case though, it sounds like the dr. is confident the casting will work.
A little background on me....I played softball, sprained my ankle real bad, with partially torn ligaments. This also was my right foot, and I live alone. This happened back in may, then with PT and other therapies it healed, until the posterior tibial tendon acted up. They called it a tenonitis. The dr. tried all different therapies, along with the cortisone injection, going back to the boot, more PT, and then in october he casted it for 6 weeks. He had high hopes that it would work, but of course,,,,,it only did for about a day, then the pain came right back..... So, now I am scheduled for surgery on feb. 22. I have no idea what to expect. He called it a tenosynovectomy....basically he said he would go in and clear up the fluid thats still in there and clean and debride it. He said I would be in a cast for 6-8 weeks. Ugh. Please. does anyone have any experience with this. I am an active person so am ready to get back to normal.
Thanks, Kristen....and good luck in your recovery

 
Old 01-30-2008, 10:06 PM   #6
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Re: Posterior tibial tendonitis ???

Kristen... Hello. I have no idea if this is the same thing at all... but the Topaz treatment I had done on my plantar fasciitis is Microdebridement, and is more often used for tendon treatment. Dominiqu Moceanu (no idea how to spell it), the gymnast from the 96' olympics had it done on her ankle and was able to get back into competition fast. Anyways, if that is what you're having done then I can offer a little bit of insight if necessary. Good Luck either way!!!

Last edited by moderator2; 01-31-2008 at 06:54 AM.

 
Old 01-30-2008, 10:59 PM   #7
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Re: Posterior tibial tendonitis ???

Kristen,
It is so frustrating to go through the PTT stuff...it takes forever and the treatments don't always work. I had the posterior tibial tendon repair as well as an Evans osteotomy last May. I'll be undergoing the same procedures on my other foot Feb 26. The repair of the tendon involves an incision along the posterior tibial tendon, opening the sheath (which surrounds the tendon), cleaning it up...cutting out any areas that are deteriorating, suturing tears, etc. with the goal of reducing inflammation and helping the tendon heal. Part of the problem with the PTT is that there is limited blood flow, so it can't get the old junk carried away and the nutrients in to help heal. That's probably part of why the cast has to stay on for as long as it does. That said, I had a splint on for 2 wks, then a cast for 4 wks and a boot for 4 wks (able to walk in boot) and that included a bony procedure. Are you just having the tendon repaired or are they going to do something else with the bone? Did he say that this will be permanent or that there is a chance it could come back? The recovery tends to be long...muscles atrophy (probably have already since you haven't been able to walk!) and you have to strengthen up and build up a tolerance to exercise. I was able to start running at 4-4.5 months post-op (which is exactly what my dr told me to expect)...but my procedure was a little different with the addition of the osteotomy. You might want to ask your dr about the timeline, PT, etc. Read some of the posts from an older thread called "posterior tibial tendon surgery" and "posterior tibial tendon updates"...there's a ton of info. Ask away here...great place to learn more! Sorry I rambled a bit! Hopefully it makes sense...it's late!
Krista

 
Old 01-31-2008, 07:39 AM   #8
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Re: Posterior tibial tendonitis ???

Well I have an appointment with a Dr. in the city on Wed.I really thought another opinion wouldn't hurt. So I had to get the MRI report for the ortho and there were a few things in it that he never mention to me. Along with the tear there it seems I have a ganglion cyst at the talous level, ankle effusion(that is not a big surprise), mild bursitis and something about an old ankle injury??? I have never hurt this ankle. The only problems I have had with this foot have been in the arch area. So after reading the MRI report myself I am now even happier that I am getting a second opinion! Not sure why he never mentioned the cyst since I told him that the second surgery I had they remover a large tumor from my foot. Hope everyone else feels better! I know I will after I hear that this is the way to go with this!

 
Old 01-31-2008, 11:17 AM   #9
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Re: Posterior tibial tendonitis ???

Krista,
Thank you so much for your help. As far as I know, he was just going to clean and debride, and remove the sheath that is containing the effusion. Then the cast and boot and rehab. When I got my disability papers that he filled out, it stated I would be out a total of 10 weeks. When I was in his office, he told me about 6 weeks. I do have all the confidence in the world in m,y dr. but am just worried now that this won't be the only procedure I will have to undergo. I saw in my dr. note that there may be more surgeries, but he hasn't said anything like that at all.
I have built up a good rapport with him and am happy with everything so far, but am worried about the healing process. Were you able to put any weight on it at all? Since I live alone, should I stay with someone for at least the first day or so?
Just want to be prepared, and thank you for such a quick response.

Kristen

 
Old 01-31-2008, 11:27 AM   #10
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Re: Posterior tibial tendonitis ???

Thank you for your help. I am not sure what type of procedure my dr. will be performing. He called it a tenosynovectomy, and told me he would go in and clean and debride and remove the fluid filled tendon sheath and repair anything else that needs it. I can call him and find out. I am just so ready to be done with all this.

Kristen
P.S. Don't get me wrong, I am ready and dying to get back to running, but am not even close to being in the great condition of a gymnast. In fact, when this injury originally happened, it made me remember that I'm not as young as I thought I was.

 
Old 01-31-2008, 12:56 PM   #11
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Re: Posterior tibial tendonitis ???

I was just pointing out that the healing process with that may not be as long as others since its less invasive. Its sounds like you're having a bit more done though.

 
Old 01-31-2008, 03:40 PM   #12
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Re: Posterior tibial tendonitis ???

Does any one know of a good site to buy a cast cover? And what brand is best?

Thanks

 
Old 01-31-2008, 05:24 PM   #13
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Re: Posterior tibial tendonitis ???

Kristen,
I also live alone, so stayed with my parents for 4 days after leaving the hospital (stayed overnight). I have a dog who needed to be let out and given some attention...as well as me! I was certainly ready to go home and have my own space again though. I know they tell you that you have to have someone with you for the first 24 hrs after surgery due to the anesthesia. So, it probably would be a good idea to arrange something, even if it is only for a day. It's hard to get around, especially when on pain meds.

I couldn't bear weight for 6 weeks, then had 4 more weeks in a walking boot where I could bear weight as tolerated. I was doing that within a week of being in the boot. I used and will use again a Turning Leg Caddy, which is a knee scooter. It's waaaayy better than crutches and kept me more independent and at least one arm was free. You might want to look into one if you're not going to be weight-bearing for some time. Insurance covers most of mine.

As far as cast covers...I got one from my drs office and it's called an Aquashield. I really liked it and it was inexpensive, easy to use and never leaked. I used it to sit with my casted foot in the pool this summer too. There are lots of them out there. Do you have cast socks? I'm going to try a place online called cast cozy.

You'll probably want a shower bench/chair, a handheld shower head, a bunch of pillows for elevation (or a wedge), ice packs, easy to fix foods, etc.

I totally understand the feeling of wanting to get this over with and move on. I'm there too! I wish surgery was sooner...booked this just before Christmas and the 26th of Feb was the soonest I could get in. My foot feels worse and I just want to be spending my time healing and gearing up to be active again. It's a long haul...but worth it in the end.
Krista

 
Old 01-31-2008, 09:10 PM   #14
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Re: Posterior tibial tendonitis ???

Krista,
Thank you so much for your support. I'm sorry that you know what I am going through, but it also makes me feel better to know that you know how I am feeling. I also have a dog and live in apartment, so I have to have someone watch her for the whole time, since there is no way I will be able to walk her outside.
I thought I would need to stay with someone for at least a day or so and will stock up on easy foods since I won't be able to carry food.
I understand what you are going through with the waiting game. I told them that I would come in any day they had scheduled it right after the holidays and feb. 22nd is the first available. t I will be thinking about you on the 26th.
Thank you for all the tips. I have the hand held shower head, and will call my insurance company about the shower chair, and will stock up on the ice packs, and will buy some pillow wedges.
I am so glad I found this website and am glad you understand what I'm going through.People at work don't fully understand what its like. They tell me to just work through the pain.....sure, ,,,its just that easy,,,,why didnt i think of that......
Anyways, Now I'm rambling. Thanks again and keep me posted on your progress.


Kristen

 
Old 02-02-2008, 08:43 PM   #15
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Re: Posterior tibial tendonitis ???

momofmmsd5,
Hope you are doing well and that you are getting around o.k. with your cast. I am hoping that you can answer a question for me. Where is your pain. Is it only in one spot, in the ankle or up more on the leg. I have also had PT tendonitis and have tried many things to make it go away. I have had two MRI's and a bone scan - tendon is not torn- but it acts that way. Thanks for the info.

 
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