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Old 08-02-2008, 08:13 AM   #1
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Question Posterior Tibial Tendon Surgery and running after surgery

Hello- I will be having surgery to correct a torn posterior tendon that including cleaning out the tendon, replacing it with the FDL tendon and realigning the heel bone. I tore this tendon falling quite hard down a flight of wooden stairs and jamming my foot into the wall at the bottom. I am a runner and this is devastating to me. Are there any runners out there who have had this surgery and are able to run again as they did before the surgery? I've run thousands of miles in my life injury free and to be injured this way really stinks My surgery is in a little over a week. Also, is it realistic to think I'll be able to return to work after one week??? I'm a university professor and the new term is starting. I'm worried because I have to move around alot to get from here to there and I really won't be able to elevate as consistetnly after the first week.

Last edited by smile2006; 08-02-2008 at 08:27 AM. Reason: word choice

 
Old 08-02-2008, 07:13 PM   #2
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Re: Posterior Tibial Tendon Surgery and running after surgery

Hi there,
I had PTTD in both feet/ankles, so small tears, stretching and irritation in the posterior tib tendon, but luckily no complete tear/rupture of the tendon. Because my tendons were able to be repaired, I didn't have the FDL transfer. I did have an Evan's osteotomy in both (put a bone graft/wedge in the outside of the foot...and no hardware was needed). I returned to work at 3 wks post-op both times and like you, I am not at a desk job. I was in my car, driving, going into homes, facilities, etc. and could not consistently elevate or ice during the day. I found that I was tired and often napped when I got home for a few weeks after going back. And of course I iced and elevated then too! I took pain meds pretty regularly still, though I was careful when I took them. Everyone has a different pain threshhold, so it's hard to say how your foot will be feeling and what you'll need medication-wise.

One thing you might want to look into is a knee scooter...it'll make getting around campus and standing a lot easier...there are brands like Roller-Aide, Turning Leg Caddy (I had both times, loved it), etc. and can be found at medical supply stores...but if you want to use one, I'd jump on it quickly because it can be hard to find them.

I was a runner, probably nowhere near as serious of one as you, before surgery too. After the first ankle was done, I started "running" at around 4 months post-op. However, my other foot went bad during the recovery, so it made it hard and painful to run. So, the second one was fixed and I just started running a few weeks ago at 5 months post-op. It's really been over a year since I've been able to work out hard, break a sweat, so my muscles have gotten weaker...doing some PT to help with that. My dr told me that I'd probably never run a marathon after having surgery...not that I wanted to, but his point was more that anything extreme would not be in the cards.

Have you been given the timeline for the splint/cast/boot, how long you'll be NWB, when you'll start PT, etc.? Do you have a shower chair, cast cover, handheld shower head, pillows for elevation, etc?

Feel free to ask questions if you have any. I know there's another PTTD gal (kristim06) who is a runner as well and had exactly what you're having done...maybe she'll be able to answer some questions as well. Good luck and let us know how everything goes for you!

 
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Old 08-02-2008, 08:13 PM   #3
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Re: Posterior Tibial Tendon Surgery and running after surgery

Hi
I had a posterior tibial tendon transfer, spring ligament (the one in the arch) repaired, and a calcaneal osteotomy (same as you will have). I was in a large bandage for two weeks, then in a cast for four more. It is important to keep the foot elevated -- toes above heart -- pretty much all the time. I was on crutches, non weight bearing for six weeks. I didn't work for the first two weeks at all. I began some light work from home for the next two weeks. I then returned to work and have been working since then only about 3-4 hours a day. I am at the end of my third week of PT and I go three times a week for two hours each session. I am still pretty tired. At the beginning of this week I would walk with one crutch and by the middle of the week can walk without crutches, although I still use one part of the day because it is difficult to walk without for long stretches. I have been in a heavy boot since the cast came off. I had my surgery on June 4th, so it has been just over 8 weeks. I will remain in the boot three more weeks and can then wear a shoe. I have to sleep in the boot for another 2 months.

I don't want to rain on your parade, but I don't think you will be back at school in a week. You need to ask your doctor what his timetable is. I am actually healing well and excited about my progress since physical therapy. I am to stay in PT for at least six more weeks and have been told full recovery takes 9-12 months. I am not a runner, but I am worried about just being able to take walks without pain and have everything heal right. I think there are runners on this board and they cantell you more about returning to running.

The first six weeks, I have to admit, were kind of tough. Lots of laying around. I had help (my mom was here) which was wonderful. I don't think I could have done many of the things she did on my own. I have a shower chair, shower wand, and the knee scooter. The knee scooter really came in handy in the past month.

Hope this helps you some.

 
Old 08-03-2008, 07:36 AM   #4
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Re: Posterior Tibial Tendon Surgery and running after surgery

Thanks for the replies. This has all happened so quick for me. I injured my foot with the fall down the stairs in February and messed around with it only to find it would not get better even with rest from running and cycling, two things I love. I finally went to the doctor mid-July and through an MRI and exam was diagnosed. My surgery is August 13 so I have little time to prepare. I am trying to get the surgery in before classes start. It will literally be one week after surgery and I'll be off to campus. This is not my preference but I thought it better to try to do it before the semester began then to start the semester and cut out on my students (no subs at the University level ) Waiting until December and winter break was not recommended plus it just plain hurts at this point. I have the shower thing taken care of and I ordered a cast cover. I was planning on just going with the crutches. I was told I'd be 7-10 days in a surgical cast which I guess is a half-cast around the back of the lower leg and some bandaging to allow for swelling, stiches out and then a hard cast non weight bearing for 3 weeks, a walking hard cast for three weeks and then a walking boot. Also, they are saying one night in the hospital, is that normal?

I've never been on crutches or had a cast so maybe I just don't know what to expect. I do expect everything to take 3 times as long! It's my left foot so at least I can drive. My husband knows he will be waiting on me alot but he hates that I hurt right now and he is a runner/cyclist too. It will be hard to see him go off when I can't. The doctor does say I will be able to run again although said many of his patients just decide not to after something like this. Anyway, the one week to classes concerns me. I hope to be totally off pain medication by that point or I know my thinking will not be up to parr to teach....is this a possibility?

Last edited by smile2006; 08-03-2008 at 07:42 AM.

 
Old 08-03-2008, 09:32 AM   #5
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Re: Posterior Tibial Tendon Surgery and running after surgery

I hurt my foot two years ago. It would get better and worse. I finally had a MRI that showed damage. They thought PT could help it, so I did that for four weeks, and it just got worse. It was so bad, I couldn't really walk without pain. I was wearing a boot anyway just to keep the pain down. So, I went ahead with the surgery. I was really bummed about not being able to do the things I love in the summer. The entire first two months I still had lots of time feeling down, but now that I am on one or no crutches, I see light at the end of the tunnel (although the light is way down there). It will be hard seeing your husband go off and running when you can't. But you can't go with him now, anyway, with the pain, so you gotta do what you gotta do (that's what I kept telling myself). I got angry at times that this had to happen, mad, frustrated, but that is all normal, too.

I spent one night in the surgery center's hospital room. That is standard to see if your pain is managed. The foot has lots of nerve endings and is very painful. I had a leg block and that controlled my pain very well. I never had really bad pain, just discomfort. I had never been on crutches before. I practiced a bit before surgery so that I could feel more comfortable prior to doing it with a sore foot that I couldn't put on the ground. Crutches are a pain. After the surgery, I was tired just after taking a shower and getting dressed. I was in bed with my foot elevated or on the couch with my foot elevated for the first month. I am 8-1/2 weeks now and I still keep my foot up on a chair beside me or up on the recliner when I am sitting.

I used pain meds for the first couple of weeks, especially at night. It is hard to sleep with the cast/bandage/boot. I still don't sleep very well and will occasionally take a pain pill just to help me sleep.

It's a long, hard road -- definitely doable, I'm just not certain about a realistic timetable for you to return to work. Keep asking questions!

 
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Old 08-03-2008, 10:25 AM   #6
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Re: Posterior Tibial Tendon Surgery and running after surgery

What type of damage actually showed up on the MRI? Also did you have general anthesia and the block in the leg? I have yet to have an appointment at the hospital to find all this out. The nurse at the doctor's office mentioned both of these but I don't know if she meant I'd have one or the other or both.

(BTW I was married in Sedona just last year, it was a beautiful place for a wedding. I used to live in Las Vegas so I've always loved Sedona!)

 
Old 08-03-2008, 01:34 PM   #7
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Re: Posterior Tibial Tendon Surgery and running after surgery

I had a MRI done at a facility my doctor thought produced fairly poor quality results. My injury was workman's comp, so they refused to let me have another one at another facility but I did have a repeat at the same facility. My MRI showed Thickening and increased signal in the posterior talofibular ligament with partial tear. Small partial tear of the posterior tibiofibular ligament. Minimal fluid surrounding the peroneus longus and peroneus brevis tendon - may represent mild tenosynovitis. Peroneus longus tendon demonstrates minimal increased signal which may be mild tendinitis.

One of those is the ligament in my arch which had a lot of pain. The doctor recommended posterior tibial tendon transfer, spring (arch) ligament repair, and calcaneal osteotomy. Another doc (podiatrist) recommended a procedure that places an implant in a joint space (forgot the name), but I opted for the procedure that would actually fix things. I felt the osteotomy might be overkill, but it really was necessary. That's when they cut your heel bone, realign it and place a screw. It seemed daunting at the time. Now, two months out, I have a lot of hope as I'm beginning to get my life back.

Yes, Sedona is beautiful. Flagstaff is beautiful also. You canforget Phoenix and Tucson, in my opinion. Did you visit Flagstaff?

 
Old 08-04-2008, 07:49 AM   #8
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Re: Posterior Tibial Tendon Surgery and running after surgery

Are you sure about the timeframe? You said 7-10 days splint, 3 wks cast NWB, 3 wks walking cast then the boot? Typically if you have a bony procedure, like heel realignment, there's at least a 6 wk period of being NWB. It sounds waaaayyy too soon to be bearing any weight at 4 wks. Weight bearing is usually at 6-8 wks post-op, while in the boot.

I had general in both surgeries, but did have the popliteal block in the second one and it was great! I had no feeling until midnight that night. However, you still do want to take pain meds because when it wears off, bam...there's pain and it's much harder to catch up to pain than to stay ahead of it. I'm not sure you'll totally be off pain meds in a week...I was on them for a few months (less as time went on, but still had to use them).

This is a pretty major surgery...it takes quite awhile to recover and be back to normal. You might be more frustrated if you try to put too unrealistic of expectations on yourself. I would talk w/ your dr about timeframes for everything and pain mgmt before surgery.

 
Old 08-04-2008, 08:06 AM   #9
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Re: Posterior Tibial Tendon Surgery and running after surgery

smile2006
Hi There, I am was/am in the same position you are right now. I was diagnosed with PTTD in May of 2007 and went through all the non surgical methods first. I had sugery to fix PTTD in Jan. 2008. I had the cleaning out of the ptt, FDL transfer and the realigning of the heel bone, along with the reshaping of the heel bone and a screw put in my heel to hold it together while it healed. My injury came from constant spraining of my ankle, that and I tended to over pronate anyway from a very early age. I too have run thousands of miles, I was a 4 year varsity cross country, indoor/outdoor track runner in both high school and college. I had also completed 3 Boston Marathons. After my surgery I attempted to return to work almost a week after surgery (one day shy) the thing was I could do it but was very very tired. And unforutnatley you are going to have to find a way to put it up otherwise you will be in a lot of pain. Sunny is right try to find the knee scotter (the roll-a-bout). I work a desk job but I also had to walk (crutch 3 blocks to work from the train station)
I started running about 4 months post op as well. I too began having issues with my other foot, and the screw in the surgerically fixed foot. I just had the screw removed at about 7 months post op. which I am looking forward to getting back into some running before I have to get the other foot fixed. I have not been told I will never be able to run again and my doctor would have told me that. I may not be able to run a marathon again but will be able to run and stay in shape.
My timeline for surgery was 2 weeks in a surgical splint (huge pain in the butt very large) then I was in a cast for 4 weeks and NWB, then went into a boot for about 6 weeks I believe and that I went from PWB to FWB. During the boot phase I was in PT and working toward running again.
I personally did not have a ton of damage show on my mri it was much worse when they went in to actually fix it. I had torn the tendon and it did not show on the mri. I had both the general anthesia and the leg block and it was great.
It is a long hard road but there is a light at the end of the tunnel. You will be able to run again it will take some time and you have to be patient. Please let me know if you have any other questions. I am more than happy to help. Good Luck on your surgery though. Remember don't push it too much or you will be right back to where you are now.

Kristin

PS~ Everyone I am doing great since the screw removal last Thursday (7/31) my left foot is taking a beating again but it is all part of the course. And my doctor when he first saw me before surgery he asked about my other foot and then asked my mom about it when he spoke with her which bascially means he is really concerned about it because he would not have mentioned it to both of us if he wasn't. So who knows when that surgery will be. I should be FWB in a few days right now I am PWB from the screw removal. Hope all is well with everyone!!

 
Old 08-04-2008, 03:13 PM   #10
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Re: Posterior Tibial Tendon Surgery and running after surgery

Hi- Thanks so much for the reply. I just want to know there is hope of running again. It seems that there are a lot of issues with the screw for the heel correction. I can see how this would present a problem with something like runnning which is a good deal of pounding. I never ran in school but picked it up heavily in my late 20s and haven't stopped since (well until now). I've done marathons in the past (2:48 PR ) but have no desire or the time to train at that level now. I no longer race but I just hope to be able to run like I do now which is 4-6 miles about 3 or 4 times a week supplemented with road cycling. Right now running is very hard in my arch, ankle area and down to my big toe. I hope the surgery will fix things back up. I guess the tear is bad enough that nonsurgical options weren't even recommended. I do have over 70 accumulated sick days in my job but I want to be back for the first day of class. If I just can't make it back, I can always take some of these days. I found the scooters online and I'm indecisive about that. Might give the crutches a try first. I'm nervous because I haven't heard anything from the Dr.'s office or hospital since we scheduled the surgery on July 30. It seems impossible that it will come together in just over a week. Until then I'm better off on my bike........it's going to be a long haul without running. This is my first downtime from running since 1989 and caused by falling down freshly sealed wood stairs with socks on

Last edited by smile2006; 08-04-2008 at 03:14 PM.

 
Old 08-09-2008, 10:20 AM   #11
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Re: Posterior Tibial Tendon Surgery and running after surgery

Well after reading many of the threads here and getting more information from my Dr. I feel more prepared for surgery this Wednesday. When push came to shove the feeling seems to be making it back for the start of my semester is unlikely which would be one week after surgery. I'm still going to try but if I need a couple more days I'll take them. I did find out I will have heavy sedation with the block anesthesia. They will do a debridement, FDL transfer and a Dwyer osteotomy. I am told the surgery will be 2-2 1/2 hours. I finally got a copy of the MRI report. The MRI showed a focal, longitudinal partial tear of the posterior tibial tendon from the ankle joint to just above the navicular with excessive swelling/fluid in the tendon sheath.

I am having the surgery the outpatient department of a hospital. I will be kept for 23 hour observation. For insurances purposes I dont have to be fully admitted to the hospital but I still go to a regular room in the main hospital overnight. Seems weird to me but from an insurance standpoint it's probably not so weird. My husband is off work Wednesday through Friday with me but intends to go back the following Monday. I have been doing "above my share" of the cooking, cleaning and doing the yardwork lately because he knows he will have to really chip in (and I know he will). I am not looking forward to the recovery and being on crutches with a cast for the first time in my life but I need my foot back and if this is what needs to be done then I guess I'm ready.

 
Old 08-10-2008, 02:50 AM   #12
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Re: Posterior Tibial Tendon Surgery and running after surgery

hi smile....just want to say good luck with the surgery. and better to take days off for better healing, than be off months later for complications! an ounce of prevention etc etc. hope it heals well. Dee

 
Old 08-22-2008, 04:38 PM   #13
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Re: Posterior Tibial Tendon Surgery and running after surgery

I had my surgery on August 13 and went back to work today for basically a half day (enough to teach my classes). Yes, it was a rough day and my toes look like sausages again. I felt pretty good while at home this morning and had taken myself off pain meds as of Wednesday (one week after surgery) but the day did take its toll. My surgery took a little bit of an unexpected turn. Due to excessive tissue growth the FDL tendon could not be definitively identified and my surgeon used the tendon to the big toe instead for the tendon transfer. He said the results should still be good. The excess tissue was biopsied for possible rhumetoid arithitis but the results came back negative. Other than excessive tissue in the surgical area I have not had symptoms that would point to RA so I'm a bit confused by all of this. I have a history of this in my family so the doctor had me get a complete line of blood tests for RA, the results are still not back. I'm hoping for good news when the results arrive.

I was suprised how painful this surgery was in the days immediately following surgery. I was sedated with block anesthesia. I was in the hospital one night and on morphine while there. The first 2-3 days at home were rough and I needed to basically stay in bed with my foot up. My husband has been home with me. I definately could not have managed full days on my own. I was told to ice with two 10 pound bags of ice 6-8 times a day. This alone could not be handled by one person. I would say most of my pain is in the ball of my foot and into my arch and inner ankle (my three biggest toes are quite numb and my heel where the osteotomy was done hasn't been painful yet) I had the surgical splint changed to a cast on Monday and what a relief that was from the standpoint of weight. The new cast is feather light! I go back to the surgeon for another cast and to have the staples removed a week from today (next Friday). I was also sort of suprised to see how big the incisions are (three of them), guess I'll have some nice scars. I'm looking forward to increasingly pain free days and less swelling soon (hopefully). I'm wondering how long it took the swelling to calm down for most people?????

Last edited by smile2006; 08-22-2008 at 04:40 PM.

 
Old 08-22-2008, 09:16 PM   #14
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Re: Posterior Tibial Tendon Surgery and running after surgery

The swelling can last for the first 3-4 months...but it's variable. My first surgery was in the spring/summer and I had a lot of swelling (and pain from that). The second one was during the winter and I had a lot less swelling and pain. It may be less swollen in the AM, but as your are up, gravity brings it back. Also, once you start to bear weight and do PT, you will likely have more swelling. Be careful with how much you push yourself...it's early and doing too much can cause more problems and prolong recovery. The recovery is long...and it's not easy to be patient with it! Just keep thinking of the ultimate goal...to get back to running! That's what kept me going and I am back running every other day now.

 
Old 08-23-2008, 04:45 AM   #15
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Re: Posterior Tibial Tendon Surgery and running after surgery, now in recovery mode

So wonderful to hear you are running again. How long was it after surgery that you were able to run? I know this recovery is long but it is so hard to just sit around (as everyone here knows). It's only been 9 days and I'm not liking my new routine of immobility at all. My husband just went off on a three hour road ride and here I sit. What a great guy he is though, I just got up and I have a covered commuter cup of coffee on my bed table waiting for me and bowl of cereal alredy poured in the kitchen. I know what you mean about too much too soon. My foot was just throbbing last night after a half day on campus. I ended up taking a pain pill around 11:00 to calm it down enough to sleep. On top of it I lost my balance attempting to sit on the toilet in the middle of the night and put my foot down, that scared me to death. Hope I didn't do anything to it. OK, time to think happy thoughts of running rather than complaining!

Last edited by smile2006; 08-23-2008 at 04:47 AM.

 
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