tendonitis posterior tibial tendon AND tendinitis flexor digitorum longus tendon
I have been diagnosed with tendonitis involving the posterior tibial tendon and flexor digitorum longus tendon of the left foot which is causing severe foot pain - this has been confirmed with an MRI. My doc wants to perform surgery but I would like to do this only as a last resort. I am very active: running, dancing, climbing, scuba diving, etc are there alternatives to surgery? I am 40 years old in otherwise healthy condition. My feet do have a high arch and I am afraid that perhaps the arch is falling ... could this be true?
The posterior tibial tendon is a major player in holding up your arch, so if you have some degeneration, tears, splits, frays, etc. in the tendon, it could be lengthening and causing your arch to flatten. I think the second tendon you named also runs in the same area, so I"m sure your foot isn't too happy right now. What forms of treatment have you tried so far? Anti-inflammatories, icing, rest, PT, immobilization? Ususally conservative treatment is tried first, but if it fails, surgery is required to fix it more permanently. Part of the problem with the posterior tib tendon is that the blood supply is very limited, so healing takes forever, if ever. It requires a lot of patience, whether that's early on or after having surgery! I am in my early 30s and have had to have both posterior tib tendons repaired and a bony procedure (osteotomy) to create an arch, thus taking the pressure off the tendon to do that. Sometimes conservative treatments can allow for healing to happen and many times it can't. Each doctor has their own plan and if you would need surgery, what types of procedures would be done. I'm also a runner and have been able to return to it, but was told up front that I probably wouldnt be going for a marathon or extreme sports after having surgery. That wasn't my goal anyway, so didn't bother me. There are a ton of postings here about PTTD or issues with the posterior tibial tendon, so look for them. There are also a lot of active posters here who have had various procedures done for it. Are you going back to your doctor soon? Sorry you're having to deal with this...
to answer your questions: I have tried immobilization, electric stimulator (before I realized what the injury was), icing and resting. I am not good with meds so I have to say I passed on the NSAIDs. The pain started about 5 months ago after dance and has progressed. I also have to admit I have a high tolerance for pain and since it came and went and only bothered me when I stepped a certain way I let it go.
I have been in the walking boot for approximately 3 weeks with no improvement and actually I feel like it is getting worse.
I found a great deal on the internet regarding the PTTD but not much on the flexordigitorum longus tendon or the two injuries combined. This truly is my delemia. Do I continue with conservative treatment, should I just let it go and deal with the pain ... what are the consequences to this or is surgery really the only option?
I felt like my foot got worse in the boot too and was in it for 4 wks. As far as whether or not to go forward w/ surgery...it depends on how you're tolerating the pain. If it's something you can live with, you don't have to do surgery. However, it could get worse since the tendon can continue to degerate, tear, lengthen (worst case is a rupture) over time. What has your doctor suggested? Did he talk about what procedures he would want to do?
If you do have surgery, know that the recovery is long...usually 6-8 wks of no weight bearing, then a period in the boot (walking as tolerated) and PT. I was back to "running", working out, etc at 4-5 months post-op.
I guess it's up to you and your doctor as to whether you continue conservative treatment or go forward with surgery. If you're having a lot of pain and it's affecting the quality of your life, maybe moving toward fixing it and getting on with life would be best. It's a hard decision. Feel free to post more questions/thoughts here.
I am also a very active person (43 years old, runner, road and mountain biking) and recently had surgery for a torn posterior tibial tendon (transfer, debridement and Dwyer osteomoty). My tear was a result of falling down the stairs rather than from sport itself. Did your MRI show an actual tear of some sort? If you don't have an actual tear perhaps you are treating it early enough to avoid surgery. However, an actual tear typically requires surgery especially if you want to be physically active on the foot. As others here have said the recovery from surgery is very long. I'm just past the 5 week mark and in a walking cast. I am able to walk on the cast without crutches for most of the day. A really long stretch of walking like 10-15 minutes I still use one crutch (I work on a college campus so have some walking to do at times...parking is always an issue even though I have a temporary handicap parking permit). I've still been able to do upper body weight workouts since about week three. I'm hoping to have the cast off and into a boot of some sort on Friday which I am looking forwad to. It's tough when you are used to being active to deal with inactivity. I waited way too long to get my issue checked by a foot/ankle orthopeadist and by the time I did, surgery was inevitable. Good luck with getting better, whether that involves surgery or not. I'm glad I did the surgery but have yet to see the final results including whether I will be able to run as I did before.
PS- You also said that your flexor digitorum longus had tendonitis. In my case I had so much excess (inflamed) tissue around this tendon that the tendon from my big toe was used for the tendon transfer. If you had a tendon transfer which tendon would they use? According to my surgeon results with either tendon are comparable.
I had the same exact thing with my fdl and pttd the mri also showed a tear in both, my Doctor (awesome Doctor, seems like he actually cares)and I decided after about 6 months of trying other things to go on with surgery. I can't say the surgery was easy at all, it is a very painful recovery, but I did have a pretty bad infection. What he did is tendon repair and then he attached the 2 tendons together which I highly recommend, he also put in a subtalar implant which I will have removed this Friday the 19th due to it being painful. My foot feels so much better I can not believe the difference, once that implant is out I think I might be 100% back to my old self. I am also active, I am a Correctional Officer at a state prison, I was a runner, rode horses, and avid hiker. Perhaps you should bring up the attaching of the two tendons? I do believe the implant made the healing process go much faster.
It has been about 4 months since my surgery for the repairs.
I wish I could get a reply on the removal of the implant recovery and pain.
Last edited by Rachel1972; 09-17-2008 at 09:24 AM.
Had the same. My PT and FDL were both shot. Surgeon gave me the option of an allograft - but cautioned me it was experimental, and had not been performed extensively. On Dec 9, both tendons were replaced. Cast removed last friday, still can't walk on it though.
I noticed you are from SC. Who did your surgery ...was it outpatient? I am meeting with surgeon on Monday..tried conservative treatment with cast for 4 weeks and PT for 4 weeks but the year would not heal....any helpful ideas I should take care of prior to surgery next week.
I am not for sure how this msg. board even works. But, I also at 59, have had the
complete surgery of my left foot. Tibial tendon removed, transfered tendon from toe
area with back hind foot cut through to move over so many centimeters to protect that
smaller tendon. Help at home, etc. I could give a lot of information to those seeking it
if I knew how. Guess will work on that one! The first surgery was about 2 and 1/2 years ago. MRI said severe, acute and chronic tibial tendonitus. Tryed walking boots,
staying off feet, etc. Finally, my Dr. (ortho) decided surgery best solution. I am now
dealing with many factors which are attributed to the surgery. I have done swimming,
PT for about a year. I guess a lot of nerve damage from moving heel over for protection.
So, it has been going on 2 and 1/2 years. I am a farm girl and can't go up steep slopes,
etc. Now, it looks like right foot has done the same thing. In my case, it is weak arches
and pronation of the feet that stretched the tendons to being unable to perform their
I think everybody on this web-site needs hugs and a support group!
This has been a very informative and encouraging site. I was diagnosed with stage 3 posterior tibeal tendinitis, and I just had tendon transfer surgery along with screws put into my heel to help create a new arch. I had the surgery two weeks ago, and I just got my stitches out yesterday. I have 5 more weeks in my cast and I've been propping my leg to keep the swelling down.