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Old 03-12-2010, 11:51 AM   #1
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Posterior tibial tendon tear

I am new to this problem. My dr has said I need surgery but I am having a hard time deciding that it is the best option right now. The pictures I found on the web and the stories I have found on this board have helped tip me toward surgery. My problem is I don't seem to have a lot of pain right now and I am worried I will be trading in some pain for more pain. The only thing I know at this point is I have a tear in my posterior tibial tendon, my arch is flatter than it has been since I was fifteen (I am 49) and it achs more when I walk alot. It hasn't been explained to me, in terms I can understand, what the dr wants to do but I am getting an orthotic brace this afternoon. My family doesn't seem to understand why I am having a hard time with this surgery because usually I am fearless when it comes to having surgery for my health. I'm kind of confused by my apprehension too. I will appreciate help with what questions to ask.

 
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Old 03-12-2010, 02:24 PM   #2
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Re: Posterior tibial tendon tear

Hi - welcome to the boards - they have been a big help to me too. I would favor surgery based upon my own experience. I can understand the hesitancy, though, I felt that way initially - especially since a fusion was recommended. I was diagnosed with a ptt tear in October - was placed in an air cast boot for three weeks but the tendon failed and had fully ruptured by the time I reached surgery in January.

I'm 7 weeks post op now and have started PT and walking with full weight for short periods. The pain I experienced before surgery was far greater than anything since. The first two weeks post op there was pain, of course, but managed well with pain meds. Everyone's experience is different, and your tendon may be able to heal on its own - but I do want to encourage you that the thinking about the surgery for me was harder than actually going through it. I wish you the best in your decision.

Mary in Iowa where Spring has come!!!

 
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Old 03-12-2010, 08:04 PM   #3
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Re: Posterior tibial tendon tear

Thanks for the encouragement Mary. I was fitted for an AFO (Ankle Foot Orthosis) this afternoon and it took an hour and forty-five minute. So many adjustments but when I got home and took it off to look at it I decided that surgery would be necesary. My foot and ankle are very misshapened even if it doesn't hurt to bad yet.
A little more of my story is in order though. My ankle started to hurt in December of 2008. It didn't hurt to bad so it took me two monthes to go to my family dr. She sent me to a othopedic dr. He said stress fracture which didn't show up on x-ray of course and put me in a stirrup type brace for six weeks. It didn't do anything so he sent me for a bone scan it showed something so he took another x-ray. Well that showed a little round spot so I get a MRI which showed a PTT tear. He tells me I need to see a foot and ankle specialist and I can wear the brace or not since it doesn't help the pain. It takes 8 monthes to get into the specialist and he says lets try a boot for 4-6 weeks but he thinks surgery is needed. The pain at this point gets a little more pronounced. Last week I see the specialist again and he tries to tell me surgery again. Luckily I have my daughter with me this time so she can tell me later "Mom he said surgery." So I look back at the MRI report and get the name of the tendon that was torn and do the research and find this site. So now I have a brace and know I need surgery.

Sally from Kansas where it rained all day but it didn't snow.

 
Old 03-12-2010, 10:20 PM   #4
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Re: Posterior tibial tendon tear

Hi Sally. Welcome! Unfortunately once this condition has progressed to the point yours has it won't heal on it's own. Eight months to see a specialist? Why so long? I really wish you could see someone sooner. The procedures that will most likely be done for your foot are tendon transfer (in my case they used the FDL tendon which is the one that controls your last two toes. You have two so you can afford to lose one), a calcaneal osteotomy which means they basically cut your heel bone off and move it over to realign the foot. This is held in place with a large screw or several small screws. Some doctors use a wedge of bone to accomplish the realignment. So I would ask what type of osteotomy will be done. In some cases an osteotomy is not needed but usually once it has progressed to a Stage 2 or 3 it is required. You can also ask what stage your foot is in. In severe cases (Stage 4) a fusion may be needed. In this case they screw the bones together in one or multiple joints. If a fusion is required, depending on what joint is fused, you will lose some motion in your foot-usually the side to side motion. You can have a fusion and function perfectly normally, just may have problems when walking on uneven ground. I didn't have a fusion and still lost inversion in my foot but I don't need it.

I had a tendon transfer and calcaneal osteotomy and I was a Stage 2. I was in a splint the first two weeks. then put in a cast for four weeks. At six weeks I went into a boot and began PT. I was pretty much "toes above nose" for the first month, gradually increasing the amount of time I put my foot down. This six week period was non=weight bearing (NWB). Once I got in the boot I became partial weight bearing (PWB). I gradually placed more and more weight on the foot over the next few weeks. I used a cane or a single crutch once I became FWB. I was in PT for about four months. You can expect the recovery to take about a year.

I know it seems scary and it is a long recovery but in most cases the outcome is very good. I just really wish you did not have to deal with this for eight months with surgery looming over your head. You will find lots of information and support on this board. Try not to freak out

You can do this. Feel free to ask any questions you may have. If I can't answer them I'm sure someone on here can. take care.

emmie

Last edited by emmie54; 03-12-2010 at 10:23 PM.

 
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Old 03-13-2010, 02:41 PM   #5
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Re: Posterior tibial tendon tear

I too have been advised to have surgery. And I must say this site has given me a world of info. Much more than the doctor provided. I am really having second thoughts about going through with it now.
I just started about 6 months ago with pain whenever walking or standing for any length of time. When I first saw the doctor about 6 weeks ago, he put me in a boot which helped. However, when I took the boot off and walked without it I was back to the same feeling. When I returned to him he said the only other thing to try was a brace. But surgery was really the only answer.
My family and friends think I should seek a second opinion. They wonder why he did not recommend orthotics and PT. I'm not excited with the prospect of a surgery and lengthy recovery but the idea of expensive orthorics and endless therapy with the eventual same outcome worry me too.
I am stressing over this and don't know what to do at this point.

 
Old 03-13-2010, 03:22 PM   #6
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Re: Posterior tibial tendon tear

Hi Westy -

I can only share with you from my experience - and I'm glad you found the boards! In my case, once the tendon started to tear, it was too late for orthotics and pt because by that point the foot had completely flattened and the heel was slid way out of position. I did seek two opinions - which may be the way to go for you, too. I can honestly say that thus far (almost 8 weeks post op) I'm very glad I had surgery.

I wish you the best possible outcome - keep us posted!

Mary

 
Old 03-13-2010, 05:21 PM   #7
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Re: Posterior tibial tendon tear

Thanks all,
I guess the first thing I need to ask is what he thinks needs to be done. the least and the most so I know what I am looking at. I am looking at the end of May for surgery. I want to whine a little because it stresses my family out so much when I whine to them. I didn't know for the eight monthes what they were talking about. All I knew was I had a torn tendon. It is hard to think of surgery as necesary when I went that eight monthes with no more support other than a good pair of tennis shoes. It's hard to switch gears when I have dealt with the symptoms I read about for years with no extra pain. I do have neuropathy in my feet so that accounts for some of my relief from pain. One Dr said the neuropathy can make it worse though. That did get my attention. Oh well I am tired of whining.

So I have been sitting hear thinking and I really can't think of more questions that what he wants to do to my foot.
Sally

 
Old 03-13-2010, 09:20 PM   #8
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Re: Posterior tibial tendon tear

Sally,

Repeat after me: "whining is good for the soul.....whining is good for the soul"

Now, don't you feel better?

Come here to whine all you want to! We all do!

 
Old 03-14-2010, 01:46 PM   #9
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Re: Posterior tibial tendon tear

I like it!

Thanks emmie

 
Old 03-14-2010, 06:56 PM   #10
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Re: Posterior tibial tendon tear

Thanks Mary,
My dr. only took x-rays and checked my gait. He never said how bad it was (what stage).Can he even know at this point?

 
Old 03-16-2010, 01:41 PM   #11
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Re: Posterior tibial tendon tear

Hi m4g3 -- I saw my ortho today and finally, after 5 1/2 months of tests, cortisone shots, boots, etc... I am having surgery on the 14th of April. My doctor likes to call what I am having done the "All-American Special" or as I prefer to call it -- The Full Monty. I will be having the tendon transfer, the calcaneal osteotomy (realigning the heel to support the new transferred tendon), and the triple arthrodesis (fusing of the joints). Not looking forward to the 6-8 weeks of NWB but I have to say I am relieved to finally have a definite course of action. I was going out of my head after 4 months of no diagnoses-- I can't imagine waiting 8 months to see a surgeon. Keep up your spirits and just take it a day at a time. Based on stories/experiences I've read in this forum, the physical aspect is the easy part. The important thing is to keep it together mentally. Hang in there. You have a lot of support on these boards. Without getting too spiritual here, let me say that prayer does work!!

 
Old 03-16-2010, 04:47 PM   #12
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Re: Posterior tibial tendon tear

Congrats on getting your surgery date. I had to go through six months of conservative treatment before my surgery and it absolutely drove me nuts. While I was glad that my surgeon wasn't "knife happy" I still felt like I was just spinning my wheels.

At least your pain going forward will be healing pain and you'll know that every day brings you closer to full recovery!

 
Old 03-17-2010, 12:36 PM   #13
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Re: Posterior tibial tendon tear

Pophead
It is almost relief to make a decision. Now you can concentrate on how you will get better instead of worrying if you are on the right course.
I went for a second opinion this morning and am more stressed. This dr. could not believe I had not had an MRI. He said there was no way to decide without it! Then he asked me what my original surgeon wanted to do and wanted to know why he was using the tendon from my small toes instead of the one coming from the ankle. How do I know? It really makes me uneasy. How do I know who to believe. My surgery was scheduled for April 8th but now I feel like I should get the results from this MRI and this second opinion.
Have you all gone through this?

 
Old 03-17-2010, 01:43 PM   #14
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Re: Posterior tibial tendon tear

Westy239,

I have been in a similar situation recently although for a different procedure.

I went to get a second opinion, but came out with more questions than answers. The first thing I did was go back to my treating ortho to tell him what the second opinion had said and give him a chance to respond. I'm really glad I did - he reiterated his philosophy on his treatment plan which reinforced my belief and confidence in him. However, he was unaware that a particular treatment was even being used which made me wonder why - was it so new I would be a guinea pig if I chose to go with the second opinion dr's recommendation? or was my dr out of touch?

Therefore, I got online and did some research of my own. I haven't found many people performing the surgery the second opinion dr offered me which makes me think I would be his guinea pig.

When in doubt - go to the people you trust and ask more questions. Find out what your treating ortho would be doing in the procedure and why. Maybe that will make you feel better.

Finally, you can always get a third opinion. I plan on going to another ortho who may be somewhere in the middle - not super conservative, but not exactly on the cutting edge either.

Good luck! Keep us posted!

Step

 
Old 03-17-2010, 09:38 PM   #15
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Re: Posterior tibial tendon tear

Westy239 - I had an MRI a while back but my surgeon told me he has found them to be less than completely accurate at catching what is going on in that area. He said that based on my lack of motion and the persistent swelling, that my tendon was shot. Was very reassured when he told me he has done over 900 of these procedures. Hopefully you can get that kind of peace of mind before going in for surgery. I am very relieved to finally be getting it done. Hang in there!! There is a lot of support to be found here!

 
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