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Old 01-02-2011, 09:21 PM   #1
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Need advice on PTTD surgery

I need advice on proposed surgery for posterior tibial tendon insufficiency. I was diagnosed 5 years ago with stage 2. I refused surgery at the time and was able to get along pretty well with just an orthotic. I am retired and don't have to be on my feet for extended periods. I square dance and was able to dance several evenings a week until recently. I was towing a canoe up a river bank (in sandals) when I stepped on some very uneven ground and hurt my foot further. I rested it and got some more images done' The foot deformity has gotten some worse but it is still stage II. I can get around with moderate activity most of the time, if I wear my speed lace ankle brace and othotic and don't spend more than about 20 minutes on my feet. Then it starts feeling as though I'm stepping on knives.

I have two different opinions on treatment. Both of them sound awful and I am wondering if it is worth it to go through those months of recovery, or to just stay with limited activity and see if I can get by until I'm senile and don't care. I am 65 now and in good health, but I don't get much exercise now as I spend a lot of time sitting, resting my foot.

The other question is which surgical approach to use. The orthopedic surgeon in town wants to treat it as early stage III and do a subtalar fusion as well as an osteotomy and some tendon work, screws in my heel and probably achiles lengthening. The sugeon in Atlanta who used to teach this stuff said that he would do the standard stage II surgery with calcaneous osteotomy with media slide and tendon transfer. I don't know what the relative success rate, benefits and drawbacks of each approach are. Any input would be greatly appreciated. I am having a terrible time trying to decide.

Thanks for these boards.

 
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Old 01-03-2011, 03:28 AM   #2
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Re: Need advice on PTTD surgery

I'm in the early (13 days post op) stages of recovery from what sounds like the equivalent of the stage 2 surgery you mention.

In deciding to have the surgery I considered three major issues:

1) How much pain was I in and how would this change over time. In 2004 I was in a lot of pain but this diminished rapidly when I started to use orthotics. Up until my operation I was able to walk reasonable distances and even jog for up to five minutes without getting into too much discomfort. Where I really had problems was walking and even standing on uneven ground. My doc told me that whilst my pain was minimal most of the time, it would get worse and start to move from the foot to my ankle and possibly elsewhere.

2) What did I want to do and how long did I want to do it for? My wife and I own a house up the side of a mountain in Italy. We plan to retire there and grow some crops and take an active role in a rural community. For me this would be impractical if I had to use crutches or a walking frame all the time. This is what drove me to have the surgery as my surgeon told me that the likely worst case scenario is that my condition should not be any worse than it was on a long term basis.

3) Could I handle the recovery? It's a long and sometimes painful recovery. So far I've had minimal pain but it's extremely awkward being non weight bearing. On the plus side your hopping skills will improve significantly

I'm not sure if this helps but it sounds as if your decision, like mine, centres around lifestyle choices. I wouldn't hesitate to recommend surgery to someone who was in constant and seriously disabling pain provided that they got the right surgeon. I think you probably need to decide how active you want to be for the next 15 to 30 years.

 
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Old 01-03-2011, 03:53 AM   #3
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Re: Need advice on PTTD surgery

I agree with London Chap on what you need to look at when deciding whether or not to have surgery.

For myself I am 33 years old, and have had flat feet and bunions gradually growing my whole life. Without knowing there was any other way to deal with the flat feet other than orthotics. I had gotten to the point that I could no longer exercise, or stand for long periods of time without pain. After seeing a podiatrist for what I thought would be another set of orthotics, he recommended surgery. To make a long story short, after getting several opinions I decided to have the surgery with the first doctor. I am 12 weeks post op and feel great. There is some mild discomfort, but overall I feel like the biggest struggle is how the doctor has put it "to slow down". If you are looking for another opinion for a doctor in the Atlanta area I would highly recommend him.

If you decide to go with surgery, there are several good threads describing how to prepare, and what to expect.

Either way I hope everything works out for you.

 
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Old 01-03-2011, 12:54 PM   #4
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Re: Need advice on PTTD surgery

I think it depends on what you can deal with. I was also diagnosed with stage II but was in severe pain the last several months I worked. Turns out I had a fractured bone in there I was walking on. I had orthotics which really did not help alot for me and they also tried a soft cast and a hard cast before deciding on surgery. For me because of the fractured bone, I really had to have the surgery. I am currently 4 months post op ptt tendon repair, fdl tendon transfer, calaneal osteotomy, kidner procedure, achielles tendon lengthening and there was a sixth procedure but I cannot remember. I returned to work today, and my foot responded very well. No swelling and no pain or aches. The pain I have had post op never came close to the pain I had prior to surgery. You have to make sure you trust the doctor who will be doing the surgery and what the benefits/drawbacks are to you for having the surgery. If I had to do it all over again I would definately decide to have surgery.

 
Old 01-03-2011, 01:51 PM   #5
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Re: Need advice on PTTD surgery

Thanks Missy, I tend to get pretty scared about the surgery when I read on these boards about all the problems folks have recovering. It's good to hear that you are doing so well. That is encouraging.

One of my problems is that the ankle ortho here seems so brusque. He has not spent any time with me at all. He explained what he wanted to do only very briefly and left the room. He maybe spent 7 minutes with me, total. I think that it is a factory type ortho center. Also, since he wants to do a fusion of the subtalar joint I am concerned that I will not be happy with the quality of my walk afterwards. I am also concerned about the altnernative - driving an hour and a half to go to the one in Atlanta.

I live alone and have an old, ailing cat that I take care of which complicates my decision, too. I don't want to wear out my friendships having them come in and help me out. Lots of days I think that I can get by without surgery as I am pain free most of the time, when I just putter around the house. You can see how I go back and forth.

Cara

 
Old 01-03-2011, 01:56 PM   #6
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Re: Need advice on PTTD surgery

After surgery, you will need to have help. It is really difficult getting around when you are nwb. Even the smallest tasks take a long time to do. In most cases post op, you are really supposed to have you foot elevated all the time and iced for several weeks. Is there anyone who could help you? I had my daughter to help me but she was also post op hip arthroscopy. We were a pair!

 
Old 01-28-2011, 05:23 AM   #7
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Re: Need advice on PTTD surgery

Hi, I am about your age and had this operation 7 weeks ago. I also was hesitant about going thru the operation, and finally decided that I am not getting any younger! and since the recovery process is not at all easy, better go thru it while I still can.
I have 2 things to say to you.
1) Do not go thru the operation with a doctor u do not trust, or one u feel is holding info from you! He should be willing to sit withg u for as long as it takes to answer any question u might have. Without giving you the feeling he is doing you a favor.
2) You definitely cannot do this alone, help at home is crucial! I myself was (and still is) helped by my husband, who is an angel.
Best of luck!

 
Old 01-28-2011, 04:29 PM   #8
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Re: Need advice on PTTD surgery

It sounds as though you might not completely trust your doctor. It may benefit you to get another opinion. I am not saying you should not or do not need the surgery. I really believe you have to trust your doctor. This surgery was my first surgery and I was extremely scared and nervous. I got very lucky with my doctor. I think the surgery is just the beginning of the process. You will see the doctor for many weeks/months afterward so trust and comfort is really important.

 
Old 01-29-2011, 05:46 AM   #9
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Re: Need advice on PTTD surgery

I agree with missy luke. If you are not sure, you may want to go for one more opinion. A calcaneal osteotomy requires screws in the heal. I went for four opinions because I was getting different treatment plans from different doctors. I had my surgery the end of July and am doing so much better than prior to the surgery. My recovery is incredibly similar to MissyLukes. I was a stage two or two B. My posterior tibial tendon and spring ligament were repaired, I had a tendon transfer, calcaneal and cotton osteotomy and my achillese tendon was lengthened. You HAVE to trust your doctor. It is a major surgery and you have to do your homework in selecting a doctor. With the right doctor, you could have a positive outcome. I went back to work the beginning of December. At this point, I am probably at about 80% of normal. I am quite satisfied with my recovery so far.
If you are having problems performing your activities of daily living because of the foot, you are wise to have it addressed now.

Good luck!!!!

 
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Old 01-29-2011, 07:29 AM   #10
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Re: Need advice on PTTD surgery

Thanks, Roxy,
I certainly did not feel a connection with my local surgeon. He barely spent any time with me and didn't communicate well. During the brief exam he used the heel of his hand to push upward onthe ball of my foot. I thought that he was testing my muscle strength and resisted. Then when he told me what he was going to do he mentioned doing an achilles lengthening and off-handedly remarked that there was a lot of resistence to flexing the ankle. It was only much later that I realized that my resisting his pushing was a test of flexibility, not muscle strength. If he had told me to relax, it would have made a difference.

If I had a good feeling about my relationship with the surgeon I would be much more comfortable with doing the surgery. Right now my foot has very little pain and I think that I'm going to postpone. I have no help at home and I don't want to wear out my friends' good will. My cat needs twice daily medication and trips to the vet three times a week. And my 86 y.o. mother, who lives half a continent away, is having serious health problems.

There are just too many issues for me to contend with. I can't handle the complications of a surgery that will disable me for months. I can keep restricting my activities and get by.

 
Old 12-13-2011, 08:44 AM   #11
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Re: Need advice on PTTD surgery

Update on my PTT - one year later I have not had surgery. It was just too scarey with no support system.
I am dong really quite well. I took care of myself by staying off the foot as much as possible and wearing the lace-up, cross stapped AFO with rigid sides. It took a year before I could comfortably spend much time without the AFO, but I finally got there. I can't say that the ankle/foot has healed, but there is very little discomfort with it when I am on my feet for hours at a time. I still occassionally use the AFO if I'm going to be walking much. But I am happy with my condition compared to the disability and pain of the surgery.
I still might end up with it in the future, if the ankle gets worse again. THis was the second time it had flared up in 7 years. I certtainly can't go for long hikes, but all in all I'm fine.

 
Old 08-30-2013, 06:13 PM   #12
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Re: Need advice on PTTD surgery

It has been over two years and although the first year and a half were difficult it has been well worth the trouble. In fact I still need to have the other foot done, but have been waiting to build enough savings to pay for it. There were two doctors that I saw. The first was Dr. McGlamry, and the second was Dr. Richardson. They used to be in the same practice but no longer are.

If no one has told you at this point, it is not a surgery for the faint of heart. There were many days that I questioned the decision to have the surgery, but I can tell you that I wish that I had done this earlier. Now my only foot that bothers me is the one that I have not had surgery on.

I hope that this helps you in your decision, and if you have any other questions let me know.

 
Old 08-31-2013, 11:35 PM   #13
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Re: Need advice on PTTD surgery

Georgia chicken,
I was so shocked at the major surgery the first doctor suggested so I drove ninety miles to get a second opinion and really liked the second doctor so much. He had a littlest e comservative approach and mentioned fusion is a last resort. It's only if the first surgery fails . I had the surgery seven and a half weeks ago. Although still sore, the searing pain in my arch I had before surgery is gone and I am hopeful that the results will be good! Good luck. You can hire caregivers to come in for a couple hours a day for under twenty bucks an hour such as Home Instead. I have a friend who lives alone who did that for a couple of weeks. That could help you put if you someday have surgery. Good luck

 
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