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Old 05-22-2012, 01:33 PM   #1
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Possible PTTD and Adult Aquired Flatfoot surgery

Hi,
I'm new to the boards and am hoping that I can get advice. I may also vent a bit...
I have always been active. I danced for close to 23 years ballet, modern and jazz. Both my grandmothers had flatfeet (born with it) as does my father. I was born with this too and is how I ended up starting dance so young.

I am now 55, still very active, love to dance and take long walks. (At least I used to.) I am in excellent health. I am not overweight.

Two years ago I had a sudden attack of Plantar Fasciitis with a heel spur. I was told it would go away in a couple of weeks. It didn't. I returned to have injections that did nothing and an MRI that really didn't show anything. A possible hairline fracture on my heel was suspected and I was put in an aircast (walking boot) for 6 weeks. The aircast gave me immediate relief.
The pain did not go away and I went to a top Orthoped in Boston who told me some people find the Plantar pain takes longer to go away up to one year. He also sent me to another specialist Orthoped for an experimental treatment. That doctor suggested I try traditional physical therapy instead. I completed 5+ months of PT and finally gave up. I also noticed that my left foot (the problem foot) had started to roll over.

My GI sent me to another Orthoped who had performed surgery on a nurse in their office. This Orthoped works with my first Orthoped. By the time I saw her for the first time I was almost at the two year point. I had further tests - one to check for nerve damage and one that injected novocaine/lidocaine into my ptt. I experienced about 80% relief but my arch area still hurt.

I had to wait another 10 weeks (doctor's policy) to see her again and be told that nothing showed up with my nerves. Looks like it could be PTTD. She gave me very little information. I am now getting my third orthodic, a more "robust" one. She also suggested I try wearing an ankle brace.

I see her again in late August.

How did your doctors diagnose your PTTD and Adult Aquired Flatfoot?
My arch is gone and about 10 months ago I noticed that my problem foot rolls over. I also noticed that I cannot tread water and walking is not getting any better.

The only other thing this new doctor said to me is that if the orthodic didn't work surgery might be needed.

My symptoms:
Left foot pronates and I have constant pain. My calf feels like it is split in half (upper and lower) and you can actually see a line and indentation.
My arch swells.
My arch constantly hurts and I have to wear shoes with orthodics all the time.
Aircast gives me relief.

Thanks for listening. Advice welcome. Yes, I am not pleased with this new orthoped.

 
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Old 05-22-2012, 02:53 PM   #2
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Four years ago, I had plantar fasciosis which did not respond to treatments including ESWT. Finally, cryo helped get rid of the pain. About a year later, I started having pain along the ptt and into the arch. I tried orthotics and later a brace which didnt help. I was dx with stage 2 flexible flat foot. Any decent foot and ankle ortho should be able to dx pttd based upon exam (too many toes sign, pronation, allignment and symptoms). Two years ao, I had successful flat foot reconstruction surgery at HSS in NY. I used a surgeon who is highly specialized in pttd

 
Old 05-22-2012, 06:37 PM   #3
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Thank you Roxygirl1. It sounds like my case is similar to yours only you suffered two years longer.
I had expected the current orthoped to diagnose me immediately and she did not. It feels like the condition is getting worse. Usually it is a constant pain, today, maybe due to the rain, it really hurts and is swollen.

 
Old 05-23-2012, 06:25 AM   #4
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Who have you seen in Boston? I'm from the area too and have seen a few folks for ankle joint issues.

-Bob

 
Old 05-23-2012, 08:05 AM   #5
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

First went to Dr. DiAsla at Mass Gen who sent me to Dr. Bluman at B&W for an experimental therapy. Now going to Dr. Johnson and will probably go back to Dr. DiAsla.
Who have you seen? Any recommendations? Thank you.

 
Old 05-23-2012, 09:21 AM   #6
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Chiodo at B&W is supposed to be good and I know does flat foot reconstruction. Theodore at MGH comes recommended as well. I actually like Dr Johnson but have not had surgery with her, she is doing some great, cutting edge stuff with OCD's in the ankle joint (which is not your condition).

As Roxygirl mentioned, HSS in NY is probably the best for any foot and ankle issue if you can swing the trip down there.

-Bob

 
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Old 05-24-2012, 01:07 AM   #7
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Roxygirl is correct. Most docs can tell just by examining your foot. The to many toes sign is a common sign as is over pronating. My doctor knew from the signs and ordered an MRI for confirmation. Before having surgery, he tried all conservative methods first.

 
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Old 05-24-2012, 07:08 AM   #8
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

<<Looks like it could be PTTD>>

<<The only other thing this new doctor said to me is that if the orthodic didn't work surgery might be needed.>>

From your original post, it sounds like the new Dr is thinking its PTTD and trying conservative measures before surgery, which is pretty much standard.

The waiting 10 weeks to get results of your EMG/NCV does not make sense as you should have been given results via a phone call within a week or so. That seems odd and not sure what happened there.

In any event, if you are having difficulty with your doctor you should seek another opinion, especially with a major pending surgery like you may have you will want a few solid opinions.

-Bob

 
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Old 05-24-2012, 10:43 AM   #9
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

What is PTTD?
Obviously, I am new to this message board as I recently started having foot pain. Diagnosis posterior tibal ??

 
Old 05-24-2012, 03:03 PM   #10
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Have any of the doctors done an MRI yet? This may give them more information. Which ever doctor you decide to stick with, it is really important to do your homework. Make sure they do many surgeries to correct flat foot. I is a complicated surgery and you need to be sure they are qualified to do it.

 
Old 05-24-2012, 03:24 PM   #11
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

I have had flat feet for years, along with plantar faciatis, hammer toes, bunions and you name it and I have always been very athletic. To cut a long story short, there is NO reason any one with flat feet needs to be operated on and wearing inserts is the worst thing for that problem because inserts just make the foot and ankle weaker, in the long run. If the plantar facia is tight, it will throw the whole foot off as well as the ankle, which , in turn, will make the feet crooked and the ankles weak. I found myself a VERY, VERY good physical therapist, who has made my feet so straight that I cannot believe it and he has done this simply by making the ankle, feet and hips much stronger. Please do not rush into any surgery until you have checked out a GOOD physical therapist. There are generic physical therapists and there are others. I found mine at the private gym I belong to.

 
Old 05-28-2012, 06:46 AM   #12
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Hi there,
Just wanted to put in my 2 cents regarding Dr.Bluman. My son was operated on by Dr Chiodo but had seen Dr.Bluman for a second opinion.I have a hard time believing that Dr. Bluman would not be able to diagnose PTTD as he is an expert in that field.Just performing a single leg heel raise and testing inversion strength against resistance should provide information. Dr.Chiodo is one of the top f&a orthopods in the U.S, so no need to go to HSS despite it's reputed excellence. Plantar fasciitis, if that is what you have, is notoriously difficult to treat and does mimic PTTD in terms of the type of pain you experience. It took me lose to a year to get rid of mine and I have had one true recurrence in the past 13 yrs, but I have never completely gotten rid of it. PT did nothing for me The most useful things I have found were ALWAYS wearing shoes that elevate the heel and calf stretching. I try to avoid standing around and walking barefoot partularly on hard surfaces. During the acute phase, I avoided walking long distances and biked and did deep water pool running for exercise. I have a high arched foot which is the opposite of your scenario so I don't wear orthotics and I need well cushioned shoes. Hope this was slightly helpful to you.

 
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Old 06-03-2012, 07:35 PM   #13
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Hi. Im sorry You have had such a foot issue. A year ago February I started with pain on inside of ankle and it radiated up the inside of lower calf. Went to family physician who sent me to a podiatrist who treated me for Posterior Tibial Tendonitis. I did 30 visits of PT which did not help. Finally I got an MRI which showed a tear. I then went to an orthopedic surgeon who put me in a custom brace with a 50/50 shot of it helping. It did not and I had surgery May 18.
Sure sounds like you have had your share of doctors and remedies. I am suprised they dont have you return before August. I would be so frustrated! Good luck to you!

 
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Old 06-04-2012, 08:08 AM   #14
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

Rd2Recovery, thank you so much for your post. It sounds like we have similar situations.
I went to an excellent PT 2xweek for just short of 6 months. He was most helpful in giving me information to give to the doctors as to where the pain exists. My regular physician goes to him as does my father. Unfortunately, I didn't feel any better. Improvements were temporary. Last time I went was in Dec. 2011.

My current Orthoped suggested I start walking much more. Her concerns were that I had rested my foot for so long that the lack of serious activity may be a cause. I've just returned from a 5 day vacation where I forced myself to walk a lot. (Approx. 10 miles a day). I had the walking shoes for pronation that the doctor suggested along with my orthodics. I walked through the pain and rested when needed. I don't think my foot feels any better but I have to admit my mind does.

I have not had an MRI for my PTT just for my arch area and my heel. The arch was done in Dec. 2011.

My current doctor mentioned tendinitis as the cause of the pain.

I am not keen to have surgery but would like to be able to walk comfortably and to dance again. I did speak to a psychologist who specializes in Pain Management. My biggest concern was feeling like the doctor thought I had a "low tolerance" for pain. (Those were his words). I do not. The psychologist told me her practice is overflowing with patients who complain of doctors making them feel their pain isn't "real," when in fact they just aren't able to satisfactorily diagnose what the problem is.

Thank you again for the replies.

 
Old 06-04-2012, 08:15 AM   #15
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Re: Possible PTTD and Adult Aquired Flatfoot surgery

I see that you walked with the inserts and that is the worst thing you could have done. Please try walking without them and do some of the things I suggested. It will take time. As far as dancing goes, I am a person who lived on the tennis courts and had to give it up, so I can sympathize with you. However, I am not too sure you will have to give it up if you start doing some exercises and get rid of those inserts. Those inserts do nothing but make a person's muscles weak. Please believe me. Let me go reread your note about surgery and I will get right back to you.

 
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