Ruptured Posterior Tibial Tendon

flatfoot65

Hi dwest, I am dealing with PTT injury too. Although it is more of a long (4 months) problem. Surgery is looming in my near future and I am scared of the difficult and lengthy recovery.

How did you rupture it?

DAWN537464

If your PTT is ruptured, all the physical therapy in the world is not going to correct it. It does not mend like a broken bone. In my experience, as I have had the PTT rupture in BOTH my feet, you can get away with a few years of ignoring it with some pain, but eventually you will be walking on the inside of your ankle as your foot continues to roll inward. Since I speak from experience, I feel qualified to give you an idea of the possibilities. My condensed story: My left foot went first, didn't get correct diagnosis because I believe podiatrists just want to sell orthotics. Wasn't until I went for an MRI that it was diagnosed properly on right foot. since my left foot was already caved in and often felt like the outside of my ankle was being crushed, I had an MRI on that one as well -- both feet ruptured PT tendons. I got my first surgery in April 2016. In order for the tendon transfer to be successful to restore an arch and straighten the foot, the heel bone must be moved with an osteotomy and perhaps an osteotomy on the top of the foot as well. Otherwise the newly placed tendon will will stretch and fail because the foot will be too flat and poorly aligned, and place too much pressure on the tendon. I am dreading getting my other foot done, because it was a ROUGH ROUGH recovery. Five or six months after surgery, I swore I would suffer for the rest of my life with the other foot rather than "fix" it. However, now that it's been a year and half, I am happy to say the corrected foot is much better than the uncorrected, and the uncorrected foot continues to worsen.

PTTD is progressive. It does not get better and it does not level off and stay at a bad but stable stage, it continues. Take it from me, I know. The corrected foot is not as I imagined it would be. It is not even what I hoped it would be, but it is a lot better than the foot I still need to get fixed. It's not as bad as it sounds-- I can walk fast 5 or 6 miles, hike, I even dare to jog slowly a few minutes here and there. so even though it does not feel like it did when it was a healthy foot, it performs. the uncorrected foot is taking a beating though!!!

Don't rush into anything. If your rupture is new and causing you a lot of pain, guess what, after five or six months the pain will lessen and eventually disappear, but you will have other types of pain to replace it as the foot flattens and caves in. Look into your options, and contact me if you want more info.

flatfoot65

Is there really a difference between a rupture or a tear?

DAWN537464

Yes, there is a difference between a ruptured tendon and a torn tendon. A ruptured tendon is completely torn apart two ends not together. You can have damage to your tendon with a tear by having a long tear in it without completely severing the tendon

flatfoot65

Any difference in the symptoms?

DAWN537464

I am not really sure about the difference in symptoms. Although I would imagine that before my first tendon completely ruptured, maybe it was just torn, but I didn't know and kept going on it. I even ran 10 miles on it. Who knows? Maybe that's what made it ruptured. There were difference in symptoms on both of my feet even though the same result in both . You might say different strokes for different folks

flatfoot65

@DAWN537464, LOL! Yes for sure. I had a TKR 4 years ago and that was a piece of cake compared to the surgery and rehab for this!! I am really apprehensive.

dwest

I am really frustrated with doctors. I had been seeing a podiatrist for five months about this ankle. He gave me orthotics, had me do physical therapy, even eventually gave me a cortisone injection, which is totally not recommended. Finally my rheumatologist said this had just been going on too long and ordered a an MRI, which showed a full rupture. I am not really sure when the rupture occurred. If may have been ruptured the entire 5 months, or only ruptured recently. In any case, I have heard such different things from different doctors. I feel like the podiatrist completely mishandled the situation. My most recent visit, he was even saying my symptoms were not consistent with tendon problems and he thought it might be neuropathy. Guess what? An MRI two days later showed the rupture.

So I've seen the specialist at UCLA, and as I said, she wants me to do physical therapy and wear a custom ankle support for two months in the hope that I can live with it. But my physical therapist said she has never seen anyone be okay without the tendon repair. She has suggested I see another do doctor at Cedars Sinai who is supposedly a "world-renowned expert" in this particular problem. so I now have an appointment with him in October.

Right now I am only able to do a very small amount of walking, say to the grocery store, and that results in enough pain that I end up doing nothing else the rest of the day. I just retired in May, and this is not the way I imagined my retirement. I can't see being this physically limited and being okay with it.

I too have had a TKR and also a broken hip which was repaired, and this recovery sounds much worse. My regular orthopedic, said he would never recommend this surgery to anyone he cared about. And the doctor at UCLA, said that the reason they want to see if I can live with my ankle like it is, is that the surgery is a very long surgery, and the recovery is very difficult. So I am thoroughly warned about how difficult this will be, and a little freaked out, but still, I don't think I can accept living as limited as I am now. DAWN537464, what you say sounds similar, and I would be most happy to be able to walk even a mile and be able to hike again.

Thank you all for your replies.

I met someone recently who went through this surgery and he said, yes it was long and difficult, but now his foot is so much better.

dwest

Also, DAWN537464, can you tell me what exactly was so horrible about the recovery? Is is the amount of time without any weight-bearing? Is it the pain? Or the overall length of recovery time? Or all of the above?

flatfoot65

Hey @dwest,

Looking forward to hearing from Dawn.

But just wanted to tell you what my surgeon told me. He puts some kind of implants in the foot to insure success of the surgery. Plus the solid cast for 6-8weeks then a boot for 4 more weeks. He said the pain would not be as much as the TKR.

He does 2-3 of these surgeries every week, and said they are 80-90% successful.

This has absolutely ruined some plans I have made and looked forward to for a long time, but like you, I cannot live like this. I will be going for my MRI and have scheduled surgery for the 28th of this month. He said it will take 1.5 hours to do the surgery. I am
very scared of the down time.

dwest

That's good to know. Where is your doctor located?

dwest

I'm not sure how I ruptured it or even when. I've been having a lot of pain for 5 months. I was experimenting with shoes because my other foot hurt and wore shoes without enough arch support. That's what started it. But recently I tripped, really clenched my foot and leg to catch myself, and that may have been the final stroke.

I recently read that the highest incidence of this problem is in women over 50 who stand on their feet all day, and that most often there is no clear incident that causes it. That all fits for me.

flatfoot65

@dwest

I will try to PM you

DAWN537464

dwest, the pain right after surgery was a piece of cake for me. The pain was very well managed, and I stopped percocet completely 3 or 4 days afterward. I started again a few months later when I had to begin walking! That was the hard part for me. VERY VERY hard! I was convinced my surgeon messed up and I was soooo depressed. The non-weight bearing was inconvenient, but there is really no way around that so you make it work. You will find ways to get done what you need to get done. I started driving to work every day at 3 1/2 weeks after surgery. I would scooter to my car with the help of my partner getting it down the stairs and me down the stairs using crutches, he would put the scooter in the trunk, a co-worker would meet me in the parking lot, get the scooter out, roll it to my side of the car, and off I would go. I propped my foot up on the desk a lot or on a large box under my desk. You figure things out. I think my recovery after the cast and boot were gone was worse than most. The physical therapist couldn't do anything with me, The whole outside of my ankle and up the side of my leg HURT when walking on the foot, I should say limping, because my ankle was not accustomed to this new position my foot was put in. It felt like I was walking entirely on the outside of my foot, and it felt AWFUL. For weeks I swallowed at least four advils a day. I still have an issue with feeling like I'm walking on the outside of my foot although much much less now. Without further detail, I will just say walking without extreme and depressing pain was a very long slooooooww process, and I was convinced I was ruined for life. I also believe most of the reading I did on this site gave me expectations for it to be much easier to begin walking so I believe it is for most. Maybe you'll be lucky!