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    Old 06-07-2005, 07:20 AM   #1
    arras
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    Question Posterior tibial tendonitis

    I'm new to posting on this board and hope this post is okay.

    Been to see a podiatrist/biomechanics today for conservative measures on posterior tib/torn tendon. Surgeon I originally saw wanted to do flat foot fusion which I thought was drastic. He didn't seem to keen on me wearing my orthotics I practically had to beg for them initially!

    My question is, and I have been all throught the board and no one seems to have the same thing as me, should I be using orthotics or do I visit my GP and get him to refer me to somebody else. Is all this making my flat foot/posterior tibial worse?

    I'd really appreciate some replies because this has been going on 3 years and I feel I'm not getting anywhere and can't find any info on the net, etc.

    Thanks for reading this.

    Last edited by arras; 06-07-2005 at 09:08 AM.

     
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    Old 06-07-2005, 09:08 AM   #2
    sbrewer
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    Re: Posterior tibial tendonitis

    Hi,
    I have supination and my Dr. talked about orthotics, for $400 I really would like to know if they work before investing that kind of money. However, because of the supination, I also have Haglund's Deformity which caused achilles tendonitis, so my Dr. sent me to physical therapy(which did nothing) now I'm wearing a cam cast to see if it will do anything. She REALLY is talking surgery which I REALLY did not want to hear..Anyway I may try the orthotics next(before surgery) My question is how well do the orthotics work?

     
    Old 06-07-2005, 11:31 AM   #3
    arras
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    Re: Posterior tibial tendonitis

    From one newbie to another
    I definately feel orthotics are worth trying first because an operation means you've reached the end of the line and there's nowhere else to go, as was pointed out to me by one health worker I saw. I agree $400 is a lot to pay but if I had to pay for mine (which I would have done had I gone privately) I must admit I'd think twice but I do think you need to explore every option as you will never know otherwise.

    Hope this helps

     
    Old 06-07-2005, 12:06 PM   #4
    sbrewer
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    Re: Posterior tibial tendonitis

    arras,
    What is "posterior tib/torn tendon"? Is that the same as the achilles tendon? And what is flat foot fusion? And last but not least, why did your surgeon object to the orthotics?
    Thanks,
    sbrewer

     
    Old 06-07-2005, 12:09 PM   #5
    sbrewer
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    Re: Posterior tibial tendonitis

    arras,
    What is "posterior tib/torn tendon"? Is that the same as the achilles tendon? And what is flat foot fusion? And last but not least, why did your surgeon object to the orthotics?
    Thanks,
    sbrewer

    ps OOPS! one more, isn't flat foot where you walk with pronation(on the inside of your feet)?

     
    Old 06-07-2005, 01:27 PM   #6
    arras
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    Re: Posterior tibial tendonitis

    Just different terms I think across the big pond! Yeah, flat foot is where you walk on the inside of your foot which you call pronation. Posterior tibial tendonitis is where the tendon which keeps your foot in place becomes either torn like mine or ruptered. This runs down the back of your leg and along the side of your foot so I guess its the same as achilles tendon. The flat foot fusion which my surgeon suggested is where bones at the ankle and further down the foot are fused together to keep the foot in place, oh and he also wanted to lengthen my achilles tendon which runs down the back of my leg.
    I have no idea why he objected to the orthotics.

    Do you have similar symptons because I've never found anyone who has Posterior tibial tendonitis before and would be good to talk with ppl who experience same symptons.

     
    Old 06-07-2005, 02:03 PM   #7
    sbrewer
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    Re: Posterior tibial tendonitis

    Well, sorta...I have supination(I walk on the outside of my feet) which has caused Haglund's Deformity(the bone sticks out on the back of your heel) which caused achilles tendonitis(the back of the heel very painful). My Doc talked about the orthotics. She said she would have to cast my feet for them, but first she sent me to therapy, I guess to relieve the tendonitis, but it didn't work. My next app. she talked about surgery which I'm not fond of and at this same time she put me in a cam cast. So I go back in July(she wanted me sooner but I wanted to prolong it) and I don't know if she'll try the orthotics or surgery. I really don't understand what the orthotics will do. Can you give me input on that?
    sbrewer

     
    Old 06-07-2005, 02:19 PM   #8
    arras
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    Re: Posterior tibial tendonitis

    I too had physiotherapy (PT) which did nothing. Sorry, if I've not helped. Orthotics are very thick insoles for your shoes. Be warned you can get them in very few shoes - we're talking wearing trainers most of the time. The idea is that they realign your foot so you walk correctly and hopefully, don't suffer from any, or less, of your symptons. Custom made/having your foot cast orthotics are obviously made purely for your foot so I pressume you would get a better result as the others are 'one size fits all'. As for the surgeon not being 'to keen' on orthotics when he discharged me he told me to keep wearing them. I think as he was a surgeon he only saw in operations if you know what I mean.

    I found out today that apparently I too turn and walk on the outside of my foot when walking through before finally putting full weight on it. My orthotics have been adjusted and built up more in the arch to try and compensate for this.

    I've also been told my foot is unstable. By the way, whats a cam cast?

     
    Old 06-07-2005, 03:16 PM   #9
    sbrewer
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    Re: Posterior tibial tendonitis

    A cam cast is a removable cast or boot it comes up just below the knee. I have to wear it at all times accept showering or sleeping. Thursday will be 2 weeks that I've been in it and so far I still have the pain in the achilles tendon area. My doc told me that it we did the surgery I would be in a hard cast above the knee for 8 weeks also absolutly no weight bearing for that time..and the procedure didn't sound too good either..I'm very worried about that but someone else on the board(Boarderchic) had the surgery Friday but I haven't heard anything yet..I hope she's well.
    Thanks for listening(or reading)
    sbrewer

     
    Old 06-08-2005, 02:44 PM   #10
    coopere3
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    Re: Posterior tibial tendonitis

    Hi everyone-
    I just wanted to respond to a few posts about the difference between the achilles tendon and posterior tibialis tendon. The two are not the same. The achilles tedon, is the big tendon which attaches to your gastroc muscle (calf) proximally which then attaches to the cancaneous (heal bone) distally. The tibialis posterior, and flexor digitorum longus, and the flexor hallucis longus are the 3 tendons which make up the posteriomedial complex of the ankle. The are also known as 'tom' (tibialis posterior), 'dick' (flexor digitorum longus), and 'harry' (flexor hallucis longus). Something called tibialis posterior disfunction results when the ankle is not stopped against eversion. The tibialis posterior is one of the main supinators of the ankle and when the 'dysfunctio' occurs, flat feet result (and over pronation)--well at least that is one of the causes, some people are just born with flat feet. Just wanted to clarify about that.
    -Liz

     
    Old 06-08-2005, 02:53 PM   #11
    sbrewer
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    Re: Posterior tibial tendonitis

    Liz,
    Do you know anything about Haglund's Deformity? That's what I have and achilles tendon is affected by it as well.
    sbrewer

     
    Old 06-08-2005, 03:12 PM   #12
    arras
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    Re: Posterior tibial tendonitis

    Hi Liz

    I have a short achilles tendon and the tendon in my ankle is torn. My surgeon wanted to repair my torn tendon, put pins in my ankle to stabalize it and stop me turning over, fuse a couple of bones in my foot and also lengthen my achilles tendon.

    Does having a short achilles tendon mean that you are more likely to be flat footed? This in turn would I assume lead to a torn tendon because the ankle is being pushed out of alignment.

     
    Old 06-08-2005, 03:59 PM   #13
    MFordCNA19
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    Re: Posterior tibial tendonitis

    Hello

    I have just been told that I have tendinitis of the posterior tibial tendon. I had ankle ligament reconstruction and arthroscopic debridement of the ankle done 10 weeks ago. I had been in physical therapy for a few weeks when I started having pain along the inside of the ankle and along the arch of my foot. I have also been experiencing locking and popping of the ankle in the region of the tendon when the ankle is moved (mostly when I move the ankle into dorsiflexion). I had been experiencing the popping since before I had the surgery and my orthopedic surgeon told me that it wasn't something in the joint causing the popping, because he would have seen it on the scope, and it was probably the tendon. Anyways, my physical therapist told me the the pain is most likely being caused by posterior tibial tendinitis, but he didn't know about the popping. I go back to my ortho June 30.

    I fell dome some stairs about a year and a half ago and fractured and tore all the ligaments in my ankle and it never healed, so thats why I had the reconstruction surgery. I am just wondering if when I fell, I could have injured the posterior tibial tendon as well because it is strange to still having the popping and locking happening after I had my other problems fixed. Hmmm...i just don't know!

    Well, anyways I just wanted to let you know that you're not the only person out there with posterior tibial tendon problems!!

    Megan

     
    Old 06-08-2005, 06:25 PM   #14
    coopere3
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    Re: Posterior tibial tendonitis

    Hi SBrewer and Arras-
    First, just wanted to give you a little background about my knowlegde. Obviously, I am not a doctor, but hope to be entering med school in the fall of 2006. I am very interesting in orthopedics, shadowing a lot of surgeons as well as have had some personal injuries myself. Three shoulder surgeries and most reciently an ankle surgery for a torn flexor hallucis longus.
    Anyways with that said. SBrewer, as far as the Haglund Deformity. From what I have read and heard, it occurs due to a combination of achilles tendonitis and also inflammation of a bursa. There is a retrocalcaneal bursa in the ankle, which is located underneath the achilles tendon. The reason for the inflammation of the bursa and tendon is many times due to a 'bump' located on the posterior superior aspect of the cancaneous. The 'bump' is what irriates the tendon and the bursa during activity. This bump can just occur (again genetic issues-probably born with it) or it occurs very often in runners. So, as you said that you achilles tendon is affected by this, that makes total sense. Other than that, I don't know much about that injury.

    Arras-First, I am not sure what tendon you are talking about that is torn. I have not heard of a short achilles tendon causing tears, instead a short achilles tendon may be be caused by poor foot mechanics. If indeed it is caused by poor foot mechanics, the poor foot/walking mechanics would probably be a better guess as to why the tendon tore. Everything stems from something and normally one injury doesn't cause another and normally an actual problem (ie mechanics) causes a chain reaction in injuries. Many times physical therapy helps in this or even orthotics. It is always hard to know what causes things because many times the way the body compensates for itself it not textbook. People react differently to so many things.

    Both of you guys have great questions and I'm sure your doc would be better at answering them than I can! Let me know if you do have any other questions and I will try to help

    -Liz

     
    Old 06-09-2005, 06:35 AM   #15
    sbrewer
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    Re: Posterior tibial tendonitis

    coopere3,
    Thanks for the information. My Dr. did discuss these things with me and sent me to therapy, and now a walking cast but it still does not seem to be any better. Today makes 2nd week in cast, and she only wanted me in it 3 or possibly 4 weeks, so I guess she thinks it should be better by then or surgery(YUK!). anyway it's still swollen and painful but maybe 1 or 2 weeks will make a difference.
    sbrewer

     
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