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  • Posterior Tibial Tendon Repair Recovery Guidance Please

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    Old 02-04-2008, 08:57 AM   #1
    di from London
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    Posterior Tibial Tendon Repair Recovery Guidance Please

    My name is Diane, I am from London. Could I ask for some recovery guidance from the members here? My recent history is:

    PT tendon, right foot - minor damage causing pain in June 07. It would not improve, despite physiotherapy for 4 months. Issue was referred to a foot & ankle surgeon eventually. I was also referred to a podiatrist for orthotics; she warned me that I might have a tear.

    22 Nov 07 the surgeon’s appointment; wear & tear damage diagnosed - probably brought about by recovery issues following a bad break and surgical repair of the other ankle in 2003.

    My surgeon advises of a misshapen foot & a seriously swollen tendon – suggested to her a ruptured tendon with stretching and multiple smaller tears and likely fluid in tendon sheath – confirmed by MRI. She said I urgently required surgical repair/FDL transfer. Fortunately my ankle was still mobile so no osteotomy was required.

    She advised I would be off work 6 weeks - cast for 3 weeks and 3 weeks in a boot, and then I would be able to drive after that time. I thought all I had was a minor problem so this was frightening at the time. Oddly the problem got very much worse in the weeks before surgery and I quickly became unable to walk without a stick or walk down stairs easily.

    Surgery - 12th Jan 08 – opening and cleaning tendon sheath of debris, debrided tendon, shortening of stretched part of tendon, repair of torn section & rupture, reattachment of PT tendon at site where FDL transfer usually takes place [thankfully FDL transfer was not necessary]. This repair seems very conservative compared to other posts on this site.

    It is now 3 weeks on and my cast is to be removed in a few days, then a boot and start physiotherapy, but now it seems this may not be as straightforward as the surgeon has suggested. The plaster technician has warned me of potential delays to recovery, including the possibility of another cast if my foot is not flat enough for a boot!

    I have been searching this site – very recently discovered - for advice on recovery but have not found any surgery that matches my situation and recover timescale. Can anyone help me with the following queries?

    1. A realistic timescale for recovery – I need to go back to work as I am not being paid presently and they want to know as well. My surgeon is very hopeful for 6 weeks – perhaps a little too hopeful?
    2. This is my right foot I need to be able to drive in heavy traffic to return to work – is this honestly likely in the next 3 weeks?
    3. Is there anything I can do to help my physiotherapy and recovery speed along from your own personal experiences?
    4. I am a serious walker [10 miles minimum] and want to get back to the countryside – when will this realistically happen? It’s been so long since I walked comfortably and that is the most frustrating thing presently [apart from the pain].
    5. I’ve been told that I will get about a 90% recovery from this surgery – is that your experience?
    6. I am having some issues in finding related posts [probably me!] – any page links that you can point me to would be very useful!
    Thank you all.

     
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    Old 02-04-2008, 09:40 AM   #2
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Hi! I don't know if you've read any of my other posts, but basically I too am a walker... 50 years old.... in good shape, but always with a history of flat feet. I've just had my second surgery on 12/27/07. The first surgery didn't accomplish enough and then my recovery was pretty rushed. As a result, my bone graft failed. I had total range of motion in my ankle beforehand. I was told that the bone graft was used to help straighten the foot out and to give extra support after the "fix." Your surgery is different from mine at the very onset, so it's hard to guess what your recovery time would/should be, although three weeks sounds like a short time in my opinion. All I can tell you with certainty is to be conservative and careful before you have to go through a second surgery like I just did. Be patient. I was also given the 90% success rate statistic. Before my first surgery, I worked out more... particularly for upper body strength to handle crutches more easily.... I think it helped. Just the fact that you're a conditioned walker, though, probably puts you ahead of the game all by itself. Make sure you talk to physical therapists. The therapy might seem like mere common sense, but if the therapist is a good one, it's sooooo much more than that. Mine was very helpful to me.





    1. A realistic timescale for recovery – I need to go back to work as I am not being paid presently and they want to know as well. My surgeon is very hopeful for 6 weeks – perhaps a little too hopeful?
    2. This is my right foot I need to be able to drive in heavy traffic to return to work – is this honestly likely in the next 3 weeks?
    3. Is there anything I can do to help my physiotherapy and recovery speed along from your own personal experiences?
    4. I am a serious walker [10 miles minimum] and want to get back to the countryside – when will this realistically happen? It’s been so long since I walked comfortably and that is the most frustrating thing presently [apart from the pain].
    5. I’ve been told that I will get about a 90% recovery from this surgery – is that your experience?
    6. I am having some issues in finding related posts [probably me!] – any page links that you can point me to would be very useful!
    Thank you all.[/QUOTE]

     
    Old 02-04-2008, 09:49 AM   #3
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Oh by the way, if you haven't already done so, just type in "posterior tibial tendon" in the search box on this page and you'll find lots of other stories and posts.

     
    Old 02-05-2008, 09:28 AM   #4
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Hi Diane!

    I am now 7 weeks post OP and am just starting physical therapy today. My surgery was on my right foot and my doctor has still not released me to drive. I was non-weight bearing for 6 weeks. I only started partial weight bearing with the help of a walker last Friday. I also wear a boot.

    I have been out of work since my surgery on 12/20. I have a desk job but I do a lot of walking around the office so the doctor won't release me to go back to work yet. I go back for my next check up on 2/20 and am hoping to be released then. I am lucky as that I have been with my company for 15 years and have very good benefits. I have been receiving full pay and will continue for up to 26 weeks. But if I don't get back to work soon, I think I'll go crazy. I can't wait until I can walk again!

    Last edited by Debvzw; 02-05-2008 at 09:29 AM.

     
    Old 02-07-2008, 03:54 AM   #5
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Thank you ladies for your replies.

    I have been silent because I have been to the hospital twice in the past 2 days - once to have the cast off & the boot fitted and the second time to have it re-fitted in a bigger size. I was numb during the first fitting and it was too tight across the ankle - oh the pain from walking about in a boot that was rubbing on the tendon which I only discovered when it woke up! It took 5 hours to stop hurting and now I need some sleep.

    The surgeon was very much clearer this visit - no rubbing on the tendon as it was not yet healed [thanks for that to the technicians!] Healing will be another 4 weeks so the airboot must be worn for 4 weeks with physiotherapy possibly starting next week. Maybe I can drive in 3/4 weeks if my foot will bear it.

    The timescale to go back to work is now moved to 8 weeks from surgery, which is still good but more sensible.
    It's great to be out of plaster and less dependent on crutches - I have pretty bad crutch callouses on my hands and sore shoulders. I had to be shown how to walk again......

    Actually it's my third boot - one broke as it was being fitted this morning - I'm glad that did not happen at home.

    Di

     
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    Old 02-07-2008, 04:06 PM   #6
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    I know what you mean about things "waking up." We went to Chicago on the coldest weekend of the year and I didn't feel the cold one single bit on my surgery foot when the toes weren't covered. I actually had to remember to cover that foot so I wouldn't get frostbite! After six weeks it's just waking up and it now gets cold where it didn't before. I suppose there was no way anyone could have anticipated what would happen with that nerve of yours. Good that you have more time off from work. One thing that I can definitely say from experience is that it's important not to rush things.

     
    Old 02-10-2008, 03:49 AM   #7
    di from London
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Thanks for your support.

    I seem to still be in immense pain from this boot - that was expected for a day or so but this is now 4 days from the boot fitting. Is this normal?

    I am now back on all my serious pain medications from the hospital and I got drug reactions pretty soon afterwards. Some details are not that pleasant - I had to go to my GP for advise and different narcotics to see if I could tolerate them better, which I can presently. Now I feel a bit spaced out.

    The wound has reopened - possibly it was not properly healed in the first place. I think this is as a result of the boot pressing on the injury - which it still is as it is an air cuff and designed to fit tightly when inflated. However this is also the cause of at least 50% of my pain.

    I think I will have to get this dressed and seek advice on whether I should be wearing this air cast boot. I am getting a bit concerned that damage to the repair may be occurring. It is now 4 weeks from tendon reconstruction.

    Any advice that can be offered from experience would be welcomed.

    Regards,

    Di

     
    Old 02-11-2008, 09:38 AM   #8
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Wow, that sounds like a Catch 22... pain from pressure on the wound, but needing support to the area after surgery. I would think that if you could get the pain under control, that would be the first step. What do the doctors think you should be doing next? I think I know what you mean about unpleasant side effects of the narcotics. I had trouble processing food, and then I didn't want to eat at all. I actually lost five lbs. rather than the weight gain I expected from all the inactivity. I hope you're feeling better soon. What pain meds are you on now? I had to have an anti-nausea medication along with my pain meds.... those things affect me pretty severely.

     
    Old 02-13-2008, 12:20 PM   #9
    di from London
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    Re: Posterior Tibial Tendon Repair Recovery Guidance Please

    Sorry about the delay - I've been a bit busy seeking help. My surgeon has temporarily vanished, as has her secretary. As a specialist in the NHS she works in hospitals all over this area and only does a clinic locally every 2 weeks I have discovered - they refer me to her secretary. Meanwhile I saw my GP's nurse about the op wound issue today and got great advice and dressings - just as well as yesterday I became allergic to the plasters I was using to stick down the dressings I was using. Now large parts of my foot are red and swollen and the boot is even more painful to wear. But the advice should work in the long term - she suggested I should wear the boot looser and maybe the rubbing will apply to other parts of my foot and take the pressure off - worth a try. She also said it was impossible to wear a boot weighing 5lb all day and not to!
    Another suggestion was to just turn up at emergency department the hospital and complain about the boot and they would have to see me. But I was told by the plaster technicians that the only have one other option for me - to take it off and put me back in plaster. I really don't want that - maybe the boot will get better but now this is over a week and the pain was pretty bad again last night.

    I saw my Physio yesterday and was given plenty of gentle exercises to get my foot function back on track and some exercises for general leg strength so I can improve quickly when the boot officially comes off. Of course she said I needed to see my surgeon about the boot issue. Back to square one.

    The wound is still opening up on each wear but it is slightly better now I am wearing it less!

    I can only cope with one of these meeting each day - I need to rest my foot after that. I have an old friend who is a private physio with considerable sports injury experience. I am going to see him tomorrow and meanwhile try out my latest advice.

    If no more improvement then I will have to get better pain meds and a plaster -but this will just slow my recover so much I want to be sure first. Meanwhile it time to rest the foot.

    Pain meds presently [uk names are the only ones I know]:

    30mg dihydrocodeine every 4-6 hours
    1gm paracetamol 4 times per day [not enough but it is toxic at higher doses
    standard ibuprofen doses every 4 hours for anti inflammatory effect and pain control
    40mg omeprazole re the bleeding as below
    I am taking all of this and still not getting full pain control

    Pain meds before - 50 or 100 mg Tramadol [suddenly they gave me me nausea at 50mg and made me sick at 100mg]
    50mg Cyclizine to control the reaction above [thye have always they given me spasms and physical jerking but it got dramaticaly worse]
    paracetamol as above
    50mg Diclofenac for anti inflammatory effect as well as pain control [this suddenly made my duodenum bleed]
    20mg omeprazole to prevent duodenal ulcers

    Di

     
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