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Torn Posterior Tibial Tendon

 

   


pharding

Mar 14, 09 2:25

Post #1 of 11 (7229 views)
Torn Posterior Tibial Tendon Quote | Reply

Unfortunately I have torn my posterior tibial tendon (PTT). This is the tendon that extends down within the calf of the fore leg wraps under the ankle and attachs to a bone in the foot creating an arch in one's foot. For now it will be treated with orthotics. Does anyone else there participate in sprint triathlons with this type of condition? Undoubtedly running will be the toughest part.


09 Cervelo P3
09 Pinarello Prince
10 Stevens Carbon Team

(This post was edited by pharding on Mar 14, 09 2:28)


timberdick

Mar 14, 09 3:50

Post #2 of 11 (7220 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

I torn my ptt tendon in 2003. I was supposed to compete in the world championships. I figured I could walk the whole marathon, and at least I'd still get to be in the event. Did you have an mri? If it's torn, orthoitcs not the cure and doing any kind of running or walking is not advised. My doctor suggested wearing a boot thing to immobilize the foot, but he said it still may not work. I took a more aggressive action and had the operation to repair the tears. If the tendon gets so damaged they can not fix it, they sometimes have to use a different tendon in your foot. You have three that connect to different parts of your foot. Now I'm lucky to be able to sort of run, but I was severely cautiond that if I hurt it again, walking may be in question. This is an injury you do not want to mess around with. One little trick to see it the tendon is torn, is to stand on the injured foot and hold the other off the ground. Then try to raise up on to your toes. lifting your heel off the ground. If you can not do that, changes are the tendon is torn. I am a retired professional dancer, if this injury had happen to me while I was dancing, it would have been a deal breaker. the internet also has lots of good info. I hope this info was helpful to you.


johnpostmd

Mar 14, 09 7:35

Post #3 of 11 (7200 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

Phar-you mention PTT tear but are stingy with the details. This is not one of those problems that you want to ignore but to gather as much information as you can now so that you and your doctor can accurately define it's current state, your options, and how to have the best function ten years from now by actions taken, or not taken, in 2009.

Unlike many other human tendons, the PTT can deteriorate over time, slowly.....or it can just rupture. In the early stages of tendon "degeneration" conservative measures of foot support can include orthotics or casting (I favor the latter.) In more severe instances, or in cases of frank tendon rupture, a repair is indicated. Occassionally this repair is augmented with a tendon graft. Post-op rehab can be relatively time consuming.

So, in my view, you need to have a thorough eval by your local ortho doc, sometimes even an MRI (and although plain x-rays don't show tendons, in my office they always precede an MRI) if the situation dictates. Good luck, do it this week.

John Post, MD
Medical Director, Training Bible Coaching
@johnpostmd
http://www.johnpostmd.com
Dr. Post's Blog is a medical/injury resource for triathletes.


timberdick

Mar 14, 09 8:56

Post #4 of 11 (7192 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

I hope you carefully read Dr. Post comments on the ptt tendon, and go to a doctor.


rroof

Mar 14, 09 10:56

Post #5 of 11 (7181 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

Definitely need more details regarding your "tear". We will assume a longitudinal tear diagnoses on MRI as no one would treat you with orthotics with a complete, transverse tear.

That said, posterior tibial tendon dysfunction is a continuum of disease from tendonitis, to tenosynovitis, to tendinopathy, to to tearing/fraying, etc. If the longitudinal tearing less less than about 2.5 cm (about 1 inch), CAM boot immobilization or below the knee casting is preferred as the tear "may" heal. Larger than 2.5 cm, surgical repair is generally recommended in most active people to prevent a lifetime of issues :( (with or without tendon grafting/harvesting or the newer tendon augmenting tissues - you can google Pegasus biologics for an example). You will probably be in orthotics after no matter how you go though.

Good luck

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


pharding

Mar 14, 09 11:12

Post #6 of 11 (7177 views)
Re: Torn Posterior Tibial Tendon [johnpostmd] [In reply to] Quote | Reply

In Reply To:
Phar-you mention PTT tear but are stingy with the details. This is not one of those problems that you want to ignore but to gather as much information as you can now so that you and your doctor can accurately define it's current state, your options, and how to have the best function ten years from now by actions taken, or not taken, in 2009.

Unlike many other human tendons, the PTT can deteriorate over time, slowly.....or it can just rupture. In the early stages of tendon "degeneration" conservative measures of foot support can include orthotics or casting (I favor the latter.) In more severe instances, or in cases of frank tendon rupture, a repair is indicated. Occassionally this repair is augmented with a tendon graft. Post-op rehab can be relatively time consuming.

So, in my view, you need to have a thorough eval by your local ortho doc, sometimes even an MRI (and although plain x-rays don't show tendons, in my office they always precede an MRI) if the situation dictates. Good luck, do it this week.

Thank you for your input. I am a 57 year old overweight, yet semi-fit, architect. I was a really fine high school athlete and I have exercised throughout my childhood and adult life. I have always had flat feet even as a child. 3 years ago I injured the foot climbing scaffolding on a job site. I stupidly ignored the substantial and lingering pain and did not go to the doctor for a year. When I went to my GP it was misdiagnosed as plantar fasciitis. The substantial pain gradually went away, although my foot felt bad when I ran my usual 3 mile run. Last year I took up cycling which I have enjoyed immensely. Six weeks ago I joined Vision Quest Coaching and started training for a sprint triathlon. I enjoyed that immensely also and I especially like the variety of training. Everything has been going great except for walking as a precursor to running. After walking for 1 hour and 45 minutes two weeks ago the pain was substanal in my foot and this lasted for one week. On Thursday March 12 I finally went to see an orthopedic surgeon at Northwestern Hospital here in Chicago. Based upon his examination, he said that my foot was worn out and that the tendon was ruptured and that I was a candidate to have my foot reconstructed. He recommended orthotics as the next step for which I was fitted for immediately. He said if that didn't work the next step would be brace. Beyond that the next step would be to have my foot including the tendon surgically reconstructed or skip that and have operation which entailed cutting the heal bone in two and realigning the heel with a screw type connection. It is now clear that I exercised incredibly stupid judgment in not getting my injured foot examined promptly 3 years because I was too busy to take time out to do so. The orthopedic surgeon said that I could run in a couple of sprint triathlons, but running for training would likely not be a good idea if after having orthotics my foot hurt the next day. The seriousness of my foot injury and the implications are beginning to be painfully clear. I have enjoyed training for the sprint triathlon immensely. It appears that I will likely have to give that up for this season and focus on swimming and cycling with an operation in the fall with an extended very disruptive recovery period. The situation which could have been avoided is rather depressing.


09 Cervelo P3
09 Pinarello Prince
10 Stevens Carbon Team


rroof

Mar 14, 09 11:31

Post #7 of 11 (7168 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

Thanks for posting - important story/read for others on slowtwitch and one I hear almost every day. You mostly have the typical younger, fit triathlete here who ices and stretches everything, gets A.R.T. and runs barefoot or in racing flats ;)

Best of luck to you!

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

(This post was edited by rroof on Mar 14, 09 11:33)


pharding

Mar 14, 09 11:47

Post #8 of 11 (7161 views)
Re: Torn Posterior Tibial Tendon [rroof] [In reply to] Quote | Reply

Thank you. What is A.R.T.?


09 Cervelo P3
09 Pinarello Prince
10 Stevens Carbon Team


johnpostmd

Mar 14, 09 11:50

Post #9 of 11 (7160 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

Phar-Oh, I don't know, I wouldn't be so hard on myself. It could have been a large rotator cuff tear effectively ending both your swimming and ability to pick up your grand daughter! Triathlon is a sport, and if we keep in that perspective we win. I'm a little older than you and I can name 3 guys right off who've been killed on bikes training. So maybe you swim a little more and bike a little more. My in-laws all live in Chicago-land and I find the folks who live in the Windy City, and in your bike and swim groups, to be exceptionally social and fun. And who knows, have you thought of archery, or bridge, or........
Good luck, I know you'll do well.

John Post, MD
Medical Director, Training Bible Coaching
@johnpostmd
http://www.johnpostmd.com
Dr. Post's Blog is a medical/injury resource for triathletes.


pharding

Mar 14, 09 15:25

Post #10 of 11 (7132 views)
Re: Torn Posterior Tibial Tendon [johnpostmd] [In reply to] Quote | Reply

You are right, of course. Swimming has worked out great so far. I'll have more time for swimming and cycling. they are both great for my cardio vascular system. We'll see how the foot plays out though. I may have the surgery the first week in November.


09 Cervelo P3
09 Pinarello Prince
10 Stevens Carbon Team


rroof

Mar 14, 09 16:04

Post #11 of 11 (7126 views)
Re: Torn Posterior Tibial Tendon [pharding] [In reply to] Quote | Reply

In Reply To:
Thank you. What is A.R.T.?

Active Release Therapy

A physical therapy type modality "invented" by a chiropractor. Excellent results with some pathologies, but is often overused/abused when a clear diagnosis or misdiagnosis is present. Would be very bad for your particular pathology for example.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

   
 
 
 



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