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Posterior Tib Tendon, I'd Take Any Risk to Tie Back the Hands of Time




This is an edited redo.  One of my most popular blogs of all time. Certainly the one that has generated to most "will I ever be able to exercise again?" mail came from that writing.  If you're reading this as one with the problem, why not make a pit stop by the Q&A that follows the previous post. It serves as a good library and just might answer your questions.

Previous post.  
http://www.johnpostmd.com/2009/03/posterior-tibial-tendon-problems.html

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Posterior Tibial Tendon Problems


We have to take good care of our feet to do what we do. Many have learned the hard way about Plantar Faciitis, metatarsal stress fractures, interdigital neuromas and the like through unplanned interaction with the medical community. I have always felt the more knowledgeable the athlete, the better. The ones with problems who end up in my office who've already asked around or researched their concerns on the net seem to be in a better place to help me help them.

Athletes frequently complain of two types Posterior Tibial Tendon difficulties. The first is a slow, subtle deterioration process that actually tears or can even stretch the tendon leading to what's known as an acquired flat foot deformity. The tendon has slowly, over time, lengthened and can, in some cases, no longer do it's job in maintaining the longitudinal arch of the foot. In other instances, the tendon will actually rupture frequently leading to surgical repair. Those who seem to be at higher risk for this injury are the obese, diabetic, rheumatoid arthritics including those who may have had a steroid injection in the area.

I used this black and white out of one of my old Anatomy texts as it shows only the business part of the PTT (labeled Tibialis Posterior)coursing behind the tibia and inserting on the navicular.

So, if you have pain over the inside of the ankle, get it checked out. Your doctor will examine the ankle looking for tenderness over the course of the tendon, swelling, weakness...and those with a real problem...a gap in the tendon. The doctor will check your muscle strength by asking you to stand on your toes or determine if there's an asymmetry in the arch while weight bearing. Although this is usually a clinical diagnosis, an MRI may be required. In my office, although tendons are not normally seen on x-ray, a plain x-ray always precedes an MRI.

If a PTT problem is noted in the early stages, a supportive orthotic might be recommended or even a cast. I'm partial to casts. If, over time, the problem continues to worsen, then an operative procedure may be recommended to repair the tendon, occasionally using a nearby tendon as a graft. In the worst case scenario a fusion of the foot bones is done to restore the arch of the foot. As you might expect, rehab is considerable and even with appropriate treatment, one's triathlon future might be in jeopardy.

The take away is that patience is key in the athlete with early symptoms and just because you may have had a scan which shows a tear, you still may not require surgery and wouldn't think about it until after 3-6 months of rest in many cases.  So as Maxwell Smart might have been thinking in the TV show of the 60's or movie from the movie from 2008, if you have a musculoskeletal issue, do your homework, read up on it and "Get Smart."



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