I'm in trouble. In a dilemma. And need advice and feedback. I'm a very active older guy. Have been bothered for a couple years by severe ankle pain. MRI shows an un-fixable tear of the post tibial tendon. Have seen two podiatrists and two orthopedic surgeons--all recommend surgery--but each has his own idea of how to do it. From taking a tendon on the outside of the foot and replacing the torn tendon to fusing bones and everywhere in between. None can assure me of success or being able to resume a pain free life. Any ideas?
Post by Jason Ahuero, MD on Jun 23, 2010 22:01:00 GMT -6
Posterior tibial tendon dysfunction is relatively common in our practice. By the sound of your description, you are dealing with a stage II or III problem. I assume you have had some collapse of your arch as well? Can you stand with your weight on the injured side and rise up on your toes without difficulty? Assuming your tendon is not functioning and your arch has collapsed, it is next important to know if there is any arthritis in the joints of the hindfoot (subtalar and transverse tarsal). This can be determined by xrays and CT scan. If there are no arthritic changes and your hindfoot joints remain supple, you would be a candidate for an FDL tendon transfer and calcaneal osteotomy. If there is symptomatic arthritis however, most would recommend hindfoot fusion along with tendon transfer. Treatment with an Arizona brace or a UCBL orthotic may be a reasonable non-surgical option as well if you have not had any conservative treatment.