My Foot Saga- Posterior Tibial Tendon Dysfunction (PTTD)

I'm  baaaaack! I haven't blogged in a while, because I am recovering from foot surgery number 3.  Many people are wondering "WTF?", because of how many surgeries I have had for my foot.  Even family members are having trouble keeping up with it all.  I thought I would try to help you understand with this blog.   

Posterior Tibial Tendon Dysfunction (PTTD): The posterior tibial tendon is the tendon that essentially holds the arch of the foot up. It connects to the calf muscle and runs across the arch of the foot. Having a dysfunction of this tendon is also known "flat footed."  My PT tendon tore and got calcified (most likely as a result of having the connective tissue disease called lupus).  There was never an acute injury to cause my problems.

People with extreme PTTD, will have feet that lean in, because the tendon can no longer hold the foot up. The bone structure of the foot will begin to change.  There is a thing doctors look for called "too many toes sign."  This is when most of the toes can be seen from the hind view of the foot, making look like there are extra toes on the foot. 

Surgery # 1 September 2010- Tendon debridement/repair, and tendon transfer.
The doctor's goal was to be as conservative as possible, while still relieving my my pain and swelling.   At this point, he thought he could get away with just removing the torn, calcified part of the PT tendon.  He cut this portion completely out, then re-attached the 2 ends of the tendon together.  He also moved the flexor digitorium longus tendon and piggy-backed that to the PT tendon to add some extra strength and support for my foot.  I was in a hard cast and non-weight bearing for 6 weeks after surgery, then did about 3 months of physical therapy.  

After surgery #1, I never had relief of pain or swelling.  I waited an entire year and kept up with physical therapies at home.  

You can see the severe swelling that continued many months after surgery. 

Surgery #2 August 2011- Tendonectomy, calcaneal osteotomy, and Achilles tendon lengthening

 Because the conservative approach of the first surgery failed, the doctor decided it was time to completely removed the PT tendon (the tendon was so nasty looking, my doctor used it as a teaching tool). The flexor digitorium longus tendon, that was piggy backed to the bad tendon, stayed and was tacked into my bones in the arch of the foot.    This surgery also included sawing off the heel bone, moving it over, and screwing it back on.  This needed to be done, because the foot structure had become so crooked.  He essentially moved the bone back to the center position it was supposed to be in.   Sliding the heel bone over also meant he needed to lengthen my Achilles tendon, which is attached to that heel bone.  Three cuts were made in the Achilles to accomplish the lengthening.  I was in a hard cast and non-weight bearing for about 8 weeks after this surgery.  I then went into physical therapy for about 4 months.  

These x-rays show the screw used to reattach the heel bone. 

After surgery #2,  I have 100% relief of the pain and swelling on the side of my foot.  Unfortunately, my recovery was affected by my connective tissue disease.  The Achilles tendon, that was lengthened, failed to heal properly.  It became severely swollen and full of scar tissue knots and tears that caused a lot of pain. 

Surgery # 3 July 2012- Debridement and repair of Achilles Tendon  I am still in recovery for this one.  The doctor had to go back in, to clean up and repair the Achilles tendon.   He removed several areas of  dead and scarred tissue until it was smooth, healthy tissue left.  He then sewed it back together.    I am in a cast for 3 weeks this time, but I was only non-weight bearing for 5 days.  I am currently in a walking cast that is due to be removed in 2 days.  I will then be in a walking boot.  I am unsure of what physical therapy will entail this time. 

*UPDATE (10/16/2012) - I am still in terrible pain after surgery 3.  My Achilles is super tender and quite useless right now.  I don't walk well and still can't drive with that foot. I am unable to do my full physical therapy regimen at this time.  I made the choice to see a pain management doctor, in hopes that he can get the pain under control.  I am not able to take any oral steroids or NSAIDs because they cause complications with other health problems.  My pain doctor is compounding a cream that contains pain medications and anti-inflammatory medications.  This way, the drug is delivered via the skin and wont affect my organs.  I am waiting to receive the cream.  Hoping it helps!  My case is complicated with pain, because of my other diseases.  My central nervous system is in overdrive right now.  I am definitely not in the normal category for healing from PTTD surgery. *

This has been a very trying experience for me!  I can't say it is worse than my spinal fusion in 2008, but it is close.  It is so hard to be disabled and in pain for so long.   I own nearly every medical assistance device available and I am only 28 years old!  

I have had almost every cast color the doctor's office offers...

 decorated for Halloween

 Decorated for breast cancer awareness month

Decorated for interstitial cystitis month (a bladder disease I suffer from).

I hope this explanation helped some people understand why I have had so many surgeries on my foot.  I am praying that this is my last one!  I do have fear that it will not heal properly, again.  I don't know what would happen then.   I am just going to focus on the here and now.   Thank you to everyone who has supported me!

If you came across this blog, because you suffer from PTTD, please feel free to ask questions.

I will be back with more food, garden, and craft topics soon!