Tuesday, May 10, 2016
Great Review Article on Posterior Tibial Tendon Dysfunction
I am treating 7-8 patients right now in this Stage 2 PTTD predicament. Our surgeon is ready to do surgery. The goal to prevent progression to Stage 3 and the need for more advanced surgery. The surgeon feels great when doing this surgery to prevent the disease from progressing. I feel great helping the patients that conservative management works well. Surgery causes disability although temporary. The surgical patients I follow do really well thanks to our surgeon Dr Remy Ardizzone. The ones that I treat and treat and treat that end up needing surgery make me feel sad. Who needs surgery? Definitely patients who have no tolerance for the art of rehabilitation, and its ambiguities.
Definitely patients who can not do a single heel raise or have no strength on posterior tibial strength testing. Definitely patients who show no improvement in disability in a 3 to 6 month level. Patients like Joni (she knows who she is) have done great with conservative management. Patients like Suzanne did not on one side, but her other side is doing well with conservative care. My bias is conservative management, but I can only treat these patients with a surgeon at hand. We are a team of three with the patient making the triad.