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Tuesday, March 25, 2014

Tuesday's Patient Question of the Week: Posterior Tibial Tendon Dysfunction

Dear Dr Blake: 
Thank you for your wonderful blog and devotion to truly mastering your craft and helping others! Here is a patient question-of-the-week(I know you may not answer!)

I've had five years of dealing with chronic re-injury of the posterior tibial tendon and achilles.I've never let it go too far, but stop and rest for three weeks to three months, incorporating taping and strengthening until it feels strong enough and no pain.

After twenty practitioners and thousands spent on modalities and orthosis, I am no further ahead, although my first orthotic had a flange up the side-back of the heel that stabilized the foot and healed it more quickly. My longest time without injury was when I went minimalist, stuck to a soft trail and did steep hill workouts(I've loved running for 25 years;  I miss it so very dearly). 

I wonder if this strengthened my PT and achilles enough to stay running?  I greatly reduced mileage.I  went back to roads due to winter conditions on the trail and within months was injured again. It is so anxiety-provoking to live this crippled. Could a leg length discrepancy be at fault? I also have a pelvic tilt, according to my chiropractor, and hyper-eversion(valgus) of the affected foot at the ankle bone.And hip arthritis and OCD lesions in the knees, but the PTT is a deal-breaker. It seems I cannot keep this foot neutral, no matter how much work I do on my gait or core.I know the ankle seems "loose".

 Will it help to build up my own orthotic(currently, a custom SOLE) How do I find the material and tools, and can I use duct tape?:) I am willing to experiment; I have done a lot of it with shoes and insoles, but feel a bit out of my league! Do you think you could make me an orthotic that works? I am 50 years old, but it is the new 80! I don't want to be in a wheelchair in ten years.
Thank you so much for your earnest blog and practice!
Marina (name changed)

Dr Blake's comment: Marina, thanks for your wonderful compliment. I have a wonderful love hate affair with Posterior Tibial Tendon Dysfunction. Developing the correct orthotic device is a crucial first step in stabilizing you, along with arch taping, PTTD Braces and then tons of posterior tibial strengthening. Check out the many blog posts on this site on PTTD. It takes alot of work to get the right orthotic, so I would be happy to try if you want to come to San Francisco. Not a bad place to have a two week vacation. The minimum time would be an initial Fri afternoon visit for evaluation and orthotic stuff, followed by a dispense visit on Monday AM. This has to be all arranged. Perhaps followup can be done locally by a podiatrist or orthotist. Contact me directly through by email and I will arrange things, give me 2 or 3 weekends that you can do this. If their is someone locally that can at least adjust my work, that would be wonderful. The video below discusses this problem.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.