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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. 


  1. Thank you for this post! After writing to you and continuing to try conservative treatment my PTTD is not getting better after 6 months. I saw Dr. Mark Myerson and am proceeding with surgery this month. To his observation, my PTTD is Stage 2C, the tendon is torn, orthotics won't work, and conservative treatment is putting off the inevitable of surgery.

  2. I forgot to mention that I cannot do a single toe raise in that foot.

    1. Jennifer, thank you so very much for your comment. I wish you very well with the surgery. Please consider sending an email to following surgery with any of your observations that can help others. You and I are in a unique situation that we can help. Your inability to do the single toe raise is the deciding factor here pro surgery. You could start a one year process of removable boot, etc to avoid surgery, but you have less than 30% odds that you can benefit from this, and without great effort. Rich


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.