Other/Mixed Posterior tibial tendon

[Baron von Raschke]

This thread is a continuation of a conversation with @Amy in her Strength or Conditioning First question in the Kettlebell forum. I moved this particular discussion over here because it's not really kettlebell related. Everyone else is welcome to chime in.

In April of 2016 my 47 year old wife, a runner in high school, noticed swelling and tenderness in her right foot. Most noticeable was the apparent loss of her arch. A trip to the emergency room with x-rays found nothing and diagnosed it as cellulitis. A few weeks later with no improvement, a local ortho said it could be gout. A few weeks later, still with no improvement, a local orthopedic foot surgeon diagnosed it as most likely a torn or ruptured posterior tibial tendon. He suggested a custom orthotic, which is supposed to retrain the lower leg muscles to compensate for the loss of the PTT. She's been wearing the orthotic for several months now and it's hard to say if it's getting better, but it doesn't appear to be getting worse. If the orthotic doesn't work, then it will be a tendon transfer surgery with the accompanying recovery with physical therapy. She walks pretty close to normal while wearing the orthotic, but that limits her shoe selection to whatever can accommodate the device.

Amy, it sounds like you have not had yours repaired. You tried the orthotic and the Richie Brace with no luck? Are you able to walk around ok with both PTT's torn? My wife hasn't had an MRI, but the doctor said her inability to do a single leg heel raise points directly to this condition. I introduced her to kettlebell swings in an attempt to get her some lower body strength and to end her sedentary lifestyle that has taken over since our now 4 year old son was born. The doctor said any low impact exercises are fine and the swings fit the bill. I've been doing them myself for a year or more. If the kettlebells work for her but the orthotic doesn't, then I feel she'll be in a better position to handle surgery and the recovery due to the strength and conditioning she'll have gained from the kettlebell workouts.

There is a limited amount of info online for treatment of this injury. What I've found tends to point to strengthening the hips, glutes, hamstrings, stretching calf muscles in conjunction with wearing the orthotic as much as possible, and hoping for the best. And then there's surgery and it's inherent unknowns and recovery time. Difficult, as you know, with a young active child.

Mark

 

[coachnathanwhite]

In April of 2016 my 47 year old wife, a runner in high school, noticed swelling and tenderness in her right foot. Most noticeable was the apparent loss of her arch. A trip to the emergency room with x-rays found nothing and diagnosed it as cellulitis. A few weeks later with no improvement, a local ortho said it could be gout. A few weeks later, still with no improvement, a local orthopedic foot surgeon diagnosed it as most likely a torn or ruptured posterior tibial tendon. He suggested a custom orthotic, which is supposed to retrain the lower leg muscles to compensate for the loss of the PTT. She's been wearing the orthotic for several months now and it's hard to say if it's getting better, but it doesn't appear to be getting worse.

More than likely, your wife suffered from micro tears in the tendon years ago and the symptoms are now showing up after years of inactivity plus the birth of your child which can lead to the lengthening of tendons. This type of issue is typically called progressive flatfoot.

Whether or not she will need surgery is unknown, although in the mean time continuing to strengthen the posterior chain as you mentioned is always a good plan as long as your doctor has signed off on her prescribed level of exercise type / frequency / intensity. All the best.

 

[Baron von Raschke]

Thanks @natewhite39, you are correct. Doctor said it was from years of wear and tear with overpronating that led to this. She'd had trouble with Achilles tendonitis in the past as well, which probably indicated poor mechanics, tight calves and just general lower body dysfunction. My research has shown that this injury is 4 times more likely in women than men and typically hits women over 40. Though marathons and triathalons with poor mechanics and genetics can lead to a rupture at a much younger age.

I guess this can be looked at as a cautionary tale. She showed no symptoms whatsoever prior to failure. She'd seen a podiatrist a few years ago for Achilles tendonitis but no mention was made of possible PTT issues. It's a very subtle degradation apparently, then suddenly it just goes. She has not had an MRI yet but the foot specialist was certain about his diagnosis.

Thanks for the well wishes.