Question
QUESTION: First of all, thank you for volunteering your time to this site to answer questions! I am a 22 year old female who just had a modified kidner procedure on my foot, along with a peroneal tendon repair and a  calcaneal osteotomy to correct a hindfoot varus. I have had tons of foot and ankle problems in my life, including peroneal subluxation, hindfoot varus deformities in both feet, and lastly, the extra navicular pain. For some reason the pain didn't get really bad until my peroneal tendons started tearing, and the braces I wore for the subluxation irritated the extra navicular bones.

Once I am healed from this surgery, my OS plans on doing the same surgery to the other foot (osteotomy, modified kidner, peroneal tendon repair).

Some other possibly relevant information: Apparently the extra navicular was quite large, and the navicular itself was prominent and had to be shaved down. The tibial posterior tendon was detached from the accessory navicular and then attached surgically to the navicular itself. The surgery was performed a little over four months ago and I am having a lot of soreness and tenderness in the arch/inside of my right foot. My PT says it's the posterior tibial tendon. I am so scared that the surgery didn't work. I am out of school and work until both my feet are fixed, and I'm worried this could be really bad. On top of that, I made the mistake of googling posterior tibial tendon pain. I read all these horror stories online about peoples' arches collapsing and people having lifelong pain from posterior tibial tendonitis...not comforting lol. I really regret researching it. I'm trying to not panic. My surgeon is well known, experienced, and has a great reputation, my PT is awesome, and hopefully it's just a glitch. I'm hoping someone can tell me that it's common to have ptt pain after this surgery and that there is no need to worry. I am scared my foot will flatten out like other people with pttd and I will need more surgery down the road. I am so overwhelmed with the surgical plan already :( ANY advice is greatly appreciated and would help me with some serious anxiety about all of this. Does it get better with time? Thank you so much!

ANSWER: Bee,

Posterior tibial tendon dysfunction is a complicated disease state due to the multiple contributing factors that cause the problem.  In short the surgical procedure that was performed on your foot will take time to heal.  Everyone heals differently and so patience may have to be your friend.  I would also consider supporting the arch of the foot with a custom orthotic so that less stress will be applied to the PT tendon.  Also, if the pain is severe enough consider a custom AFO brace.  These are two conservative options which will support the arch and the ankle so that you may recover more rapidly.  

Best of luck to you!

Dr. Cruz

---------- FOLLOW-UP ----------

QUESTION: Thank you for the advice! I bought an aircast recently so that may help a little, but still limping really badly after two weeks of complete rest other than up to living room and back. do you know if an ultrasound would tell us anything at this point? After surgery my foot jerked really really hard and I felt a sharp intense pain in that area and I think that may be what caused it to be so painful in the first place. I'm thinking bout trying to set up an appointment for an ultrasound to make sure I didn't tear it. Is that a good idea?

Answer
Bee,

If you felt suffered a different trauma during your recovery period your surgeon should know this.  Either an ultrasound or an MRI would be beneficial to see whether or not the posterior tibial tendon has been compromised in anyway.  Meanwhile please utilize a pneumatic walking boot to help offload and immobilize the affected limb.  If you have pain and swelling then please exercise RICE therapy.  Rest, Ice, Compression, and Elevation.  Most important factor is notifying your surgeon of the recent events.  He or she will have a better understanding of what to do since he/she knows your foot the best.  

Best of luck!

Dr. Cruz