Question
QUESTION: I was dx with posterior tibial tendonitis which did not respond to conservative treatments.  A year ago, I had a modified kinder which initially resulted in somewhat reduced symptoms; however about 9 months post op,  symptoms became increasingly worse.  Even when I wore a custom gauntlet afo, by the middle of the day, I was in pain. I recently received a copy of the report from an mri that was done in June of this year.

The purpose of the MRI was to determine the integretrity of the posterior tibial tendon and spring ligament.  A synopsis of the MRI follows


MRI of the left ankle demonstrates flatfoot deformity with profound degeneration of the posterior tibial tendon between the medial malleous and navicular attachment with marked scarring of the parantendon but relative preservation of the remaining long medial flexor tendons.  Supermedial fibers of the spring ligament are thickened.  The inferior fibers appear chronically disrupted and encased in hypertrophic synovium.  Two discrete osteopchondral lesions are seen over the talar dome, the largest of which is noted medially, with mild subchondral collapse and areas of high grade cartilage loss. The cartilage over the hindfoot is degenerated.  Hindfoot valgus is noted.  The talonavcular joint is notable for dorsal capsular thickening.  There is no disproportionate midfoot arthrosis.  There is degeneration of the plantar fascia. The Achilles tendon is intact; however there is scarring of the pre-Achilles fat with an edema pattern, tethering to the pre Achilles and superior peroneal retinacula

Could you help me interpret the report beyond my very basic understanding that there are problems with the ptt and Achilles tendons, spring ligament and some arthritic changes?

ANSWER: Stacy,
It looks like your PT tendon dysfunction has caused malalignment in your rearfoot, causing breakdown of the joints.  The talar dome lesions is essentially an ankle injury/arthritis.  This is due to excess pressure when the foot rolls in.  

If you haven't already, you should try a gauntlet AFO to control motion and eliminate pain.

All the best,
Andrew Schneider, DPM

http://tanglewoodfootspecialists.com
http://www.houstonrundoc.com
http://www.facebook.com/HoustonPodiatrist
http://www.twitter.com/HoustonFootDoc

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

QUESTION: I already tried an rx gauntlet afo. Initially, it seemed to help, but after about 2 months, even wearing the gauntlet, I was experiencing increasing pain as the day progressed.  I am scheduled to have a flat foot reconstruction.  The proceedures planned are repair of the posterior tibial tendon using a tendon transfer, repair of the spring ligament, calcaneal slide, lengthening of the achilles tendon and possibly a cotton osteotomy.  The surgeon that I plan to use has had extensive experience with flat foot reconstruction at a top ranked orthopedic hospital. The doctor asked me specificaly about the location of my pain.  He said that despite having arthritic leisons, they do not appear to be symptomatic at this time.  If they are asymptomatic, he will not touch that area as doing so may "open a can of worms"

Answer
Sounds like you're on the right path with the surgeon you're consulting.
I wish you the best of luck.

All the best,
Andrew Schneider, DPM

http://tanglewoodfootspecialists.com
http://www.houstonrundoc.com
http://www.facebook.com/HoustonPodiatrist
http://www.twitter.com/HoustonFootDoc