Question
About 5 years ago, I was dx first with plantar fasciitis and then fasciotis.  No response to ALL conservative treatments inluding ESWT. Finally despite fascia continuing to be Very thick 7.5, two rounds of cryo took care of the pain.  18 months ago, was diagnosed with posterior tibial tendonitis secondary to accessory navicular (flexible flat foot).  I was put in a cam walker for a few weeks to no avail.  I was then put in a cast to no avail.  I was given a non custom richie style brace along with pt. The brace was great for short periods of time but it rubbed on the accessory navicular, causing a great deal of pain.  

After 8-10 months of conservative treatment, I was experiencing increasing pain despite the tendon being functional.  I was able to do 6-8 single foot toe raises before the pain kicked in.  An MRI was ordered which showed tears by the insertion of the tendon. The doctor put a hyprocure implant in to remove the pressure on the tendon.  After two months, the implant had started to back out and was removed. A modified kinder was done at the same time.  The doctor said that there were numerous small tears (much worse than indicated on the mri). The accessory navicular was removed, tendon repaired and a plastic anchor used.  It is now 10 months after the modified kinder.  I went through pt.  Both the doctor and pt said that strenght and function of the tendon was good.  Despite a seamingly "successful" surgery, I continue to have intermittent pain and sensitivity by the surgical site.  I have some days when I am almost pain free, however out of the clear blue I start to experience pain along the tendon (along the side of the foot and into the arch).  The pain is similar to that which I experienced prior to surgery.  The surgeon prescribed a custom arizona style gauntlet brace which goes about 2 to 3 inches past the ankle.

I am FRUSTRATED. Is it common to have so many problems after a surgery like this?  How come I continue to have pain 10 months post op if the function and strength of the tendon are good? I did go to a different podiatrist for a second opinion.  He also agreed that the function and strength were good.  His reccomendation was to wait until a year post op an if problems continue to try the hyprocure again and then to go in and check the tendon repair. This is all after having a late stage 1 to early stage two posterior tibial dysfunction.

Any opinions would be appreciated.  I am tempted to go into NYC to see an orthoedic surgeon who specializes in PTTD; however I am not sure what he could tell me that I dont already know.

Answer
Amy,
It really sounds like you've been the ringer and I can hear and understand your frustration.  Unfortunately, I don't have a golden answer for you.  I do agree that another opinion could be helpful.
I do apologize that I couldn't offer more...
All the best,
Andrew Schneider, DPM

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