Question
I was dx with plantar fascittis three years ago. After going through a myriad of treatments, I finally got reasonable pain relief from cryo despite inflammation of 7.5 remaining in the fascia.  About three months ago, I suddenly was unable to wear my custom orthotics due to pain by my accessory navicular.  I was dx with posterior tibial tendonitis and flexible flat foot. I was in a short leg cast for three weeks and then a boot for three weeks to no avail.

An ultrasound revealed the tendon continued to be very inflamed at the insertion site and you could see swelling along the tendon in my foot.

Mri results were: Intermediate T1 signal within the posterior tibial tendon regional to the accessory navicular is present but there is no definite edema within the tendon on the T2 weighted images. There is surrounding soft tissue edema. There is edema seen within the navicular at its medial margin and insertion site of the posterior tibial tendon. There is linear bright T2 signal at the insertion site of the posterior tibial tendon. This is likely some partial tearing at the insertion. No definite underlying fracture line is seen. There is fluid in the extensor digitorum longus tendon sheath at the level of the ankle joint compatable with a mild tenosynovitis. There is edema within both the medial and lateral margins of the talar dome.

One podiatrist wanted to do a modified graston without addressing the arch. He also wanted to do a plantar fascia release "while he was in there" even though my pain has been very manageable since my second round of cryo.  The second podiatrist felt that the chances of a subtalar implant reducing the pressure/irritation on the tibial tendon was good.  If the implant was not sufficient, a modified graston could always be done.

I am now three weeks post op. The spasms in my arch are about 90% relieved; however the posterior tibial tendon continues to be sensitive when I lightly press on the area of the insertion site. The doctor said that he is happy with the correction achieved.  My husband could see a difference in my foot. Now when I stand, he can see an arch instead of the foot completely flattening. Today my husband and I walked the dogs for about 1/2 hour with no major foot pain. I am able to walk on flat surfaces with minimal discomfort; however when I walk on slightly uneven surfaces, my ankle hurts. I just started pt to strengthen/stretch. The doctor feels that pt will help my foot adjust to the new mechanics and normalize my gait. Is it normal for the irritation by the insertion site to continue three weeks post op? If the surgery has worked, how long should it take for the pain by the posterior tibial tendon to start to wane? When I start to walk after sitting for any period of time, my foot is kind of crampy and spasms when I first walk. This can last for up to three minutes before subsiding. Is this normal? I sometimes feel a pulling sensation on top of my foot. Will it improve with time?

Thank you for your response  

Answer
HI Amy,

It sounds like you are doing well.  You've had some pretty fast relief and should get better over time.  Physical therapy will certainly help as will orthotic devices.  It can take months for the tendon to completely heal and in some cases you may still have some pain even with the surgery.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com

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