Posterior Tibial Tendon Dysfunction. In other words…PAIN.
Any words of wisdom, Wendy?
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odd but I may have it as well. I just made an appointment with my PT. I did not know about PTTD.
AI Overview
Yes, physical therapy is a highly effective treatment for posterior tibial tendonitis, also known as PTTD or posterior tibial tendon dysfunction. It focuses on reducing pain, improving strength and flexibility, and restoring normal foot and ankle function.
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First, you need to understand the structure and function of the Posterior Tibial Tendon (PTT).
Think of the arch of the foot like an engineer. It’s like a bridge that connects the heel and the forefoot. It absorbs and then releases energy with every step.
There’s a lot of stress put on the arch so it is supported from above by a cable similar to a modern cable-stayed suspension bridge.
The tower of the bridge in the leg is the tibia (shin bone). Buried behind the tibia, where you can’t see it from outside, is the PTT. It descends along the leg and wraps under the ankle bone like a pulley. Then it inserts into the center of the arch.
Evolution has provided this system to enable humans to become long-distance runners on two feet. It adjusts to the flexion of the arch while supporting it. Unfortunately, there are two major weak spots: the “pulley” where the ankle bone presses against the PTT (this is where mine failed) and the insertion into the arch.
Like the bridge cable, the PTT is a bundle of much smaller cables called microfibrils.
In 2017 my foot began to hurt when I did Zumba. I figured that it was a minor muscle strain and continued to dance in my usual high-impact fashion.
BIG MISTAKE!!!
Within 3 weeks my ankle hurt so much I thought it might be broken. An X-ray showed the bone was intact. The failure of the PTT was gradual since the breaking of the microfibrils threw the stress onto the fewer remaining microfibrils.
Now I had a lot of PAIN and could hardly walk. I couldn’t stand on my tiptoes on my right foot. I couldn’t even lift the heel 1/4".
My primary care didn’t know what it was or what to do. Amazingly, it was the Facebook computer that referred me to the PTTD support group.
Several members of the PTTD support group posted the X-rays of their surgeries showing 2" screws embedded in the bones of their feet. Some had more than one surgery since the earlier ones had failed.
I decided I was going to let my body heal itself no matter how long it took. Tendons are very slow to heal. It took a year.
I posted this in the Guides section of the PTTD Group
How can I avoid surgery if I have PTTD?
Each person is different. It may be possible to heal from PTTD, even from Stage 2 PTTD, without surgery if you are not too overweight, if the bones of your feet are normal and if the PTTD is due to an accident or overuse injury. People who are overweight and/or have bone or tendon abnormality will probably need surgery because the staples, screws, fusions and tendon transfers mechanically stabilize the ankle.
In 2017, I noticed that my ankle began to hurt. I figured that it was a simple muscle strain and would go away. I continued to do Zumba dancing like a 25 year old. (I was 63 at the time.) BIG MISTAKE!! Within 3 weeks my PTT had failed. I had painful Stage 2 PTTD.
My Stage 2 PTTD was pretty bad. I couldn’t lift my heel even 1/4". I couldn’t stand for 30 seconds without pain.
My ankle was so bad that I thought it might be broken. I went for an X-ray. My bones were fine. My primary care didn’t know what to do. It was the Facebook computer that diagnosed me with PTTD and referred me to this group with nice people and lots of information.
I decided to take all the time I needed to heal after seeing the X-rays of the very nice people in this group with the screws in their feet. Also reading about their multiple surgeries and PAIN. I figured that I would have less pain even if it took a longer time to heal.
After research, I developed my own plan for healing from PTTD.
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Tendons are made out of parallel bundles of collagen microfibrils, similar to the cables in a suspension bridge. If too much stress is placed on these more of them will break. Don’t tear any more microfibrils in your tendon! High impact exercise like dancing and running are O-U-T until you are healed.
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The arch has to be supported from below. Get a good orthotic. I went to a podiatrist who molded my foot with plaster and made a custom orthotic. I wear this for my highest impact activities but also got less-expensive commercial orthotics for my other shoes. Only strong shoes or boots. No shoe that will twist easily in the heel area. High heels – NIX!!
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I wear ankle braces to prevent twisting and side bending of the ankle which puts more stress onto the PTT. However, I don’t believe in rigid support (such as a boot) because that causes atrophy of the leg and doesn’t stimulate the PTT to heal. I wear the inexpensive Ace Deluxe ankle brace with plastic side supports. This fits easily into athletic shoes and is comfortable while sleeping.
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Rest is important to heal the tendon, but not too much rest! Tendons are mostly non-living collagen. But they are embedded with dormant (sleeping) stem cells that can potentially build new collagen if they wake up. The trick is how to wake up the stem cells without damaging more microfibrils. Gentle daily exercise, such as swimming, recumbent biking, slow walking and physical therapy is needed. I did a deep-water aerobics class four days a week. I did my own physical therapy with my own hands because only I know how much my PTT hurts. Tendons do not strengthen with more exercise the way that muscles do. It’s easy to overdo the exercise and cause pain and inflammation in the tendon.
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Collagen can be added as a supplement to the diet to speed the healing process. Older people do not make enough collagen to meet our needs in general, much less to heal collagen structures. I take 2 tablespoons per day of collagen hydrolysate powder (mixed into food) to provide the needed amino acids to build the healing collagen microfibrils.
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PATIENCE! A LOT OF PATIENCE!! This is the hardest ingredient of all. Tendons are SLOW to heal. I did Zumba sitting in a chair for a year (the Zumba class was after the water aerobics class) so this was like a part-time job. Little by little, I was able to get up during Zumba class to dance slowly. After over a year I was gradually able to do the whole class. But I still wear orthotics and ankle braces. And I recently had a setback by dancing too hard and by doing some of the toe-standing exercises in the physical therapy.
Bottom line: you may be able to avoid surgery but it will take dedication and a lllllooooonnnnnggggg time.
I also posted this about collagen:
What is collagen? Why do you recommend it? What brand should I take?
Collagen is a protein. It’s a strong, elastic building material used all over the body in tendons, ligaments, joints, skin and the matrix that holds all our cells together.
https://en.wikipedia.org/wiki/Collagen
Like all proteins, collagen is made out of amino acids. One particular amino acid, proline, is especially stiff. Proline is rare in most proteins. However, collagen is about 25% proline. This is what gives collagen its strength. The difference between eating a tender chicken breast and a tough beef chuck roast is that the beef contains a lot of gristle. The gristle is all collagen.
Because people don’t eat a lot of gristle, our body has a natural process that turns a common amino acid (glutamate) into the uncommon amino acid, proline. Unfortunately, this process gradually goes away as we get older. People lose our collagen since we all shed our entire skin once a month. As we age, it’s harder to replace the collagen. All our collagen structures degrade. That’s why people get wrinkles as we age.
My grandmother told me, about 50 years ago, to eat gelatin to have stronger nails. (Gelatin is collagen.) When I was about 55 years old, I noticed that my nails were breaking. So I did what Grandma advised – I started taking a packet of Knox gelatin per day. Within 3 months, I noticed that I had stronger nails, thicker hair and the pain in my knee went away. Since I’m a chemist, I started to research this. It’s real.
I now take 2 tablespoons of collagen hydrolysate per day. My PTTD did not begin to heal noticeably until I increased my collagen to this amount.
The key ingredient in collagen is the proline amino acid. Good brands of collagen list their amino acid content on the label. I buy only organic, grass-fed beef collagen hydrolysate powder which dissolves more easily than gelatin and has a high proline content. I buy in bulk (5 pounds at a time) to save money. I put the powder into a smaller container for handling convenience. I buy the collagen over Amazon.com. There are several good brands but they vary a lot in price. Do due diligence in comparison shopping. Don’t be distracted by marketing hype – look for the price of the proline per ounce of product. Don’t waste your time with capsules – they are very expensive and don’t have enough collagen to make a difference.
I am currently buying the 5 pound bulk pack of Custom Collagen but that could change if the prices of the products change. I’m not endorsing any one brand, only the high-proline organic grass-fed beef type of collagen.
https://www.amazon.com/…/ref=ppx_yo_dt_b_asin_title_o03…
Vitamin C and Vitamin D are also important for incorporating collagen. I eat an orange every day and take 5,000 I.U. of Vitamin D every day that I’m not sitting in strong sun.
As a result of eating so much collagen, my skin is unusually smooth for my age (67). I’m able to do Zumba within reason. In my opinion, every person age 45 should be taking collagen. That goes double if you are trying to heal any type of wound, including a tear in a tendon. [end quote]
I’m now 71 and I continue to take collagen daily. My cardiologist remarked on how quickly my surgical wound healed.
Although every person is different I would caution about physical therapy.
I’m a great believer in physical therapy for muscle and joint issues. But a tendon is not a muscle. It doesn’t respond the same way. When I did some mild, supported physical therapy exercises (toe stands) I tore my “good” PTT. Now I wear ankle braces on both ankles.
I’m sorry to hear that you have PTTD, @VeeEnn. On top of your other foot issues…bummer!
First, be careful not to make it worse. Second, follow my guide and hopefully it will heal in time (figure 6 months) without surgery.
Wendy
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Thanks. I knew I could rely on you. I hope that I’ve avoided the worst of PTTD. I’ve really only had this worsening discomfort for about 3 weeks…prior to that, most everything could be explained by lingering healing time post surgery. My feet following the lapiplasties feel quite different from their pre surgical state and, as you mentioned, ligaments and tendons are the slowest responders in situations like this so I was frustrated but didn’t allow my impatience to get the better of me.
With the school vacations on us, I’ve been doing a lot more driving in my role of grandma/uber lady and maybe that aggravated an existing problem. Who knows. Fortunately I managed to grab an appointment with my orthopedist on Tuesday…primarily because I wanted reassurance that the lapiplasty was ok and the ironmongery didn’t need to come out. I have the referral for PT (appointment already made … and caution noted!), recommendations for soft ankle brace (already delivered) and names of a couple of places for custom orthotics
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@VeeEnn the last time I got custom orthotics the podiatrist molded my feet with plaster and they cost $850. Medicare didn’t pay for it. I guess it’s in the same category as glasses and hearing aids. I do think they are worth the money.
I recently started wearing Hike brand shoes ankle height boots around the house. They are shaped like feet so they are more comfortable. But they are “barefoot-like” soft-sided so I wouldn’t wear them for serious activity (especially dancing since my ankle braces don’t fit into them). Given your bunion surgery you might want to try them. I wear commercial orthotics in them (not my custom orthotics which I wear for Zumba).
Beware of worsening discomfort. It may not seem like much at first but it can become crippling. For some reason, TMF won’t allow the word L-I-M-P but that’s what I ended up with for many months.
Wendy
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Well, the oddest thing. I’d say that my foot felt a bit worse than usual for about 3 weeks(subtle enough that I wasn’t sure if it was imagination or not) Last Friday I decided not to procrastinate as usual…just in case I was ignoring a problem that would end up crippling me or something. Called the office…expecting a longish wait with people on vacation. Turns out it must’ve been more patients on va-cay than staff as I was offered Tuesday.
Whaddaya know…rather than clearing up completely (the way these things often do) the foot started to get progressively worse so by Tuesday, the signs and symptoms were all there and radiographs showed excellent healing and osseointegration with the hardware. I’m no martyr when it comes to pain so I’m reasonably sure that I haven’t been provoking the issue for months. Not a guarantee of a return to normal but hopefully I won’t have to endure a lisp for an extended period.
Thanks for the recommendations.
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I am not 100% sure what i have.
Adding
The tendon attaches to the posterior shealthing or muscle behind the calf.
The began stretching that this year but not strengthening it.