In my recent piece on Posterior Tibial Tendon Dysfunction I mentioned Carol (AKA Jeepers on the RW forum) and her problems with this. She’s very kindly agreed to give RunningPhysio her story, in the hope it might be helpful to others. Even if you’ve never heard of PTTD it’s a heartening story to read, to hear how someone has overcome a potentially serious injury.
Over to you Jeepers!
I have extremely flat feet – something that I didn’t know until I ruptured my tib post tendon. I woke up one morning, stretched just before getting out of bed and felt a sudden, excruciating pain in my foot. The sharp pain disappeared to be followed by an a persistent ache and when I stood up, my foot collapsed under me completely. I realised that I had done something, but as an ex-school, club, county and England netball player, because I hadn’t incurred the injury while playing, assumed that it was not important. Wrong!
I have an extremely high pain threshold, so once I’d got used to the ache, got used to the fact that my foot didn’t work properly, I just carried on, thinking that it would get better in the next few days, then weeks. But it didn’t. My foot was swollen, red, very hot to the touch, painful and completely collapsed, but I still thought that it was nothing. I limped and by supinating, managed to get by. It was only when I had to attend a funeral, three months after it had happened and realised that I couldn’t get my shoe on (and other people noticed my foot) that I thought about getting medical advice.
On my first visit to the GP I was told that it was a broken bone. Having wasted a few weeks waiting to get an x-ray, it turned out not to be broken. The next diagnosis was DVT. Wearing the support hose helped (obviously supporting the broken tendon) but it was third time lucky when it was diagnosed by a GP who had an interest in sporting injury – apparently the symptoms were classic “text book”.
I was referred to a biomechanical specialist who strapped the foot up, put me on crutches and referred me to a specialist surgeon. He agreed immediately, said the other foot was on the point of going too. Instead of a sudden rupture across the tendon, due to the stress placed on the tendon by flat feet, years of heavy-duty netball playing in nothing more sophisticated than Green Flash plimmies and years or running around after two young boys (in “sensible” flat shoes), I had gradually shredded the tendon along its length, with filaments breaking off gradually until the last one went as signalled by the pain.
He confirmed the extent of the damage via MRI scan and then, 6 months after the initial incident (almost to the day) carried out tendon replacement surgery. He removed the damaged tendon, replaced it with one from somewhere else in my foot, repaired the tib anterior (?) tendon on the other side of the foot that I’d damaged by the way that I’d compensated for the ruptured tib post and then cut into my heel bone, to correct my biomechanics.
He pinned my heel bone back into a new position and stitched all the bits back up. I spent the next three months or so in plaster, every 3 / 4 weeks a new plaster cast was fitted, the foot being turned slightly each time to encourage the tendon to work properly. I was then giving a walking plaster but soon after discovered that I’d developed osteopaenia from being non-load bearing for so long as the bone was crumbling slightly and tearing the new tendon. So it was back onto crutches for a short while followed by around three months in an aircast.
Physio was nothing more than massage along the scar lines to start with, every other day, but after a month or so, I was able to do some limited mobility exercises. Then it was a case of building up strength in the tendon and leg (my calf muscle in that leg is still smaller) and it was about 12 months before I was allowed to do any form of activity.
Once I was out of plaster, I was fitted for full length orthotics which I wear religiously every day, in all footwear – not just runners.
The other foot should have been done, but for various reasons, it was not an option. I do Pilates and mobility / flexibility exercises and stretching every day and so far, have had not a twinge. About two years after the surgery, I started running and to date, have worked up to 40 – 50 miles per week, have done a few HMs and am training for maras. I do HR training which suits me, my age (mid 50s) and my feet! I have a pod who I see every 12 – 18 months to check on the orthotics, wear support shoes as well and as she says, see no reason why I shouldn’t be able to continue running – as long as I’m sensible. At my age, I’m too old and too ugly not to be!