Posterior tibial tendon dysfunction

by Marge
(Lincoln, Nebraska)

I have had flat feet all my life.(I am 67 year old female.} I was used to walking 3 miles a day until last fall when both feet started hurting something awful. They were burning and stinging so bad I could hardly walk on them. One ankle and foot surgeon wants to do a tendon transfer and the other one, order custom arch supports. Will I have had the supports for about 3 weeks and they are so high that the arch and the ball of my foot is also hurting. The only thing that has improved, is not so much burning and stinging. Would I be a good candidate for the HyProCure Procedure. Both my feet and ankles are very flexible. Thank you.

RESPONSE

Hi Marge,

The Hyprocure implant is one type of implant that is inserted into what is known as the sinus tarsi or subtalar joint which is the joint just below the ankle joint.
The purpose of the implant is to eliminate or greatly reduce excess pronation (flat feet). So, in theory if your pronation was eliminated there would no longer be an overstretching of your posterior tibial tendon and your pain would diminish.
Here's the rub. My guess, due to your age, you would not be a candidate for the implant, simply because at age 67 there has been too much arthritic degenerative changes in your feet that in an effort to reposition your foot (eliminate pronation), it would probably lead to other foot, ankle, possibly knee and hip problems. I am only making a calculated guess here because I do not have the luxury of actually examining you and reviewing x-rays of your feet.
The fact that the orthotics (custom arch supports) have helped your pttd is very encouraging.
Orthotics can be adjusted. What you need to do is go back to the doctor who prescribed them and tell he or she about the issues you are having. You do not mention what type of material the orthotics are made out of, but almost all orthotics can be adjusted.
People who have been very flat-footed their whole life will have trouble wearing orthotics where the arch is too high. Even though the higher the arch is made, the greater the degree of pronation reduction that occurs, there sometimes is a fine line between too much correction.
If you presented to my office with your complaint, the first thing I would do is reduce the longitudinal arch. I would have you then walk around and see if that still helped your pttd. If you were not getting the kind of relief you were hoping for, then I would add what is known as an external rear-foot post and possibly fore-foot post which would help reduce your pronation without raising the arch.
The other consideration is the material with which the orthotic is made out of. If it is a hard plastic with no "give" to it, then you were prescribed the wrong kind of orthotic, however, in these cases the arch can still be lowered and a cushioned top cover may be placed over the hard plastic to give you more cushioning.
My advice to you is to work with your doctor. Have the orthotic adjusted until you come up with a compromise that allows you to walk comfortably.

Marc Mitnick DPM
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