Posterior Tibial Tendon Dysfunction (PTTD)

Foot Facts

  • Each foot has 26 bones
  • There are more than 100 ligaments in each foot
  • Diabetes is the #1 cause for lower extremety amputation
  • A toenail takes 4-9 months to completely grow out
  • Pain in the feet is NOT normal

Surgery: YES OR NO????

  • Deciding whether or not to have surgery is a big decision. 
  • Our foot and ankle surgeons are skilled in both surgical and conservative options. 
  • We will present the options most suitable for you and help you with your decision.

How much pain should I be in before I make an appointment?

  • Foot pain is not normal.
  • Foot pain is a signal that something is not right.
  • Any degree of foot pain warrants an evaluation to determine the source of the pain and possible treatment options.
  • Most foot pain left untreated will get worse and become more difficult to cure.
  • If you have foot or ankle  pain, make an appointment, do not wait.

Will soaking cure my ingrown toenail?

  • Soaking an ingrown toenail will often make it feel better, but it will not cure it. 
  • The symptoms of an ingrown toenail include pain, redness, and swelling.
  • An ingrown toenail is easily cured with a simple in office surgical procedure. 
  • The toe is anesthetized so that pain is not felt during the procedure.
  • The ingrown nail, or portion of the nail, is removed.
  • Most people feel no pain afterwards and return to normal activities the next day. 

What are orthotics?

  • Custom made foot arch supports designed to hold the foot in its optimum position
  • Can alleviate the discomfort caused by a number of foot conditions such as heel pain, bunions, and flat feet. 

Happy Feet...Happy Bride

happyComfortable footwear can help make the perfect day even better. Many times foot or ankle discomfort can be alleviated with appropriate shoes. It is not unusual for people to buy shoes that are too small for their feet. If your foot problem has an easy solution, our podiatrists will gladly provide you with that information. Sometimes the right shoe is not enough and custom-made orthotics is necessary to help the feet maintain the best position. Our podiatrists can utilize a three dimensional digital scan to have custom made inserts (orthotics) fabricated for your shoes, made from the scan of your feet to correct your specific foot abnormality and fit your feet only. If your foot or ankle problem can be resolved with conservative treatment, our podiatrists will advise you of the best treatment for you. There are times when the best solution for a foot or ankle problem is surgery. If you require foot or ankle surgery, our podiatrists can provide you with the latest state of the art surgical techniques. They will take the time to explain to you what to expect before, during and after surgery and will try to answer all your questions. Whatever your foot or ankle problem may be, our podiatrists will explain the various treatment options available to you. Everyone is happier when their feet are happy!

Thoughts on Celebrating 30+ Years

anniversarySome thoughts from Dr. Jacoby:
On April 30, 1984 I took over this podiatry practice. Elgin became my professional home as well as my personal home. I am forever grateful to Dr. Roger Hess who started this practice 50 years prior. Dr. Hess was a gentleman whom I admired and emulated both professionally and personally. I am forever honored to continue caring for the patients who initially trusted Dr. Hess.

My first office was at 860 Summit on the East Side of Elgin. I remember painting the office myself. I moved twice into larger space at 860 Summit. Eventually we outgrew the space there and moved to larger space at the Sherman Hospital Medical Building and then finally here to 750 Fletcher. I am grateful to the multitude of patients we have had the privilege of treating and that have kept us growing. I am also grateful to the multitude of other physicians in the area whom I am so privileged to work with.

Not only has this practice grown in physical space, but we have grown technologically as we offer many state of the art alternatives.  My staff has been and continues to be essential.  To all my staff, both past and present, I say a most sincere Thank You.

I look back on the years with much pride and sentimentality. I look forward to the future with the same enthusiasm and joy I felt on April 30, 1984. I love what I do and every day I realize how blessed I am to be in this wonderful profession!

What Is PTTD?
PTTDThe posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot.

 

PTTD is often called “adult acquired flatfoot” because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse, especially if it isn’t treated early.

Causes
Overuse of the posterior tibial tendon is often the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Symptoms
The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.

PTTD2For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.

Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.

As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.

Non-surgical Treatment
Because of the progressive nature of PTTD, early treatment is advised. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested.

In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

In many cases of PTTD, treatment can begin with non-surgical approaches that may include:

  • Orthotic devices or bracing. To give your arch the support it needs, your foot and ankle surgeon may provide you with an ankle brace or a custom orthotic device that fits into the shoe.
  • Immobilization. Sometimes a short-leg cast or boot is worn to immobilize the foot and allow the tendon to heal, or you may need to completely avoid all weight-bearing for a while.
  • Physical therapy. Ultrasound therapy and exercises may help rehabilitate the tendon and muscle following immobilization.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Shoe modifications. Your foot and ankle surgeon may advise changes to make with your shoes and may provide special inserts designed to improve arch support.

When Is Surgery Needed?
In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Your foot and ankle surgeon will determine the best approach for you.