Wednesday, March 23, 2011

PTTDS - POSTERIOR TIBIAL TENDON DYSFUNCTION

This is the official diagnosis for me.. it is a progressive  problem..   and eventually I will have surgery.. 
PTTD .. 
went and got fitted for NEW orthotics .. paying 200.00 for that luckly they can use the original molds of my feet so i did not have to redo those.. sadly since I have not met my deductible I  have to pay that out of pocket.. and I had to pay 100.00 the first time.. shesh getting these feet straight is a expensive issue ... my goal just to be able to take myself and my dogs for a walk because I can not even do that right now..  ... so below are some of the self treament choices.
So below is what it is:


Posterior tibial tendon dysfunction (PTTD), also known as posterior tibial tendonitis, is one of the leading causes of acquired flatfoot in adults. The onset of posterior tibial tendon dysfunction may be slow or abrupt. An abrupt onset is typically linked to some form of trauma, whether it be simple (stepping down off a curb or ladder) or severe (falling from a height or automobile accident). PTTD is seldom seen in children and increases in frequency with age.
The characteristic finding of posterior tibial tendon dysfunction include;
Loss of medial arch height.
Edema (swelling) of the medial ankle.
Loss of the ability to resist force to abduct or push the foot out from the midline of the body.
Pain on the medial ankle with weight bearing.
Inability to raise up on the toes without pain.
Too many toes sign.
Lateral subtalar joint (sinus tarsi) pain
Too_many_toes_sign.
A common test to evaluate PTTD is the 'too many toes sign'. The 'too many toes sign' is a test used to measure abduction (deviation away from the midline of the body) of the forefoot. With damage to the posterior tibial tendon, the forefoot will abduct or move out in relationship to the rest of the foot. In cases of PTTD, when the foot is viewed from behind, the toes appear as 'too many' on the outside of the foot due to abduction of the forefoot.
Sinus_tarsi_x-rayIn advanced cases of PTTD, in addition to the pain of the tendon itself, pain will also be noted in the subtalar joint and sinus tarsi. The sinus tarsi refers to a small tunnel or divot on the outside of the subtalar joint that can actually be felt. This tunnel is the entry to the subtalar joint. The subtalar joint is the joint that controls the side to side motion of the foot, motion that would occur with uneven surfaces or sloped hills. As PTTD progresses and the ability of the posterior tibial tendon to support the arch becomes diminished, the arch will collapse overloading the subtalar joint. As a result, there is increased pressure applied to the joint surfaces of the lateral aspect of the subtalar joint, resulting in pain.
There have been many proposed explanations for PTTD over the years since this condition was first described by Kulkowski in 1936. The most contemporary explanation refers to an area of hypovascularity (limited blood flow) in the tendon just below the ankle. Tendon derives most of its' nutritional support from synovial fluid produced by the outer lining of the tendon. Extremely small blood vessels also permeate the tendon sheath to reach tendon. This makes all tendon notoriously slow to heal. In the case of the posterior tibial tendon, this problem is exacerbated by a distinct area of poor blood flow (hypovascularity). This area is located in the posterior tibial tendon just below or distal to the inside ankle bone (medial malleolus).
Tendon is most susceptible to fatigue and failure at an area where the tendon changes direction. As the posterior tibial tendon descends the leg and comes to the inside of the ankle, the tendon follows a well defined groove in the back of the tibia (bone of the inside of the ankle). The tendon then takes a dramatic turn towards the arch of the foot. If the tendon is put into a situation where significant load is applied to the foot, the tendon responds by pulling up as the load of the body (in addition to gravity) pushes down. At the location where the tendon changes course, the tibia acts as a wedge and may apply enough force to actually damage or rupture the tendon.
Equinus is also a contributing factor in cases of posterior tibial tendon dysfunction. Equinus is the term used to describe the ability or lack of ability to dorsiflex the foot at the ankle (move the toes towards the shin). Equinus is usually due to tightness in the calf muscle, also known as the gastroc-soleal complex (a combination of the gastrocnemius and soleus muscles). Equinus may also be due to a bony block in the front of the ankle. The presence of equinus forces the posterior tibial tendon to accept additional load during gait.
Additional contributing factors that contribute to the onset of posterior tibial tendon dysfunction may include obesity, hypertension, diabetes, peripheral neuropathy, smoking or arthritis.
PTTD is a progressive condition, meaning to say, that if left untreated, PTTD will become worse over time. The progression of PTTD begins with focal tendonitis. If left untreated, tendonitis will progress to partial and then complete tears of the posterior tibial tendon. Several classifications have been developed to describe posterior tibial tendon dysfunction. The classification as described by Johnson and Strom is most commonly used today.
Stage I Posterior tibial tendonitis without tendon tear

Tendon status - Attenuated (lengthened) with tendonitis but no rupture.
Clinical findings - Palpable pain in the medial arch. Foot is supple, flexible. Too many toes sign may be positive or negative.
X-ray/MRI - Mild to moderate tenosynovitis on MRI, no X-ray changes found.
Stage II Posterior tibial tendonitis with partial tendon tear
Tendon status - Attenuated with possible partial or complete rupture.
Clinical findings - Pain in arch. Unable to raise on toes. Too many toes sign positive.
X-ray/MRI - MRI notes tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint.
Stage III Posterior tibial tendonitis with partial to complete tendon tear.
Tendon status - Severe degeneration of the tendon with likely rupture.
Clinical findings - Rigid flatfoot with inability to raise up on toes. Too many toes sign positive.
X-ray/MRI - MRI shows tear in tendon. X-ray noting abduction of forefoot, collapse of talo-navicular joint
Os_tibiale_externum_x-rayAn additional consideration in diagnosing PTTD pain is the presence of an accessory bone called an os tibiale externum. The os tibiale externum, or what is frequently called and accessory navicular, is a small bone that resides within the body of the PT tendon. The os tibiale externum functions to facilitate motion around the navicular. The os tibiale externum functions much in the same way that the knee cap (patella) works to guide the quadraceps tendon around the knee as it bends. The os tibiale externum can undergo degenerative wear called chondromalacia. The os tibiale externum also can fracture. Therefore, the os tibiale externum must also be considered when diagnosing PT tendon pain.
Treatment of posterior tibial tendon dysfunction
Treatment for PTTD is dependant upon the clinical stage and the health status of the patient. It is important to recognize that PTTD is a mechanical problem that requires a mechanical solution. This means that treating PTTD with medication alone is fraught with failure. Prompt introduction of some form of mechanical support is imperative.arizonabrace.JPG
PTTD is a condition that increases in frequency with age and the prevalence of poor health indicators such as diabetes and obesity. As a result, many patients with PTTD are poor surgical candidates for correction of PTTD. Prosthetics such as an ankle foot orthotic (AFO), Arizona Brace or other bracing may be very helpful to control the symptoms of PTTD.
Surgical procedures which focus on primary repair of the posterior tibial tendon have been very unsuccessful. This is due to the fact that tendon heals slowly following injury and cannot be relied upon as a sole solution for PTTD cases. Surgical success is usually achieved by stabilization of the rearfoot (subtalar joint) which significantly reduces the work performed by the posterior tibial tendon.
Stage I PTTD may respond to treatment that includes variations of rest. Variations in rest include an ankle brace, walking cast with an elevated heel or a hard, below the knee non-weight bearing cast. Pain and inflammation may be controlled with anti-inflammatory medications. It is important to be sure that Stage I patients realize that the use of shoes with additionalarch support and heel elevation is imperative. Arch support and heel elevation should be continued indefinitely. Arch support, whether built into the shoe or added as an orthotic, helps support the posterior tibial tendon and decrease the amount of mechanical load applied to the posterior tibial tendon. Elevation of the heel, reduces equinus, one of the most significant contributing factors to PTTD. If Stage I patients return to low heels without arch support, PTTD will recur.
Stage II patients typically require surgical correction to stabilize the subtalar joint prior to further damage to thesubtalar_joint_arthroeresis posterior tibial tendon. Subtalar arthroeresis is a procedure used to stabilize the subtalar joint. Subtalar arthroeresis may only be used in flexible feet. Arthroeresis is a term that means the motion of the joint is blocked without fusion. Subtalar arthroeresis can only be used in cases of Stage II posterior tibial tendonitis where mild to moderate deformation of the arch has occurred and MRI findings show the tendon to be only partially ruptured. Subtalar arthroeresis is typically performed in conjunction with an Achilles tendon lengthening procedure or endoscopic gastrocnemius recession to correct equinus. These procedures require casting for a period of weeks following the procedure.

We gotta deal with what we gotta deal with .. as far as I am concerned I will do what I can to avoid surgery.. for now.. make the day count.. I sure will..

Monday, March 21, 2011

ONE LITTLE CHANGE and a DEAL ON TWO LIGHTLY USED BATHING SUITS

It seems to me that one little change can make all the difference.. 
For example.. in my strange little mind I always believed that the swimsuits with the little skirt always looked best.. Fact=when you are large, overweight, obese whatever... no bathing suit.. is going to make you look your best.. WHAT you go for is .. what is the most comfortable . I found black tank regular bathing suits.. at Wallhell... These suits work great.. and I feel so much better in the water.  I am going to sell the two swim suits  here are photos of them if you are interested... I will gladly UPS them to you.. the cost for both suits is  40.00 includes shipping

The brown and aqua colored suit (2010 style)   cost me about 80.00 when I bought it last year... It Figures is the brand and they run anywhere from 50.00 to 125.00.

The black and multi color suit is a Suddenly Slim by Catalina available at your fine  WallMart retailers.. they run around 32.00.. and is a 2011 style.   Let me know if anyone is interested~
The brown and aqua is a 14  W ( this comes from IT FIGURES who makes larger bathing suits with out using the W sizing) 
the black and flowered suit is a regular XL (16/18) and is not a plus size.

The skirts are usually not the wrinkled sorry  for that .. just noticed that.. Let me know if  anyone is interested!
Make it a great week!
I know I am ..

Friday, March 18, 2011

YOU DON'T WANT TO WAIT

YOU DON'T WANT TO WAIT:

UNTIL your joints hurt
UNTILyour feet hurt
UNTIL walking up steps take more effort each and every time.
UNTIL you get winded way to easily
UNTIL walking is no longer simple 
UNTIL moving hurts
UNTIL you know you need to do it or you will die if you do not
UNTIL your blood pressure is sky high
UNTIL your first Heart Attack
UNTIL your pants are too tight
UNTIL you are embarrassed to buy clothing
UNTIL you get the pitiful stare
UNTIL someone calls you because they are scared you are either going to get horrible diseases or die
UNTIL your phone no longer rings
UNTIL you hear your first nasty cat call and then another until the words do not hurt you any more
UNTIL you can not bend down
UNTIL you can not tend to your foot health
UNTIL you lose your sex drive
UNTIL you hate yourself

UNTIL YOU ARE DEAD~


DO NOT DO IT FOR HIM
DO NOT DO IT FOR HER
DO NOT DO IT FOR GOD
DO IT FOR YOU!

Thursday, March 17, 2011

YAY FOR THURSDAY

It has been a good week so far..
Finally Spoke with the doctor .. have a foot plan now.. I am getting the orthotics remade with more of a boost and support for the issues I am having.. because this issue is progressive.. I  can no longer do  exercise with any type of impact.. in order to build strength in the tendons and create a more balanced environment for my bones in my foot.. swimming is now my new best friend..  On monday I was in the therapy pool doing the exercises I was given.. water jogging.. marching.. side steps, kicks and knee lifts.. will be adding resistance weights soon and using a jog belt in the full pool..  It was an epic fail on Monday though.. thought using a robe would help me with the long walk from the pool area to the locker room.. the robe gathered all the water from my bathing suit and clung it to my legs.. by the time I made it to the locker room I was shivering.. today I treated myself to a new bathing suit and 2 new big bath sheets.. (towels) .. this way .. I will use one bath sheet which will absorb the water after I swim.. and then one after I shower.. keeping the shivers at a minimum YAY!

CRAZY BUSY IN MY WORLD

Been super busy in my world.  Getting ready for 2 food shows.. taking care of Honi..  getting appointments set up for my new orthotics, getting appointments set up for hypnotherapy for pain management and weight loss.. yeah you might think it cheesy but .. sometimes you have to be open to new things.. and I am always open to new things that are natural and self imposed..  so we shall see......
Hope everyone is having a great week!

Tuesday, March 15, 2011

GET YOUR CRUNCH ON ( why YES ! Virginia there are healthier options out there for a snack attack )

 FOR YOUR CHEEZY NEEDS.

Pepperidge Farm Baked Naturals
Simply Cheddar Cracker Chips




27-piece= 130 calories,
3.5g fat,
250mg sodium, 
24g carbs,
2g fiber,
4g sugars, 
2g protein
  GET YOUR CRUNCH ON :

FLAMOUS BRAND FALAFEL CHIPS 
In Spicy and Original
, a 1-oz. serving (about 10 - 11 chips)
118 calories,
6g fat, 
79 - 80mg sodium,
6 - 17g carbs, 
4g fiber, 
0 - 1g sugars, 
4g protein



 MORE CRUNCH FOR YOUR MUNCH

  1-oz. serving (about 7 - 17 pretzels, depending on the variety)
has 110 - 120 calories,
2 - 2.5g fat, 
290 - 390mg sodium,
20 - 22g carbs, 
<1 - 2g fiber,
<1 - 4g sugars, 
and 2 - 3g protein


My Favorite  New Kid on the block :
I love the Trop50s .. sweetened with Stevia.. and just the best We love the Apple Juice, Pomegranete Blueberry Juice and look forward to Raspberry Lemonade and Lemonade.. yum...  not a huge Pepsi, V8 or Ocean Spray Fan..

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Monday, March 14, 2011

MORE SNACK ATTACK

Per enchilada:
140 calories
3 g fat
9 g protein
3 g fiber

Per bar:
110 calories
3 g fat
9 g sugars
2 g protein
3 g fiber

 
Per bar:
150 calories
4.5 g fat
10 g sugars
3 g protein
9 g fiber




Per pocket:
220 calories
6 g fat
10 g protein
4 g fiber

Per 5 pieces:
110 calories
4 g fat
3 g protein
2 g fiber


Per 13 crackers:
120 calories
4.5 g fat
22 g carbohydrates
5 g fiber

Per package:
90 calories
8 g fat
5 g carbohydrates
1 g protein
1 g fiber


This comes with a dipping Ranch Dressing 

Enjoy...