Advice for case with PTTD post HAV surgery

admin · Jun 30, 2011

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I have been asked for some help on this problem:

The patient is a 75yrs female having had a lapidus procedure 3mths go. The surgeon has said it has not gone as planned, she has come to see me as her arch hurts and she feels as if she is in her word rotating collapsing in on the arch.

When I looked at her the surgery has healed well, 1st digit is now shorter than the 2nd , no range of motion at the MPJ at all and a very flat foot which the patient say flatted before the op ( post tib dysfunction acquired adult flat foot ?) the other foot has a hallux valgus and bunion with a good medium arch.

The patient initially went to see the surgeon as she was losing her balance and falling over. He been a surgeon did what surgeons do and operated on her.

I find myself thinking .
1. Did she have post tib dysfunction pre-surgery as she say or is it a result of the surgery, she is convinced pre- surgery.
2. The surgery has taken place and cannot be reversed , so what can help?
3. Accommodative orthotic with deep heel cup, medial and lateral flange. Rt foot
4. Left as needed.
At this point a full bio has not been performed that is next week I am just having some quite time and reflecting, and trying to think of the best treatment for the patient, any help would be greatly appreciated to provide best care possible.
Click to expand...

Your input will be much appreciated.

Robertisaacs · Jun 30, 2011

First thing which jumps out at me is

When I looked at her the surgery has healed well, 1st digit is now shorter than the 2nd , no range of motion at the MPJ at all and a very flat foot which the patient say flatted before the op ( post tib dysfunction acquired adult flat foot ?) the other foot has a hallux valgus and bunion with a good medium arch.
Click to expand...

They'll see a foot as flat only in static. They cannot see the windlass. If there is no ROM at the 1st MPJ the may have been some supination moment from windlass which they've now lost and the PT may be taking up the slack.

hunninblue · Jun 30, 2011

Thank you for you response, could you give me any advice on treatment options for this patient please? it would be greatfully received

RobinP · Jul 1, 2011

Loss of balance. Aquired flat foot pre op. Questionable neurology?

Admin2 · Jul 1, 2011

Related threads:
Other threads tagged with posterior tibial tendon dysfunction or PTTD

Trevor Prior · Jul 1, 2011

hunninblue said: ↑

Thank you for you response, could you give me any advice on treatment options for this patient please? it would be greatfully received
Click to expand...

Are you able to provide pre and post op x-rays - AP and lateral weightbearing?

There are a number of factors with a Lapidus that could cause a problem - for instance a short / dorsiflexed metatarsal.

The biomechanical evaluation will help but this is a case where x-rays are a must.

Also, 3 months post op is early days for a Lapidus, especially in a 75 year old patient.

Trevor Prior

efuller · Jul 1, 2011

The patient is a 75yrs female having had a lapidus procedure 3mths go. The surgeon has said it has not gone as planned, she has come to see me as her arch hurts and she feels as if she is in her word rotating collapsing in on the arch.
Click to expand...

What does collapsing on the arch mean? It hurts to bear weight? Knowing what the problem is really helps.
What anatomical structure of the Arch? Fascia? Bony? Muscle?

When I looked at her the surgery has healed well, 1st digit is now shorter than the 2nd , no range of motion at the MPJ at all and a very flat foot which the patient say flatted before the op ( post tib dysfunction acquired adult flat foot ?) the other foot has a hallux valgus and bunion with a good medium arch.
Click to expand...

Often PT dysfunction patients have a bunion. Certainly plausible.

The patient initially went to see the surgeon as she was losing her balance and falling over. He been a surgeon did what surgeons do and operated on her.
Click to expand...

I wonder if there was any discussion on how the surgery would help the falling over problem?

I find myself thinking .
1. Did she have post tib dysfunction pre-surgery as she say or is it a result of the surgery, she is convinced pre- surgery.
2. The surgery has taken place and cannot be reversed , so what can help?
3. Accommodative orthotic with deep heel cup, medial and lateral flange. Rt foot
4. Left as needed.
At this point a full bio has not been performed that is next week I am just having some quite time and reflecting, and trying to think of the best treatment for the patient, any help would be greatly appreciated to provide best care possible.
Click to expand...

If there is a PT dysfunction a varus heel wedge should be helpful. Position of the STJ axis?
More info needed.

Advice for case with PTTD post HAV surgery

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Advice for case with PTTD post HAV surgery

admin Administrator Staff Member

Robertisaacs MVP

hunninblue Welcome New Poster

RobinP Well-Known Member

Admin2 Administrator Staff Member

Trevor Prior Active Member

efuller MVP

Case Study advice - What has gone wrong?

We need your advice! Clinical case

Advice for case with plantarflexed 5th ray/met

Advice for case of Grave's Dermopathy

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