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    Posterior Tibial Tendon Dysfunction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Posterior Tibial Tendon Dysfunction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Posterior Tibial Tendon Dysfunction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Ebook101 pages58 minutes

    Posterior Tibial Tendon Dysfunction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

    By Kenneth Kee

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    About this ebook

    Posterior tibial tendon dysfunction (PTTD) is a medical disorder that results in inflammation or tearing of the posterior tibial tendon.
    The posterior tibial tendon attaches one of the calf muscles to the bones located on the inner foot.
    Consequently, PTTD causes flatfoot because the tendon is not able to support the arch of the foot.
    Flatfoot is when the arch of the foot is fallen and the foot points outwards.
    PTTD is also called adult acquired flatfoot as opposed to congenital flat foot.
    Doctors can normally treat this disorder without surgery, but sometimes surgery is essential to mend the tendon.
    Incidence
    Posterior tibial tendon dysfunction (PTTD) is more frequent in women.
    It often manifests in the sixth decade.
    Mechanism:
    The exact cause of PTTD is not known.
    It is an acute injury (e.g., ankle fractures caused by pronation and external rotation vs. long-standing tendon degeneration)
    1. Early disease
    Early tenosynovitis continues to PTTD
    It results in loss of medial longitudinal arch dynamic stabilization
    2. Late disease
    PTTD supplies attritional failure of static hind-foot stabilizers and collapse of the medial longitudinal arch
    1. Spring ligament complex (e.g., superomedial calcaneonavicular ligament)
    2. Plantar fascia
    3. Plantar ligaments
    Fixed degenerative joint changes happen at late stages
    1. Foot deformity
    2. Pes planus
    3. Hind foot valgus
    4. Forefoot varus
    5. Forefoot abduction
    Risk factors are:
    1. Obesity
    2. Hypertension
    3. Diabetes
    4. Increased age
    5. Corticosteroid use
    6. Seronegative inflammatory disorders
    Frequent activities that induce an overuse injury are:
    1. Walking
    2. Running
    3. Hiking
    4. Climbing stairs
    5. High-impact sports
    PTTD tends more to happen in:
    1. Females
    2. People over the age of 40
    3. People who are overweight or obese
    4. Diabetics
    5. People with hypertension
    Symptoms of PTTD are:
    1. Pain, normally around the inside of the foot and ankle
    2. Swelling, warmth, and redness along the inside of the foot and ankle
    3. Pain that worsens during activity
    4. Flattening of the foot
    5. Inward rolling of the ankle
    6. Turning out of the toes and foot
    Physical examination is by inspection and palpation of the foot
    1. Pes planus or flat foot is evident
    2. Collapse of the medial longitudinal arch is present
    3. Hind foot valgus deformity is seen
    4. Forefoot abduction is seen in Stage IIB disease
    5. The "Too many toes" sign is present
    6. >40% talonavicular uncoverage
    7. Forefoot varus
    The doctor may look for swelling along the posterior tibial tendon.
    The doctor will also assess the range of motion by moving the foot side to side and up and down.
    PTTD can provide problems with side-to-side range of motion, and issues with moving the toes toward the shinbone.
    The doctor will also observe the shape of the foot.
    They will examine for a collapsed arch and a heel that has shifted outward.
    The doctor may also assess how many toes they can see from behind the heel when the patient is standing.
    Normally, only the fifth toe and half of the fourth toe are seen from this angle.
    MRI and ultrasound scans can verify PTTD
    Most cases of PTTD are treatable without surgery.
    1. Reducing Swelling and Pain
    Early treatment helps decrease pain and swelling and permits the tendon to heel.
    Applying ice to the sore area and taking non-steroidal anti-inflammatory medications (NSAIDs) can decrease swelling and pain.
    The doctor will also advise the patient to rest and avoid activities
    2. Foot Support
    Dependent on the seriousness of the PTTD, the doctor may indicate some form of support for the foot and ankle.
    Surgery may be required if the PTTD is serious.
    FDL transfer
    Calcaneal osteotomy
    Arthrodesis
    TABLE OF CONTENT
    Chap

    LanguageEnglish
    PublisherKenneth Kee
    Release dateMar 18, 2017
    ISBN9781370984411
    Posterior Tibial Tendon Dysfunction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Author

    Kenneth Kee

    Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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      Book preview

      Posterior Tibial Tendon Dysfunction, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee

      Posterior Tibial

      Tendon Dysfunction,

      A

      Simple

      Guide

      To

      The Condition,

      Diagnosis,

      Treatment

      And

      Related Conditions

      By

      Dr Kenneth Kee

      M.B.,B.S. (Singapore)

      Ph.D (Healthcare Administration)

      Copyright Kenneth Kee 2016 Smashwords Edition

      Published by Kenneth Kee at Smashwords.com

      Dedication

      This book is dedicated

      To my wife Dorothy

      And my children

      Carolyn, Grace

      And Kelvin

      This book describes the Posterior Tibial Tendon

      Dysfunction, Diagnosis and Treatment and Related Diseases which are seen in some of my patients in my Family Clinic.

      (What You Need to Treat Posterior Tibial Tendon

      Dysfunction)

      This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

      If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

      Thank you for respecting the hard work of this author.

      Introduction

      I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Condition) for the benefit of my patients since 2007.

      My purpose in writing these simple guides was for the health education of my patients.

      Health Education was also my dissertation for my Ph.D (Healthcare Administration).

      I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

      This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Conditions into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

      From which many free articles from the blog was taken and put together into 800 amazon kindle books and 200 into Smashwords.com eBooks.

      Some people have complained that the simple guides are too simple.

      For their information they are made simple in order to educate the patients.

      The later books go into more details of medical conditions.

      The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

      Since 2013, I have tried to improve my spelling and writing.

      As I tried to bring you the latest information about a condition or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

      Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

      I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

      I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

      I apologize if these repetitions are irritating to some readers.

      Chapter 1

      Posterior Tibial Tendon Dysfunction

      What Is Posterior Tibial Tendon Dysfunction?

      Posterior tibial tendon dysfunction (PTTD) is a medical disorder that results in inflammation or tearing of the posterior tibial tendon.

      The posterior tibial tendon attaches one of the calf muscles to the bones located on the inner foot.

      Consequently, PTTD causes flatfoot because the tendon is not able to support the arch of the foot.

      Flatfoot is when the arch of the foot is fallen and the foot points outwards.

      PTTD is also called adult acquired flatfoot as opposed to congenital flat foot.

      Doctors can normally treat this disorder without surgery, but sometimes surgery is essential to mend the tendon.

      Incidence

      Posterior tibial tendon dysfunction (PTTD) is more frequent in women.

      It often manifests in the sixth decade.

      What Are the Causes and Risk Factors of PTTD?

      Mechanism:

      The exact cause of PTTD is not known.

      It is an acute injury (e.g., ankle fractures caused by pronation and external rotation vs. long-standing tendon degeneration)

      Pathoanatomy

      1. Early disease

      Early tenosynovitis continues to PTTD

      It results in loss of medial longitudinal arch dynamic stabilization

      2. Late disease

      PTTD supplies attritional failure of static hind-foot stabilizers and collapse of the medial longitudinal arch

      1. Spring ligament complex (e.g., superomedial calcaneonavicular ligament)

      2. Plantar fascia

      3. Plantar ligaments

      Fixed degenerative joint changes happen at late stages

      1. Foot deformity

      2. Pes planus

      3. Hind foot valgus

      4. Forefoot varus

      5. Forefoot abduction

      Linked conditions are:

      a. Inflammatory arthropathy

      Young males with mild

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