Magnesium and Gout - Posterior Tibial Tendon Dysfunction (PTTD)Posterior tibial tendon dysfunction (PTTD), also referred to as posterior tibial tendonitis, is one of the leading causes of acquired flatfoot in adults. The onset of PTTD may be slow and progressive or sudden. An abrupt beginning is usually linked to some form of trauma, whether it be simple (stepping down off a curb or ladder) or severe (falling from a height or car accident). PTTD is rarely seen in children and increases in frequency with age.
There have been many proposed explanations for PTTD through the years because this condition was first described by Kulkowski in The most modern day 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 actual outer lining of the tendon. Really small blood vessels also permeate the tendon sheath to arrive at tendons. This makes all tendon notoriously slow to be able to heal. In the case of the posterior tibial muscle, this problem is exacerbated by a distinct part of weak blood flow hypovascularity). This area is located in search of healers for joint pain tendon just below or distal to the inside ankle bone (medial malleolus).
Additional References Include;Cantanzariti, A.R., Lee, M.S., Mendicino, R.W. Posterior Calcaneal Displacement Osteotomy with regard to Adult Acquired Flatfoot. J. of Foot and Ankle Surgery. 39-1: 2-14, 2000 As the information we produce in our writing forum about gout be utilized by the reader for informative purposes, it is very important that the information we provide be true. We have indeed maintained this.
Stage III patients require stabilization of the rearfoot with procedures that fuse the primary joints of the arch and base. These procedures are salvage procedures and require prolonged casting and disability following surgery. A common procedure for Stage III is called triple arthrodesis which is a technique used to fuse the actual subtalar combined, the talo-navicular joint as well as the calcaneal cuboid joint. Isn't it amazing how much information can be transferred through a single page? So much stands to gain, and to lose about Gout through a single page.
Stage II patients, or Stage I patients that do not respond to rest and help, require surgical correction in order to stabilize the subtalar joint prior to further damage to the posterior tibial tendon. Subtalar arthroeresis is a procedure used to stabilize the subtalar joint. 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 I or II wherever mild to be able to moderate deformation of the arch has occurred and MRI findings show the muscle to be only partially ruptured. Subtalar arthroeresis is typically performed in conjunction with an Achilles tendon lengthening procedure to fix equinus. These methods require casting for a period of weeks following the procedure.
Biomechanics: The function of the posterior tibial tendon is to plantarflex the foot on the toe away from phase of the gait cycle and to support the medial arch.
Stage II Symptoms are Seen With More RegularityPain is present at the onset of walking and running. Some limitation of the ability to raise up on the toes will be present. It is rather inviting to go on writing on Gout. however as there is a limitation to the number of words to be written, we have confined ourselves to this. However, do enjoy yourself reading it.
Myerson, M.S. Adult bought flatfoot deformity. J. Bone and Joint Surgery. 78-A;780, 1996 Johnson, K.A., Tibialis posterior tendons rupture. Clin. Orthop. 177:140-147, 1983
Treatment Posterior Tibial Tendon Dysfunction (PTTD) - Richie Brace
- Myerson, M.S., Corrigan, J.
- Treatment of posterior tibial tendons disorder with flexor digitorum longus muscle transfer and calcaneal osteotomy.
- Orthopedics 19:383-388, 1996