Posterior Tibial Tendon Insufficiency

Posterior Tibial Tendon Insufficiency
The Warrantee Runs out at 40


In May 1996 I "sprained my ankle" while walking on a flat sidewalk. I did not twist my ankle, or step on a rock: it was a flat surface. When the pain didn't go away, I went to my doctor a week later. He diagnosed a sprained ankle, and we treated it as such for the following months.

The pain went away, but the foot started to deform. In April 1997 I was diagnosed with posterior tibial tendon (PTT) insufficiency. Dr. Jonathan Deland at the Hospital for Special Surgery operated on the foot on 2 June 1997, and I have been recovering since.

The treatment for this left me with a lot of time to write it up on these web pages. Since then, many have found my pages useful. You can find various details below.

The bottom line: I had the surgery. It wasn't especially fun or convenient, but it was well worth it, and I still don't think there any really useful alternatives. The foot is working fine and life is back to normal.

5 Jan 2004 Update.

I continue to get queries about the status of my foot. It is doing fine: I have no trouble with it, and am very glad that I went through all this. Lately I've taken up Dance Dance Revolution for cardio workout. My feet and ankles are holding out just fine, though I will never be really good at this.

I have started a Yahoo group (a mailing list) for PTTI. See below for details. I continue to welcome correspondence, and will answer as best as I can.

Older updates are available here.

Contents and Resources

  • Notes of my experience with PTT insufficiency. These are quite lengthy: I had a lot of time on my hands. I have put them up to give others with this rare condition some indication of what lies ahead for them.
  • Introduction.
  • PTT Insufficiency.
  • In the Hospital.
  • First week at home.
  • Update - Two weeks post-op.
  • Update - Eight weeks post-op.
  • Update - Twelve weeks post-op.
  • Update - Fourteen weeks post-op.
  • Four months post-op.
  • Checkup at 4.5 months post-op.
  • 155 days post-op: the cast is off.
  • almost six months post-op.
  • February: eight months post-op.
  • Fourteen Months, and All is Well.
  • PTTI mailing list. I have started a Yahoo group at on the subject:
    Post message:
    List owner: (me)
  • My doctor, Dr. Jonathan Deland at the Hospital for Special Surgery in New York City.
  • describes the gauntlet, or "Arizona brace," which several people have claimed is more comfortable and more effective than other braces. This might be an alternative for surgery, but I haven't heard any stories yet of people who were cured by any brace.
  • The American Orthopedic Foot and Ankle Society, which has doctor references and sponsors conferences on diseases of the foot and ankle.
  • A description of this disease. I had Stage II, and was treated with an FDL transfer and some other things.
  • Susan Grandy's pages on her experiences, which are much more recent. There is new equipment to help you manage postop, including mobility, that sound very useful.
  • Some common questions and answers.
  • Many of you have written with your stories and some results from your research. Thanks for your help.

    References and Links

  • A highly technical review of recent (c. 2002) papers and results. Notable is a fairly high regard for non-surgical results, and a suggestion that the rate of this problem may be on the order of 1 case in 10,000.
  • A new review article is due out August 1999 in the Journal of Bone and Joint Surgery by Manoli and Pomeroy. My thanks to Arther Manoli, II, MD, for the heads-up. For those of you not accustomed to research papers, a review article covers the state of the art in a field. They have dozens of references for further information. He also reports that the Aug 1999 Clinical Orthopedics and Related Research is a symposium on the subject.
  • Posterior tibial tendon insufficiency. Its Diagnosis, Management, and Treatment by Churchill and Sferra, Department of Orthopedic Surgery, Cleveland Clinic Foundation, American Journal of Orthopedics, May 1998 27(5):339-347.
  • A new operative approach for flatfoot secondary to posterior tibial tendon insufficiency: a preliminary report. Pomeroy and Manoli, Portland Orthopedic Foot and Ankle Center, Maine, Foot Ankle Int 1997 Apr; 18(4):206-212.
  • Nonoperative management of posterior tibial tendon dysfunction. Lynn, Foot Ankle Int 1997, Jul; 18(7):457-458.
  • Back to my home page.