This blog was written during my recovery from surgery to correct Posterior Tibial Tendon Dysfunction, there seemed to be very little information regarding the recovery of this and so I have decided to chart the recovery. (especially as I had all that time on my hands with no opportunity to get up and do anything else)!
Although I had always suffered from flat feet, I had not suffered many symptoms but as I got older it became painful to walk distances and finally on the May Bank Holiday Weekend after a two mile walk to town I found my right ankle was swollen and bruised and was too painful to bear any weight. I applied ice, elevated and rested but no improvement and went to physiotherapist for what I thought was a sprained ankle. He advised then that he thought it was tendon dysfunction and also pointed out that my arch (always only a slight one) was now completely gone in the right foot and my ankle was turned in. I went to see a podiatrist to see if I could get orthotic inserts to help and initially these did help the pain a little but this was short lived and I went back to the physiotherapist who then referred me to a consultant who specialised in ankle reconstruction.
The consultant initially looked and agreed with the physiotherapist and referred me for x-rays and MRI which showed a thickened posterior tibial tendon,and a torn spring tendon. Following this, he advised that it was unlikely to improve without surgery and as my mobility was now limited to less than 50 meters, I agreed to undergo the surgery.
I had a month to prepare and so I went on line to look up mobility aids that I would need and found a wonderful device - stride-on scooter - this is a knee scooter and meant that I did not have to rely on my crutches only for mobility and as I am 53yrs with poor upper body strength and recent carpal tunnel surgery to both hands, this was a godsend! I also got a bath board which meant I could shower while sitting or intially kneeling on the board and finally a rubber cast protector which meant the cast would remain dry while I showered.

Day One
I was admitted as an afternoon case and the surgeon came to draw a big arrow on my right foot (reassuring I guess that he knew which one to do!) The anaesthetist came around and explained that I would also undergo a nerve block and this would help the pain control following surgery, he said it would last around 72 hours and I would be kept in hospital for the three days. He spent some time explaining that the best pain relief once I was home would be elevation and it was best to expect to spend the next four weeks with the leg elevated above the heart for most of the day as this would make a big difference to recovery.
He also explained about the Clexane injections (blood thinners) and the compression stocking for the "good leg" which were important as I was likely to be less mobile than usual and this would help prevent any blood clots.
I was wheeled back to the ward three hours later with a device that allowed me to deliver pain relief into the intravenous line however I found that the post operative pain was really low which was likely due to the nerve block. My right leg was elevated and was in a back slab of plaster with a dressing and bandage and it really looked good. I found it a bit tricky moving around and getting up to go to the toilet but overall it was manageable and it was certainly better to have stayed that little time in hospital as the anti-inflammatories were given regularly intravenously and they cared for all my needs for the first couple of days which meant I had a good rest.

Day two
The surgeon came round to see me and explain that he had re-enforced the posterior tibial ligament, replaced the spring ligament and cut the heel and moved it one centimeter to the left and inserted two screws into the heel and he was pleased with how things had turned out.
He removed the dressing and the plaster technician put on a lovely blue plaster cast which was below the knee and gave some advice regarding elevation.

Day three
Husband came to collect me and brought my trusty stride-on scooter which meant I could get up and move around easily on my own steam to the car and lifted it on the dashboard (all that talk of elevating it made it seem important) once home, I found a chair all set up for me with a shaped memory foam cushion to elevate my leg nicely placed in the lounge with the remote controls nearby and close enough to the kitchen to request hot drinks which was lovely but meant that I had to get up frequently and dash off to the loo! I found that a combination of crutches to stand and scooter to move worked perfectly and luckily I live in a bungalow which meant that I could get everywhere in the house. Although initially I was tired and did also spend part of the day in bed for the first week, it meant that I felt much more normal and included in the family life.
I also found from reading other blogs that it was important to keep on top of the pain and although the pain was not severe, the regular paracetamol was very helpful in making sure everything stayed painfree.
Initially sleeping was difficult and I found that I could sleep on my side provided I used the conform cushion and keeping the leg elevated was definitely the way to ensure that pain was kept low. As soon as the foot was put down, the pain made itself known and as soon as I raised it up again, everything settled down so I kept it elevated.
Injecting the blood thinners was a bit of a chore as was the compression stocking but ultimately worth it I guess :-)

Week two
Back to see the consultant and have the clips taken out. The nurse removed the plaster and the wounds were quite impressive! one long cut along the inside of the foot and a slightly shorter one on the outside with a large blood blister on the back of the heel. The nurse said that it might sting a little taking the clips out - biggest understatement EVER!!!!! It was so painful!! and there were loads of them! I took two paracetamol right after she finished (I had them in my handbag in case it hurt) WOW unbelievable but that was more painful than the surgery! The consultant came in after they were removed and we all admired the wounds which all things considered, were doing great. Only two weeks and the scars looked good, there was some bruising along the calf but obviously old as it was already green and yellow. The consultant then put another plaster on (not as well as the technician it must be said) and that was it for another four weeks. Still non weight bearing but hopefully in four weeks if x-ray looks good then a walking boot and weight bearing to start.

Week four
All going well, still elevating and scooting around but able to get about much easier now, also able to prepare meals and do laundry (thank goodness for the scooter)! Much easier to shower now as well, I use a chair to the side of the bath and step with good leg into bath and kneel on bench and shower and then reverse back onto chair and dry off - takes around an hour and I need a sit down when I finish with washing and dressing but still much easier and everyday seems to get better and better. No pain now and I can drop leg down for brief periods without feeling pain. I am still off work as I can still only manage short distances and brief periods of activity and have not yet left the house (thank goodness for online shopping) Also keeping leg elevated for most of day.

Week Six
Return to hospital for X-ray and then on to consultant for removal of plaster and check of wound and healing. Nurse removed plaster and dressings and wounds look great, slightly scabby with large scab on heel due to blood blister but bruise along calf much smaller and faded and apart from very dry scaly skin, leg looks great. Consultant came in and said all looking good, bone healing very well. He checked range of movement and all good there. Nurse showed me how to put walking boot on and I stood upright on my own for the first time in six weeks. It felt great! slightly painful and tender underfoot and heel burning but using crutches I can actually walk which is great. Physiotherapist showed me how to walk and adjusted crutches to correct height, (hands need to rest around hip height to prevent "hunching").
Consultant said he would see me again early December after xray and if all going well then it will be likely that I can get rid of boot! He also said that I would then start intensive physiotherapy and would be able to cycle and run (looking forward to that as I couldn't do it before surgery so this could be life changing)! :-)
Appointment made to see physiotherapist for gentle physio and instruction on walking next week. I am pleased about that as yesterday my "good leg" suddenly had knee pain and is very swollen, I think I twisted it getting up. Anyway scooter goes back today and now I have to manage all on my own with only crutches and walking boot.
Dry skin - as gross as this sounds, this is a real issue now, I have looked on other sites and see that it is an issue generally and the advice given is to soak the leg twice a day, gentle rubbing with soap and then gentle drying off with towel and frequent application of moisturising cream. This has made a huge difference and has helped the scabs fall off by themselves quickly.

Week 7
Appointment with physiotherapist today - I have strained the patellar tendon in the "good leg" so need to ice frequently and elevate as much as possible. Also shown how to walk properly in the boot. Silly as this sounds, it has made a huge difference to my walking, I can now walk almost comfortably although heel is very painful at times. After physiotherapy I walked across the road to coffee shop and sat down and had a coffee and slice of cake all on my own for the first time in 7 weeks - heaven!
Very tired now and needed to rest all of afternoon and next day but now walking a bit more and definitely easier moving around the house. I seem to see and feel improvement every day and it is so much easier to sleep at night now without the compression stocking and cast.

Week 8
Return visit to physiotherapist and now walking much better and even at times without the crutches especially in the house, I can get up and around little distance without them and have been out on my own quite a bit this week using taxi's and using the free motorised wheelchairs at the shopping centre.
Physio happier with "good leg" and very happy with right foot, I had complained about a bit of tightness in the heel where the blood blister had been and he said that it was due to scar tissue and gave it some manipulation which has freed it up and he has shown me how to do this, it means that now I can flex the foot upward with no pain. Still using ice on "good leg" but generally improving all round in mobility in both feet. I am very pleased with progress and can manage most things on my own albeit slowly at times. Boot still very comfortable although a bit tricky to put on and if you are in a hurry, then it really slows you down. Three large velcro straps also means that you can't quietly get up and out of bed without waking anyone else - whoever makes quiet velcro will make a fortune!!
So now just waiting to get better, increasing walking every day and looking forward to next x-ray and hopefully will get out of boot and possibly be able to get back in the car!! Next blog will be in two weeks after physiotherapy appointment. Planning to get back to work next week as well, will have to be working from home initially until I can drive and mobilise better but really pleased to be getting back to "normal"

Week 9
Starting to walk a little more and I am finding that every day definitely gets easier. I am still using the crutches when outside the house and inside when I sit down or get up to ensure that I am not straining the "good leg". I also feel a lot better with more energy and that may be due to sleeping a lot better at night as the foot doesn't seem to hurt at night like it has been doing until now. I am also going out a little more socially so the foot gets tired and aches a little at the end of the day but a short period of elevation sorts that out, there is not much swelling at the end of the day which may be due to wearing boot and only doing short periods of standing. I am very lucky that I have not yet been back to work but this Friday, went back for the team meeting which was really good, I didn't realise how much I missed the company of the colleagues. I was only there for a couple of hours but was wiped out when I got back and my foot was a bit sore. That should all improve though and I am now starting to challenge it a bit more, getting up and moving around a lot more and doing a few household chores as well as sorting out the meals in the evening. I aim to get back to work shortly and will be doing this based from home until the boot comes off and I can drive as I need to drive for most of the work that I do so until I can drive, it means I will be stuck doing the audits and other home based work but hopefully this will only be for a short time, it will be good to help ease back in as well so probably all a good thing really.
Still doing all the gentle movements that physio suggested and it definitely is getting easier to move all directions now and I can even place some pressure on the foot with no pain which is really good, when I stand I can also see a small arch (first time ever) which is very exciting.

Week 10
Return visit to physiotherapist, mainly for "good leg" which is improving although still swollen and some difficulty moving the "good leg" at times. He said that it should settle after 6 weeks and has now given it some gentle manipulation and given me some exercises to do with it. Also checked how foot was doing, and was very impressed with range of movement and general recovery, I can stand without the boot and walk a couple of steps on the foot with no difficulty which is great, he gave a few exercises to do to help strengthen the foot for when the boot comes off and said that the crutches will probably be helpful again when the boot comes off (I have been walking around without them for over a week now). The evenup attached to my other shoe means that both legs are the same height so that I can walk comfortably without a limp and he said that this was good, although I am still not able to "push off" with the foot yet, but the boot is designed with a "rocker" motion which will help the foot walk in a normal gait and make it easier to learn to walk again once the boot comes off. I asked about pain when standing and he said that it is likely due to the muscles all being used in a different position due to the correction of the heel and said that it would likely be painful for around a year post op although should improve gradually with time.
So no more physiotherapy until next consultant visit on 2nd December and then x-rays will be taken and if good, the boot will come off and then real physiotherapy will start.
Overall I am really happy with progress myself, there is almost no swelling and I do not elevate the foot during the day but just get on with my day and later in the evening while watching television I elevate it above heart height and apply ice and this seems to be effective. The scars are just faint red lines on the foot and the numbness around the scar area is smaller now, some numbness persists but this gets smaller and smaller each week.  So now I wait and recover, hopefully progress will be maintained.
Week 12
Not much new to write about just continuing to walk around in the boot although it is much easier now and I am not using the crutches in the house. Swelling seems to be less as well at the end of the day which is good. I find that I can now stand in the shower and have got rid of the shower bench and best of all I have managed to get in the bath at last (and out) all on my own. I have also managed to drive a short distance to the shops and do some shopping and home again which is wonderful. Three weeks to go until the appointment with consultant for x-rays and boot removal and then I probably will go back to using the crutches again as I find whenever I make progress, it seems to set me back a couple of steps but then the physio said that the real recovery work will start so I should see progress from there.