I was diagnosed as having stage 2 Posterior Tibial Tendon Dysfunction (PTTD) in March 2018 by an Orthopedic Surgeon specializing in ankle and foot disorders. I was put in an ankle brace, which did help a lot, and told that I would wear the brace until problems with my foot progressed to stage 3. My doctor said that once the problem was at stage 3, he would do surgery and fuse several bones in my foot and ankle which would render my ankle basically unable to flex at all from side to side, and only allow flexing in a foot front/rear up and down, walking motion. When I asked why not do surgery now, this doctor told me that he could, but there was nothing to gain, and that the surgery would result in roughly the same level of mobility and discomfort (pain after walking much distance) that I had with the brace on. He told me that the brace might keep me at stage 2 for a year or two, or possibly up to 5 years, and that he recommended waiting to have that surgery so that it would make all that pain and extended non-walking recovery period (3 months non-weight baring) feel like it had a benefit since I would go from stage 3 back to the function of stage 2. Well, that was just depressing. So, I decided to seek a second opinion. I did a lot of research and I found Dr. George Liu. I made an appointment with Dr. Liu, took him all of my prior x-rays and MRI’s, and told him what my current doctor had done for me and about the treatment plan (wear a brace, delayed surgery). Dr Liu asked me if I understood what stage 3 of this disease really was? I said “no, not really”. And then he explained that Stage 3 was when the disease progressed to the point that resulting arthritis in the ankle made it very painful to walk, and that stage 4 (the final stage) is when the arthritis progressed to the point that the ankle was locked up and largely immobile. He told me that what my current doctor had planned was a very conservative and traditional treatment method and asked why I had come to see him. I told Dr. Liu my experience with waiting on things to get worse before taking action just seemed like a bad idea, and that I hoped to be able to find a doctor that could help me gain full mobility again. Dr. Liu agreed with my thoughts and told me he thought he could help. He kept my x-rays and MRI’s and asked me to give him some time to look at them and to come back in 2 weeks. 2 weeks later, he had a surgery plan. Here’s what he did, and my experience: Dr. Liu harvested some tendons from my 4 smaller toes and grafted onto the damaged posterior tibial tendon (holds up the ankle), then he relocated the connection from of that tendon from the toe side of the foot arch to behind the arch. Because this would have left me with no arch, he cut the bone on the toe side of the arch (the 1st metatarsal), and inserted a wedge shaped bone graft from the top, which gave me the needed arch in my foot (normally this is one of the functions of the posterior tibial tendon). And to hold that bone graft in place he put in a metal plate and screws on told of the bone. Then he cut off the ball of my heel bone and moved it slightly over towards the inside of my foot and put 2 screws though it to hold it there while it healed in that new position. This moved the center of gravity to take some of my weight off the inside of the foot and relieve some of the weight load from the tendon and transfer that to the outside of the foot. The surgery lasted about 4 hours. I did a lot of research on recovery from these kinds of surgeries, and saw several people that commented that the recovery took almost a year, and I thought to myself “no way it will take me that long to recover, I heal fast and have a high pain tolerance; they must just be weenies… Well, let me tell you…. nope. It took almost a year before I was pretty good. I was completely non-weight bearing from 10 weeks, then walked with a cane for about 3 months. In that time on the cane I made a bad mistake, I started walking with my foot turned out so that the arch did not need to flex (which caused some discomfort when it flexed). Bad mistake. That messed up my knee and I started having a lot of knee pain (knees are not designed to bend that way). Don’t walk with your foot turned out, bad idea! Just work thru the foot discomfort as it’s healing! All that said, it’s now been a year and a half, and I have what I wanted, complete full mobility and no pain at all. So, you might ask, in hindsight and now knowing what I know now, do I think I made the right decision, and would I do it again? And to that I honestly say, ABSOLUTLEY on both questions. I am also convinced that Dr. Liu has to be one of the absolute best doctors in the entire world at repairing PTTD. Absolutely fantastic results. He has my complete confidence, and if I ever have any foot or ankle issues again, it doesn’t matter where I live then, I will absolutely come back to Dr. Liu.