I am having a horrible time with Post-tib tendonitis. The sx started in January, and by March I couldn't walk and was put in a cam-walker and on crutches. My MRI in March didn't show any abnormalities in the tendon, but by April, the pain and swelling was all over the arch of my foot and up around my inner ankle and into my calf. I was put in a hard cast for 3 weeks, then a boot. I was just taken off crutches a few days ago! :bouncing:

I am now in an aircast, plus orthodics. I am using a cane.

Now, the swelling is down, but I still have pain.

How long does this last? Is this absolute hell or what? Is it normal for tendonitis to last this long and be this painful? :confused:

I am in PT now, but I can't walk without pain.

I can't believe that flat feet plus massive pronation can cause something this horrible. I over-exercised all through my teens and twenties, but laid off for the last couple of years (I'm in my early 30's now) because of my work schedule. However, I was in a job that required me to stand on my feet, so maybe that tipped the scales. (I was unable to keep working when it got so severe).

I was worked up by a rheumatologist and neurologist, but thankfully, I was fine. I just can't believe this can be so bad. It sort of freaks me out that the MRI showed nothing but "bone marrow edema" or trauma to bones but no tendon abnormalities and yet tendinitis is my diagnosis. At the same time, I guess it has improved because the swelling *is* down, even though it still hurts to walk on it.

I guess I'm posting for reassurance. Part of me is still scared... I've never had anything like this before!

Thanks,
Scarlett

Scarlett,

I know exactly how you're feeling. I used to be very active and the last 5 years have been discouraging as I have been battling Post-Tib tendonitis(now chronic), due to flat feet (which really isn't that flat, but I pronate...). I have the same symptoms: pain along tendon in arch and up through the inner part of the ankle and into the calf(cramping) everyday. Not great for my teaching career, but we all find a way to make it through and tough it out.

I'm in my mid-thirties and frustrated that all this is slowing me down now. I have had 2 podiatrists go the less invasive route (not going with the post tib tendon transfer + calcaneal osteotomy to fix the arch/pronation) and I have had a gastroc release and tarsal tunnel release (surgeries) that did nothing but provide me with residual surgery pain.

My doctor wanted me to get some blood work (rheumetoid, etc...) and I know that this will come up negative like yours did. Also, my MRI's and X-rays have shown some edema but nothing else substantial.

After going through all this hassle(5 yrs) I am positive now that I have severe posterior tendonitis (causing adult acquired flexible flat feet) and most likely need a CALCANEAL OSTEOTOMY to create more of an arch (and fix my pronating), as well as a POST-TIB TENDON TRANSFER to alleviate the pain I have along the tendon.

Keep me updated with your condition (I will too). I believe we have the same thing going on and filling each other in with what we have been told by the doctors (and what we may do) will be helpful.

Good Luck :)

Kyle

My husband woke up one day with and aching ankle. He couldn't put any weight on it. He went to a primary who sent him to an ankle specialists. They told him that as people as their foot flattens out. I am not sure that I agree with this. They did X-rays and an MRI and then put him in a small brace and told him that it had to live with it. They did'nt mention rebuilding his arch. The brace is not helping one bit. His foot hurts, his ankle hurts and he can barely walk. They told him that he has tendonitis. Any time any one uses a word with itis on it I think that they just don't know what they are talking about.

Any time frame given for the tendontitis to subside?

Hi ,

I also have posterior tibial tendon dysfunction , was told that late last year. The history on this is that I have always pronated and had orthodics that I was fitted for in the late 80s due to what was diagnosed as "tendinitis" of the left ankle at that time. I wore them faithfully for several years and really should have kept it up and got a new pair but did not and I believe I am paying for that now. I say that as my ankle was stronger then. I had repeated ankle turns to that ankle prior to that and that caused some of the problem I am sure. and then since that time i have had that ankle turn also so it is a case of repeated injuries for me.

Then last year my back went out and that was a first for me. I think due to that I was walking differently , while recuperating. And in Sept. I found that my left ankle started to hurt. I turned it a couple times in autumn and the doctor suggested a flexible brace to protect it while I did strenghtening exercises. The chiropractor I go to for my back suggested an air brace and I was using that faithfully with my sneaks and also new orthodics that I was fitted for this year. It has got better but not fully and nowhere near where I'd like it to be. We went on a trip to Disneyworld in May and I wore the air brace with sneakers/orthodics most of the time and then at night if I was not doing walking I would wear a sandal with a flexible brace. That is what I still have been doing now that summer is here.

If I do not have the flexible brace on or airbrace, it is certainly not the ankle it once was before all this and I too wonder , will it ever be normal again. I am doing the exercises that they gave me , now more religiously than before and hoping that will help strengthen it.

I can fully relate to being anxious about it and wanting this to subside. They told me it could take a year for the ankle (or more) for it to be stronger.

Thanks for listening and also for making me realize I am not the only one with this thing!!
rmc

I would like to know how can you stengthen your ankle if you are always wearing a brace? I had issues with ankle instabilty and surgery to correct it. I was told in PT, the more I wore the brace, the more dependent my ankle would become on it. I now only wear my brace when I am walking on rough terrain. Best wishes to all of you.

Eko,

I guess in re-reading my post I miscommunicated : I am not wearing the brace at this time "all the time". I wore it when I was doing extensive walking on vacation as naturally one would not want to re-injure it as it is still vulnerable. I still use it for extensive walking.The brace helps to stabilize it during those times but is not something I wear 24/7 and in all situations. But I do wear it if I feel my ankle will be vulnerable.

You asked how can one stengthen their ankle if one is always wearing a brace. For me the ankle, although not what it was originally yet, has become stronger with therapy and the exercises. I certainly do not want to reinjure it again and wearing the brace prevents this when I am in situations as I said where my ankle would be vulnerable.

rmc

Hello, all. I have been dealing with this stupid ankle problem for six months, feeling very alone, and decided to poke around the web to see if others shared my delimna. Although I sympathize fully, I was glad to see that I was not alone, after all. I believe I have had flat feet all my life and for the past year or so, my left ankle had been bothering me more than usual. I have also twisted my anke numerous times and probably made things even worse by using too much incline on the treadmill in February. I started getting swelling late in the day in my ankle and finally went to an orthopedist four months ago. Since being diagnosed with posterior tibial tendonitis by the doctor, he has exhausted every means of non-invasive help. I have worn a brace, had orthodics made, gone to PT three times a week, ice every nice, shots of cortisone, an elastic stocking, anti-inflammatory meds. Finally, he put me in a hard cast for three weeks. When it came off, no difference had been made. Now I am awaiting an appointment with an ankle specialist in a few weeks and am terrified that I will end up with surgery. I could use some moral support through all of this, and will do the same for you guys. GEE, I MISS MY HIGH HEELS (but I would settle for walking without pain again). Hang in there! :wave:

It is disheartening to hear that the cast did not help. My husband is two weeks into it now and has four more to go. It is my belief that the cast is not going to work for him either but it is just one of the hoops and hurdles that he has to jump for insurance purposes. We are not sure what the next step is, but we are not going to agree to any surgery.

This is not a work related injury, just age, we are thinking. He was told that feet flatten out in some people and there is basically nothing that can stop it.

I have done a lot of research on the net and can't find any answers to this problem.

:confused:

:wave:
Hello new foot in pain friend! If I didn't know you wrote this ...It could have been ME! Your pain and description is exactly as mine; with the exception I am on my 4th Dr. I am 44 and not ready to be w/support to walk. I am somewhat a busy persona nd not ready to be tied down. Has your "FOOT" became a symbol ALL it's own? The last Dr. I went to put me in a cast for 3 weeks, have been out for 3 weeks an to PT twice a week since; orthodics made and steriod topically for the last 3 appointments, but to no avail. Dr. states surgery, but I am so not ready to have surgery. I have been taking Darvocet daily (which I don't like) as well as Viox - atleast up until Friday and then the big scare came out re: it's use. I am new at this posting but hopefully can figure it out. Feel free to write me @ [ removed ] I would love to find what (if anything) has helped you. Thanks, Good luck - I FEEL YOUR PAIN!!!!

What was your big Vioxx scare? I have been predicting I would need to use this in future years, so far I don't need it. Is it bad for the long term? Also - is Vioxx the same as Celebrex (ie; same scare)? Thanks.

Hi, I'm back again with an update. Finally got to see the holy man himself, the ankle specialist I'd waited six weeks to get an appointment with. He looked at my file, xrays and MRI, looked at my ankle and said, hmmmm. Then he said I was definitely NOT at the stage for surgery, which I was happy about, but in the same breath told me he didn't exactly know why the problem was not getting any better after all I had been through. Actually, while I was waiting all that time to get in to see him, I had stopped wearing the flexible brace, stocking, etc. and the symptoms subsided. I started massaging my ankle gently and it seemed to help. Anyway, the great doctor decided that I needed to be in "a hinged ankle AFO" and sent me off to an orthotics office. They made a cast of my foot and ankle and just a couple of days ago I went back and they put me in this bizzare plastic walking thing with hinges on the side. In other words, I can walk, but it keeps the tendon from moving. Well, wouldn't you know it -- the first night I took it off, my ankle had once again ballooned up and was pounding with pain. I am supposed to wear this for 2 months and go back to the ankle doctor. I am beginning to think these people don't know what the heck they are talking about. If this doesn't start working in about a week, I'm taking it off. It wasn't hurting for about 4 weeks, now it's killing me again and I have to ice it to get the swelling down. I don't think my ankle WANTS to be immobilized. I hate to say that I know more than the doctors, but it is my ankle and I can see how it is reacting. I am so frustrated, I could scream !!! :eek:

I feel your frustration. Just remember to have patience, and don't quit the plastic thing just yet. It is not unheard of to go through several doctors before you find one who can figure you out. You are right - sometimes they DONT know what is going on, and the advice they give is merely a guess.

I was fortunate to have a brilliant podiatrist, he seemed to be able to extract words out of my head as I struggled to even try to describe the feelings and pains I was having. I was afraid it would be akin to taking the car into the shop because it's making a funny noise, but the noise won't appear for the mechanic to observe. Our "pain" can not always be seen, so you hope the doctor has had enough experiences that he recognizes what you are going through. My doctor "got me" right away, so much so that I actually was giddy and excited to have scheduled my surgery. My new gait is far better (not always painfree, but more mechanically correct and improving all the time) than it was before. I hope you find the right doctor as well.

One more comment ANYone with tissue issues: avoid those cortisone treatments if you can. They are SO! SO! bad for you. Just say no.

Hi Scarlet

I've being going through the very same thing.. did the tendon in about 4 years ago.. tried s few types of orthotics to no avail. MRI and cat scan was clear bar edema.. Really frustrated and a bit scared i'll be this way for life!

Now i'm consulting with a surgeon and a very qualified orthist.. I think a lot of orthotics are wrongly proscribed - first of all you need to make sure there is a wedge in it as oposed to just an arch support.. My last orthiotic was prescribed by a podiatrist but it had no heal wedge so my surgeon said it was useless..

However here's the good part.. at one stage i did manage to get it to a manageable level whereby i could to a 3 mile walk on MTB's..

I noticed that when i walked my hips revolved outwards on affected side which caused me to pronate more.. So i got PT to strengthen a thigh muscle which in turn rotated my foot outwards which meant it pronated less..

At the same time i eccentrically strengthened tendon and opposite tendons which is really the only way to help them and this also helped. Also walked in MBT's with took pressure off the arch and very over a couple of months noticed a big improvement.. Then of course i did too much and damaged the tendon again..

I'm now back to stage one PTTD for past 5 months.. however because i managed to get it to a workable level at one stage i hope i can do it again..

I'm really feeling you're pain.. any questions let me know:)

Geoff

Hello everyone,

So sorry to hear of the frustrations you're having... I've been there myself. When I was first diagnosed with PT tendinitis, my dr. gave me a cortisone shot, slapped me in a Cam Walker, but made sure I had a rigid orthotic in it. At that point, he told me it would take AT LEAST 6 MONTHS TO HEAL. I about fainted.

It hurt so bad that by the end of the day I was in tears; my husband thought I'd lost my mind... but that's a whole different story! The point is that until you've gone through it, you cannot imagine how much it hurts!!

After 2 months in the Cam Walker with only a little bit of relief, I was put on 1/2 time work, given another cortisone shot, and sent to physical therapy. The physical therapy plus being on my feet less did help, but only up to a certain point. By this time (4 months into treatment) my dr. sent me for an MRI which showed the tendon had started having not just tendinitis, but also tendinosis.

I was put on full disability in December and sent for another round of physical therapy, but by this point the tendon was really starting to give out quickly and my arch was dropping more and more... since we'd already exhausted all non-surgical methods, in January we started talking surgery (which I had done in March).

So I guess what I've learned though this process is that if you catch your PT tendon dysfunction early enough, you CAN help it to heal if you are willing to let it rest. The ankle really needs time with immobization so that the tendon can heal... the arch also needs aggressive support to help take the pressure off the tendon.

It's a long, painful, and frustrating thing to deal with, but hopefully you'll be able to make it through without having to resort to surgery. While I am glad that I had my surgery done, it is BRUTAL to recuperate from.

Good luck to you,
Deb

P.S. Kyle, I see you're in Folsom - what doc do you go to? I'm also in this area.

Hi Deb,

I've seen quite a few. They all have their specialties in types of surgery. I've had a quite a few since my last post.

Here are the podiatrists I have seen.
Dr. Larsen (Folsom)
Dr. Pinney (Sacto)
Dr. Medawar (Carmichael)
Dr. Basso (Davis)

Who have you seen?

Kyle

Hi Kyle,

Larsen is my doc and I'm really happy with him. You've seen quite a few... any luck? I saw after I posted that your post was from quite a while ago. Have you made any progress since then?

Deb

Dr. Larsen is a really nice guy. He was one of the first ones I saw. I guess it was a matter of identifying some of the foot problems I had personally, then finding the right fit with a podiatrist that can do what I wanted/needed.

I did a lot of preliminary surgeries before delving into a fusion surgery. I started with tarsal tunnel release, then gastroc release, then a MBA implant (which I had removed), then a calcaneal osteotomy-ptt tightening-naviculocuneiform fusion(a joint above the arch that really doesn't effect the range of motion). I wanted to exhaust all these types of surgeries before doing something like a talonavicular fusion(more major than the others which limits the range of motion but takes the ptt pain out of the equation) which is what one doctor suggested to rid myself of the pain I've been having. Looks like he may be right 'cuz the others really didn't work for me. Frustrating though 'cuz of all the recovery time from each surgery.

Doing the research for the right podiatrist with the right procedure for your needs is the key.

Kyle

Kyle, I just noticed that you started with a tibial tendon release, I had my left foot released a year and a half ago, and I was relatively pain free for a couple of months, but now my foot hurts worse than ever. The initial diagnosis before the tarsal tunnel was PTT, but the MRI only showed a small spot of irritation. So the doc went with the tarsal tunnel based on the positive tinel’s sign. Now it looks like the PTT is back with a vengeance. In your case did the release add to the PTT?

Actually the gastroc release was a 'calf tendon release'. Some choose to have the achilles tendon release. Pretty much the same effect: more dorsiflexion (up and down) motion, thus not so tight. It didn't didn't help one way or the other. Just another surgery I had to recoop from. Actually, I cannot do as many calf raises as the other foot. So, it hindered it a bit from being as strong. I just want to rid myself of the pain, not too concerned with losing some strength though.

In may case I believe I let the problem go on too long and it resulted in more problems (ligaments and tendons stretching, bones shifting, etc...). So I've had to endure more surgeries and have a quest to find the right one while avoiding fusing the whole foot/ankle (i.e. triple arthrodesis).

fyi- One doctor told me that tarsal tunnel release works 50% of the time and that it can be a temporary thing, thus impingment on a neve down the line could happen again. Could be in your case?

Kyle



Kyle, I just noticed that you started with a tibial tendon release, I had my left foot released a year and a half ago, and I was relatively pain free for a couple of months, but now my foot hurts worse than ever. The initial diagnosis before the tarsal tunnel was PTT, but the MRI only showed a small spot of irritation. So the doc went with the tarsal tunnel based on the positive tinel’s sign. Now it looks like the PTT is back with a vengeance. In your case did the release add to the PTT?

I guess I misread, I'm going back to the Doc on Friday, if I can get off of work. Unfortunately my right foot started really acting up this week, out of the blue and with my right foot it feels like something is stuck in the outside part of the ankle. I guess I'll see what the doc has to say, really don't want to go back into a boot...