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allykay 10-01-2012 09:49 PM

Is this posterior tibial tendonitis?
 
I'm a 23 y/o female runner who developed inner ankle pain a little over a year ago (August 2011). My ankle started hurting during a run and progressed to hurting while walking. Since almost exactly a year ago, I have had ankle pain every day. I haven't run, I can't bike or walk more than short distances, and I can't really go out with my friends. I wear only athletic shoes with a supportive orthotic. I have tried a richie brace, PRP injections, icing, physical therapy, ART therapy. Nothing has helped at all.

The weird thing is that any imaging I've had looks "normal." I have had 2 x-rays, 3 MRIs, and a high-res ultrasound. At this point I've seen 4 orthopedic surgeons; two of them think that I have slight swelling of the PTT, the others think my PTT is completely normal.

Has anyone had a normal (or almost normal) tendon on multiple images and still needed drastic surgery? The doctors are telling my symptom-wise, I clearly need surgery (haven't improved one bit in 9 months), perhaps even a tendon-transfer, but the imaging suggests that I shouldn't even be in pain.



Thoughts? Anyone had multiple normal MRI's only to find that your tendon was actually tore up??

Thanks!

hallirackit 10-02-2012 11:59 AM

Re: Is this posterior tibial tendonitis?
 
Ally,
I was 23 when I had my surgery (about 6 months ago) and I just wanted to write because our stories are similar. I had extreme pain for about a year and half and nothing showed up on any imaging. I was at the point where I wanted them to come back and tell me it was torn to shreds so I could just get on with it, but it looked normal on all imaging. I tried absolutely everything, saw 3 doctors, and finally decided to have the surgery.
At 6 months post-op, I am PTTD symptom free. The difference is extraordinary. I think, if you follow your instincts, you will be fine. The surgery sucks and the recovery is long. But, like you, I got to the point where I couldn't take it anymore and did what I had to do. I would absolutely make the same decision again.

allykay 10-02-2012 12:07 PM

Re: Is this posterior tibial tendonitis?
 
Thanks SO much for replying


Three questions, if you don't mind:

What surgery did you have?

What did the tendon look like when they went in and did surgery?

Are you able to run/be active? Or do they anticipate you will be able to participate in athletic activity at some time soon in the future?

Thanks!! :)

hallirackit 10-02-2012 02:57 PM

Re: Is this posterior tibial tendonitis?
 
I had a Gastroc recession last November in hopes that there would be enough improvement to put the major surgery off. This didn't help like we wanted it to so in April I had a calceneal osteotomy, tendon transfer of the FDL tendon (to replace/patch the removed piece of PTT), and lateral column lengthening. I also had a hypermobile big toe joint so this was fused at the same time.

My surgeon said the tendon was shredded when he went in. He said sometimes it just doesn't show up on MRIs, but it was definitely destroyed once he opened it up.

Unfortunately, I'm having some unrelated problems with my peroneal tendons. But I am confident in saying that the pain I felt before is gone, and that if I didn't have other problems, I would be able to be back to physical exercise. I think as long as you have a competent, helpful surgeon and a knowledgeable physical therapist, it is not too difficult to get most of your strength back. It does take time though. It is long and frustrating and sometimes painful, but I think being young is also an advantage.

Let me know if you have other questions. I know it's hard to make the decision, but I am here for you if you need any other information.

allykay 10-02-2012 03:46 PM

Re: Is this posterior tibial tendonitis?
 
Wow, thanks so much! That's all super helpful information.

6 months is one of the more optimistic time frames I've heard for this type of surgery. I mean, 6 months is a LONG time (we all know- I haven't even had a surgery, but dealing with pain for 12 months has been forever!). I've heard years to be able to walk normal/bear weight, which has SUPER scared me- I really just want to run!

I am sooo sorry you're having peroneal tendon issues now, that's realllly sucky. Any reason as to why you've had so much tendon difficulty?

I know I have a surgical problem- I have tried so many conservative measures over the past year & I haven't seen any improvement. I've just had so many different surgeries suggested to me, I wish there was a consensus for docs as to which surgery I should have, so I could just get it done!!

I really appreciate all of the useful information & support!! You have no idea how helpful this is! If I have any other questions I will definitely ask you!

allykay 10-02-2012 05:48 PM

Re: Is this posterior tibial tendonitis?
 
One more question- could you ride a bike (like, say a spin bike) before you had any surgery done?

hallirackit 10-02-2012 06:26 PM

Re: Is this posterior tibial tendonitis?
 
You are right, recovery time does vary for everyone. My doc said a year before I would be 100% and I believe that, but as of 6 months, I would say I'm about 75% (not counting the other unrelated issues). It depends on your doctor and your physical therapy regimen, of course. I am a firm believer that being in good shape ahead of time makes the recovery easier, though.

I feel your frustration. I know how it feels to just want to be better and to be through it all. I have definitely been there. I think you just have to find a doctor you trust and who you can talk to, and to be realistic about the recovery. It won't be immediate, as much as you'd like it to be. It takes a lot of work, but I just couldn't see myself living the rest of my life the way I was. I knew I had to take the chance and do what I had to do.

My doctor recommended biking as a low impact exercise and that was about what I was limited to in the months before the surgery. I used a stationary bike... not sure if a regular bike would be different. But I thought it was a good way to get some activity in without putting too much stress on my foot. I did get some stiffness from it but if I made sure to stretch my calf before and after it helped a lot. I found biking to be much less painful than walking or running, though. I kept my gym membership up until my first surgery and I think having some lower body strength was helpful in getting around while non-weight bearing.

allykay 10-02-2012 08:26 PM

Re: Is this posterior tibial tendonitis?
 
Interesting. Yeah, I know if I get surgery it will take a long time to get better and that is extremely frustrating, but right now I just feel like I will never get better. I haven't seen any improvement in my condition since January, which as a good time ago.

When I first got this, my doctor told me that I would have to "quit running and take up biking" so my wonderful mom promptly went out and bought me a spin bike. This was last Nov. I really can't use it at all. Biking hurts about as much as walking does for me. I haven't ran in a year, but I imagine I wouldn't get much farther than the end of my street before I'd fall over! My doctors have been a little thrown off by the fact that biking hurts as much as it does; I have been referred to chronic pain to investigate something potentially wrong with my nerves. I really wanna get those appointments taken care of, because if everything there comes back negative I guess I really am going to need to have surgery on my tendon (the most likely culprit!)

hallirackit 10-02-2012 09:32 PM

Re: Is this posterior tibial tendonitis?
 
I know exactly that feeling. I still feel that way sometimes and it's hard to explain to people who have never been there. But you definitely want to get it right. I'm sure they want to make sure they're treating you in just the right way.
I'm sorry there was no hope in biking for you. Must be even more frustrating to not be able to do that. You can always look forward to using it in your recovery. I used one in therapy to help regain stamina so maybe you can look at it that way. Maybe it will help you get back to running someday. I know it's really hard to look at it positively from your end of things. You still have to take it one step at a time and it is miserable, I know. But one day it will get better. Have to keep reminding myself that too!

ginger62 10-03-2012 06:05 AM

Re: Is this posterior tibial tendonitis?
 
Allykay,
Keep in mind too that as this injury progresses and you adjust your gait to accommodate, it throws everything else out of whack. It puts more stress on your good leg, your hips and back. Physical therapy even before your surgery can help. Good luck!

FastpitchSball 10-04-2012 01:24 AM

Re: Is this posterior tibial tendonitis?
 
You're right, Ginger. As things progress with my ankle injury my knee started to hurt terribly. Then about a couple weeks before my surgery my hip began to hurt as well. When your compensating like I was, your whole body ends up out of alignment.

allykay 10-05-2012 10:25 AM

Re: Is this posterior tibial tendonitis?
 
I have such a bizarre case of PTT (And I'm not just saying that, EVERY doctor I've seen, whether they thought I had PTT or not, has said I'm a bizarre case). My symptoms haven't changed the whole time I've had this. GREAT that it hasn't progressed, super annoying that it hasn't healed. I'm missing a few classic symptoms too, like pain w/heel raise.

Anyone ever heard of/tried the TOPAZ procedure? I know the research evidence isn't there (and I do research, so I should care lol); and PRP was similarly touted & did nothing for me. But I'm SO against having a tendon transfer for a tendon that we're not even sure if damaged, that I'm considering trying TOPAZ, even if it costs a lot.

Missyluke 10-05-2012 03:06 PM

Re: Is this posterior tibial tendonitis?
 
I have had several MRI's which have not indicated any tears in tendons or any problems but once the doctor went in, they have found tears in ptt, and my peroneal. I am grateful the my surgeon went be the symptoms (which were consistent with a tear) and operated to fix the problems.

exdancer2 10-05-2012 04:52 PM

Re: Is this posterior tibial tendonitis?
 
Allykay,

I have had a similar situation and will only say - do not give up!

If you are in pain, the pain is real and there is a problem.

Mine started in early April 2010. I suddenly developed plantar fasciitis and couldn't walk. Was told it would go away in a couple of days. 2.5 years and 3 doctors later and it clearly wasn't "just" plantar fasciitis. I have PTTD and Adult Acquired flat foot.

The tests and MRI didn't show anything other than my posteriar tibial tendon had "slightly" thickened. One of the tests, where they injected novocain and lidocaine in a small pocket near the tendon, gave me 80% relief for about an hour and was proof that one of the issues is PTTD.

BTW, the second Orthopaedic Surgeon I went to told me I had a, "low tolarence for pain." I, like you, am soooooooo sick of this.

Good luck and hugs to you.

allykay 10-05-2012 06:57 PM

Re: Is this posterior tibial tendonitis?
 
Oh my gosh, that all sounds horrible!! I'm going so crazy after one year (and I'm sure you were too), I can't even imagine how much worse it gets!

Do you know what treatment you are planning on trying next??

Also, based on your screenname- you used to be a dancer?? What type of dance did you do? I did tap for 15 years and jazz for 13 :)


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