I have had pain in my inner ankle for the past year and I'm really desperate for help, sorry the following story is a little long but if you have dealt with any thing similar PLEASE let me know if you have advice/have suffered something similar.
History/Injury: I'm 23, female, was a tap dancer from age 5-18, NO history of injuries. About 5 years ago (end of high school) I got into running to continue to stay fit post high school. No history of pain/injuries from running either. Last year (Aug 2011) I started having a nagging pain in my inner ankle. Mileage at the time was about 20-30 per week, also supplemented with elliptical cross training, and no increase in mileage of change in routine at the time. After the pain started I would switch to the elliptical for a few days, but when I would go back to running the pain would get worse. About 7 weeks later, early October, the pain got REALLY bad to the point where I couldn't walk. This is when I started receiving treatment (see below)
Sports medicine doctor at university: Stress fracture
Foot/Ankle orthopedic surgeon #1: posterior tibial tendonitis
Foot/Ankle orthopedic surgeon #2: nothing structurally wrong, potentially nerve pain- i.e. "car light goes off even when nothing is wrong with the engine" analogy
Foot/Ankle orthopedic surgeon #3: shin splints
Foot/Ankle orthopedic surgeon #4: posterior tibial tendonopathy
Imaging done/radiologist conclusions:
Oct '11 X-ray- normal
Oct '11 MRI- normal (whole leg, not zoomed in enough on ankle potentiall)
Nov '11 MRI- mild posterior tibial tenosynovitis
June '12 MRI- chronic sprain of deltoid ligament (deemed irrelevant- wrong location); slight attenuated appearance of posterior tibial tendon
July '12 X-ray- normal
I haven't run, or used the elliptical since Oct 12 2011. I can't. I only have about 10-20 mins, no resistance, on spin bike before it hurts too much (so I RARELY use it). I have about 20 mins max walking before I am in a decent deal of pain. I wear exclusively supportive athletic shoes.
This has affected my happiness and my social life and anything I want to do to an incredible degree. It got better for the first 2 months, as in at first I couldn't walk at all and now I'm 20 mins, but I haven't gotten better in 6+ months. I'm SO scared and depressed and I just want to get better and most of the doctors I've seen are confused and not sure how to help if anyone has ANY suggestions please help me
Okay, so it seems like the posterior tibial tendon is where the problem might be. Trouble is, the doctors aren't seeing severe problems there. However, MRIs of the foot and ankle aren't always 100% reliable. It may be that the MRI is picking up a little swelling when really there's a lot of swelling.
I'd go back to foot/ankle surgeon #4 and continue to push for treatment. Posterior tibial tendon problems can sometimes be resolved with orthotics or a period in a boot or brace, and possibly physical therapy. Otherwise, surgery may be necessary. Definitely, keep icing a few times a day.
I know how frustrating chronic leg injuries can be. Hang in there. Can you try a sport that doesn't put strain on your legs, maybe? Weight lifting helped me a lot emotionally when I had an ankle injury.
The problem is I've already spent 2 months in a boot, 4 months in a brace, and 4 months in orthotics. None of the above relieved my symptoms even a tiny bit :/ And I'm not willing to have my tendon removed when 50% of the doctors I've seen are sure that my tendon is fine. I am swimming to stay fit but I really don't like it very much.
The tendon isn't usually removed. Removing the tendon would cause a lot of other problems!
In milder cases, when the foot still has an arch, the surgeon just repairs any tears or swelling along the tendon. In more severe cases, the foot bones may be fused together, but yours doesn't sound that advanced.
There are some simple physical tests to check for PTT problems. Does your pain get worse when you stand on your toes? Also, the doctor can do an ultrasound to specifically measure swelling in that tendon. It's worth looking into, anyway.
Both of the doctors that thought it was tendonitis talked about removing the PTT and replacing it with the toe tendon (forget what it's called) and fusing the bone. I can stand on my toes with no pain. I recently had an ultrasound and the doctor who did the ultrasound (another doctor) thought my tendon looked "fine." I dunno if the ultrasound would be more or less accurate than the MRI, but neither gave me a conclusive answer as to "yes" or "no" whether its tendonitis.
Hmm. If you stand on your toes without pain, the surgery is probably a bad idea.
Is there anything you can pin down about the pain? Where EXACTLY is it? Other than running generally, what sorts of motions or activities trigger it? Do you have full range of motion in your ankle? Any visible swelling?
The pain is basically on/behind the bone that sticks out in the inner ankle. it's kind of a dull ache-y pain. Walking hurts. In the mornings or after sitting for an extended period of time I can walk about 20 minutes. I'm a student, and walking around campus between classes (not a big campus) is enough to put me in pain for most of the afternoon/evening. It isn't an extreme pain- on a scale of 1-10, generally a 4 and 6-7 at worst. It is persistent, I can say that it has bothered me for a part of every day for the past year. Using my spin bike is about the same as walking- it isn't horrible but at about 10-20 minutes (no resistance) I start feeling enough pain that I stop because I can feel it escalating. I can stand for notably longer than 20 minutes, but I'd say by 40 I'd for sure be in pain. Right now, since I'm walking to class, I can poke the bone that sticks out and above it (as in, higher along the course of the bone) and it bothers me. During summer when I was honestly just laying around the house as to not aggravate it, I couldn't feel anything when I poked & prodded at it, only 20+ minutes of walking. Full range of motion, there's not a way I could move it (without touching or weight-bearing) that would cause pain. It could definitely be the posterior tibial tendon, but it just seems slightly off to me that I am so limited in walking but not even irritated by a heel raise, and not showing on any of the imaging.
Also, I REALLY appreciate you taking the time to read my post!!
Your symptoms sound like mine did. The bone that you're speaking of is the navicular and the post tibial tendon attaches to it. After trying conservative treatment I ended up having surgery 4 weeks ago. I ended up having an FDL tendon transfer like you mentioned (among other things). I however did not have a fusion, nor would I have consented to it. I'm only 29 and still play competitive sports, so getting my ankle fused would have ended my playing days immediately. Since you're young as well, I'd get away from anyone who suggests a fusion. Just my opinion though.
I had three MRIs over the course of 9 months and each time the radiologist claimed that I just had a lot of swelling. Although my last MRI in August reported that I had so much swelling in that area that it was difficult to actually see if there were any tears in my PTT. When my Dr. finally did go in, my tendon ended up being really torn up.
Very interesting, thanks for sharing. My MRI shows "minimal" or "no" inflammation of the tendon, depending which doctor looks at it. No one has deemed it to be a significant amount. That of course doesn't mean that it ISN'T my tendon, or that it isn't notably worse than it looks on MRI, but it makes the surgery decision REALLY hard b/c the last thing I want to do is remove a healthy tendon!!
I hear you on all the wanting to be athletic thing! I haven't done anything competitive in 6 years (I was a tap dancer previously), but I NEED to be able to go out and run multiple days/week just for my sanity, haha.
I hope your surgery recovery goes really, really smoothly!!
You might also try and post your story in the "foot problems" section of this message board. There are a ton of people there who have had PTT problems. They'll be more than happy to help you. I don't know if you're looking for yet another opinion but since I see you're also from Las Vegas, have you tried Dr. Watson? He specializes in foot/ankles and did my ankle surgery.
I too am desperate for answers about my ankle. My pain sounds very similar to yours, and in the same place. 8 months ago I actually went through with the FDL transfer after suffering for 4 years with daily pain. (I am 28 years old, and I agree, too young to be unable to get a vigorous workout in).
Prior to my decision to have the transfer, I was with a doctor who administered two cortisone shots to my ankle, and it is believed that the second one blew out my tendon. No way to know for sure, I also bounced around to doctors who tried to guess what the answer should be, and similarly again, the MRIs were relatively inconclusive. The main difference between you and I is the awful atrophy (muscle and fat deterioration) in the area you described (inner ankle, behind, above, and along the bone).
It's possible we had the same issue before I had the cortisone injections, that was a terrible decision on my part. Maybe an FDL transfer will help you, unfortunately it did not completely clear up my problem, and my doctor now is discussing the possibility of "tendon debridement" to go back in and basically get rid of the problematic tendon completely.
I have never known anyone to have this exact issue and neither has my doctor or his colleagues. Maybe our issue is not the same, but please keep me updated on any new findings, AND IF ANYONE READING THIS HAS ANYTHING TO ADD PLEASE DO SO!!!
Yes is There ar some straightforward physical tests to examine for PTT issues. will your pain intensify once you stand on your toes? additionally, the doctor will do Associate in Nursing ultrasound to specifically live swelling therein connective tissue. It's price wanting into, anyway.