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  • suggestions for post tib tendonitis

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    Old 05-08-2007, 02:18 PM   #1
    bstuart191
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    suggestions for post tib tendonitis

    2 1/2 years ago i had a sudden pain just above my arch and in front of my ankle. The pain started with routine walking. I've been pretty demanding on my feet during my life (sports, job, etc.) and thought I might have a stress fracture. After 3-4 months with pain, family Dr. gave me a cortisone injection for tendonitis after X-Ray was negative. For the next year, I was able to stay basically pain free as long as I got a Cortisone injection about every 3-4 months. My Dr. referred me to an ortho. after the injections started only lasting 2-3 weeks. Ortho gave me another injection and had me fitted for custom orthotics. As soon as the cortisone wore off (<1 month), I was back to square one (minimal relief from orthotics). I toughed it out for a couple more months and went back to the ortho. I got another injection (total 5 in about a year and a half) and was placed in a walking cast for 2 weeks. After the 2 weeks, I had a slight improvement. I really couldn't tell whether the cortisone or the cast helped, actually neither helped very much. At this time MRI and Bone Scan were negative. Ortho referred me to an ortho foot and ankle specialist. I was prescribed a wedge type heel insert and sent to PT. 1 month later I returned with increased pain. The Dr. put me in a cast with crutches for 7 days and then a walking boot & PT with gradual weight bearing over the next 2-3 weeks. (At this time another MRI was obtained which showed tendonosis with enlargement of the PTT & Bone Scan which only showed a little arthritis). At 50-75% of my weight, I began having increased pain. The Dr. said it was normal and to push through it with stretching and strengthening. I was kept in the walking boot for 2 more weeks and was given a steroid dose pack. My pain decreased to a minimal level and I was given a carbon fiber insole for my shoe. I did very well with a minimal pain scale for 3-4 months. Over the past 2 months, my pain has gradually increased back to a pretty significant level.

    I was wondering if anyone has had any similar circumstances, what their outcome was, and would love to hear suggestions. At this point, I am planning to make another appointment, but I believe the Dr. will use the same course of treatment. My pain is not so much with just moving my foot, it seems to be with placing weight on it. It just seems like a lot of time out of my life and my job if the pain is always reoccurring. I even wonder if I should just use ice, take ibuprofen, and learn to deal with it. At this point, the only relief I have gotten has been from cortisone, steroid dose pack, and the awful time I spent on crutches.

     
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    Old 05-08-2007, 04:45 PM   #2
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    Re: suggestions for post tib tendonitis

    I've been through pretty much what you've been going through.

    I'm on my feet 8 hours per day, and the pain at the end of the day would be nearly unbearable. I went to a foot/ankle specialist (a DPM, not ortho) and got a cortisone shot and was placed in a Cam Walker boot. I did that for a month with some decrease in pain, but still enough pain to be uncomfortable. At that point I got another shot and remained in the boot. At that point he also sent me for physical therapy. After a month of that, no decrease in the pain, so he sent me for an MRI which showed tendinitis and tendinosis. At this point I was put on 1/2 time work, another shot, and another round of physical therapy. Still no results, so I was put on full time disability and stayed off my foot as much as possible. That helped, but after I was on my feet for about 20-30 minutes, the pain set in.

    So, since there was no improvement with therapy, cortisone, and less weight on foot, we scheduled surgery.

    March 13th I had it done:
    1) posterior tibial tendon debridement
    2) tendon transfer (FDL) strengthened with horse-heart tendon
    3) Evans procedure calcaneal osteotomy with bone bank graft

    I'm now out of my cast and the pain has really subsided. I've got about a week and a half before I go back in to see the doctor, and at that point I'm told he will let me begin to bear some weight on the foot. It will be a total of 9 weeks non-weight bearing. Then I'll start physical therapy.

    The thing is, both tendinitis and tendinosis are very slow to heal, and often times even if they DO heal, the bones of the foot remain in poor alignment, often with the arch beginning to fall, and the tendon will begin to stretch and tear again. Left untreated, arthritis will set in and you may have to have bones fused together. If your bones are in good shape, however, you do stand a chance of the PT tendon healing. It's a hard call; I'd be totally candid with your doctor and discuss any and all options.

    It's difficult to deal with the chronic pain; I know. And when it begins to interfere with your day to day activities, it's time to take a long look at what's going.

    Good luck with it all,
    Deb

     
    Old 05-09-2007, 06:19 AM   #3
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    Re: suggestions for post tib tendonitis

    Thanks, for the reply. I have gotten to the point (mentally & physically) that I just want to get well, regardless of what it takes.

     
    Old 05-09-2007, 11:27 AM   #4
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    Re: suggestions for post tib tendonitis

    Have you had a series of x-rays done that show the alignment of the bones in your feet? I would think that might help you as you discuss options with your doctor.

    There are LOTS of different procedures out there... and it is always wise to get a second (or third!) opinion.

    Good luck,
    Deb

     
    Old 05-09-2007, 01:02 PM   #5
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    Re: suggestions for post tib tendonitis

    Thanks for the reply. The 1st visit to my ortho, several x-rays were taken. Some of them while I was standing. My Dr. didn't mention anything about the results. I have actually been considering a second opinion, but haven't really decided on the right Dr. I think I am going to give my Dr. one more chance. I will probably do like you said and be very frank, letting her know I've grown weary of the reoccurring pain and am ready to do what it takes to get well. If I question the results, I will probably get a 2nd opinion at that point. If I should see another Dr., would you recommend a podiatrist or another ortho?

     
    Old 05-11-2007, 01:43 PM   #6
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    Re: suggestions for post tib tendonitis

    Hey, have you heard about a treatment called ASTYM? It really worked for my plantar tendinosis, and I'd be willing to bet the therapy would work on post-tib tendinitis. Good luck!

     
    Old 05-11-2007, 04:50 PM   #7
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    Re: suggestions for post tib tendonitis

    bstuart,

    As to whether to get a second opinion from an ortho or DPM, I'd call medical groups in your area and ask around for references. Not all orthos deal with foot and ankle problems, and it can be hard to find them (or get in to see them). Before I made any decisions, I saw 2 DPMs, an ortho, and a sports med doctor. Overkill? Yeah, maybe, but I'm glad I did!

    Deb

     
    Old 05-13-2007, 06:01 AM   #8
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    Re: suggestions for post tib tendonitis

    thanks, I'll see what I can find out about it.

     
    Old 05-13-2007, 06:05 AM   #9
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    Re: suggestions for post tib tendonitis

    thanks, I guess the reason I ask is b/c I haven't found anyone around here that really knows anything about post tib tendonitis. I have a couple of doctor friends and neither of them mentioned a podiatrist. Both thought it was o.k. to use the foot/ankle ortho that i am using.

     
    Old 05-13-2007, 05:35 PM   #10
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    Re: suggestions for post tib tendonitis

    It's VERY important that you find someone who is familiar with posterior tibial tendinitis in your case!

    When I first started trying to pinpoint the excruciating pain I was having, my primary care doc kept trying to tell me it was plantar faciitis or a heel spur and this went on for MONTHS before I insisted that they do x-rays or an MRI or something. So I got x-rays which showed a heel spur. I was given a referral to a DPM, and after examining me, he immediately said "Yes, you have a heel spur, but that isn't what's causing your pain." He knew right off the bat what was going on.

    You rely so much on your feet, you don't want someone doing surgery on something they don't fully understand. Keep searching until you find someone who knows about PTT dysfunction.

    Good luck,
    Deb

     
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