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kristim06 04-27-2008 10:58 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Clouth, my mri did show definite tenosynosis of the ptt, but not tear in it (which when he went in and did the surgery he found a rather large rip.
I had some issues with my big toe associated with the pttd.
My symptoms is I had rolled it so many times and I had little stability with my ankle plus constant pain. my ankle turned in all the time

i hope this helps.


clouth 04-27-2008 12:08 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Thanks Kristin, that does help.


clouth 05-02-2008 06:16 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Hi everyone,
Just an update. As I mentioned, I'm going to see Dr. Theodore in Boston on May 13. The podiatrist/foot surgeon examined me again last week and still doesn't think it's PTTD, despite my fears. But he has agreed to order an MRI with contrast, which I will have Monday afternoon. The machine is also stronger (3.0T vs. the 1.5T that I had in January) so maybe that will help.

He will also do weight-bearing Xrays for me next Thursday, and we're going to talk about orthotics but I don't think I can afford them right now. The custom ones are $400. I'll get them if I need to.

So, I feel nervous for the test results, but relieved that I will have these test results in-hand when I go to Boston.

Hope everyone's having a good day. My son's first communion is tomorrow so I'll be putting my ankle through it today getting the house ready. :)

Thanks for reading,

emmie54 05-02-2008 10:11 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
I never knew there were different strength MRI machines! I've had 5 so you would think I would know more about it. Seems that would make a big difference. Congrats on the first communion. My son is in seminary to become a priest. He has 3 years left.

Don't overdo today or you will be miserable tomorrow! Just take the pain meds and you won't care if the house is dirty! Did the pod offer an opinion on what he thinks it is? Glad you are getting the second MRI.

clouth 05-05-2008 05:11 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Yeah, I didn't know about the different strengths either. I'm figuring, almost six months have gone by since the first MRI, that plus the added strength should help! Although, the MRI place called Friday afternoon, and they don't want to do the contrast. So now I have to call the podiatrist this morning and get that figured out.

The communion was wonderful. He wore a white suit. :) Lots of family here for the day. It got my mind off my ankle for the day, until it really started hurting at the end of it. And yeah, the house wasn't the "normal" clean, but who cares? Wow, you're son's in seminary, huh? That's awesome.

The podiatrist said that there's a mass there. He can't be sure what it is: vein, tendon, benign tumor. That's why he wants the contrast. He said it's "sizable," and not on the other ankle, and he thinks it could be the cause of my problems.

He doesn't see any weakness in the PT tendon, but until these tests come back, I guess it's anyone's guess. I should have a better idea of what's going on after this MRI, the standing Xrays, and my Mass General appt. next Tuesday. Now I'm just praying for something that's "easy" to fix. :)

emmie54 05-05-2008 09:54 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
I'm anxious to hear your results. I'm sure YOU are. Don't you hate it when they use the word "mass"? Sounds scary - but could be anything. We'll hope for the best.

maggietaz 05-06-2008 09:43 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
How did the MRI go? Sure is frustrating when you have the pain and it doesn't show up well. When they did the tendon surgery for my peroneal tendons, it was worse when they went in, then what they saw on the MRI. I think I have decided to go back and see the foot and ankle specialist that I saw for the peroneal tendons and who did the surgeries. I am o.k. - not much pain some days and other days with just a bit too much exercise, I am in pain. It is hard to figure out where most of the pain is, since I have PF as well as problems with the PT tendon.

clouth 05-06-2008 12:06 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Thanks for thinking of me. I did get the MRI with (and without) contrast. And, the contrast was NOT injected into my ankle -- woo hoo!

I haven't gotten the results yet but of course popped the disc into my computer when I got home. There is a big bright area where my pain is. Bright like a Christmas tree! So now, I just wait.

I'll let you know when I hear!

clouth 05-06-2008 12:53 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
I'm sorry you're going through this too. Sounds like a good decision to your foot/ankle surgeon again, especially if you had a good experience with him before. Glad you're not in too much pain at least some of the time. Today is a painful day for me. I just popped some advil. I think looking at the bright spot on my MRI made it hurt more. ;)

clouth 05-08-2008 11:00 AM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Well, I got the MRI report today.

"There is increased signal surrounding the distal Achilles tendon. There is a small amount of fluid surrounding the posterior tibial and flexor digitorum tendons. No tendon signal abnomality is noted. The flexor hallucis longus tendon is unremarkable. There is a joint effusion. No evidence of mass lesion is noted.
1. Unremarkable MRI of the tarsal tunnel without evidence of mass lesion or muscular atrophy.
2. No evidence of tendinopathy, tear or tenosynovitis.
3. Achilles paratenotis.
4. Joint effusion.

He also did standing xray, noticed early arthritis in my big toe joint, said I have an accessory navicular, saw some bone degeneration that he said was from wearing the cam walker for 2.5 weeks (!), and said my arch was "fairly normal."

The podiatrist still believes cortisone and/or orthotics will be the best course of action.

I was surprised that with the fluid on the PT and FD tendons, that was considered normal and not a sign of tendonitis or a problem. I'm glad they're not torn, anyway.

My podiatrist still does not think it's PTTD. I'm not sure why. I guess I'll see what the guy at Mass General says on Tuesday!

Does this still sound like PTTD to any of you?

clouth 05-13-2008 02:06 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Hi all,
I just wanted to update you on my appointment in Boston.

He felt that the MRI was totally normal. And that my PT tendon is strong, equally as strong as on my other foot, so he doesn't believe at this point that it is PTTD. He said it could be in the subtalar joint given the "healing activity" showing on the bones scan and the CT.

Here's the plan as I understand it:
- Nerve study with a neurologist. If that comes back normal then
- cortisone and numbing agent into the joint.

If the cortisone injection makes the pain go away forever, well, that would be great.

If the pain goes away and comes back, he might do arthroscopy of the joint.

If the pain is unaffected by the cortisone, he might open up to take a look at the tendons/soft tissues.

That's it for now. I'm trying to see if I can get in earlier for the nerve study. Right now it's five weeks away.

Did anyone else's diagnosis take this long and winding road?


janewhite1 05-13-2008 03:13 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
11 months, 6 doctors, 1 PA, 2 physical therapists,
CT scan, 2 sets of x-rays (one regular, one weight-bearing), MRI.
6 or 7 possible diagnoses.
More appliances and sticks than you can shake a stick at.

Long and winding road? You betcha. But now it's pretty nearly perfect, so, hang in there.

clouth 05-13-2008 06:34 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
You know, that was a really stupid statement on my part. If there's one thing I've learned in the last 7 months it's that the "Long and winding road" seems to be the rule rather than exception when it comes to foot problems.

Thanks Jane. You are always an encouraging voice to me.


clouth 05-20-2008 06:18 PM

Re: Inner Ankle Pain: Struggling to get a diagnosis
Well, my nerve study/EMG came back normal. A good thing! The doctor said that it doesn't appear I have tarsal tunnel syndrome. When he called me last night the caller ID said "Boston Red Sox." :cool:

Next step is a cortisone shot into the ankle joint to help the doctor figure out if it's in the joint or outside of the joint.

So this will make it:
-[B]x-rays [/B](weight bearing and not)- normal, accessory navicular
-[B]bone scan [/B](healing activity in joint)
-[B]ct scan [/B](healing activity in joint, bone island)
-[B]mri [/B] - fluid near heel, "normal" fluid on posterior tibial and flexor digitorum longus
-[B]whatever the test is for deep vein thrombosis [/B]- normal
- [B]physical therapy [/B]- improvement with stretching/ice, worse with strengthening, activity
- [B]nerve study/EMG [/B]- normal
- [B]cortisone injection [/B]- TBD

I'm putting the shot off until next week. I"m out of the cam walker brace for now too -- passing myself off as a normal person! "Good ankle" is acting up and bumming me out though.

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