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Posterior Tibial Tendonitis, is this normal protocol

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Old 07-12-2011, 12:11 PM   #1
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Posterior Tibial Tendonitis, is this normal protocol

A bit of background. Last year I was training for my black belt and exercising ALOT. I ended up getting some foot pain and ended up having 2 MRI's trying to figure out what was wrong. In the end, it appeared I had bruised my navicular (stress injury) and had a mild case of hypertrophic posterior tibial tendonitis and achilles tendonitis. There was also tendonosis and evolving peritendonitis in the posterior tib. There were other little things but nothing too noteworthy. I ended up in a boot for a month and then I actually asked to be casted because the boot sucks for me and PT wasn't doing anything either. So, I was casted for 4 weeks. No problem for a year. Fast forward, I have since quit training due to a shoulder surgery also last year and worried about foot stuff. 10 days ago, I spent the weekend leisurely swimming in a pool with my husband and kids. By the second day, my foot was hurting on the inside. It has gotten worse with time. It's normally bad while weightbearing or at night if I sleep in the wrong position (with toes pointed). I have iced it and rested it for the most part, but just not doing much walking. But, within minutes of being on it, it aches and I end up walking around on my heel and outside of my foot. It feels so weak and like it's going to roll inward at any time. It's visually larger than the other foot but not hugely swollen. I am an overpronator as well and it feels like it's weakening.

Anyway, I saw my current OS. (Not the one that casted me... he moved offices). I gave him a copy of my MRI from last year showing the tendonitis. I was there for a pre-op actually to have a cyst taken out of my wrist and he was 1.5 hours behind schedule. He looked briefly at my foot... at the MRI.. and concluded "yeah it's your posterior tib". And then, asked if I had done PT before... I said yes, and I am not a huge fan of it. It didn't help me much. He said ok... and then said "we usually cast or boot these". Ok... I told him I have a boot at home and just didn't put it on (I hate the thing honestly... I'm horribly undisciplined about wearing it). I told him my last OS casted my foot for a month and I was golden after that. He said "okay then we'll do that, but I'm running behind". He initially said he'd do it if I could wait til he got rid of some of the patients that were waiting. I said fine. Then he looked at my pants and said the leg was too narrow and he wouldn't be able to get the pants over the cast. I told him I didn't care! Cast the foot, I'm tired of hobbling around, I'll cut the pants off! Then he said "no, can you wait until your stitches come out of your wrist in a few weeks". He said it will be too cumbersome with a cast on and the wrist in stitches.

Okay, I see his point, and I left on my shoe with my ace bandage and hobbled out of his office. But, I asked him if waiting another 2 weeks when I was already over a week into the inflammation was going to hurt and he didn't seem to care. He said when I came in for my stitches removal he'd remove the stitches and cast the foot. In the meantime, he said "throw the boot on".

I get what he's saying that it's alot to deal with in cast and a wrist splint all at once. But, I also asked if I should be NWB while I was resting the tendon and he said NO. I've been lying down as much as possible because it just hurts to walk on it for very long... or stand for that matter. I'm just confused because if this is a chronic thing since it's my second round of tendonitis and there is clearly evidence that the tendon is degenerating... why so cavalier? I asked if there was risk of rupturing it and he said yes... but that's it?

It just seems I see everyone on here who's doc see PTTD stage 1 (which is what I believe I am even tho he didn't use that term)... is normally SO super aggressively conservative... like NWB is a MUST while that tendon is inflamed. "Throw the boot on"... is not how I see other docs handling this. I've always liked him, he's done well for me on my shoulder and I trust him with my wrist. But, I find his reaction to this sort of odd. Maybe I am overreacting?

So, I put my boot on and will try hard to discipline myself into keeping it on even while at home around the house (which I am AWFUL at). Just wanted to hear from others about how serious *I* should be taking this... and how serious the docs normally are?

*** EDITED to ADD: I forgot he actually threw out the words "cortisone shot" too... I always heard these were very contradictory to tendonitis in the foot!??

Last edited by Karatemom40; 07-12-2011 at 05:04 PM. Reason: Typos and additional info

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Old 07-12-2011, 05:29 PM   #2
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Re: Posterior Tibial Tendonitis, is this normal protocol

I think you should go for a second opinion. You need to see a foot/ankle orthopedic surgeon. One who handles injuries to the foot. I would think your doc would want another MRI to see what is going on ...but then I'm not a doctor.

Good luck!

Before my doc had me in a boot a couple of different times. When it was obvious that wouldn't help we did the MRI. He also wanted me off of the foot as much as possible and to elevate and ice it.

Old 07-13-2011, 09:26 AM   #3
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Karatemom40 HB UserKaratemom40 HB User
Re: Posterior Tibial Tendonitis, is this normal protocol

Thank you for your response.

I've been googling and researching and really paying attention to my symptoms. And, I think I may have a stress fracture in addition to the tendon issue. It seems my pain worsens the more I bear weight and sometimes it's where the tendon is and sometimes it's on the tibia near the medial malleolous which on the last year MRI said there was inflammation indicating chronic sprain pattern. I took an awful beating on that bone last year and wonder if a stress fracture has formed. It seems better with rest but the minute I stand up or let blood flow to the foot, it starts aching. I'm seeing an foot/ankle OS but they couldn't get me in for 3 more weeks!

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