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  • pain PTT/Navicular insertion site Right Foot

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    Old 08-25-2013, 04:06 PM   #1
    NFek
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    Unhappy pain PTT/Navicular insertion site Right Foot

    I'm new to the board, but have come across it several times in my many hours of internet research on PTTD.

    Some background first: July (2013). I was at work, at the end of my 12 shift = 36 hrs a week. I noticed that my right foot was sore at the PTT/Navicular insertion site. I didn't think anything of it at the time, being on my feet as much as 11.5 hrs of my shift three times a week, I've had this feeling before. (The pain was a sharp, burning pain. About a 4/10). That night, I went home and iced and elevated my foot then went to bed.

    The next morning, I had some trouble walking initially when I got out of bed, and noticed that the affected area was red and swollen. The pain subsided as the morning went on, and my ability to walk seemed to improve some. I went on about my normal day. That night, by 9 pm my pain was 7 or 8/10, swelling was increased and I had a lot of difficulty walking. Iced and elevated again.

    The next morning, Saturday (2 days after noticing pain at work). I woke up and could not walk AT ALL. Pain was 9/10. I couldn't put any weight on my foot at all. My husband took me to urgent care. X ray was negative and I was given crutches, an ace wrap, told to continue icing and elevating and taking ibuprofen for pain and to see my doctor if it wasn't improved by Monday or Tuesday. She also gave me a note to return to work on crutches(!... I'm on my feet, carrying things ALL day!!)...

    Monday rolls around, I still can't put ANY weight on my foot at all (including the weight of a bed sheet!). I had spend the entire weekend with my foot elevated and I iced every 4 hrs and took ibuprofen every 6 hrs. Went to my md that day who referred me to a podiatrist and gave me a note to be off work.

    Saw the podiatrist that Wednesday or Thursday. He pressed on the insertion site of my PTT/navicular. I nearly cried from the pain. He gave me a boot, ordered an MRI, told me to continue what I was doing at home and gave me a note for work.

    Had the MRI done and returned to podiatrist. By this time, I've been wearing the boot around the clock for three days or so. My heel was getting sore from the constant pressure, and I was losing range of motion in my foot. Podiatrist says to wear the boot only when up (instead of all the time), and says that he was "shocked" because my MRI was essentially normal, except for a "slight thickening of the tendon, a slight separation of the tendon from the bone" and (exact quote here) "a little white line that we don't know what it is but we don't think it is a big deal". He said he was convinced that I had ruptured the tendon at least partially. He sent me home with a referral to physical therapy.

    I have now been to four PT sessions and have definitely had improvement in my range of motion and general pain. The PT has had me wean myself out of the boot and I'm doing three hours of exercises every day. The thing is, I STILL can't walk long distances without pain at the insertion site. I've never had pain along the course of the tendon (although oddly, I do feel a "relief" feeling when the tendon is pressed/massaged above the ankle, despite never having had pain up there). I am walking some, but not far without PAIN at the insertion site, certainly not anywhere NEAR enough to go back to work!

    My job requires me to be on my feet all day, and the treatment for PTT is to refrain from the aggravating activity!!! Not possible in my case!! My employer is unable to find a "desk" job for me to do, despite my md having cleared me for this type of work, and I've made less than $1,000 in the past month!!! I NEED to get back to work... now.

    How long does this typically take to heal?? All my podiatrist will tell me is that I don't need to change my job at this point and that I will "eventually" get back to work!

    Did any one ever have symptoms like mine? A sudden LOCALIZED pain, inability to walk and swelling without any obvious injury and with a normal x ray and essentially normal MRI? How long did it take you to heal??

    I have not ever had any surgical interventions on this foot. I'm asking for length of healing time after non-surgical interventions.

    Sorry so long!!! Thanks for your help!!!

    Last edited by Administrator; 08-25-2013 at 06:29 PM.

     
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    Old 08-25-2013, 07:52 PM   #2
    NFek
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    Re: pain PTT/Navicular insertion site Right Foot

    I realize this is a very long post, but I felt I needed to give a full background in order to see if anyone else has had a similar overuse injury such as the one I have due to walking. As well as to see if this is significantly impacting someone's life beyond limiting their exercise regimen. This is preventing me from working or even walking normally. If someone could please respond I would really be grateful! Thank you!

     
    Old 08-25-2013, 08:50 PM   #3
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    Re: pain PTT/Navicular insertion site Right Foot

    Oh, NFek,
    I totally feel your pain! I can relate. I had had foot pain before but last Christmas decided to start exercising every day. I was on the elliptical and my pain in the same place in the arch began. It didn't go away with rest or changing shoes as it had in the past. Nothing showed up on my MRI , but the orthopedic foot and ankle specialist I saw told me I needed surgery. I had already tried ibuprofen and had been wearing orthotics for years. I got a second opinion from another OS and he did the MRI. I guess it showed some inflammation. We tried the cortisone injection into the tendon sheath. That worked well for four or five weeks but then the pain came back although not as bad as before. It , too, interferes with my work. Also wearing a pttd air brace helped some of the time. I am a teacher so it was a tough semester. I scheduled surgery for July, all the time wondering if this was the right choice. Well I know it was because they discoveredy tendon was mostly torn from the bone. That did not show up on MRI. I'm hoping to get my regular life back on the not too distant future. I am six weeks postop. It definitely disrupts your life but I don't think I had a choice. Good luck and keep in touch. I am going back tomorrow on my knee scooter until I'm more comfortable walking. I hope this is helpful to you. I feel your pain.

     
    Old 08-25-2013, 08:59 PM   #4
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    Re: pain PTT/Navicular insertion site Right Foot

    Thank you for your response! I'm half tempted to BEG my doc to do surgery at this point! I know it would mean several months of recovery but at least maybe then I would have an end in sight.

     
    Old 08-25-2013, 08:59 PM   #5
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    Re: pain PTT/Navicular insertion site Right Foot

    You might think about finding an orthopedic surgeon foot and ankle specialist for this surgery since it is major. It sounds like you may be headed on that direction , surgery, and I know how that feels. I limped and could barely function for months. Now at least I'm on the road to healing.

    Last edited by Hikerdreams; 08-25-2013 at 10:12 PM. Reason: Duplicate

     
    Old 08-26-2013, 03:11 PM   #6
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    Re: pain PTT/Navicular insertion site Right Foot

    Hi NFek! Welcome to the board. I'm not sure if my story is helpful, but my issues sound similar to yours, so here it is! I started training for a half marathon last fall. I completed the race, but ended up with a navicular stress fracture. The fracture was near where the PTT tendon inserts into the navicular. Did the cast and crutches thing for 7 long weeks! I noted some improvement, but in March 2013 I was still having a lot of pain. I had a follow up MRI which showed that the fracture had healed, so my ortho sent me on my way. Saw a podiatrist a month later and did PT for awhile. At this point the diagnosis was tendonitis at the insertion. I did see some improvement with PT, but still couldn't be on my feet for long periods of time. I ended up having a modified kidner procedure done almost a month ago. I did end up having some small tears of the tendon right where it inserts into the navicular and the navicular bone that was shaved was "soft" presumbably from the initial injury. These tears never showed up on the MRI. The MRI just showed some mild tendonitis. I just got my cast off today so am looking forward to walking again! Prior to the surgery my pain was very localized to the insertion and it hurt to press on it. After standing for awhile, my whole foot would start to feel achy and tired. I was told that I had no flat foot issues and that my issue was just caused by overuse. I'm hoping the surgery fixes everything and that I can get back to walking/jogging another half. I'm told it is possible! Good luck to you. Let me know if any specific questions I can answer.

     
    Old 08-26-2013, 03:31 PM   #7
    NFek
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    Re: pain PTT/Navicular insertion site Right Foot

    Thank you for sharing! It does help to hear things like that. Since all of my imaging is considered normal, I have often wondered if it was just in my head... Even though I KNOW it isn't.

    One thing that really throws me is that in nearly every case I have read, the PTTD sufferer has been a runner. I am not, nor have I ever been a runner (nor have I ever been big on formal exercise plans. I am not significantly overweight either, but my job keeps me walking very quickly for 11 + hrs a day three days a week. My guess is that this is the cause.

    Either way, it does help to hear that others have been validated despite normal imaging!! Thank you again!!!

     
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