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Foot & Ankle Problems Message Board

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My apologies in advance if this is lengthy.

Last Winter, I was plagued with several attacks of diverticulitis which lasted most of the Winter and was on bed rest per my Gastro. (My antibiotics were not Fluoroquinolones) Unfortunately, by the time I recovered and Spring came around, my legs and calves had quite a bit of atrophy. (BTW, I'm in my 50's and am thin)

To try to build my legs back up, I began taking nightly walks around the block. On the second night, I noticed that my ankles, hips and back were hurting me. Fortunately, this resolved by morning. I thought perhaps that my gait was off, so I took a few days off from walking.

Within a week of doing so, I began feeling stiffness and a mild swelling within my left foot and ankle. I saw my primary physician twice, went to an Urgent center in which I was diagnosed with a sprain and given a boot, went to the ER twice and eventually got in to see an Orthopedic twice. The ER didn't have much to offer and the Orthopedic took a few x-rays and suggested a sprain and offered PT. (I never sprained my ankle on my walks) When I went for my second visit there, they requested an MRI (which my insurance denied) and threw their arms up and suggested that I see a Rheumatologist since this pain was becoming a bilateral issue. At this time, I was better able to pinpoint the pain and it was my peroneal tendon on the outside of both ankles which traveled up my lower calves.

During this time, I iced and did try going to PT once which really irritated the problem further, so I discontinued the PT.

My primary then suggested seeing a fairly prominent Podiatrist in the area who specializes in biomechanics. He examined me and took weight bearing x-rays of my feet and ankles and said that I had a dropped navicular bone with some secondary tendonitis. He also said that I was a pronator, which I never noticed, nor did I ever have any discomfort with. Apparently, my arch collapses when I walk. He said that I needed custom orthotics and wrapped my feet up to provide somewhat of an arch until the orthotics were complete.

When the orthotics arrived, I was told to only wear them for an hour a day and then to increase my time wearing them. Having never worn orthotics before, they really hurt my feet terribly only wearing them an hour a day. They were of the very rigid variety. I made it 5 days in those and went back to see the Podiatrist. At this point, not only were my peroneal tendons hurting, but also my posterior tibial tendons on both ankles.

At this time, my insurance approved an MRI. The results showed inflammation throughout my left ankle as well as:

"Low-grade posterior tibial tendinopathy in the inframalleolar portion without tenosynovitis or discrete tear."

As for the orthotics, I was told that perhaps making them out of a cork material would be better for me as they had more "give" and I was given Powerstep insoles (or similar) with them built up in certain areas. My gait was examined and I was told to come back a few times a week for infrared treatments.

I'm still wearing the Powerstep-type insoles at the moment and was initially told to wear them for 30-45 minutes a day to get used to them for a week or so and to also wear them while in the house. I've been doing this now for about a week and a half. While I can say that I've gotten used to wearing them, my pain levels have not decreased. The only short-term relief I seem to get is with my husband massaging my ankles, feet and lower calves. (My calves have so many knots in them)

I have spoken to my Podiatrist, who might I add is a good listener and over-all physician who seems to know what they're doing regarding my concerns that I'm still in pain. I was told that it took me a while to get to this point and that it's going to take some time to get back to being pain-free and I'd have to be patient.

I'm really trying hard to be patient throughout this 4 month issue but my patience is wearing thin and I'm becoming depressed. I was assured that I was not a candidate for surgery and that I would get better.

Has anyone had any decent relief with custom orthotics and if so, did it take more time to feel better than I've allowed?

I did question the Podiatrist regarding the pttd diagnoses and was told that the navicular drop caused this (due to pronation) and the pttd was mild and secondary.

I guess that I'm looking for reassurance and also if anyone has dealt with this before as well as their outcomes. I'm very concerned about this becoming a chronic, degenerative problem.

I really feel for everyone that has pttd-related surgeries. After reading some of the stories about it, I had nightmares for weeks. My heart goes out to all of you.

Thanks for taking the time to read this as well as any thoughts you may have.[/QUOTE]

I want to begin by telling you how sorry I am for all you're going through. Sounds like you've done everything you know possible, and not sure which way to turn.

My situation was similar in ways to yours and maybe I can be of some help.

First, please keep in mind I'm not a doctor, nor am I trying to give you medical advice as such. We are all individuals and what works for one person might not help another. Your doctor should always be the one who decides whether another's approach could be of benefit to you as well.

With that said, let me describe what I've gone through and how I'm doing now. This may be lengthy too, so you might want to pull up a chair. Lol..

I too am an older female but I have worn orthotics for many years because of flexible flat feet. Never really had too many problems until the last few years.

First, I broke my right ankle three years ago. No surgery, non-displaced fracture. Had lots of peroneal tendon issues and took some time to rehab but was getting back in the swing of my daily walks again. I've been an avid walker for years. It's always been my stress relief.

Was so glad to be back to my three miles/day when I developed plantar fasciitis in my left foot. Knocked me out of my game, and lasted five months until the summer of last year when it evolved into posterior tibial tendonitis in that left foot.

I saw a foot/ankle certified Orthopedist who told me much of what you heard - that I was not a surgical candidate, and that it looked like it could be treated successfully. Gave me some exercises, and prescribed new orthotics.

Before I could even get into the orthotic place, I developed posterior tibial tendonitis in the right foot too, about six weeks after the onset of the same on the left.

I stopped my daily walks and tried to concentrate on rest, elevation, etc. Bought different shoes. I also began a daily routine of hip/glute exercises to build up those muscles.

At first, the new orthotics were wonderful. I thought they were the solution. But as time passed, though my inner ankles were much better, I developed full blown metatarsalgia ( ball of the foot pain ) in the left foot. Every single step was like stepping on a sharp rock. Tried everything but nothing really helped until I found something that worked.

The solution for that has unexpectedly also really helped my posterior tibial tendons. Now this is where things might get dicey. Remember, I'm only saying this has helped me. Not trying to tell anyone else what to do.

I dusted off an old copy of a book I bought years ago that had seemed interesting at the time, but wasn't something I felt I needed then.

I opened it up again and found my solutions. I'm not associated with this book or author in any way. It's just something that has really helped me.

It's called 'Pain Free: A Revolutionary Method for Stopping Chronic Pain' by Pete Egoscue. Mine is paperback, copyright 1998. I checked the Amazon site and was thrilled to see it was still relevant, with over 1200 reviews. The average rating of over 4.5 stars out of 5.

The author believes the body is all connected and that many ills are from faulty biomechanics. His book has many specific procedures to follow. I hesitate to call them exercises, because they're actually body positions. Holding different positions for a precise period of time. Some of them seem bizarre, but it's his belief that the recommended positions break the faulty hold of poor biomechanics.

Within a couple of weeks my metatarsalgia was gone. Completely. I had had it for four months. The added bonus was my ankles were much better too. I never even have twinges any more.

Oh, almost forgot about the orthotics. After I got the metatarsalgia I couldn't bear to wear them anymore. So I drug out my old cheap Walkfit orthotics I bought years ago. They distribute the weight on my feet very well. I'm still wearing them and they have helped me more than any of my expensive custom made ones.

Another thing I do is to always wear knee length compression stockings. I wear the brand SB Sox which provide 15-20 mmHg moderate compression. They feel wonderful and this brand is very easy to get on and off. Some others were much harder.

At my last check up in March, my orthopedist repeated my x-rays and said my arches were fine, and my posterior tib tendons were both strong.

I don't know how long my success will last. Hopefully forever, but realistically I know once it's there, it's usually progressive.

What I've tried to keep in mind is the importance of today. Trying not to let the anxiety and fear rob me of the present moment.

I will say too that I became a 'posterior tibial tendonitis' researcher! I want to do everything I can to keep it at bay.

However, if the time comes where I lose this fight, then I know the vast knowledge of experience by others here will help me get through surgery if I have to have it.

Sorry for being so wordy. Hope there's something here that might help you. Good luck and please keep us posted..

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