Thank you for spending your valuable time (for free) reading so many posts and helping people who want to resolve the inevitable suffering they are experiencing in their bodies.
I'm writing to address a general concern I have in my recovery process with Posterior Tibial Tendonitis. I'm a man, in my mid-thirties, and I live on the west coast. I'm 5'9" and weigh about 163 lbs. I have a healthy diet and adequate access to health care in my hometown. I have had very few foot problems in my life (shin splints once in high school from running on flat feet--orthotics cured this).
Anyway . . .
On April 1st, 2010, my orthopedic doctor (top in his field for hip arth.) performed a hip arthroscopy on me to repair a 12 year old labral tear. A couple of weeks after the arthroscopy around April 25th or so I began using a stationary bike to help with hip recovery (per the advice of the Doctor and PT). I have very low arches (almost no arches) and without knowing what I was doing, I began biking one to two times a day WITHOUT ANY SHOES : (. Towards the end of each 35 minute ride, I would feel a small amount of pain (2 out of 10) under the inner ankle bone (malleolus medialis), mostly on the right side. I kept biking not thinking much of it and it disappeared every time I got off the bike. I kept this up for about three weeks and then told my PT. He said that he thought I was getting tendinitis and should stop. This was May 20th. I stopped and the next day went for a half hour walk (which I hadn't done before). A few hours later, it was as if my ankles were on fire (maybe a 6 out of 10 for about 5 hours). The PT couldn't figure out what it was, specifically. Around June 15th I re-injured it. When I saw the hip Doctor around July 1st, he immediately gave me the Dx of Posterior Tibial Tendonitis and explained, thoroughly, why it happened. Around July 20th I re-injured it again, both times feeling that I had recovered and then doing too much activity.
So, July 20th, after the 2nd re-injury I threw my hands up and gave in. I was going to go through a slow road to recovery--carefully. By now the pain was under BOTH the malleolus medialis and just around the point where the PT attaches to the bone (in the arch). Standing for more than 5 minutes was extremely difficult and caused arch pain lingering for about 15 minutes after rest. Walking caused ankle pain for about the same amount of time after rest. The pain occurred in both feet but mostly on the right, however it sometimes switched back and forth with the same intensity (maybe a 3-4 out of 10) lasting more than 15 minutes after rest.
Things were rough. I wore orthotics in shoes religiously. I refrained from standing and walking as much as I could. I used Ibuprofen for about 9 weeks: 600mg. 3x/day, tapering off to 400mg. 2x/day and then none due to stomach pain. I now use herbal anti-inflamatory meds (Devils Claw, Boswellia, and Turmeric to name a few--they seem to help and do not upset the stomach). I did not wear a brace, nor did I use crutches. I performed my physical therapy conservatively and carefuly only a few times overdoing it slightly. It was not until a month later that I finally noticed a 10 to 15 % improvement. So that was a few days ago. I could stand on it slightly longer and walk on it longer as well. I was happy, there was definite improvement. I thought: "okay, maybe I'll change my expectation to being fully recovered a year or so from now rather than in a few months."
Three days ago I went to my PT who thought it was time to work on the hip again in a pool (without arch supports). I trusted he knew what he was doing. I didn't think about it. Re-injury number three!! Several hours later. I was in pain again -- arch and ankle. I think I might have lost about two weeks of recovery, maybe less, maybe more. So it isn't so bad, but it is really difficult with these re-injuries. I've decided to stop the PT visits for now and go back to my conservative management (home PT, stretching, 2 half hour thermal contrast baths a day, resting, and herbal meds.) I do not have the appearance of a bulging inner ankle that people talk of with more severe PTTD but it is obvious that I pronate.
The questions I have: How long have you seen this process go on for? Is there hope for full recovery with multiple re-injury PTT? Is there anything else I should be doing? Can I expect a very gradual recovery in a year or more with conservative treatment or is such a drawn out recovery strange or rare? Is it possible to walk barefoot again? Do you have any recommendations for me?
I apologize for such a long thread. I don't plan on having a continuous dialog with you--just a quick one, I hope.
So, thank you for taking the time to read or skim this. I appreciate it, any bit of information is welcome.
I would like to be able to give you meaningful advice, but without actually examining you and determining whether or not I agree with what was possibly a shoot-from-the-hip diagnosis, I really have no basis for responding to your questions with specific recommendations or prognosis. It is simply beyond the capability of a forum responder to adequately address your issues, but it is certainly not only within the purview of the attending to supply you with these answers, but is his/her duty. If you are not getting the information and the results you desire from your doctor, you need to consider a second opinion based on examination and re-evaluation.
__________________ Foot Doc
Last edited by FootDoc; 10th September 2010 at 02:44 PM.
Hello again Doctor,
Thank you for taking the time to read my post. I will see my hip doctor in a few weeks and pose some of these questions to him. When you said "shoot-from-the-hip" (no pun intended?), I would tend to agree. He listened to what I had to say about my foot but did not do a physical examination. Perhaps I can ask him to perform a physical examination rather than Dx me from an oral report (he's a hip man and his primary examination when I see him is to check and see how the labral repair/chielectomy is doing).
In terms of my other questions to you, I understand that you prefer not to answer questions about specific foot problems and would like writers to ask specific questions to their own doctors. However, you will answer general questions. So rather than these being questions about me specifically, could you answer from your general experience the following:
What frequency of patients do you see with posterior tibial tendonitis or for that matter, other forms of foot tendonitis who avoid surgery but have a very long recovery, say a year or two, and fully recover? Is this rare/common?
When is it, in your experience, that a foot tendon is beyond the body's repair and surgery is necessary? I ask this because I have a feeling that people are busy, working and moving around and expect to get better from a foot injury but they continue to prevent it from healing because they operate as if they are not compromised (especially with tendon issues because the tendons are slow to show immediate pain/damage and thus people unknowingly re-injure themselves). The result is impatience and the desire for a quick fix like surgery.
Again, thank you for your time and energy in answering so may questions from your forum.
Does Anyone else have any bright ideas?
Any recovery stories out there on how best to recover from PTT without surgery?
Are there any recommendations for what to do at this point from others on the forum?
Any information would help.
Generally speaking, orthotics that provide greater support to the inner arch will help. This eases the tension on the PTT. When you bear weight and/or step off, the PTT tenses. In a relaxed state, it will be under less tension with a high inner arch support than it will without.
i had to have the surgery. i could have prevented it (I believe) if I'd gotten orthotics sooner (i have high arches and need HIGH arch support). Long story - and in another post - but my PTT tear was brought on by a different surgery (plantar fascia release many years ago wherein the doc cut partially across the fascia to prevent heel spur recurrence - which worked, but was the primary cause of the eventual PTT tear over about 15 years).
Anyway, if you have high arches, then yes, I recommend orthotics FROM A DR, and NOT Dr. Scholls.... (nothing against those, but you need a podiatrist to prescribe because he will do so based on your foot and your condition, i.e. PTT issues, not just a fancy footprint on a machine).
If your PTT problems are farther along, then immobilization is probably in order. While it's great to jump on crutches to remove the weight bearing aspect, that may not be entirely necessary (yet) - a walking boot which inhibits flexion and extension of the PTT will really probably help. Again, depending on how advanced your problems are, the Doc may still Rx crutches AND immobilization - for the fastest and most complete healing. Inconvenient, yes, but better than ending up under the knife. Trust me on that one, I didn't heed the symptoms and paid the price - surgery. And it sucks.
So, yes, PTT issues: Orthotics from a Foot Dr or Ortho, then maybe also walking boot, then also crutches on top of that. All to prevent the need for surgery. If you can get it healed up before a tear occurs, then you can prevent recurrence with just Orthotics by themselves.
All based on my personal experience, I'm not doc, so take it with a grain of salt.
I am a 30 year old about a year and a half in from developing PTT. I was ignoring my body's warning in the form of shin splints and was running 3-5 miles 5 days a week. I suffered a soccer injury in high school which eventually led to shin splints and progressed into PTT. I am naturally a little heavier and rely on cardio to keep the weight off. (Went from 170 to 195 since the injury...) I have tried P Therapy, seen a sports med specialist and now wear superfeet inserts for arch support. The inserts help with my low arch but have not solved the problem. It doesn't seem to matter if I give the foot complete rest for 2 weeks or 6 months, the injury rears it's ugly head each time I try to jog any more than a half mile. I've resorted to the elliptical and stationary bike, but have experienced enough pain even on these to restrict how much time I spend on each workout. I'm afraid the answer may be a complete life change by using swimming or some other cardio method. I'm intrigued by some of these new "stable" rocker shoes that provide a lot of cushion but restrict side to side movement (like the Z-coil or Ryn brands). I haven't tried any yet but would love to hear if someone else has.
Have you gone to a foot and ankle specialist lately? Do you have tendonitis or rips in the tendon? Rips will not heal. Two years ago, I had posterior tibial tendonitis. It eventually progressed to a partially ruptured tendon despite wearing good shoes eith orthotics and eventually wearing an arizona style brace. I had flat foot reconstruction surgery about 8 months ago. My surgeon does NOT want me wearing one of the stable walkers as they can put increased strain on the achillese tendon. You may be best served by seeing a doctor to determine the condition of the ptt and find out if he feels that the stable rocker would be safe to use. Good luck
Like the rest of you I am really struggling with the time this PTT is taking to heal! I am a dance professional and have pulled back on all non-essential activities for 16 weeks! There is some improvement in that I can walk without pain, but any kind of barefoot activities just sets this off. I am very concerned as I return to my teaching responsibilities tomorrow, and this is simply not supporting my leg and still painful. It seems like people have been talking about a year or more to recover fully. I would be really interested in hearing techniques for speeding recovery and also rationale for why this particular tendonitis is so slow to heal. Thank you.