I realize no one on here can give me any personally specific answers for my situation for these questions, but I would appreciate ballpark answers (what the normal ranges are) so I know if I am being impatient or if I should be more forceful in looking for answers.
Here's my background so you know why I'm asking:
I inverted my ankle almost 4 months ago, broke the base of the 5th met, which took a long time to heal (over 11 weeks). I was in a fiberglass cast for 6 weeks, then an aircast boot for 6 weeks while waiting for my appointment with the ortho because there was minimal healing at 9 weeks. However, I also seem to have injured my tendons, with very bad burning/tearing pain when weight bearing under the cuboid area, and burning around the outside ankle. Foot and ankle are swollen. The ortho did all the foot tests (where he has you do things against resistance, etc.) and when I asked if they were torn, said no, but had inflammation (which I assume is tendonitis?). He prescribed a custom orthotic to take pressure off the cuboid area so I could weight bear without pain (hopefully), and told me to take anti-inflammatories and come back in 6 weeks. I get the orthotic this week, and am really hoping it makes me able to walk without pain, but don't want to get my hopes too high. I took it upon myself to also go to physio to get ultrasound etc. to help with the inflammation and am having that 2x a week. The ortho said when I see him at the 6 week mark (which will be 19 weeks after the injury) that he will put me in a weight-bearing cast to help with healing if it hasn't cleared up.
It doesn't seem to match tendonitis as anything I read says it is worse after inactivity, when getting up in the morning, and when moving the ankle in specific ways? Mine feels the best in the morning when I have been off my feet for hours, and when I rest it. It feels worse when I put weight on it, and when there's pressure in that area of my foot (e.g. with most shoes). I can do the ROM exercises with no real pain, though I cannot evert my foot fully and if I'm too enthusiastic, it will start burning in the outside ankle region. I had to buy 2 pairs of shoes, one 2 sizes larger than the other, and am wearing the larger shoe on my bad foot because of swelling but it still gets sore. I also have 1" of padding on the insole of the shoe for cushioning. Even with all that, I can't walk very far without the pain increasing. It's like walking with a big rock in your shoe that is cutting and tearing at the bottom of your foot. I cannot lift my heel off the floor, so walk by lifting up that foot and placing it, not rolling forward. I keep trying to walk "normallly" by rolling onto the ball of my foot, but it just won't do it.
I also have the weird thing of either my big toe is being pulled up and over (pressing on my 2nd toe) or else the middle 3 toes are being pulled down. I've actually had to put a cotton ball between the big toe and 2nd toe to relieve the pressure. I do have a mild bunion, but have never had issues with it, and this sensation is more pronounced when my foot is inflamed and burning (e.g. after trying to do some walking, or at the end of the day).
The physio also says something is "lower" in the cuboid area but wasn't sure what, thought maybe inflammation, and that my 5th met (at base of the baby toe) is higher compared to the other foot. I thought I was imagining things when I thought my toe didn't look right. It doesn't touch the floor on that foot anymore, and I can actually put my finger under it with no problem.
Neither the baby toe or the big toe are noticeably raised up or weird looking to look at it, just enough so that I can notice it. However the big toe does sometimes leave red pressure marks on the 2nd toe if I don't pad it.
So here are my questions (realizing that no one on here can diagnose me, but I just need to know if I am being impatient and whether I should wait for the 6 week follow up appointment or try to get it moved up, which I may not be able to get in earlier anyway):
1) Does this sound like peroneal tendonitis? If it does, how long should I expect it to be before the symptoms start to subside somewhat? I realize it's not an overnight fix, but am I being impatient? It's been 2 weeks with no change, even on strong anti-inflammatories, anti-inflammatory cream 3x a day, physio, and applying ice packs. It's been 9 weeks (since I started weight bearing) that I've felt the burning/tearing pain in the cuboid area which has made it difficult right from the get-go to walk.
2) If it actually is a small tear, do they normally heal on their own if not too big? (thinking if it's a tear, it can't be very big if he thought there was no tear) How long should I give it before pushing for further intervention?
3) Can you have a tear in a tendon and "pass" those tests where they have to you do things with your foot to see if it's weak or causes pain? He didn't ask me to raise my heel off the floor, nor did he press on the tendon path at all (which also causes pain in the cuboid area) but I don't know if those are part of the normal things an ortho would do when checking a tendon.
4) Why would the ortho suggest a walking cast as an intervention if I have trouble weightbearing, and after I'd been in a cast or boot already for 12 weeks? Is the foot casted in a position different than what I would have had for a fracture? I really dread the idea of another cast to be honest ...
I am also willing to pay for an MRI if it comes to that (long waiting list in my area), but will need to get my GP or the ortho to send a referral. It's expensive (almost $900) so want to use that as a last resort, and only if it will provide information not available in another way.
I have had multiple x-rays, and the ortho looked at one done at the 12 week mark. I realize tendon damage doesn't show up on x-rays, but he didn't look to see if there was anything else, at least while I was in the room.
I appreciate any advice anyone can give me. I realize no two situations are the same, but want to get more information before deciding if I should phone the ortho office asking to move up my appointment, esp. if it's not going to help anything. I'm trying to be as knowledgeable as I can about this as well so when I do go see him, I can ask intelligent questions about my particular case and treatment.
If whomever answers feels they cannot answer my questions, or can only answer 1 or 2, I appreciate your reading this anyway. I realize I may be asking more than is possible to answer on this type of forum.
The fracture healed finally, and now I want to get this part of this ordeal over. It's been 14 weeks, and my sick leave runs out in 3 weeks. I would NEVER have expected to be off this long from simply rolling my ankle. I am unable to do much of anything, as any time on my foot, even PWB with crutches, causes pain and burning to start, and it doesn't subside easily.
After doing NOTHING all day Sunday (and I mean NOTHING -- sat with my foot up the entire day), it is back to the "normal" level of hurting. I still cannot walk more than from one end of my house to the other and back (and it's not a big house) before the "rock" is burning and cutting. But at least it's not burning excruciatingly even with it up like it was the day and night before.
My hubby says maybe I'm doing too much ... If I do any less than I'm doing, I'd have to be dead. This is 15 weeks now, and it's getting really old.
If I need surgery to fix it, then I want it done NOW but I guess there are things the doctors need to try first .... Just fear that I'm sitting here for a total of 7 weeks for no benefit and will end up being told I need surgery anyway... However, I guess there's no way for the doctor to know if the 7 weeks will help or not until it's tried, so I shall have to be patient, hard as it is.
Even if no one can answer my questions, it helped just to be able to vent a bit. Thanks!
I also had a tendonitis in my right foot in July 2010, perhaps caused by a gout attack. I could not walk at all for two days , buy since I had to meet people , I had to hop around in town, (Edinburgh) with enormous difficulty. I kept taking Ibuprofen, with little effect. When in my hotel room, I put the ankle in very cold water (Scotand!) and the relief was instantaneous. However over the next few weeks the tendonites persisted. X-rays revealed nothing. I kept taking Ibuprofen , but ice or cold water seemed the best remedy for immediate relief, even if the tendonites did not go away. It lasted for about 8-10 weeks, until eventually it disappeared. Nevertheless, now and then I still seem to have light electrical shocks, (but not painful, even if worrying))in my right tendon.
In January 2011 I had another gout attack, but this time on the left foot, near the big toe, which has not yet disappeared, and which I am controlling with Ibuprofen and cold water, and I am also trying all other emedies (Cherry juice, baking soda). However nothing on my right or left tendon.
In my view, the gout attack damaged my tendon originally; when the attack ended, the tendon remained inflamed : so perhaps, there were two different problems with the tendon, a cause and effect,which required two different approaches.
Just wanted to update that I am still having issues, still major swelling, lots of tenderness and soreness around the lateral ankle (behind and below it). The physio can massage the tendon up the calf above the ankle, but it is extremely sore near the ankle and below it, and down around the cuboid bone. In addition, I also believe I have something with the OS peroneum as I feel a "rock" in my foot.
Having a CT scan next week to see what's what, as nothing is helping -- major anti-inflammatories, diclofenac cream, ice, physio (ultrasound, interferential, ice, massage)... I'm still using crutches if I have to walk much, still in major pain by evening, still have major swelling (so much so that if you press on the swelling, dimples remain ...)
I sure hope the CT scan shows what it needs to so I can get this dealt with. It's been 17 weeks since the injury.