Foot Foot/Arch: Posterior Tibial Tendinitis (PTT)

[marieltha]

Motherbone,
Happy Birthday to your Leo!
And thank you.
You are in the Pre-68. See you in October in the Living 68 to the Fullest!

 

[marieltha]

Mainegirl, I wonder about your husband’s no pain yet a limp. I have been told that about 50% of the people who rupture the tendon experience pain relief (runners web blogs have many people who say the tear brought instant relief). The other 50% say it still really hurts. The problem w the rupture is that it often results in the deformity you described and all the subsequent gait issues.
I was told also that if I ever do need the surgery, to plan on 4-6 months....

 

[marieltha]

PosteriorTibialTendinitis Update
MRI Results
August15, 2019

I got my foot and ankle mri results. “Interesting.”

A healthy tendon on an mri is a thick dark line, like you drew it with a magic marker. On last year’s MRI, I couldn’t even find the sprained tendon (posterior tibial). There was a blurry grey area which meant it was very “deteriorated”.

This year, there’s a lovely black line! BUT then there’s a sort of white notch in it—duh, this is where it is torn, but still hanging on by a bit. Sigh. And of course that “notch” is the exact spot where it hurts. So I have succeeded in rejuvenating it, but tears don’t heal.

So the plan is basically the same, but changed a bit.

First, recover this year from the shoulder and knee surgery, and ligament sprain. Regain stamina.

Next year, fix (fusion) the bunion which will also remove the spur on it and correct the genetic misalignment that caused the bunion.

Change: Leave the first smaller joint in the big toe as is (no cartilage) as fusing both that in the toe and fusing the second, bigger joint below the toe with the bunion and spur would cause too much loss of range of motion.

Then “sometime” after that, have the ankle fusion surgery (subtalar arthrodesis) to restore alignment and correct function to the foot. Tendon repairs/replacements, I’m told, only have a 38% success rate.

I will do this before the torn tendon causes a foot alignment deformity and all the resultant damage, including a limp.

The change here is that this will probably be sooner than previously hoped. This surgery requires a long period of non-weight bearing (6 weeks), with a long recovery after that, so I have to get well past the shoulder recovery before doing this.

Hard to say when I will do this surgery. The tendon deterioration is usually a slow, lengthy process.

And LOL, if the tendon tears completely through, frequently, the pain stops.

Fifty percent of people feel immediate pain relief, I’m told. Other fifty still have pain but it is probably from the misalignment issues and other foot damage.

Every time you step/put your weight on your foot, it strains the tendon so it hurts because it is compromised by the partial tear. Distance runners frequently suffer from this.

But, even partially torn, it holds up the arch (and I have very high arches). Evidently we have 2 tendons that hold up the arch. This one on the inside of the foot which goes up into the calf and becomes a muscle. The other is one of three tendons on the outside of the foot. One of those goes under the foot and also supports the arch. I have already torn that one (long time ago—who knew?) and that doesn’t hurt. So my arch will be unsupported when this injured one tears.

Conclusion:
I’m okay with all of this. I’m walking in the pool every day now (in supportive water shoes). The ligament sprain is slowly healing.

The shoulder repair recovery is on schedule.

Both Partial Knee Replacements feel very good.

And each day, the legs feel better.

 

[Motherbone]

I'm ending week 3 of 6 weeks non-weight bearing for my stress fractures. Invest in a motor chair if you can afford it. You can PM me and I'll tell you what we bought and the cost. It has made a world of difference in accessibility around the house and tolerating the restrictions.

 

[marieltha]

Thanks! I tried to PM you @Motherbone, and got a window saying I do not have permission to do that. Could you PM me, please?

 

[marieltha]

@Jockette, looked up those very good looking Abeo sandals. In my future, I hope.

Right now, I invested in Columbia water shoes that tie, have arch support, nice thick soles like those on a running/hiking shoe, and big drainage holes. Big improvement. So I am continuing to walk in the pool and loving that.

I see the foot dr (Rx orthotics) this week and will get his feedback on the mri’s. In retrospect, I think I wore the new orthotics too much too soon after the surgeries. LOL, I think taking the pain meds right after the knee and shoulder surgery made me think erroneously that my feet were okay wearing them that much. Stopped for 2 weeks and am very slowly (1/2 hour a day) wearing them again.

 

[Jaycey]

Folks - could you please keep the conversation on the board? If you PM other members needing the same information will not see it.

 

[Jamie]

@marieltha ... I checked your account and found for some reason the block that allows you to PM members was not checked. That's fixed now, so you can PM.

But I'll second what Jaycey said. Discussions about recovery and things that work for you should be on the public forum so that others have the ability to see the information and learn from it. PMs are primarily designed to be for conversations that are of a more personal nature containing information you don't want in a public domain.

 

[marieltha]

Sometimes—for me, at least—it’s confusing as to what is information sharing and what could be considered medical advice.
Sorry, I’ve been dying to use that little pic.

So your extended explanation here helps. I’m assuming you can read pm’s? I believe @Motherbone shared personal info that perhaps she wouldn’t care to broadly disseminate (I do not presume to speak for her) and that I found very helpful.

The discussion concerned ways/devices to get around when one has “no weightbearing” restrictions after foot/ankle surgery. My future ankle fusion will entail no weight on it for 6-12 weeks!

I’m very difficult to fit for crutches ( tall adolescent boys come closest—I have long arms and legs, but am short-waisted; average height and size). So I’m researching alternatives.

So how about this:
Has anyone used the iwalkfree alternative to a crutch for foot/ankle surgery?

 

[marieltha]

I have another question for @Jockette and the whole community with foot issues and perhaps leg pain:

My question arises from my wearing my new watershoes (10mm drop I think—no higher) and loving them and then, when I put on my Brooks Addiction shoes(12mm), I find I’m uncomfortable—even my legs aren’t as happy.
When I add my Rx orthotic, my heel is even higher.

Question:
Do you find shoes with a higher or lower “drop”
(Difference in mm between forefoot height and heel/rearfoot height) more comfortable?

 

[Motherbone]

From what I've read, you need to have good balance in order to use the iwalk. In my case I don't have a good leg to balance on and I probably would have hurt myself trying to use the iwalk. I looked at a knee scooter but the same issue arises: I don't have a good leg to push with.

 

[Jamie]

If you didn't get new shoes and orthotics following your knee surgeries, then that could be the problem. The surgery corrects your leg alignment back to normal. Old orthotics would most likely not be correct any longer. And your old shoes have wear patterns associated with your pre-op walking patterns.

Many people no longer need the orthotics once they recover and start doing some strength training for their legs.

 

[Celle]

Has anyone used the iwalkfree alternative to a crutch for foot/ankle surgery?

From what I've read, you need to have good balance in order to use the iwalk.

How do you get on when you try to kneel? Some people find kneeling is uncomfortable after a knee replacement.

From what I've seen of it on line, using an iwalkfree would put all your weight onto the knee of that leg.
Although I can kneel for short periods on my TKRs, I wouldn't be prepared to put my full weight on one knee, so I wouldn't consider using the iwalkfree.

 

[marieltha]

@Jamie , thanks for fixing my pm, and sharing the shoe changes—very good point.
@Celle , and @Motherbone , thanks for the considerations about kneeling and balance.

After about 10 months, I could kneel on the first PKR. It didn’t hurt, but was odd, and I rarely did it. I wanted to use the mat at the gym, so I practiced getting down and up from the floor (rug) in the bedroom. Knelt briefly to get down. Did a sort of yoga Downward dog in reverse to get up. Haven’t tried the newer left PKR knee.

My OS is conservative/risk-aversive when it comes to things that might affect safety: insists only a walker after PKRs not crutches; waits a long time after surgery until he gives the okay for a treadmill (vs plain walking). So I expect he will agree with you.

I think it was in @luvcats thread that I shared that I was 67, but still felt 47. And now I’m 68 and feel 47-ish. So although my outlook remains youthful, I do every so often have to accept some “changes”.

 

[marieltha]

My 2 foot threads runneth over.....

FYI, in case you care to read this

I posted my visit to my foot MD (orthotics) on my other Other thread (HallusRigidus big toe and Complicated Bunion),
Includes my plantar fasciitis aggravation
return , ultrasounds, orthotics etc.

Too tired to move it here tonight.

 

[marieltha]

Here are the outcomes of the the Aug29th visit:
Saw my foot MD today.
He went over the foot and ankle MRIs that my OS had ordered.

He sent my Rx orthotics back to be modified.
The whole foot is less swollen than a month ago. Voltaren gel and walking in the pool have helped. But the plantar fasciitis tendon (pft) on the mri showed swelling and it has hurt again (off and on/chronic, really).

He did an ultrasound that measured the swelling in the pft. Very swollen. Did an ultrasound guided cortisone injection. My first. Ordinarily I would not do that in a foot, but honestly, it hurts, and if the impending hurricane comes near us next week, the drop in barometric pressure will make my arthritis and all my recent surgical bone sites ache.

It feels much better.

 

[marieltha]

9-9
Can’t believe how much better the whole foot feels.

 

[marieltha]

I put this in my knee thread, but it also applies here.

After my first PKR, I was gradually returning to a gym and walking on the padded rubber floor. And pool walking at home (it’s Florida). When “my winter” came (see definition below), I switched to the outdoor Y pool (heated 81 to 83), as we don’t heat ours (cost prohibitive). I was struck by how many pool walkers there were (pre & post surgery knees, hips, backs, feet), and how much better and faster they seemed to be recovering than those I saw at the gym.

Years ago, just as I was moving from Virginia, several of the PT places there were adding small pools with underwater treadmills! @luvcats , any near you?

My blood pressure is low, so 90 air temperature to me feels like 80 for most people. So “my winter” arrives a bit earlier. My OS said for people with arthritis, the ideal pool water temp is about 10 degrees above their body temperature, so for me, that’s 87. I stay in ours in the 80’s. As it drops into the upper 70’s, I add scuba diver socks, gloves, beanie, vest, etc, as I have osteoarthritis in my feet.
When I need a wetsuit, it’s time to return to the Y.

LOL, I grew up swimming in 50 degree Atlantic Ocean water! When it reached 60–once or twice in my childhood—everyone went in and stood there basking in the bathwater warmth!

 

[Jamie]

Man, I cannot imagine putting my body in water that is below 80 degrees on purpose.

 

[marieltha]

I will give my black cat, with her permission of course, extra hugs for all the BoneSmarties who do not have a black Nurse Cat

Foot is doing okay. Much better since the injection and using the voltaren gel 3x day and icing once (down from 3+).
Ordered new shoes: Asics GT 1000 7 in a bigger size. 10mm stability shoe designed for overpronation; has gel cushioning in the heel and the forefoot. Also waiting for my Rx orthotics to come back from being adjusted to lower the heel and make the heel softer.
(Note: I like the cushioning and 10mm drop of my old Asics GT 2000 3 , but they are old and the toebox is too tight and borderline too short . So I hope the 1000s, which supposedly have a bigger toebox, in a longer length will do the trick. I will let you know. I have used an exacto knife and slit the mesh in the toebox of the old ones to give the toes and bunions more room in the meantime, and moved the laces back towards the ankle (ie, not using the two holes near the toes) New ones expected tomorrow.