Foot Foot/Arch: Posterior Tibial Tendinitis (PTT)

[Motherbone]

Love the cat. When I was growing up we had a Siamese cat who lived for 16 years.
Man, I hate-hate-hate having to order new athletic shoes. Trial and error over and over.

 

[marieltha]

Just got new shoes. I researched the size guides, measured my feet as directed in cm, and I found big differences in the sizes, even for the same brand. Glad I measured.

In the pic above, I’m wearing the new Asics GT 1000 7 in a 10 1/2 wide. Biggest shoe I have ever bought! 8mm drop (difference between forefoot and heel). The orthotics will raise this.
In cm for length, it is the same as my very recently purchased Columbia water shoes (middle, purple, wet—just got out of the pool), which are a 9 1/2 B. 10mm drop I think; might be 8. These feel great walking in the pool. Until today, this was the biggest shoe I had ever bought.
The other is my old Asics GT 2000 5, size 9 B, which I dug out and started wearing when my Brooks Addiction (size 9 B) seemed too high in the heel, with a 12mm drop. These Asics have heavenly gel cushioning in the forefoot and the heel, and a 10 mm drop, but the toebox is too tight. LOL, I carefully slit the toebox mesh with my exacto knife to give my toes room until the new shoes arrived.

The Asics GT series are Stability shoes for Overpronators. The 1000 have bigger toe boxes and smooth mesh (no stitching over bunion).

My foot doctor advised me to go bigger to accommodate the Rx orthotics (being modified to lower the heel and make the heel softer). He also advised getting a wider width to accommodate not only the orthotics, but also my very high instep, as long as the heel fits. And I was focused on the toebox as I cannot have the bunion surgery until at least next year—have to get past the ligament sprain and way past the shoulder surgery.

I gradually break in a new shoe in the house. So far, the new ones feel really good. I will update again.

Thanks to all who shared their thoughts here and in my knee and bunion threads. The comments about new knees changing one’s gait seem logical.

 

[marieltha]

Update after Followup with OS

My followup was primarily for my RCR shoulder, but that, the recent PKRs, and ligament sprain are all intertwined with my ongoing foot issues.

Great news on the shoulder progress, so my balance walking should continue to improve.

He said the foot (PTT and bunion) are the same, of course. Left foot over-pronating, so I need to be wearing the firm arch supports as much as I can.

The sprained ligament has healed but my gait is off, so I am to practice walking with a longer stride. I had shortened it, he thinks, in response to the pain. Tried this walking in the pool yesterday and the gait is better. He thinks the pain I feel is because of the awkward gait. So he wants me to work on the gait and stride to see if these are, in fact, aggravating the knee/ligament/leg.

At my request, he added an Rx for lidocaine gel5% . I have been using 4% OTC. The voltaren helps the foot quite a bit (now using it on the ligament sprain knee also).
So but with a longer stride....

 

[marieltha]

My weekend Epiphany:
I refer to my husband’s side (85min) of our sleep number bed as the Plateau and mine (45max) as the Cloud. Yesterday I visited the Plateau to do hip flexor stretches—better than a mat on the floor , which I cannot use yet per the OS because the shoulder RCR is still recovering.
WHAT AN IMPROVEMENT IN MY GAIT after the hip stretches. First time since June I could do this stretch. I couldn’t do this on the right side while the then-sprained, now healed right knee ligament was healing. Doing it on only the left side made the right side feel worse. It was agony.
Bliss!

 

[marieltha]

Monday, Sept 30, 2019 Rx Orthotics Redo Update:



My foot MD sent my Rx orthotics back for a major redo after seeing my foot MRI.
Here’s the redo:
-The arch is still firm, but
-There is an additional layer of thicker, cushy foam over the arch, under the top layer, and
-There is a different, cushier layer of foam over the whole foot, and
-The additional hard heel has been removed, and
-The whole forefoot is now soft cushion and it bends at a better place for the mechanics of my feet.

Directions:
- I am to do a much more gradual break-in period for three weeks before returning to see him:
-One hour a day (not exercising) for Week One;
-One hour one day alternating with two hours (or >1, but <2) the next day for Week Two;
-Either repeat Week Two or increase the time on some days for Week 3.
Caveats: Go slowly. Decrease time if needed. Do not rush.

If before the next visit or by then, I feel like the heels are still too hard, then he will send them back and have gel foam spot cushions inserted into the heel.

Today, I wore them for the hour as directed in the new Asics shoes and they felt pretty good. Much better.

Note: All adjustments are at no additional cost.

 

[marieltha]

I think I overdid on Sunday (steep driveway with increased speed, longer time in pool, adding Fartkeks (Swedish term used by runners for adding short increases in speed), tout ca.

Feel better today. Added easy sitting or supine hamstrings and glutes stretches to my “return to normal gait” quest. Feel better.

Doing the ultra conservative break in of the revised Rx orthotics. So far so good. I think the altered mechanics of my foot/feet do contribute to the aggravation in the right knee because with the new orthotics in, both feet and both legs feel straighter.

Think my altered gait may have aggravated the bursa on the front inner side of the knee. Strengthening and stretching of muscles, tendons, etcetera should help this.
@Jockette , any thoughts about knee bursa?

 

[Jockette]

any thoughts about knee bursa?

No, but I think there’s an article about it in the library.

Here’s a link to the whole list of articles is the Bonesmart Library. Lots of topics there!
https://bonesmart.org/forum/threads/library-index.14830/

 

[marieltha]

Thanks!
Getting used to the new BS mobile format. When I open my thread to read a new post or response, it opens to my first entry. Then I have to get to the latest page. Something I’m doing or not doing? Using an iphone/ipad.

 

[Jockette]

Thanks!
Getting used to the new BS mobile format. When I open my thread to read a new post or response, it opens to my first entry. Then I have to get to the latest page. Something I’m doing or not doing? Using an iphone/ipad.

I have not had that issue, and I always use my phone. The only time I have to go find the end of the thread is when I want to reread something I’ve already read, or want to post a reply after I’ve read the last post.

Let me know if it continues. We are still figuring out this new layout.

 

[marieltha]

Let me know if it continues. We are still figuring out this new layout.

Today, I tested and both the iphone and ipad opened at the end/last post of the threads.

 

[marieltha]

May have spoken too soon @Jockette I just 5 duplicate alerts about a like from @Trmgrl3 .
Four show the same time. The 5th is a minute later.

 

[marieltha]

from knee.pain-explained online

I am finding this chart helpful for identifying the knee bursa location as I am working to improve my gait.
@luvcats tried to add this to our “ow” conversation and couldn’t find an attach files option

 

[Jockette]

Ok, things are new here. They will settle down.

 

[marieltha]

The “revised for more cushioning“ Rx orthotics are definitely better.

But,

I have dropped them off to be revised again for the addition of the “inset extra cushioning/gel” in the heels that the md recommended and his tech (? ! ?) deleted from the last redo (have not seen her in there since). I think that will improve them also.

I will update when I get them back.

 

[marieltha]

Quick update: I will see the foot md next week (not the tech) when the Rx orthotics return. He says he wants to see me walk in them (with the two recent revisions since he has seen me) before I do another trial. So stay tuned.

PS FYI, I’ve just posted an update in my knee recovery thread about sinovitis in my right knee. I think our hips, knees, ankles, and feet work as a team, perhaps a unit. Today, after knee treatment by the OS (different from the md foot dr) yesterday, and adding a new and better quad stretch, even the feet feel better.
Interesting aside, when I searched BS for sinovitis (new for me), lots of folks here (pre and post surgery, hips and knees, full TKRs and partials) mentioned accompanying symptoms (varied) in their feet.

 

[marieltha]

RX Custom Orthotics Update 11-4-19

Today, I got the latest version of my Rx orthotics. I went 2 weeks ago, but the dr didn’t like that redo, so they went back again.

Got them today. This version feels really good. There is an additional gray layer under the top layer in the heel, and inside that is a “gel spot”, so the heels feel much much better.

And LOL, the tech said the dr also had them “adjustthe right one (my right leg is my ever so slightly shorter leg) to make my legs even when I walk. My hips and glutes seem happier.

I forgot that when you get RX custom orthotics, each foot is custom/unique.

Anyway, I’m to very, very gradually work up to wearing them all the time and go back in 2 months.

PS In my Knee thread, I describe my recent return to the gym, starting with seated Octane elliptical and seated NuStep cross trainer (basically, big flat pedals you push forward). I miss fitness walking. Thank goodness I am walking in the pool.

 

[marieltha]

12-10-19 update
The left foot, with the posteria tibial tendinitis (PTT) partial tear, continues to look normal. I still have that dancer’s high arch.

The PTT pain has increased as I have transitioned to more walking and going to the gym. So, I got a cortisone injection in the PTT yesterday. The concern is that this will further weaken the tendon, but it is so deteriorated at the tear (hanging on by a thread), that the potential pain relief seems worth the risk.

After a few days of R&R from the injection, I am going to resume the pool walking and see I can manage better with that. @luvcats My OS does not recommend the elliptical even seated for me, and perhaps my knees agree with yours about the NuStep, so I’m off that for now. I can do short, slow stints on the treadmill, but the right knee is still recovering from the sinovitis(see knee thread), so I’m going to resume the pool and save my true weight bearing walking for daily living.

LOL. @Jockette Not happy with any of my shoes or @Macknit @Motherbone (one of you asked about these) the custom orthotics at the moment.
My OS thinks I will not be able to tolerate the hard orthotic (even though it is super cushioned now) with the PTT. When I put the custom orthotics in my shoes, I do feel like everything from the spine down is in alignment, especially the left hind foot which is endangered by the PTT, so I may—well, well, well after the injection sensitivity resides—wear them a bit in the house, but not for extended weight bearing. I go back to the foot MD in mid-January, and will see if he can redo the left one with firm inner padding and no hard layer.
I’m back in the Asics GT 2000 5 (10mm) shoes for now. Sometime in the new year, I am going to go to one of the stores that professionally measures your feet.

 

[Jockette]

My foot is back to it’s (weird) normal. My plantar fasciitis is gone. I get an occasional pain here and there, but nothing that needs a professional opinion. All I’ve done for it is wear my orthotic sandals 95% of the time I’m on my feet.

I’m probably more inactive than is good for my general health, but I’ll risk that to keep my knee and foot happy.

 

[Macknit]

@marieltha I'm sorry to hear of the continued issues! On the upside, Asics have been one of my favorite walking and workout shoes! My sons, in the Navy, go through them about every 3-4 months due to their running for workouts! Our feet must just be made for that brand!?

I ditched my orthotics, because they were pre-TKR and so far I've been OK. Well, maybe I should say my foot is OK! I've way over done my knee and have reverted back to a few pain in the night insomnia episodes, due to my extra holiday activities! Plus deciding to go back to my regular walking routine (it is a 5 mile-loop, I had been doing about 2/3rds of it with no problems, then this past Saturday I felt was the day to try the full thing)!!! ARGH-H-H! I definitely caused one of those regression lines on my recovery chart!!! Wrong decision!

I’m probably more inactive than is good for my general health, but I’ll risk that to keep my knee and foot happy.

This is why I keep regressing, as soon as I feel better...I've spent the last 3 years walking regularly, losing 45 lbs and really working on my general health. So I have this built in fear that I'm going to lose all that progress and maybe even do harm!? Instead, I've set my self back with the knee/leg and yes that is where I'm doing harm! What's a girl to do??
I'm going into work late today and give myself a little extra TLC with my ice machine!

 

[Jockette]

What's a girl to do??

I guess we can’t have everything. I’m doing what’s comfortable for me. I’ve never been a high activity person anyway. Between my poor outcome partial knee, and the foot issues I’ve had for over 6 years, I’m just trying to not cause myself any additional pain.

I forgot to mention earlier that I’ve been drinking a tea concoction every morning for the past 3 months. It’s one cup of green tea, 1/4 teaspoon of turmeric, 1 tablespoon apple cider vinegar (with the mother) and 1 tablespoon of local honey. I believe each of those ingredients have health benefits, and I’ve been able to wear sneakers recently with more comfort than I‘ve had in a long time. I’m thinking this tea might be helping with inflammation.