|Impression Casts taken of a left sided PTTD showing the collapse inward of the heel and arch more than the right.|
|Removable Boot with EvenUp|
Dr Blake's comment: This requires further information Melanie. The boot, like the photo above, should have calmed the tendon down. Did it hurt just as much, 50% as much, hard to tell? There are so many factors that come into play with your injury. Normally, the below the knee boots are better than the mid calf or ankle high ones. They distribute the force of stability over a larger area. Also, with PTTD, normally wearing an arch support in the boot is crucial. If you do not have a comfortable custom one, get the heat moldable Sole supports soft athletic version (www.yoursole.com).
He also told me I had an accessory navicular bone.
|My most favorite OTC orthotic because I can adjust and you can heat mold if the uncomfortable out of the package.|
|This X-ray captured an Accessory Navicular Bone, also called Os Tibial Externum, or 2nd Ankle Bone. It forms around 9 or 10 years old, and can be painful by 16 years (my earliest patient at least).|
It seemed to get worse. ( no arch or foot support in the boot).
So off I went to the podiatrist. He gave me an a shoe insert. It didn't help.
Dr Blake's comment: One of the very crucial points I need to make to all orthotic wearers is why are you wearing them, and are they successfully fulfilling the purpose they were prescribed? Why did you get the orthotics? Pain Relief or better function??? Orthotics if done well should make the posterior tibial tendon work better, but maybe, just maybe, you are in the Immobilization Phase of Rehabilitation, not the Restrengthening Phase. So, a great orthotic device for PTTD can make you hurt a lot more just because it is being used to stabilize and restrengthen at a time you should be immobilizing and anti-inflammatoring. Not really sure if that is a real word!!! You are definitely in the removable boot with some sort of orthotic and arch taping period.
|Kinesiotape used as an arch stabilization tool.|
About a month ago, I slipped in the kitchen and twisted the ankle on the same foot with the PTTD. Since the initial fall I have rolled it two more times!
Dr Blake's comment: Once you hurt a major tendon, you body naturally protects itself. You can roll your foot to the outside which makes you more prone to sprains, or if a step will produce pain, you can just let the foot collapse/shut off and you fall to the ground. These scenarios are quite common. And, if they are happening to you, I can see why you emailed. It is very very frustrating.
I look like someone beat meup!
I keep spending money on shoes, inserts and I need some advice.
I started the tennis to lose weight, and I was.
Do I need a PTTD brace? I purchased some Orthaheel shoes but my foot for some reason gets to a weird angle in them.
I am doing the exercise you recommend for strengthening my ankles. I know losing weight will help me, but I need to know what to do so I can get back to tennis!
Thanks you so much!!
Melanie (name changed due to witness protection)
Thank you very much for writing. I hope some of my initial comments were helpful. Please feel free to comment on this post and I will try to respond reasonably in a timely fashion. To summarize:
#1 You are probably in Phase 1 of Rehabilation: Immobization and Anti-Inflammatory where you try to create a Pain Free Environment to let the tissue heal. We need to get you to that 0-2 pain level range for 2 weeks straight.
#2 You can try combining the boot and orthotic, but may have to get another boot or a different orthotic. You do not want to spend a lot of time creating this pain free environment.
#3 You should consider crutches, and even a RollAbout, for a short time, if that is what it takes.
#4 For the Anti-Inflammatory part, definitely start ice packing for 10 minutes three times daily. The ice pack can be placed in the boot and you walk around (multi-task). Consider anti-inflammatory meds, flector patches, and physical therapy for anti-inflammatory only (although you can send me a video of you bouncing on the trampoline). LOL
#5 Normally, if the accessory navicular is the source of pain, the pain will localize there as the symptoms die down.
#6 You should get (if possible) a baseline MRI of the ankle. It will show the rear foot also, and may give clues to what is broken. Hopefully, you strained but not tore the tendon.
#7 Since tennis is out of the question right now, consider elliptical or stationary bike, even some pool workouts will not irritate, as long as whatever you do does not irritate the tendon.
#8 One important bit of information I need to further advise regards pain. What produces it? How is it in the morning? See if you can write up and email the pain questionnaire from a previous post. Also, go through the various foot and ankle exercises described in my blog, at least the ones not requiring equipment, and tell me which ones are painful and which ones are symptom free.
Good luck. Rich
The mnemonic goes like this---
F Family History of similar problem? Frequency of pain (how often)?
A What is your Assessment of the problem (what do you think it is)?
What part of your Anatomy is involved?
I How Intense (use Pain Scale) is the pain? What Irritates (makes it
L With one finger, point to the exact Location of the worse pain?
E What Eases the Pain? Does the pain have an Electric sensation with it
D What has been it’s Duration (how long has it been going on)?
O What were all the events surrounding the Onset of Pain? Are there
any Observable skin changes?
P Pain Scale (0-10) Sleeping? Getting out of Bed? During Activity? End
of the day?
Q What is the Quality of Pain (burning, tingling, dull ache, sharp,
numbness, throbbing, pulsating, etc)?
R Is there Redness? Does the pain Radiate and where to?
S How does Shoe gear or barefoot affect it (or high heels, or various
types of shoes)?
T What have you done to Treat the problem? What Treatment has
helped? What Treatment has made it worse?
U Are there Underlying Health Issues (diabetes, osteoporosis,
arthritis, poor circulation, etc.)?
V Does the pain Vary (better at different times, worse at other times)?
W Can you Work? Were you injured at Work? Does this affect your Work