I am writing to you for I failed rehab after peroneal tendon repair (approx 20 mos ago)
I finally got fitted for custom orthotics at Davis shoes after an unsuccessful attempt at another orthotic place the last two months
Arnie n Michael fix up my presurgical orthotic so that I have something while they work on my real one which will be ready in several weeks.
My problem is not just fallen arches; now I understand why I struggled everyday after returning to work post surgery in superfeet
My question is what is a bad pain? My first day with this orthotics; I am better than I have been since 1/2012.
Dr Blake's comment: See my post on Good vs Bad Pain
Tonight, my legs are achy (deep) after rolling
The temporary orthotic seem to help my surgical ankle -no burning up laterally to my butt; just stings in ankle joint, but I have pain in nonsurgical inner ankle which I started to experience back in 4/2012; post tibial tendinitis
They tell me to ease into this but I am a Neonatal ICU nurse who is on her feet 8 hours (duration of my shift)
I need some help in making better choices to heal my body
Thank you in advance
Amanda (name changed)
And here was another early email
Good Morning Dr Blake,
I am writing to ask about gait training ...
I had peroneal tendon surgery 7/1/11(slipped in water n fell onto my ankle bone on 12/20/09; didn't know about torn tendon til 8/10)
5 mos (12/1/11) after surgery I returned to my job as a neonatal ICU nurse/12 hrs shift; I had problems almost immediately; I decreased my hours to 8 hrs shift at end of 1/2012 and I continue to struggle all of 2012. My surgeon recommended superfeet before n after surgery
I used superfeet n presurgical custom orthotic through out my journey. I did not realize that my problem was more than just fallen arches n lack of strength
I was at my worst by winter of 2012. I could not bear weight on my L side. My surgical ankle showed it's problem by sending burning pain up to lateral calf as well as to hip n butt
I now have a temporary orthotic from Davis shoes n can see that I don't push off with my big toe; burning to hip only happens at 6-8 hours
My podiatrist thinks it's time for EMG
I don't have auto immune disorders; just chronic pain from shoulder injuries a decade ago
I don't believe I need Lyrica
I started a PT program for core strength ( Pilate on reformer) in Jan 2013; has help me some
I think that I am doing something very wrong
So, this am I am thinking gait retraining is important
Dr Blake's comment:
Since you are in a painful state, you really should be in some form of brace for standing/walking, and then gradually restrengthen your peroneals. You probably have some nerve pain, but does icing at least temporarily calm down the pain? Watching you walk and then prescribing the right shoe inserts is crucial. But, you will still need to get very strong. Do you have alot of scar tissue? What does the PTs say is the reason you hurt? What do your doctors say? Any information is appreciated. Rich
Dr Blake's comment: Therabands are a very difficult exercise to do correctly and can take a skilled podiatrist and/or physical therapist to help you do it correctly and safely. Here is the link most likely to help.
Good Morning Dr Blake,
I spent Sunday reading your blog, contrast bathing and trying the peroneal L/B Thera band exercises, stretching my Achilles w excercise band for 45 mins, compression sleeves and staying off my feet, etc
Is it normal/ok to have this slight pain at the end range of exercise behind ankle bone?
Dr Blake's comment: Yes, and it is totally fine. You should avoid the end range of motion in either direction as you do the therabands. It is where the internal tissue is either too stretched (in one direction) or too compressed (in the other direction).
Is it okay to kick in the pool by swimming or be in water exercise class if I am having pain?
Dr Blake's comment: Again, the article on Good vs Bad Pain should be memorized. You must know the difference to rehab correctly.
I had no/minimal symptoms on R (surgical foot) when I wake this am
Burning pain left me during class but left side flared after deep water exercise class/ after my 8 hour shift on Sat; from ankle to ribs. Inner ankle to outer ankle like where perineal would be contrast help some but too uncomfortable for compression after so i just try to roll; stretching the Achilles for 45 mins at midday on Sun did help all the symptoms from my mid back/ribs/ inner thigh/knee pain
Does tight Achilles cause you pain straight down around your ankle bone?
Dr Blake's comment: Yes
I don't feel much stretch when I try this prolong stretch to my surgical ankle
I think that I am not getting it deep into or behind that bone
I have always had that problem
I also did not tell you about my bunions; R worst than L
Only had pain in that joint when I wear high heels which was very rare
Dr Blake's comment:
I had the absolute pleasure on seeing Amanda as a patient, since she lives locally. Amanda has what 10% of the population has, over supination. This motion was not really helped by her orthotics, so I adjusted them. Excessive supination as shown in the links below is devastating on peroneal injuries since the peroneal tendons must stabilize the ankle and resist the over supination. By controlling the excessive supination, the peroneal tendons should not have to over work and her symptoms should improve. I was able to see that she had Peroneus longus weakness, no achilles tightness, no scar tissue issues, and stable shoes. She should do just fine.
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