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Friday, February 14, 2014

Friday's Patient Problem of the Week: Ankle Swelling from Psoriatic Arthritis

This was a comment on my You Tube Channel. 
Dear Dr Blake:
I have a small circle of swelling that my doc said was over the posterior tibial tendon right in the posterior arch towards the edge of my foot. He said it doesn't feel like a fibroma and my MRI was normal, but three months later, I still have it, same size. Went to a second doctor for a second opinion and he said it was edema. I've had it for three months now. MRI was apparently normal and so was my Xray. I'm doing electrical stim and physical therapy for flexor hallucis longus tendonitis and peroneal tendonitis. I also just found out I have psoriatic arthritis. They're starting me on methotrexate and prednisone soon.

 Crazy how these autoimmune problems like to go after my feet! Anyways, do you know how to break up some of the scar tissue or swelling or whatever it is in that area?
Dr Blake's comment: Any inflammation of the ankle joint tends to collect fluid on either side in the back or front (depends where the loosest part of the ankle joint sac is). I am glad the MRI showed no damage, and I share your frustration with the swelling. Your therapist would be the best at telling where to massage and not irritate the nerves in the area. However to work on the swelling, see if the therapist will give you a version of Tubigrip. See the video below on RICE for ankle sprains and try to develop some easy home program. 




 Are there any gels I can put on it? 

Dr Blake's comment: I love ice packs and contrast bathing the best to do on some regular basis that fits into your routine. The most common prescribed anti-inflammatory gel is 1% Voltaren Gel that your doctor must authorize. Even though it is topical, you do get drugs into your system and that may not be a good idea if you are taking other drugs. One doctor should be in charge of all your drugs, and one pharmacist involved with all your drugs. 


I'm surprised neither of my doctors had any advice on this as it's killing me every time I put on a shoe because it rubs on the little swollen area. With peroneal tendon orthotics, it's really hard to find shoes that don't either rub the peroneal tendons or this little bump the wrong way other than crocs, which are tough to go to classes in the winter in! 
Dr Blake's comment: This is different since you do have pain with pressure. Silipos sells various gel sleeves that may be a great help to you in taking the pressure off the shoe. 

http://www.silipos.com/Products/Orthopedics/Sleeves-&-Wraps/Malleolar-Sleeve

Also, do you know if methotrexate helps with tendonitis pain at all? I don't know a whole lot about all these meds or conditions because I was just diagnosed at 25 friggin years of age, but I'm having a hard time balancing a doc who's very optimistic about the tendonitis/arthritis treatment with an ortho guy who keeps telling me sometimes tendonitis just "never gets better." Scary thought, especially since even walking is really painful right now! any help or advice appreciated!
Dr Blake's comment: Please see the link below. It describes the positive affect of methotrexate on tendinitis. 

http://www.ncbi.nlm.nih.gov/pubmed/19609527

Also, all of my patients with psoriatic arthritis seem to do just fine. You have to manage the disease well, and as early as possible, and expect a long life. Here is one link that seems to back that up.

http://www.ncbi.nlm.nih.gov/pubmed/23264338

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.