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Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Posted by salina on 8/20/00 at 13:22 (025884)

First, I have to thank Nancy for mentioning 'the long version list', I didn't know you could do that. And I found the responses to a subject from several days ago.
I read about posterior tibial tendonitis, and in some ways this seems to be closer to what I experience than actual PF. And I don't have 'first step' pain. Actually, I HAVE to keep resting for periods throughout the day, then can jump (well, maybe not jump) up and do some work, etc, then have to rest again. My feet are stiff though if I don't use the night splints. My arches are really painful upon touch. But right foot has what I think is 'the spot' yall talk about, where the fascia attaches to the heel. It is painful on the inside of the foot, right where the arch is touching the heel, so I am assuming that is 'the spot'. When I asked the doctor, he said PF and posterior tibial tendonitis are treated in the same ways, orthotics, rest, ice, taping and such. And I think I read that this is true. But if I don't get any better with these initial treatments and physical therapy, what next? What tests can be done to see what exactly I have? I am definately going to continue with these treatments, and then maybe get casted for four weeks if this fails. But if it does come down to some type of surgery later on, aren't the surgeries totally different? I woulnd't want anyone cutting my fascia if that is not the actual problem, or vice versa. The surgery for the tibial tendonitis is even more scarier though. Can you help me to understand how I can be for sure what it is that I have? thank you so much.

Re: Thanks for the input Randell :-) eom

Kim B. on 8/04/00 at 12:15 (024684)

eom

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

alan k on 8/20/00 at 15:00 (025888)

Hi Salina!

We've missed you.

Probably the two conditions are closely related, and it seems from your description that you do indeed have tendonitis in your plantar fascia or some separation from the heel bone. The whole structure gets tight, and all the connectred parts are effected. Probably there is muscle tightness higher up in the leg as well, in the soleus and gastrocs.

Press firmly with your thumbs into the calves, all around and especially to the sides of the achilles tendon between your heel and the 'fat' part of the calf higher up. Are there any spots that are strangely sensitive?

There are a lot of things you can try so don't get thinking too much about surgery. You should ask the doctor about what surgery he is thinking of. Usually they won't jump into surgery for ptt in the absence of a rupture, which it appears you don't have from what your doctor was saying.

Also, I remember you had horrible doctors, worse than mine. Did you find someone more trustworthy, informed, and informative? If not, don't even think about getting cut until someone more responsible is looking over the situation.

keep us posted,

alan k

http://www.acutai.com


.


Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Nancy S. on 8/20/00 at 15:21 (025890)

Salina, do you have any other symptoms you haven't mentioned? Any swelling anywhere? Exactly where do you feel pain when on your feet and where you touch (besides arch)? Anything in the ankles?
My oddball and constantly changing PF gait was apparently the main factor in my developing tendonitis. I have achilles, peroneal, and posterior tibial tendonitis -- 3 in 1. And it does feel like 1 -- I have trouble distinguishing among the three, since they're so close to each other and cause similar swelling and pain.
My new and great sports med. dr. says he wouldn't even consider surgery for this, and he knows plenty of orthopedic surgeons who wouldn't either.
The aircast on the worse foot is helping me, and so is physical therapy -- my doc's script for PT included all 3 tendonitises in both feet/legs, plus the PF in my left foot. And it IS helping -- consists mainly of phonopherisis (ultrasound, driving steroid anti-inflammatory into the inflamed areas through the skin), massage (hurts but is becoming noticeably less so), and heavy-duty icing at the end.
So I want to encourage you, Salina. I've had PF for 15 months and the tendonitis for about 4-5 months, and the doctor (kindly) pronounced my case 'bad.' But the aircast and the PT, plus home stretching and icing, are definitely making a difference. I'm optimistic. So I urge you to focus on PT and a reasonable home regimen, and not to worry that they won't help unless it turns out that they don't. My dr. said it is only the rarest of cases that call for surgery, and it doesn't sound to me like you qualify as rare yet -- at least as far as foot problems go! No doubt you're rare in many other, pleasing ways! Take care --
Nancy

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

salina on 8/20/00 at 15:46 (025891)

Thanks Alan, i think the confusion is just getting to me. I am definately way away from considering surgery. I have just had four different pods all tell me that since I have normal arches and normal feet, no high arches and no flat feet-that sort of thing, that i should be getting better just by wearing normal arch support. This last doctor I saw last week ordered custom orthotics and i get molded for those on the 24th. Hope they help. He just really thinks its a simple case of needing complete (like casts) rest for several weeks, to let my arches heal. But I am in a situation right now where that isn't possible, yet. Hopefully soon though.
My calves seem to be always on the verge of cramping up. I stretch every day, trying to keep them limber. The night splint helps.
Also, how are you doing with your PF? Are you faithfully exercising your feet and body with the product on acutai? By the way, my husband looked over my shoulder while I was on your website, and he got excited thinking i was ordering some type of bedroom type contraption. Men!!! Although.....hum... ??? Serious question- it looks like the toe loops might slip off too easy when in the middle of an exercise. Is this not the case? Do they stay on your toes pretty good without slipping off? I am trying to get seious with exercising my feet every day. My left one seems to be responding well. But that darn right one actually feels weaker in the arch (or just more inflamed), but I am going to stick to it. thanks again.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

salina on 8/20/00 at 16:07 (025892)

Hi Nancy, I am glad the doc is sending me to physical therapy, starting next week. My calves get cramps, and feel tight whenever I do have to walk any amount more than usual. When I press on them, I dont really feel any particular sensitive spot though. My right foot swells up every day, along the inner heel and arch, but I keep icing and that helps. The left foot doesn't swell up and just feels slightly achey if I overdo it. I just love my left foot, I think I would lose my mind if it was acting up like the right one. Also, on my right one, I can't flex my big toe back as far as the left one. I compare them every day and there is a big difference.
Does anyone know if this means anything or not? It seems to be getting some more flexibility back to it, but I think I messed it up again one day while stretching. I got mad and sort of thought I would press on it and MAKE it flex like I wanted it to. So much for aggression, i had to ice the entire rest of the day, and my foot throbbed allnight. Maybe the physical therapy will help in showing me how to do stretching correctly. My temper gets the best of me at times with this. Maybe I need a shrink more than PT, huh? I think I need some anger management classes to help deal with this. One day I swear I taped my feet so bad my toes went blue, threw on some Asics running shoes, and got all the way outside, ____bent on running around my block til I fell out from exhaustion. The only thing that stopped me was my oldest son said, 'You goin runnin?' and I realized how silly it even sounded, 'Me' and 'Running' The two thoughts together just don't even make sense anymore. So sad. But at least I did stop, go back inside, cut the tape to get life back in the toes, and slid right back in my birks. Enough about me. thank you, nancy, and I am hoping the air cast does the trick for you.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Dr. Zuckerman on 8/20/00 at 17:10 (025898)

Just had a patient with severe pt tenodonitis who also ahd pf. The exmaination is the key. The relief this patient had before seeing me was an air cast used for ankle sprain. This controls the motion that we call eversion and inversion in foot talk. This motin also aggravated pt tendonitis. You are the second patient this week that has so much pain that they told me that they were angry. Pain can make you do anything. You need to see either a podiatrist who know alot about Posterior Tibial Tendon Dysfunction (there actually is a specific name for this). I would get an mri if nothing is helping.
There are standard orthosis and or braces for this condition to help it to heal.

Re: toe exercises

alan k on 8/20/00 at 18:43 (025901)

The loops don't come off because they are partly woven rubber and crimp on. Plus, there are different sizes for small feet, but even if they were too big you could fold them over, and part of the work of the toes would be in gripping the resistance bands. So any way you look at it this is not a problem, but actually is a help to using Acu-Flex.

Acu-Flex gets the blood flowing in the feet and if combined with proper massage and stretching (Acu-Flex is also the best stretching device) will take the pressure off of a sensitive planter fascia with the corrective effects it has on foot stability and biomechanical balance of the muscles.

Your sensitive and cramped calves are a good sign that you have a problem with a lower leg complex involving muscles, tendons and the plantar aponeurosis. Massage, stretching, and strengthening should help a lot.

My pf is better through these exercises, but exercises have only partly helped my tts. Still, I'll take it!

yours,
alan k

http://www.acutai.com


.


Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Nancy S. on 8/20/00 at 18:57 (025904)

Salina, I almost did what you did one day, except I didn't put on my any gear. I just sat here thinking maybe I'll just do that, go out and run through the woods till I can't run anymore, and enjoy the freedom -- and then be sorry for months afterward. I don't know if I stopped myself, by myself, or it was the thought of someone like Kim, 'Queen of a Small Nation,' who might slap me around with a large trout!
I saw a (cheap but good) counselor for a short while in the spring to get OUT some of my grief and frustration, and it did help.
A good physical therapist should be able to help you with the toe flexibility problem, among other things. I'm on a much better road since starting PT and then finding this good sports med. dr. -- only took 14 months since foot problems began to find these people!
I am getting Alan's Acu-flex. I think I'll be ready for it in about two or three weeks.
Take care, and keep listening to your son -- he probably had just the right tone in his voice, eh?
Nancy

Re: Thanks for the Info: Dr. Zuckerman, Alan, and nancy. eom.

salina on 8/21/00 at 14:31 (025928)

eom.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

dfeet on 8/21/00 at 16:11 (025939)

Hi, salina. Have you been officially diagnosed with Post. tibial tendonitis? I've experienced similar symptoms, with the swelling neat the arches, weird sensations down to my big toe, etc. My MRI showed that I had ruptured my Plantar fascia in the right foot, but also showed bilateral flexor hallicus tenosynovitis-from what I was told this is a component of diagnosing Tarsal Tunnel syndrome. I then had a neurological evaluation which confirmed Tarsal Tunnel in both feet, coupled with the PF in the right foot. Your signs and symptoms give me a deja vu. My advice is to get some more testing done and seek out a great Physical Therapist to help you along. Most often the PT is the one who can really aid in helping assess your condition before the doc, because you see him/her on a regular basis. Good Luck-dfeet

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

salina on 8/21/00 at 16:50 (025944)

Thanks, I start PT this week. My doctor told me the loss of flexibility in the right big toe was just from the inflammation and fascia being so tight, and will go back to normal when I heal from the PF. I have not walked like a normal person in nine months either. I sort of just place my right foot pretty much flat on the ground, instead of walking heel to ball releasing off the toes like a person normally does. But I think I read where Nancy was told by her therapist that she needed to practice walking more normal, to help restore flexibility in the achiles area also. So I am purposely trying to walk at a more normal gait, especially now that I am exeriencing leg cramps and a tight achiles. Seems like one thing leads to another. I am very positive about starting therapy. I am making a list of things to ask him or her. The doc just pressed on different areas and asked what I felt, and seemed to think it was just PF only. But I am writing everything down from now on. Whenever I get a weird pain, or sharp, unusual pain, whatever, I am writing it down exactly how it feels, what I was doing at the time, etc. so I don't forget what to say to the doc on the next visit. Maybe he can better assess my problems that way, and request tests be done. thanks again. and best of luck to you on dealing with this.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

john h on 8/22/00 at 09:18 (025993)

many months ago while visiting my doctor i inquired about whether my pain might be associated with post tibial tendonitis. he said no that the PF type pain where the fascia attaches to the heel is not symptomatic of post tibial tendoitis. i think that it is easy for many of us to look for some disease process beyond the obvious (me included). sometimes if it looks like a rabbit, jumps like a rabbit, and has big ears like a rabbit that it may be a rabbit. i am not saying that many do not have tts,post tibial,stress fractures, etc but be careful not to overlook the obvious. if you have 1st step pain or pain where the fascia attaches to the heel the most common cause is going to be PF.

Re: Thanks for the input Randell :-) eom

Kim B. on 8/04/00 at 12:15 (024684)

eom

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

alan k on 8/20/00 at 15:00 (025888)

Hi Salina!

We've missed you.

Probably the two conditions are closely related, and it seems from your description that you do indeed have tendonitis in your plantar fascia or some separation from the heel bone. The whole structure gets tight, and all the connectred parts are effected. Probably there is muscle tightness higher up in the leg as well, in the soleus and gastrocs.

Press firmly with your thumbs into the calves, all around and especially to the sides of the achilles tendon between your heel and the 'fat' part of the calf higher up. Are there any spots that are strangely sensitive?

There are a lot of things you can try so don't get thinking too much about surgery. You should ask the doctor about what surgery he is thinking of. Usually they won't jump into surgery for ptt in the absence of a rupture, which it appears you don't have from what your doctor was saying.

Also, I remember you had horrible doctors, worse than mine. Did you find someone more trustworthy, informed, and informative? If not, don't even think about getting cut until someone more responsible is looking over the situation.

keep us posted,

alan k

http://www.acutai.com


.


Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Nancy S. on 8/20/00 at 15:21 (025890)

Salina, do you have any other symptoms you haven't mentioned? Any swelling anywhere? Exactly where do you feel pain when on your feet and where you touch (besides arch)? Anything in the ankles?
My oddball and constantly changing PF gait was apparently the main factor in my developing tendonitis. I have achilles, peroneal, and posterior tibial tendonitis -- 3 in 1. And it does feel like 1 -- I have trouble distinguishing among the three, since they're so close to each other and cause similar swelling and pain.
My new and great sports med. dr. says he wouldn't even consider surgery for this, and he knows plenty of orthopedic surgeons who wouldn't either.
The aircast on the worse foot is helping me, and so is physical therapy -- my doc's script for PT included all 3 tendonitises in both feet/legs, plus the PF in my left foot. And it IS helping -- consists mainly of phonopherisis (ultrasound, driving steroid anti-inflammatory into the inflamed areas through the skin), massage (hurts but is becoming noticeably less so), and heavy-duty icing at the end.
So I want to encourage you, Salina. I've had PF for 15 months and the tendonitis for about 4-5 months, and the doctor (kindly) pronounced my case 'bad.' But the aircast and the PT, plus home stretching and icing, are definitely making a difference. I'm optimistic. So I urge you to focus on PT and a reasonable home regimen, and not to worry that they won't help unless it turns out that they don't. My dr. said it is only the rarest of cases that call for surgery, and it doesn't sound to me like you qualify as rare yet -- at least as far as foot problems go! No doubt you're rare in many other, pleasing ways! Take care --
Nancy

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

salina on 8/20/00 at 15:46 (025891)

Thanks Alan, i think the confusion is just getting to me. I am definately way away from considering surgery. I have just had four different pods all tell me that since I have normal arches and normal feet, no high arches and no flat feet-that sort of thing, that i should be getting better just by wearing normal arch support. This last doctor I saw last week ordered custom orthotics and i get molded for those on the 24th. Hope they help. He just really thinks its a simple case of needing complete (like casts) rest for several weeks, to let my arches heal. But I am in a situation right now where that isn't possible, yet. Hopefully soon though.
My calves seem to be always on the verge of cramping up. I stretch every day, trying to keep them limber. The night splint helps.
Also, how are you doing with your PF? Are you faithfully exercising your feet and body with the product on acutai? By the way, my husband looked over my shoulder while I was on your website, and he got excited thinking i was ordering some type of bedroom type contraption. Men!!! Although.....hum... ??? Serious question- it looks like the toe loops might slip off too easy when in the middle of an exercise. Is this not the case? Do they stay on your toes pretty good without slipping off? I am trying to get seious with exercising my feet every day. My left one seems to be responding well. But that darn right one actually feels weaker in the arch (or just more inflamed), but I am going to stick to it. thanks again.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

salina on 8/20/00 at 16:07 (025892)

Hi Nancy, I am glad the doc is sending me to physical therapy, starting next week. My calves get cramps, and feel tight whenever I do have to walk any amount more than usual. When I press on them, I dont really feel any particular sensitive spot though. My right foot swells up every day, along the inner heel and arch, but I keep icing and that helps. The left foot doesn't swell up and just feels slightly achey if I overdo it. I just love my left foot, I think I would lose my mind if it was acting up like the right one. Also, on my right one, I can't flex my big toe back as far as the left one. I compare them every day and there is a big difference.
Does anyone know if this means anything or not? It seems to be getting some more flexibility back to it, but I think I messed it up again one day while stretching. I got mad and sort of thought I would press on it and MAKE it flex like I wanted it to. So much for aggression, i had to ice the entire rest of the day, and my foot throbbed allnight. Maybe the physical therapy will help in showing me how to do stretching correctly. My temper gets the best of me at times with this. Maybe I need a shrink more than PT, huh? I think I need some anger management classes to help deal with this. One day I swear I taped my feet so bad my toes went blue, threw on some Asics running shoes, and got all the way outside, ____bent on running around my block til I fell out from exhaustion. The only thing that stopped me was my oldest son said, 'You goin runnin?' and I realized how silly it even sounded, 'Me' and 'Running' The two thoughts together just don't even make sense anymore. So sad. But at least I did stop, go back inside, cut the tape to get life back in the toes, and slid right back in my birks. Enough about me. thank you, nancy, and I am hoping the air cast does the trick for you.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Dr. Zuckerman on 8/20/00 at 17:10 (025898)

Just had a patient with severe pt tenodonitis who also ahd pf. The exmaination is the key. The relief this patient had before seeing me was an air cast used for ankle sprain. This controls the motion that we call eversion and inversion in foot talk. This motin also aggravated pt tendonitis. You are the second patient this week that has so much pain that they told me that they were angry. Pain can make you do anything. You need to see either a podiatrist who know alot about Posterior Tibial Tendon Dysfunction (there actually is a specific name for this). I would get an mri if nothing is helping.
There are standard orthosis and or braces for this condition to help it to heal.

Re: toe exercises

alan k on 8/20/00 at 18:43 (025901)

The loops don't come off because they are partly woven rubber and crimp on. Plus, there are different sizes for small feet, but even if they were too big you could fold them over, and part of the work of the toes would be in gripping the resistance bands. So any way you look at it this is not a problem, but actually is a help to using Acu-Flex.

Acu-Flex gets the blood flowing in the feet and if combined with proper massage and stretching (Acu-Flex is also the best stretching device) will take the pressure off of a sensitive planter fascia with the corrective effects it has on foot stability and biomechanical balance of the muscles.

Your sensitive and cramped calves are a good sign that you have a problem with a lower leg complex involving muscles, tendons and the plantar aponeurosis. Massage, stretching, and strengthening should help a lot.

My pf is better through these exercises, but exercises have only partly helped my tts. Still, I'll take it!

yours,
alan k

http://www.acutai.com


.


Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

Nancy S. on 8/20/00 at 18:57 (025904)

Salina, I almost did what you did one day, except I didn't put on my any gear. I just sat here thinking maybe I'll just do that, go out and run through the woods till I can't run anymore, and enjoy the freedom -- and then be sorry for months afterward. I don't know if I stopped myself, by myself, or it was the thought of someone like Kim, 'Queen of a Small Nation,' who might slap me around with a large trout!
I saw a (cheap but good) counselor for a short while in the spring to get OUT some of my grief and frustration, and it did help.
A good physical therapist should be able to help you with the toe flexibility problem, among other things. I'm on a much better road since starting PT and then finding this good sports med. dr. -- only took 14 months since foot problems began to find these people!
I am getting Alan's Acu-flex. I think I'll be ready for it in about two or three weeks.
Take care, and keep listening to your son -- he probably had just the right tone in his voice, eh?
Nancy

Re: Thanks for the Info: Dr. Zuckerman, Alan, and nancy. eom.

salina on 8/21/00 at 14:31 (025928)

eom.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

dfeet on 8/21/00 at 16:11 (025939)

Hi, salina. Have you been officially diagnosed with Post. tibial tendonitis? I've experienced similar symptoms, with the swelling neat the arches, weird sensations down to my big toe, etc. My MRI showed that I had ruptured my Plantar fascia in the right foot, but also showed bilateral flexor hallicus tenosynovitis-from what I was told this is a component of diagnosing Tarsal Tunnel syndrome. I then had a neurological evaluation which confirmed Tarsal Tunnel in both feet, coupled with the PF in the right foot. Your signs and symptoms give me a deja vu. My advice is to get some more testing done and seek out a great Physical Therapist to help you along. Most often the PT is the one who can really aid in helping assess your condition before the doc, because you see him/her on a regular basis. Good Luck-dfeet

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

salina on 8/21/00 at 16:50 (025944)

Thanks, I start PT this week. My doctor told me the loss of flexibility in the right big toe was just from the inflammation and fascia being so tight, and will go back to normal when I heal from the PF. I have not walked like a normal person in nine months either. I sort of just place my right foot pretty much flat on the ground, instead of walking heel to ball releasing off the toes like a person normally does. But I think I read where Nancy was told by her therapist that she needed to practice walking more normal, to help restore flexibility in the achiles area also. So I am purposely trying to walk at a more normal gait, especially now that I am exeriencing leg cramps and a tight achiles. Seems like one thing leads to another. I am very positive about starting therapy. I am making a list of things to ask him or her. The doc just pressed on different areas and asked what I felt, and seemed to think it was just PF only. But I am writing everything down from now on. Whenever I get a weird pain, or sharp, unusual pain, whatever, I am writing it down exactly how it feels, what I was doing at the time, etc. so I don't forget what to say to the doc on the next visit. Maybe he can better assess my problems that way, and request tests be done. thanks again. and best of luck to you on dealing with this.

Re: Question for Dr. Zuckerman or others, PF and Posterior Tibial Tendonititis

john h on 8/22/00 at 09:18 (025993)

many months ago while visiting my doctor i inquired about whether my pain might be associated with post tibial tendonitis. he said no that the PF type pain where the fascia attaches to the heel is not symptomatic of post tibial tendoitis. i think that it is easy for many of us to look for some disease process beyond the obvious (me included). sometimes if it looks like a rabbit, jumps like a rabbit, and has big ears like a rabbit that it may be a rabbit. i am not saying that many do not have tts,post tibial,stress fractures, etc but be careful not to overlook the obvious. if you have 1st step pain or pain where the fascia attaches to the heel the most common cause is going to be PF.