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Bextra for Post-Tib Tendonitis?

Posted by jdolnick on 8/08/02 at 20:51 (092025)

Long history of flat feet and bouts of arthritic pain and PF, and have used orthotics for many years. Now fighting a long bout of post-tib tendonitis, causing excruciating pain. DPM is suggesting a new set of orthotics (on order), rest, ice, elevation, topical Ketoprofen 20% ointment, and Bextra. The literature for Bextra shows it's indicated for arthritis; both it and the topical ointment have been ineffective in reducing the pain of my tendonitis. I'm wondering if the doctors have any experience with either of these meds?

Re: Bextra for Post-Tib Tendonitis?

pala on 8/08/02 at 22:23 (092034)

i'm not a doctor but i have postier tibial tendon dysfunction with tendonitis and i've never really been clear about the difference but it took eight excrutiating months for the medical genuises i gave all my money to to figure out it was dysfunction. just thought this info might be interesting.

Re: Bextra for Post-Tib Tendonitis?

jdolnick on 8/09/02 at 05:54 (092042)

Yes, I have the dysfunction as well. An orthopoedic surgeon wanted to perform surgery, but the podiatric surgeon is strongly opposed as more conservative treatment hasn't been exhausted. That's fine with me!

Re: Bextra for Post-Tib Tendonitis?

pala on 8/09/02 at 09:31 (092051)

sounds familiar. dr #11 said i need the surgery immediately and from him or i will be a cripple for life. dr #12 said i'd be insane to let anyone do surgery on my feet. and so it goes. orthist #5 said give him 1500 dollars and i'd be just fine. orthotist #6 says that orthotic is garbage no wonder it damaged me further. just give him $700 and i'll be just fine. and so it goes for two years. i'm picking up this miraculous orthotic in two weeks and just can't hardly wait. i'm so full of hope....not

Re: Bextra for Post-Tib Tendonitis?

Pauline on 8/09/02 at 13:15 (092062)

Can hardly wait for your miracle update. Please keep us posted. Who knows you might just start a run on them.

Re: Bextra for Post-Tib Tendonitis?

pala on 8/09/02 at 13:29 (092063)

i will let everyone know how it works out.

Re: Bextra for Post-Tib Tendonitis?

Ed Davis, DPM on 8/11/02 at 11:28 (092189)

Bextra is a new cox-2 inhibitor, that is, an anti-inflammatory drug without a lot of gastrointestinal side effects. So far, I have only had modestly favorable results with the drug. I think we will need to study the dosing a bit more. Its cousin Celebrex has been revisited with higher doses and better effectiveness in the last few months.

One important question --- do you have just post. tib. tendiniitis or tibialis posterior dysfunction? Surgery would only be indicated for the latter. If you have the latter, there is a lot of good news. Two 'new' orthotic designs are showing excellent results for tibialis post dysfunction-- the Ritchie brace and the Arizone brace.
Ed

Re: Bextra for Post-Tib Tendonitis?

jdolnick on 8/11/02 at 11:51 (092194)

My understanding is that I have the dysfunction, and the tendonitis is a side-effect of it. Yesterday, I tried an Ace ankle brace and found immediate relief from the tendon pain. However, it was replaced with pain- although not as bad- in the heel and PF. Don't know what significance that has. I'm scheduled to be cast for a new pair of orthotics next week. I assume that the braces you mentioned don't replace the need for those? I'll mention them to my DPM. Also, thanks for the input on the Celebrex.

Re: PT dysfunction

Ed Davis, DPM on 8/11/02 at 12:00 (092197)

Good clarification! Now, we need to know if your PT dysfunction is in grade 1, 2 or 3. A standard orthotic will do the trick in stage 1 and early stage 2. But if you are in late stage 2 -- consider the Ritchie brace instead of the orthotic. The Ritchie brace is composed of an orthotic to which is attached two double upright struts to provide the additional stability.
Ed

Re: PT dysfunction

jdolnick on 8/11/02 at 14:13 (092222)

Sorry, Ed, I don't know what the grade is. I can broach the subject of a Ritchie with the DPM. I haven't been able to find anything about it on the internet, though. Are the upright struts thin enough to accomodate most men's footwear, especially a work boot? Thanks again.

Re: PT dysfunction

Ed Davis, DPM on 8/14/02 at 23:10 (092515)

A work boot can be somewhat problematic with a Ritchie brace. Sometimes a low cut boot (3/4 boot) will work. Would use of an athletic (running) shoe be an option?

Be sure to talk to your doc about which stage or grade your TPD is in since that is the key to matching the correct treatment.
Ed

Re: Bextra for Post-Tib Tendonitis?

pala on 8/08/02 at 22:23 (092034)

i'm not a doctor but i have postier tibial tendon dysfunction with tendonitis and i've never really been clear about the difference but it took eight excrutiating months for the medical genuises i gave all my money to to figure out it was dysfunction. just thought this info might be interesting.

Re: Bextra for Post-Tib Tendonitis?

jdolnick on 8/09/02 at 05:54 (092042)

Yes, I have the dysfunction as well. An orthopoedic surgeon wanted to perform surgery, but the podiatric surgeon is strongly opposed as more conservative treatment hasn't been exhausted. That's fine with me!

Re: Bextra for Post-Tib Tendonitis?

pala on 8/09/02 at 09:31 (092051)

sounds familiar. dr #11 said i need the surgery immediately and from him or i will be a cripple for life. dr #12 said i'd be insane to let anyone do surgery on my feet. and so it goes. orthist #5 said give him 1500 dollars and i'd be just fine. orthotist #6 says that orthotic is garbage no wonder it damaged me further. just give him $700 and i'll be just fine. and so it goes for two years. i'm picking up this miraculous orthotic in two weeks and just can't hardly wait. i'm so full of hope....not

Re: Bextra for Post-Tib Tendonitis?

Pauline on 8/09/02 at 13:15 (092062)

Can hardly wait for your miracle update. Please keep us posted. Who knows you might just start a run on them.

Re: Bextra for Post-Tib Tendonitis?

pala on 8/09/02 at 13:29 (092063)

i will let everyone know how it works out.

Re: Bextra for Post-Tib Tendonitis?

Ed Davis, DPM on 8/11/02 at 11:28 (092189)

Bextra is a new cox-2 inhibitor, that is, an anti-inflammatory drug without a lot of gastrointestinal side effects. So far, I have only had modestly favorable results with the drug. I think we will need to study the dosing a bit more. Its cousin Celebrex has been revisited with higher doses and better effectiveness in the last few months.

One important question --- do you have just post. tib. tendiniitis or tibialis posterior dysfunction? Surgery would only be indicated for the latter. If you have the latter, there is a lot of good news. Two 'new' orthotic designs are showing excellent results for tibialis post dysfunction-- the Ritchie brace and the Arizone brace.
Ed

Re: Bextra for Post-Tib Tendonitis?

jdolnick on 8/11/02 at 11:51 (092194)

My understanding is that I have the dysfunction, and the tendonitis is a side-effect of it. Yesterday, I tried an Ace ankle brace and found immediate relief from the tendon pain. However, it was replaced with pain- although not as bad- in the heel and PF. Don't know what significance that has. I'm scheduled to be cast for a new pair of orthotics next week. I assume that the braces you mentioned don't replace the need for those? I'll mention them to my DPM. Also, thanks for the input on the Celebrex.

Re: PT dysfunction

Ed Davis, DPM on 8/11/02 at 12:00 (092197)

Good clarification! Now, we need to know if your PT dysfunction is in grade 1, 2 or 3. A standard orthotic will do the trick in stage 1 and early stage 2. But if you are in late stage 2 -- consider the Ritchie brace instead of the orthotic. The Ritchie brace is composed of an orthotic to which is attached two double upright struts to provide the additional stability.
Ed

Re: PT dysfunction

jdolnick on 8/11/02 at 14:13 (092222)

Sorry, Ed, I don't know what the grade is. I can broach the subject of a Ritchie with the DPM. I haven't been able to find anything about it on the internet, though. Are the upright struts thin enough to accomodate most men's footwear, especially a work boot? Thanks again.

Re: PT dysfunction

Ed Davis, DPM on 8/14/02 at 23:10 (092515)

A work boot can be somewhat problematic with a Ritchie brace. Sometimes a low cut boot (3/4 boot) will work. Would use of an athletic (running) shoe be an option?

Be sure to talk to your doc about which stage or grade your TPD is in since that is the key to matching the correct treatment.
Ed