Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Should I get another injection in ankle..

Posted by matts on 7/06/03 at 13:00 (123658)

I had a injection in pereaneal tendon sheath on outside of ankle three months ago, it was supposed to last that long, but i only got a few days relief at the beginning and it has been swollen under the ankle bone all this time. It still hurts a lot the more I walk or anything, I am now getting return of my old posterial tibial pain and pf on the inside of foot and I am wondering what to do now. Should I let it go a while and try to let the shot work some more? I am getting real sharp pain on outside of foot that come and goes and same thing in pf area at back of arch and even some at front of foot. I had one recommendation for surgery on these tendons but the current ortho, who gave the injecttion said I should wait for surgery, this was 3 months ago. Any suggestions or comments would be appreciated. THanks.

Re: Should I get another injection in ankle..

Ed Davis, DPM on 7/06/03 at 14:47 (123661)

matts:

It is unlikely that a 3 month old shot is having any current effect. We would need a lot more information about your problem before coming up with ideas. Have you had an MRI to look at the condition of the peroneal and post. tibial tendons?
Ed

Re: Should I get another injection in ankle..

matts on 7/06/03 at 21:31 (123684)

mri on ptt showed increased signal and the pereoaneal were shown to be split, the only thing is that the recommendations on what to do have gone from surgery for repair, to injections and see what happens. I read here on this site that split pereaneals may not be unusual enough to always need surgery and that is what the doctor said, so that sounded OK to me, but I am starting to wonder if my foot will get well without surgery. one dr, ortho was going to work on ptt and the outside of the ankle. thanks for your comments and suggestions.

Re: Should I get another injection in ankle..

Ed Davis, DPM on 7/07/03 at 14:15 (123707)

matts:

The posterior tibial tendon may be more of a concern due to the possiblity of posterior tibial dysfunction.
Ed

Re: Should I get another injection in ankle..

BGCPed on 7/07/03 at 18:46 (123720)

If you have orthotics that have a fair amount of correction to deal with original post tib tendon then you may want to see if the are over correcting your foot i.e. with medial wedge. Sometimes tipping the foot out or supinating it can create relief for post tib but inflame the peroneal.

I see more cavus type feet with split peroneal, some are subtle but if you have a plantarflexed 1st met and the device is tipping you out that can cause it. Just a guess here but if you dont wear shoes or just were a cushy type sport sandal does your peroneal hurt less?

Again just a guess

Re: Should I get another injection in ankle..

matts on 7/07/03 at 21:46 (123727)

Thanks, since having pf and ptt i always try to wear some shoes, if not regular shoes i wear plastic birks around the house, when i do not have some shoe, currently my foot hurts all over ankle and arch area. If i try to where afo i got for the ptt it hurts ankle and is no longer comfortable in arch area either, reallly any support in arch area does hurt more. Dr Ed in another response suggested the post tib might still be main problem, which puts me back where i was some time ago. Thanks again for your ideas, what do think about the ptt problem. I would wear a brace again if it would take care of both problems, peroneal and ptt area. How could i get a doctor to write prescription for new brace if not his idea?

Re: Should I get another injection in ankle..

BGCPed on 7/07/03 at 23:30 (123729)

Well the extra arch support may help the ptt but can fire up peroneal. It is rather rare to get both ptt and peroneal tendonittis at same time.

Re: Should I get another injection in ankle..

Rachael T. on 7/08/03 at 14:48 (123766)

Haven't posted for sometime - but I too, had alot of ankle pain (particularly the front & outside of my ankles) & yes, I had both of my ankles at this location injected 2 times each. It helped alot...but I have observed if I don't wear corrective orthosis & switch to my birks too much, I begin to feel ankle soreness at that same spot.....so I immediately go back to my orthotics which seem to minimize the problem. My orth. are by Foot Management (done by computer topography) & they are the best orth. I've had over the last 2+ years of PF - much better & more comfy than my 2 prescription pairs made by a pod. So, I guess I am saying that my arch is padded fairly high in my Foot M. orthotics & have a deep heel & are semi rigid sport orthotic.....hope this helps give you another hopeful suggestion foryour own feet!

Re: Should I get another injection in ankle..

Dorothy on 7/08/03 at 16:31 (123770)

I, too, find that wearing the Birkenstocks 'too much' - i.e. more than a day every so often - exacerbates foot pain. I am just now trying to regain previous level of tolerable (dis)comfort after wearing Birkenstocks for a few days during recent very hot spell. I know that most people on this message board love them and I have worn them for years myself, but that was before PF when I could wear anything. They are ok as sandals but not so helpful as PF 'tools'; that is just my experience.

Re: Should I get another injection in ankle..

Rachael T. on 7/08/03 at 20:47 (123795)

I can wear my Birks for several days - & even for a shopping trip (which is not like the shopping trips of years ago where the feet were healthy!) But, after a week of Birks - or if I am going to do anything majorly strenuous - I think my orth. keep my ankles from hurting....BUT I DOOOO love my Birks & if it weren't for them, I don't think my healing would have happened. I think, though, my next Birk purchase will be the higher arch items they offer rather than the classic or the softbeds,of which I have both.

Re: Rachael...

Suzanne D on 7/08/03 at 20:53 (123796)

Hi, Rachael! Did you get my e-mail some time ago answering your question about how I got the soft footbed padding added to my removeable insoles for my Birks? I wrote to you the same night you sent it and hope it arrived. I had trouble another time in getting e-mail to you. Right now my school e-mail is down while the technology people in our district make some changes.

Hope things are going well for you!
Suzanne :)

Re: Should I get another injection in ankle..

matts on 7/08/03 at 22:33 (123804)

Racheal T,
I went to foot management website, did you scan your foot, and did a dr do a prescription for you ? How did this work, I guess is what I am asking. Thanks for the information.

Re: Should I get another injection in ankle..

matts on 7/08/03 at 22:38 (123805)

Now it seems to be either the ankle or the arch that hurts, I am just not sure how to address the problems. I think i may have had to much arch in the afo, and when i started wearing it less as the arch pain got better, the ankle started hurting and now is very painful. If shoes or supports help the arch then it seems the ankle hurts more and gets worse, if i find some shoes that do not hurt the ankle as much, which is rare, the arch flares up. I am just confused on how to address both. Thanks again for your assistance.

Re: Should I get another injection in ankle..

BGCPed on 7/09/03 at 11:16 (123853)

Matts what area are you located in?

Re: Should I get another injection in ankle..

Ed Davis, DPM on 7/10/03 at 19:16 (124006)

matts and BG:

One of the advantages of the Ritchie Brace is that it includes an orthotic foot plate with two double uprights. As such, it cannot over-invert the foot and cause the peroneals to fire up.
Ed

Re: Should I get another injection in ankle..

matts on 7/10/03 at 21:31 (124018)

I am in west Texas 300 miles west of Dallas

Re: Should I get another injection in ankle..

matts on 7/10/03 at 21:34 (124020)

I have a lace up brace with wrap around velcro straps to keep ankle staight, I was told this is similar to richie, but the one I have hurts the tender places around ankle and can really push on pf area if not careful. Are you familiar with this brace?

Re: Should I get another injection in ankle..

Ed Davis, DPM on 7/11/03 at 00:16 (124046)

matts:

Is it a custom brace? Is it called the Arizona brace?
Ed

Re: Should I get another injection in ankle..

matts on 7/11/03 at 22:55 (124179)

it was not called arizona brace and it is off the shelf, the straps are flexible cloth material and wrap around and under then up the other side of the ankle. Thanks again for your help.