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Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

Posted by William Wilt on 3/23/04 at 06:42 (147582)

Dr Ed,

I have suffred from FDL& FHL tenosynovitis for 6 months now and have tried almost all conservative options. This came on gradually as I had been walking my mail route and had taped my foot for a month for plantar facitis.I have tried PT, Hard cast immobilzation, 2 cortisone injections 7 weeks apart, orthotics,ice/heat/ vioxx, and still am dealing with pain. My pain is decsribed as a persistent uncomfortable aching type pain in the inner ankle below the medail malleous , that is more pronounced upon weightbearing and is still present at rest but to a lesser degree. I have NO NUMBNESS OR TINGLING OR SHOOTING PAINS BUT I DID HAVE A VIBRATION/BUZZING SENSATION IN THE INNER ANKLE BUT THIS IS NOT CONSTANT LIKE THE PAIN IS. At night when i sleep my ankle feels the best as there is no weight on it. I am a mail carrier and cannot work due to this. Can you offer me any additonal advice on what to pursue and the prognosis on this condition that was evident on my mri?

thnk you

ps my mri states TENOSYNOVITIS OF THE FLEXOR DIGITORUM AND FLEXOR HALLUCIS, PARTICULARLY THE LATTER, WHERE THERE IS AN ASSOCIATED SEPTATION WITHIN THE FLUID. RECOMMEND CLINICAL CORRELATION.

Re: Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

Ed Davis, DPM on 3/26/04 at 23:09 (147907)

William:
Are you getting physical therapy? That is important!
Also- tell me more about your orthotics -- how were they made and what do they look like?
Ed

Re: Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

William Wilt on 3/27/04 at 09:38 (147936)

Dr ed Thanks for responding,

About a month ago i had tried,7 sessions of a iontophoresis patch in physicasl therapy and this did not help. I am currenlty in physical therapy and my doc wants me to try phonophoresis and exercise bike along with strengthening. It seems to aggravate the area more when i even stretch it lightly. I use a towel looped around my toes and pull gently to sterch the FDL FHL area.

Now for my orthotics I am currently wearing spenco polysorbs crosstrainer which were given to me by my doctor. I used to wear full lenght orthotics that were custome fitted by 2 poditraists but each of them doid not help my problem. The one pair was a plastic material for arch support and the 2nd pair were made the same but the arch support was a a firm but soft foam type material. I am going nuts and really am at wits end. My foot and ankle doc wants to order a nerve study and continue with therapy. He mentioned surgery as an option which is the next step to go in and ' CLEAN UP THE TENDONS AND TAKE A LOOK AND FREE UP THE NERVE.' He said the success rate is 50%. Dr Ed i am only 33 and have a family and think this may be a risky surgery that could change my life if it comes out bad. What do you think about taking the chance here with this type of surgery? Would you do it? Thank you for you r advice...

Re: Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

Ed Davis, DPM on 3/27/04 at 11:41 (147945)

William:
Your situation is a bit unusual. I would really need to see the MRI to determine the extent to which the tendons are 'damaged' before making a recommendation per surgery. I have a suspicion that the orthotic prescription was suboptimal. Where do you live?
Ed

Re: Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

William Wilt on 3/28/04 at 11:27 (148001)

Dr Ed,

I live in Rochester, NY. I have been currently going to the University of Rochester Medical Center at Strong Orthopedics. What type of orthotics would you reccommend for this problem? Have you ever encountered this in your years of practice? The Foot&Ankle ortho looked at the MRI and was not totally baffled by the pictures, as he stated there is fluid and Tenosynovitis of these FHL&FDL tendons with no tear.

Re: Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

Ed Davis, DPM on 4/02/04 at 19:54 (148328)

William:
Is the fluid at the level of the inside of the ankle bone? How close are you to Elmira, NY? I would recommend a second opinion by Charles Thurber, DPM if close enough to Elmira.
Ed

Re: Dr Ed Tenosynovitis of Flexor Digitorum/Flexor Hallucis Longus

Ed Davis, DPM on 4/05/04 at 14:27 (148428)

PS Please bring your string forward if you wish to continue -- this is getting buried too far back to hunt for...
Ed