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Bextra, Vioxx, Celebrex Which one? DR DAvis, or dr z

Posted by John Martello on 5/16/04 at 17:29 (150670)

DPM,

If I have tried vioxx with limited success, would it be worth a try to try a different NSAID to see if i have good results or are they all the same? Like i stated in previous posts i have 7 months of left ankle FDL and FHL tenosynovitis and using the ibuprofen cream from this website took the edge off better than any heat or ice i've tried. I am trying to avoid a tarsal tunnel release surgery and tenosynovectomy of these tendons as my doctor stated he had suggested this surgery. My nerve test showed minimal nerve irritation to the post tib nerve and my MRI documented this FHL&FDL tenosynovitis. My only symptom is tender localized persistent pain even at rest in the inner ankle area just below the medial malleous and under the flexor retinaculum. Tried 2 cort shots, cast immobilation, 3 pairs orthotics, different shoes, vioxx,chirporactor, accupuncture, pt ionto and phonphoresis and any stretching aggravaters it. What would you reccomend as i seem to have tried all conservativre measures , but the success rate of the surgery is 50% as given by my doc. Any other conservative treatments i may have missed? Thak you for all your help on this site. You guys are true professionals who are highly regarded.

John

Re: Bextra, Vioxx, Celebrex Which one? DR DAvis, or dr z

Dr. Z on 5/16/04 at 18:11 (150672)

I like Bextra 20 mgs daily. That is if there is a inflamatory process and not a degenerative condition.

Re: Bextra, Vioxx, Celebrex Which one? DR DAvis, or dr z

Ed Davis, DPM on 5/17/04 at 11:03 (150699)

John:
The reason there are som nay different anti-iflammatory drugs is because some work better for certain people than others as opposed to a clear advantage to one drug. If you are doing well with the ibuprofen cream, then stick with it -- use it often since there is not a lot of systemic absorbtion.

Remember that we did discuss some very specific things I would like to see on your orhtotics: a Kirby skive and a first ray cut out --- have any of those been tried?
Ed

Re: Dr Ed

John Martello on 5/17/04 at 19:06 (150731)

I have orthotics mae by a pedorthist which are a soft rigid type of orthotic that provides cushion with a cork type arch support. I have had these for 2 weeks and there is no improvement. What is a ray cut out or skive orthortic? Where can i purchase these as i asked my pedorthist about these you had mentioned and he had no clue. Thanks

Re: Dr Ed

Ed Davis, DPM on 5/18/04 at 18:52 (150790)

John:

A kirby skive involves removing some of the plaster from the medial (inside) aspect of the heel which keeps the foot from rolling in as much as thus takes stain off tibialis posterior. A first ray cut out involves placing an aperture beneath the first metatarsal allowing it to drop thus releiveing strain off FHL.

John -- these are BASIC orthotic modifications that can be very helpful for your condition. If your pedorthist has 'no clue' as you state, it may be advisable to talk to someone who knows how to do this. These are basic things that need to be considered long before you are thinking of surgery. You may want to get a second opinion from a podiatric physician concerning the orthotics and to look at the entire treatment plan: http://www.acfas.org
Ed