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  #1  
Old 03-31-2009, 11:55 PM
Lyn Lyn is offline
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Default top of foot/arch pain

I have had an ongoing problem with my right foot for a few months. It started as sharp pain on the inside of the foot, at the top of the arch.(Started about a yr ago) It would act up for a while, then go away. Recently it started up again and has not gotten any better. When I take a step, there is a sharp in the area and it travels up into my ankle. I have been to a podiatrist who thought I had tendonitis in the tendon that runs down the top of my foot into my toe. I was looking at your web site, and was wondering if it could be Posterior Tibial Tendonitis, the symptoms are pretty similar and I am concerned as it has been going on for a long time. Walking is almost unbearabel, and standing on it is painful as well. It hurts the most when I try to take a step. Any ideas? I have had xrays done but nothing showed, so I was wondering if an mri might be a good idea to see if it is a tendon issue, tear or rupture.
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  #2  
Old 04-02-2009, 07:36 PM
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Default Right Foot Pain

If the pain is on the top of the arch, then it is unlikely that it is posterior tibial tendonitis. If the pain is at the inside of the arch, as seen in the image below, it is definitely possible. Sharp pain with walking at the inside of the arch that travels to the ankle and becomes dull and achy with rest is consistent with posterior tibial tendonitis (but also other foot problems). An MRI would show tendonitis, but they are not always definitive. What types of treatments did your podiatrist recommend?

If you stand on both feet and lift your heels, going up on your toes, does this cause pain? Stand on the affected foot and then lift your asymptomatic leg (the foot without pain) and try to go up on your toes, can you do this? Does it feel weak? Is it painful? Does it elicit the same type of pain you experience with walking?

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  #3  
Old 04-03-2009, 11:05 PM
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Default Hi, I'm new

Just wanted to say hello and introduce myself. Hope to be a good part of the community.
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  #4  
Old 04-04-2009, 12:26 PM
Lyn Lyn is offline
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If you stand on both feet and lift your heels, going up on your toes, does this cause pain? Stand on the affected foot and then lift your asymptomatic leg (the foot without pain) and try to go up on your toes, can you do this? Does it feel weak? Is it painful? Does it elicit the same type of pain you experience with walking?

There is some pain when I do it with both legs, but when I lift the leg without the pain and try to go up on my toes on the affected foot, I cannot, it is very weak. Yes, at rest the pain is dull and achy, I have also noticed over the lats few days a mild burning sensation. In the diagram you showed that is for the most part where the pain is, I just didn't describe it well.
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  #5  
Old 04-04-2009, 01:48 PM
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Default tendonitis

Although it is impossible to diagnose a foot and ankle condition over the internet, individuals with posterior tibial tendonitis and/or dysfunction will have weakness and sometimes pain when trying to go up on their toes, especially on one leg. The posterior tibial tendon is one of the main supporters of the arch and also a strong plantarflexor, this means that when you go up on your toes, it helps bring you up on your toes and then keep you in a stable position. But, there are other conditions in which this can happen and other conditions which can mimic those same symptoms.

Generally the first steps for treatment include eliminating aggravating activities, icing and or contrasting between hot and cold (although a year out this may not be as effective), physical therapy, supportive shoes with custom orthotics, calf stretches and sometimes other foot and ankle exercises. In more severe cases a cast boot or complete immobilization may be necessary and sometimes surgery.

If you have posterior tibial tendonitis, a follow-up with your physician is necessary because self-treatment of this condition is not recommended.
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  #6  
Old 04-13-2009, 09:13 PM
Lyn Lyn is offline
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Default

Went to the dr today. After some poking and proding and having me move my foot certain ways and no decrease in symptoms after 4 wks, he says its posterior tibial tendonitis. He has ordered a brace to see if that helps, and has temp. ****d my foot.Even with it ****d at rest it is still very sore. I have done some reading on the net and found out this is common for people with Rhuematiod arthritis, which I have. This problem has been going on for a long time now, and I am wondering after it not getting better with meds, orthotics and such if surgery would be an option, since having the RA I am also wondering if this will a constant recurring problem.
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  #7  
Old 04-14-2009, 02:29 AM
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Default Posterior Tibial Tendon Dysfunction

Unfortunately, rheumatoid arthritis complicates the problem and makes it more difficult to treat, but you are correct, individuals with RA are more susceptible to developing this.

Posterior tibial tendon dysfunction (also called adult acquired flatfoot) is not a condition that is "cured" by conservative therapy. The rest, ice, stretching, physical therapy, immobilization, anti-inflammatory medications are mostly aimed at treating the tendonitis portion of the condition. This can be resolved, but the foot collapse and stretching out (attenuation) of the posterior tibial tendon is a problem that can only be accommodated. Orthotics and shoe modifications are absolutely necessary, but will not change the shape of the foot. Strengthening exercises and physical therapy may help strengthen the tendon in earlier stages. But, the foot usually loses it's arch due to excess pronation (rotating in of the foot and ankle with associated arch collapse) and a stretched tendon, which means the flatfoot remains - even if the tendonitis has resolved. Because the tendon has excess stress due to the foot abnormal motion and biomechanics, recurrence is always possible. The pictures below show a foot with more advanced posterior tibial tendon dysfunction.

It is possible to be fully functional and pain free, depending on the stage. Conservative therapy should always be tried initially but in more advanced stages, surgery may be necessary. In individuals with RA the healing time may be longer after surgery and the surgery may not be as successful.

A Richie Brace or similar (see picture below) is designed to support the arch, the tendon and minimize the motion of subtalar joint (joint below the ankle joint) and the rotation at the ankle. Many patients have excellent success with Richie Braces, which can alleviate their pain and increase their level of function.


Last edited by officeadmin; 07-07-2010 at 03:38 PM.
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  #8  
Old 04-22-2009, 06:50 AM
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Default Posterior Tibial Tendon Dysfunction Education

This condition is an overstretching and inflammation of the posterior tibial tendon, which travel from a muscle in the calf down to the arch of the foot. this tendon is one of the major supporting structures of the foot's arch and aids in walking.DR. MAASI J. SMITH · FOOT CARE
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  #9  
Old 05-03-2009, 07:05 PM
Lyn Lyn is offline
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So I've been wearing the aircast/support for 3 weeks. The severe pain each time I take a step is lessened, until I take it off. There is still alot of pain in the tendon iself, and now there is some swelling and pain in the front of my ankle , which is getting worse. What do you suggest I say to the dr? Am I probably looking at surgery? There is a bulge now on the side of my ankle where the tendon starts to run down inot the foot also.
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  #10  
Old 05-04-2009, 02:00 PM
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Default Posterior Tibial Tendon Dysfunction

An air cast is generally designed to support the ankle, not necessarily the foot, but it sounds like it helped to alleviate your symptoms when you were wearing it. That is a good sign. A cast boot or air cast is designed to immobilize foot and ankle and lessen the stress on the tendon, to allow the tendon to heal. It can take up to 6-8 for the pain inflammation to decrease and sometimes other therapies (ie: physical therapy) are tried at the same time, or immediately following the period of immobilization. Generally, it is one step in the process. After a period of immobilization, the foot needs to be supported (orthotic or Richie Brace) and these are used over the long term. It would be best to discuss your course of therapy with your doctor. How do they feel about your progress to date? What is the course of therapy? What are your current options aside from surgery?
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