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View Full Version : Posterior tibial tendonitis-anybody have it?



Plantlady
September 9th, 2008, 09:04 PM
I have been battling posterior tibial tendonitis in both feet for over a year. At least that's what I've been told it is. Basically it's pain on the inside of my foot below the ankle bone. I've been to two podiatrist, one orthopedist and three physical therapists. I've tried strengthening PT, resting PT and none of it's done any good. Usually swimming is a recommended exercise for people with feet problems like plantar fasciitis. Well, would you believe that swimming aggravates my feet. It appears the flexion of kicking and the pointed toe position of flutter kicking are what causes the aggravation. Basically I'm only good for about a half an hour before things start getting ugly. I can only pull so much without aggravating the tendonitis in my elbow. Breast stroke is actually the least aggravating stroke.

My feet are a set up for problems in that I pronate severely. Yes, I have custom orthotics-they haven't helped, in fact the problem in the one foot didn't start until after I'd gotten the new orthotics.

Anybody ever have this? Anybody ever get rid of it? I'm really sick of this. I can't swim for a couple of weeks because of stitches (mole removal) but I'd like to get back in the swim of things after that.

Thanks for any advice or sympathy.

Jan

jaegermeister
September 9th, 2008, 10:59 PM
I haven't had it but many of my patients have. Its not an easy problem to resolve. You have to really protect and rest the tendon almost completely for weeks to let it heal.

It seems cruel that even the little movement of kicking is aggravating it, but if it is, I'm sorry to say you'll have to quit. Seems crazy to suggest it, but could you get a brace you could wear while swimming?

JimCanSwim
September 10th, 2008, 07:47 AM
Since we're on a related topic:

Has anyone had high hamstring tendinopathy? I've read it's more predominant in runners (which I'm not). It doesn't affect my swimming as much, except for kicking a bit, which is slower. But it's very annoying and healing feels very, very slow. I've done ASTYM and physical therapy but it only helped so much. Right now I'm considering getting a cortizone shot or maybe prolotherapy. It's very frustrating. Any help or advice would be appreciated!

JIM

The Fortress
September 10th, 2008, 08:40 AM
Since we're on a related topic:

Has anyone had high hamstring tendinopathy? I've read it's more predominant in runners (which I'm not). It doesn't affect my swimming as much, except for kicking a bit, which is slower. But it's very annoying and healing feels very, very slow. I've done ASTYM and physical therapy but it only helped so much. Right now I'm considering getting a cortizone shot or maybe prolotherapy. It's very frustrating. Any help or advice would be appreciated!

JIM

My husband, who is a runner, had the same hamstring problem. He also tried ART and PT, largely to no avail. He then tried prolotherapy and says it made the problem about 80% better. It's a hard problem to fix, and prolo is not fast. If he races, he still aggravates it. Very tough injury to completely heal. Probably because you've got masses of scar tissue there.

Sorry, plantlady, that does not sound good. If you've tried everything, I can only recommend PRP, plasma regeneration therapy. www.treatingpain.com.

I'm still struggling with tendonitis in the top of my right foot for over a year. I think I'm going to break down and get a cortisone shot, but it apparently results in some hobbling. So I can't do it until I claim victory in my upcoming gridges.

fatboy
September 10th, 2008, 06:05 PM
Not a doctor, but what about using a pull buoy? Would that limit kicking enough?

Rick
September 10th, 2008, 06:33 PM
Yes - I have a very similar problem that was similarly diagnosed, but also have pain on the inside of both lower legs right above the ankle bone (which has become more of a problem!). I have had ultrasound, ASTYM, deep tissue massage - all with little help (and ASTYM left me pretty bruised up!). I think this all started when I way overdid my fin work for about 10 weeks - and now even easy kicking hurts, as do flip turns. Pushing off the wall is not so bad but kicking is the problem.

I did take off for 3 weeks (but biked on a stationary bike every other day for an hour plus used my Bowflex). The pain did pretty much go away in terms of everyday walking (the biking did not bother it too much) - but I got back into the water and by the third day it was coming back.

I had an MRI today and see the ortho guy next week - he is a former swimmer and is very good, so I will let you know. Meanwhile, I sent the MRI disc to my daughter who is a radiologist to get some further insight into what I am up against in terms of damage!

Seagurl51
September 10th, 2008, 06:47 PM
What a coincidence that you post this, I was just about to make a thread about my plantar fasciitus (or however you spell it). I finally went back to the doctor after about 3 weeks of constant pain in my tendon and on top of that they think I might have a stress facture... I was diagnosed about 2 years ago, and have had problems on and off, but I agree that swimming does upset. Kicking is the worst, and for me personally breaststroke (my favorite :() I can barely do because the flexing causes the tendon to pull even more.

I'm on my way to a podiatrist (finally) next week to see what's going on. The doc at student health also recommended custom insoles which I agree seem to do very little when you hurt really bad. I was going to ask about surgery where they go in and cut the tendon. I don't know about that same option for your condition, but if it's that bad maybe surgery wouldn't be so bad.

In the mean time, make sure you stretch your feet a lot. I like to stand with the balls of my feet on the edge of the pool and push down so that the tendon is pulled slightly...definitely don't do it if your having pain though...did that once, bad idea.

I wish I could be more help, I totally sympathize with foot pain. Good Luck!

ALM
September 10th, 2008, 09:42 PM
My brother-in-law had plantar fasciitis and finally had surgery. He got a "sinus tarsi implant". It sounds like it is appropriate for people who hyperpronate.

Main page with a picture of the implant:
http://graphicsdept.com/hyprocure/home.htm

Before/after photos, x-rays, and video:
http://graphicsdept.com/hyprocure/beforeafter.htm

gobears
September 11th, 2008, 01:31 PM
Strange you should post this as I was diagnosed with anterior tibial tendonitis just last week. I think the combination of a 9 mile run on a Saturday followed by a swim that included quite a bit of kicking with hard fins on Sunday was not appreciated by my tendon. Interestingly, the podiatrist told me I could still run but to cut back on the swimming (and definitely no fins). I have no pain while running or swimming--only after I rest my foot awhile. It's very stiff/sore when I get up in the morning. It hasn't gotten any worse, but it's also not seeming to get much better. I probably haven't avoided swimming/kicking as much as I should have so I'll be cutting back this week. And I may limit my running as well. Annoying. I have nothing helpful to tell you, just that I sympathize! Hang in there.

Plantlady
September 15th, 2008, 06:38 PM
Yeah, I read about the sinus tarsi implants. The bad news is if you google carefully you'll discover that most insurance doesn't pay for it. It's considered "investigational and experimental". They'd rather people suffer through a tendon transplant and a reset heel bone (that's a good part of what they do for PTT surgery) than give a reversible procedure with a short recovery a try. Why am I not surprised.

I've had an MRI-it shows fluid around the tendons but basically intact tendons. I think everyone posting to this thread can agree that foot pain sucks. When I start swimming again (stitches out the 24th) I will be making friends with the pull buoy. The problem with too much pull buoy is that I've also had tendonitis in my elbow before and have to be careful not to aggravate that.

I'm just hoping my only water exercise option doesn't come down to deep water aerobics. Nice ladies but I'd rather be swimming.

My doctor has also told me to make an appt with a rheumatologist because of questionable results on an anti nuclear antibody test. One test was positive, one negative. This can be associated with lupus or it can mean absolutely nothing.

Off to get a dr appt.

Jan

ALM
September 15th, 2008, 07:15 PM
Yeah, I read about the sinus tarsi implants. The bad news is if you google carefully you'll discover that most insurance doesn't pay for it. It's considered "investigational and experimental". They'd rather people suffer through a tendon transplant and a reset heel bone (that's a good part of what they do for PTT surgery) than give a reversible procedure with a short recovery a try. Why am I not surprised.

I think my brother-in-law's was covered - the doctors are learning how to code it when they bill the insurance company. My brother-in-law is pretty happy with the implant so far. He had it done about 5 months ago. He's walking, biking, and has just started running again.

Hatshepsut
June 16th, 2009, 05:50 AM
Jan,
I too have been battling tibular tendonitis since September. I have cut out all running and no longer use fins. I cant even push off the wall hard or I go into a weird cramp that feels like the tendon is pulling my calf into my heel.
After PT, ultrasound, orthotics, icing and no results, I got a cortisone shot in one ankle last week. It is working well, so far- now I only have pain and cramping in one leg. I dont know how long it will last, but I am hopeful for the first time in months.
Any improvement for you since your post?
dot

mj_mcgrath
June 16th, 2009, 10:50 AM
Some folks have resolved their plantar fasciitis by wearing something called the Strassburg Sock. It keeps the ankle dorsiflexed while sleeping.

Tip: start slow--do not pull the toes tight towards the shin. Gradually increase the amount of ankle flexion.

See: http://www.thesock.com

Hope it helps.

mjm

isobel
June 16th, 2009, 07:57 PM
Sort of related (as in it's a possible overuse injury from swimming/kicking): has anyone struggled with pain on the inside of their knee(s)? I don't feel pain when swimming, but I feel pain just on the inside of one knee, right between the femur and the tibia, whenever I walk very far.

Have done PT, gotten a cortisone shot in bursa, used orthotics, all to no avail.

I have this fear that when I kick I might torque my left knee a little as I rotate. No idea how to fix this (Ande?). Though why this would suddenly flare up now, after almost 9 years of swimming, seems suspect.

I am glad I do not have the problem with ankles/feet/plantar fascitis. I have heard that it is very painful and very hard to resolve, especially if you are a runner.

FindingMyInnerFish
June 16th, 2009, 11:13 PM
Jan,
I too have been battling tibular tendonitis since September. I have cut out all running and no longer use fins. I cant even push off the wall hard or I go into a weird cramp that feels like the tendon is pulling my calf into my heel.
After PT, ultrasound, orthotics, icing and no results, I got a cortisone shot in one ankle last week. It is working well, so far- now I only have pain and cramping in one leg. I dont know how long it will last, but I am hopeful for the first time in months.
Any improvement for you since your post?
dot

I'd love to know if this cortisone will last!

I've mentioned my gimpy foot here lately, and it sounds a lot llike what I see described here. It started as plantar fasciitis, so I got off running--I'd been training for a marathon--did stretching, icing, cortisone shot, acupuncture, blah blah blah.... And just as the PF started to let up, the top of the foot and the ankle began to act up. :cane:

The only place I can get any intense workouts is in the pool and thank God for that! However, I too have noticed that kick sets irritate the foot and so does too hard a push off the wall with the affected foot.

I think my body has settled on the work-around of using the good foot to do most of the push-off. With kick sets, I try to alternate back kick (with streamlined arms) and also doing streamline kick w/out the board which seems for some reason to alleviate the discomfort.

Fortunately, so far, the pain I get in the water is only mild compared to what happens after only a few mins. of running (as opposed to being able to do most of my masters' workouts--which, granted, are short by some standards). If I didn't have the swimming and no running either, you wouldn't want to be around me. (Picture this: :badday: )

KEWebb18
June 17th, 2009, 09:08 AM
Sort of related (as in it's a possible overuse injury from swimming/kicking): has anyone struggled with pain on the inside of their knee(s)? I don't feel pain when swimming, but I feel pain just on the inside of one knee, right between the femur and the tibia, whenever I walk very far.

Have done PT, gotten a cortisone shot in bursa, used orthotics, all to no avail.

How is your hip and glute strength? Most people with knee problems don't have the strength in the hip/glute area and it causes too much stress on the knee. Try a "clamshell" exercise--just google it and you can find a video.

isobel
June 23rd, 2009, 10:07 PM
How is your hip and glute strength? Most people with knee problems don't have the strength in the hip/glute area and it causes too much stress on the knee. Try a "clamshell" exercise--just google it and you can find a video.

Been doing the clams, the reverse clams, because yes, I was told my hips and glutes weren't strong.

Last week I returned to the hamstring curl machine in the gym and was alarmed to see that I couldn't do more than 8 at a time (no weight on machine other than what is preloaded).

Does it make sense that I can swim and kick so much and only be using the front of my body, i.e., have no strength in my hamstrings or butt? Zounds! Anyone else notice they have strong fronts and weak backs of their bodies, even with a lot of swimming?

KEWebb18
June 23rd, 2009, 10:42 PM
Most females are quadriceps dominant--the quads do most of the work and activate more quickly than the hamstrings (possibly part of the reason why females may have more ACL tears than males). You are likely getting most of your force from the quads when you kick--the "down" part of the kick and not much from the posterior muscles (hams and gluts)--the "up" part of the kick.
I would venture a guess that strengthening your hamstrings will improve your kick.

JoelW
January 11th, 2012, 06:49 AM
I have been battling posterior tibial tendonitis in both feet for over a year. At least that's what I've been told it is. Basically it's pain on the inside of my foot below the ankle bone. I've been to two podiatrist, one orthopedist and three physical therapists. I've tried strengthening PT, resting PT and none of it's done any good. Usually swimming is a recommended exercise for people with feet problems like plantar fasciitis. Well, would you believe that swimming aggravates my feet. It appears the flexion of kicking and the pointed toe position of flutter kicking are what causes the aggravation. Basically I'm only good for about a half an hour before things start getting ugly. I can only pull so much without aggravating the tendonitis in my elbow. Breast stroke is actually the least aggravating stroke.

My feet are a set up for problems in that I pronate severely. Yes, I have custom orthotics-they haven't helped, in fact the problem in the one foot didn't start until after I'd gotten the new orthotics.

Anybody ever have this? Anybody ever get rid of it? I'm really sick of this. I can't swim for a couple of weeks because of stitches (mole removal) but I'd like to get back in the swim of things after that.

Thanks for any advice or sympathy.

Jan

I too have PTT. I got a partial tear in my right foot a little over a year ago playing football without my orthotics.

This injury has proven to be a huge problem. From the research I've done, and in speaking with several orthos, I've come to the realization that once it tears, theres a 99% chance it's not going to heal. It seems that due to it's location and the fact that it holds up your arch, that once it tears it just degenerates until you have surgery.

My doc advised me to stop doing anything that hurts it, and come back when it gets to be too much. He said it could be 2-3 yrs before surgery makes sense. (I'm not in enough pain yet)

I've found that swimming does irritate it, but I just try to ignore the pain because I need some sort of cardio. Like you I can't do just pulls, as I have a bummed wrist that will flare up when I overdo pulls.

I understand your frustration, and hope that you're able to get on without too much pain. Here's to hoping for some advances in soft tissue tears real soon!

Plantlady
January 22nd, 2012, 10:47 PM
Hi, Joel,
I just found your post. Mine was so long ago I didn't think anyone would resurrect it. I'm sorry you've joined me in the ranks of people afflicted with this damn disorder.

Yep, I've still got it. I think I've been to at least five doctors and about the same number of PT's. The PT's all start out so optimistic believing they'll somehow "cure" me. Yeah, right. If they could I wouldn't still be suffering. The MRI's don't indicate a tear-just inflammation. I while ago I saw Highly Respected Orthopedic Foot Surgeon who told me they don't usually do surgery unless the person is walking on the inside of their feet. The guy had the bedside manner of a toad which further impressed me. I mean, jeez, if you get to the point of walking on the inside of your foot the rest of your body has probably pretty well collapsed from foot enforced inactivity. Last year I tried a custom Richie brace which was also a bust. They never could get the thing adjusted so I could tolerate it for more than a couple of hours. After about five tries at adjustments I gave up.

So where am I now? Well, I'm still swimming. Sometimes I think it bothers my feet, sometimes I think it doesn't. I usually only swim three times a week because I'm so prone to overuse injuries-read tendonitis. I've been told I have the lousy combination of loose ligaments and tendons, hence the "flexible flat foot", and tight muscles. One might think flexible is a good thing but with feet that's not necessarily so. At this point my orthopedist is willing to refer me to the foot surgeon in his practice but I don't take surgery lightly. I almost died from hysterectomy complications. At the same time I'm really tired of planning much of my life around my feet. They especially hate standing on concrete which makes thing like grocery shopping such a joy. Some nights by the time I've hit a couple of grocery stores, done some house cleaning and cooked dinner my feet are completely cooked. They claim surgery could leave me no better or even worse off. I think part of the problem is the clinical picture; MRI's and exams don't adequately reflect the life changing suffering this affliction causes me. I pick my volunteer activities very carefully and refuse to do any that require me to stand on my feet for hours-makes me real popular with the other band parents (son still in high school). I tend to feel guilty when I have to wimp out on something because my feet hurt or I know it's going to make them hurt for days or weeks (I should really say hurt worse-they ALWAYS hurt). I'm now going to see a neurologist next month because I think it's possible I could have developed tarsal tunnel syndrome from the swollen tendons pressing on nerves. I sometimes get burning and stinging on the bottoms of my feet.

I completely agree that there needs to be more effective methods of treating soft tissue injuries. I broke my ankle once. Recovery from that was a piece of cake compared to this issue. My husband and I are currently doing a therapeutic fitness class at a local gym. It's led by a physical therapist and she of course thinks my feet problems will get better once I improve my hip flexibility, strength and body alignment. Yeah, right. Where have I heard that one before? The class seems good for keeping shoulder twinges away and making my hips feel nice and flexible but I'm not expecting any miracles in the feet department.

Again my sympathies and if you find the miracle cure be sure to let me know.

Jan

swimshark
January 23rd, 2012, 07:45 AM
Jan, almost 4 years ago I sprained my ankle by accidentally kicking a dowel on a stool just in front of the outside ankle bone. Since then I've been through 4 doctors, 2 surgeries, 1 cortisone shot, 16 weeks in a boot, 3 weeks on crutches, 3 alcohol-based injections and 5 weeks of PT. I am finally feeling more normal. I can finally kick after almost 3 full years of not being able to. One thing I did when it was really bad was tape the ankle with horse wrap while swimming (athletic wrap that stretches will work as well but the horse wrap was cheaper to buy). It helped to stabilize the ankle more and the pain was less.

The alcohol-based injections were a wonderful thing. It seems that I had an impinged nerve due to the 2nd surgery. The injections helped to deaden the nerve so I don't feel the pain any more. After that I did PT and it helped to heal it more. I'm at about 95% now. I can kick, albeit slowly, but I am moving forward. In fact, right now my shoulders are messed up and all I can do is kick. I wish you luck. I know what it feels like.

Plantlady
January 23rd, 2012, 11:18 PM
Jeez, Allison, you've been through it haven't you? I'm curious why they had to do surgery since I don't think of that as a consequence of a sprain. I'm guessing you must have torn some ligaments or tendons? I will say we swimmers are stubborn in our pursuit of our sport. Lesser mortals would have bagged it for the couch long ago.

I'm sorry your shoulders are now messed up. You must be incredibly frustrated with this coming on top of your ankle injury. I guess you could say middle age isn't for sissies.

I don't need it right now but how did the horse tape stay on in the water? I tried athletic tape once and it wouldn't stay on very well. And I know you can whip out a lot more yardage than I can.

BTW, did you know Julie Shepard when you were swimming with the Barracudas? She popped off full term twins about 7-8 months ago and swam until two days before they were born.

Jan

swimshark
January 24th, 2012, 11:41 AM
Jeez, Allison, you've been through it haven't you? I'm curious why they had to do surgery since I don't think of that as a consequence of a sprain. I'm guessing you must have torn some ligaments or tendons? I will say we swimmers are stubborn in our pursuit of our sport. Lesser mortals would have bagged it for the couch long ago.

I'm sorry your shoulders are now messed up. You must be incredibly frustrated with this coming on top of your ankle injury. I guess you could say middle age isn't for sissies.

I don't need it right now but how did the horse tape stay on in the water? I tried athletic tape once and it wouldn't stay on very well. And I know you can whip out a lot more yardage than I can.

BTW, did you know Julie Shepard when you were swimming with the Barracudas? She popped off full term twins about 7-8 months ago and swam until two days before they were born.

Jan

The first surgery was to repair damaged ligaments. They took out bad tissue. A few months later a bump popped up and they thought it was a ganglion cyst. Turns out it was scar tissue. It was better once that lump was out, though. No bumps have appeared in 17 months now :)

The horse wrap did stay on in the water. It was very sticky! In fact, I had to get rid of the shoes I wore to the pool then because the tape left sticky residue behind.And the cool thing is that it comes in neat colors. I would pick a color based on my mood.

The shoulders are improving now with some rest, PT at home and anti-inflamatories. I was trying to go to a meet in Feb but now my son won his school's pinewood derby and districts are that same day. More time to recover and get them all better.

I don't remember Julie off hand but I'm impressed! Two days before?! Wow. How is Oregon swimming now? I'll be back for a visit in June and can't wait.

erinsib31
August 21st, 2014, 04:19 PM
Jayhawk, how has your brother made out with the sinus tarsi implant after all of these years?

Thanks!

ALM
August 22nd, 2014, 09:38 PM
Jayhawk, how has your brother made out with the sinus tarsi implant after all of these years?


erinsib31,

I asked my brother-in-law and here is his reply:

"It's actually something I rarely think about and I think that is a good indication of how well it has worked for me. I am able to do most anything I want. I no longer suffer from Plantar Fasciitis though age and wear and tear seems to be causing me to limit my athletic endeavors more than anything else. If I push too hard at times I notice a little discomfort from my implant and also from my patellar tendonitis. This usually occurs once I run past about the 6 mile mark. Bicycling doesn't seem to ever be an issue with my implant... I do think the implant is a last ditch effort and everything else should be tried first, including orthotics, cortisone injections, wrapping and so on. The implant I got is something that could be removed if it eventually causes me some type of issue. If you remember I got the Hyprocure."