Hi everyone. I'm a 4th year med student who's been suffering from some long lasting PTT. I'm seeing a podiatrist, but I'm curious if anyone had additional thoughts on this.
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HPI:
May 2011: Running ~60mpw. No precipitating event, but after a run felt some soreness post/inf to R ankle. After 4 days of continued running, felt 9/10 pain 1 mile into run.
Summer 2011: Tried series of breaks from exercise, between 1 week - 1 month. Pain returned with activity.
August 2011: Saw Sports med MD:
MRI Ankle Aug 2011: There is mild fluid posterior tibialis tenosynovitis.
No midfoot fault or hindfoot valgus.
Put in cam walker boot for 8 weeks, followed by 6 weeks of PT.
Dec 2011: Still have pain with extended ambulation, tried to return to activity with elliptical but continued to have pain after ~30 minutes on elliptical.
Early January 2012: Back in cam walker boot, wearing 24/7 including sleeping.
Repeat MRI in early January 2012:
There is mild posterior tibial tendon tenosynovitis, similar to the
previous study. There is no tibialis posterior tendon tear, as
questioned. There is no talar head uncovering, or hindfoot valgus to
suggest definite posterior tibial tendon dysfunction. There is
minimal flexor digitorum tenosynovitis. The flexor digitorum and
flexor hallucis longus tendons are normal.
I'm currently seeing a podiatrist who prescribed a Ritchey brace which should be coming in later this week. My question is why the PTT hasn't been getting better with the cam walker. Is it because the cam boot doesn't provide enough medial arch support to sufficiently offload the posterior tib from inverting the foot? Secondly, as a 26 year old starting his intern year in June/July, what are the chances that this will progress further into disfunction, and what's the time scale involved? Have you guys ever seen steroid injections being used for something like this? I'm worried about the risk of tendon rupture and it doesn't seem as if it's really been validated from my lit searches in PTT, but at this point I'm honestly willing to try anything. (Platelet injections? Acupuncture? Rain dancing?)
Thanks a ton for any help you guys might have. Going from running marathons to sitting on the couch with all of my free time since last year praying for this to heal is miserable. :(
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