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Swollen legs after post tib taping applied

Discussion in 'Biomechanics, Sports and Foot orthoses' started by podesh, Mar 13, 2013.

  1. podesh

    podesh Active Member

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    Hi All,

    One of my patients had a very strange thing after I did a low dye taping on both feet. The patient is a 62 yr old lady, works as a nurse, no medical history apart from sore feet and a sore shoulder, no allergies, takes no medications. When I chatted to her today she did report lower pack pain on occasion, she must have not heard me ask about that!

    She reported long standing foot pain, both feet, worse in the right foot, both ankles ache all the time.

    On assessment, navicular drop present - both feet. Jacks test 0 - both feet, supination resistance high - both feet, calc 's slightly everted - both feet. Post tib both weak but the right, unable to rise on toes.

    Lunge test was awful, both gast and soleus were very tight. When palpating the muscles, they were tense to touch, no pain. Tenderness could be felt when a palpated along the medial slip of the plantar fascia and post tib insertion points.

    She wore good new balance joggers to work. I gave her stretching exercises, she was to return for soft tissue work: massage or dry needling and I applied post tib taking to both feet. The tape ran from the lateral border of the foot by the heel, under the foot and in medial to lateral direction up the leg, she also had some strips running across the plantar aspect of the foot. Immediate reaction, was comfortable.

    She rang me the next day to ask if the legs should hurt with the tape, I said no and to remove the tape from the legs, but keep the strips on the feet.

    I rang her today and she reports that both legs : calfs/thighs and half her bottom had swollen, she had been in so much pain she couldn't work. She had removed the tape the next day. The GP sent her for emergency dopplers thinking she had DVT;s, she had liver function, renal tests but all cam back clear. There was no rash. She described the legs as feeling like they would burst, couldn't stand anything on them and it looked like lymphodema. Her ankles, knees and hip joints - no pain.

    The GP is flummoxed, gave her diuretics, but no difference. The swelling is coming down slowly, but still very tense.

    Any ideas, did the tape cause this?? Feeling very out of my depth here, plus her feet still hurt!

  2. thekwie

    thekwie Active Member

    Hi Esher,
    I had a similar thing happen several years ago. Dredging up the details from the dark, deep depths of my mind, I believe the case was quite similar in the initial location of pain, and even being a nurse. I think she ended up being sent to a rheumatologist to investigate a possible autoimmune reaction. Unfortunatly I don't know the final outcome, as she seemed to fall off the face of the earth, I believe I tried to call her and the number was not working (again, dredged from the deep dark depths of memory). It's not vastly useful, but perhaps an avenue to explore?
  3. phil

    phil Active Member

    Thats wierd.

    What tape did you use? Rigid sports tape? Definately no rash at all?
  4. podesh

    podesh Active Member

    Hi Phil, leuko sports tape. I saw the lady yesterday and she's back to where we started. There was no swelling in the feet, ankles or knees. Just soft tissue. She said it looked like lymphodema, except around the joints. Def no rash. She's a nurse, so knows her symptoms. She had a lymphatic drainage massage and that helped.

    I've never seen anything like it.
  5. Griff

    Griff Moderator

    Hi Esher

    No idea on the tape reaction - I have used buckets of the stuff for years and never seen this (not even in the confirmed allergic reactions I've seen).

    My other comment based on your first post is what your provisional diagnosis was/is? When I hear of a high supination resistance, calcaneal eversion with navicular drop and an inability to perform a single leg heel lift then my first thought is the integrity of the Tibialis Posterior tendon.
  6. podesh

    podesh Active Member

    Hi Ian

    Sorry, yes, that was my diagnosis. I'm pretty sure the post tib is struggling. I've given her some temporary insoles with medial heel wedges and I got an email back from her today to say feet feel better already. She also got some strengthening exercises to do.

    The leg swelling, is the strangest thing ever.

    Could I ask, what type of treatment plan you would give to someone with post tib problems??

  7. Griff

    Griff Moderator

    First and foremost if there was pain and swelling and an inability to perform a single leg heel raise I would get an ultrasound scan of the tendon to try and ascertain its health/integrity (and if this was inconclusive then perhaps request an MR scan). I'd be wary of giving exercises or applying extra work demands/load on the tendon until knowing this. However from the start management would always involve some form of inverted foot orthosis to reduce the tensile loads in the tendon.
  8. podesh

    podesh Active Member

    Good!! I am doing the right thing. There was no swelling, or definitive 'ouch' area, which is why I didn't worry about getting an ultrasound. Thanks for the info and replies.
    Cheers Esher
  9. Griff

    Griff Moderator

    I'm confused... This from your first post:

    These findings with inability to perform single leg heel raise would concern me and I'd want a scan if for nothing else to rule anything sinister out. But of course I have seen or assessed the patient.

    Anyway sorry to have changed the subject! Do let us know if there is an answer to the tape reaction situation.

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