Posted by Rob on 5/20/2008, 7:26 pm, in reply to "chronic posterior tibial tendonitis + antibiotics + walking"
Forgive my tardiness. I meant to post earlier but I wanted to digest what you wrote. I am sorry about your affliction and I really wish I had the knowledge and ability to advise you with a sure fire remedy that will allow you to get back on your feet again pain free. But, unfortunately I do not. I am surprised that you spent so long on those antibiotics. A few years back, I had a need for some high powered antibiotics. I was given leviquin which is a type of quinolone. I did a little research on this type of medicine and discovered that they could cause major tendinopathy issues such as achilles rupture. Having bad achilles to begin with, I said 'no way' and did not take them. I don't know anything about nizoral but I wonder if it might be the cause of your problem? I assume you've discussed this with your doctor(s)!? If it is the cause, then maybe there might be a protocol somewhere out there for a cure?
As far as your foot tendon issues go: I've had PTT before. It went away with rest. I currently have tendinosis (very different than tendinitis) in my right achilles. I know from personal history that tendinosis won't go away with rest (had it in my left foot. had surgery to fix it. it worked). Have you had MRI's done? It is possible to have tendinitis and tendinosis at the same time, so I've read.
With your case, it does sound like the antibiotics may have been the initial cause. You should really research that to see if you can find others in the same situation to see how they've managed.
With respect to recovery plan/protocol I can only tell you generally what I did for my achilles (post surgery) but our issues seem very different. I think the only similarity is that we are both dealing with tendons and they are tricky. They like to take their sweet time to heal and don't do so very well on their own. They are also deceptive. They lead you to believe you've healed because the pain has diminished or gone away. So, you start with some light exercises and, whammo, they flare right back up. Been there done that so many times. So, if I could offer one valuable piece of advice it would be: give yourself more time than you think necessary before attempting any exercise or tendon loading. Right when you think you are ready, stop, take a breath and give yourself another week or two. (I've yet to listen to my own advice!)
My post surgery road to recovery was rather simple. I did not go to physical therapy. I just began with easy morning walks, some easy bike riding and light eccentric calf raises. The theraband you mention can be used for eccentric (resistance) work. You could just sit with legs extended in front of you and use the bands to pull your toes toward you while resisting with your feet. Always err on the side of caution and go easy. Remember what I said above. With my active recovery it still took a long time before I felt normal. About a year.
One other thing. About the knots in your legs. Make sure you have those checked out. I'd want to rule out DVT.
Sorry so long winded. I hope you get your issues resolved and I wish I could have offered more help. Good luck!
--Previous Message--
: Hi Rob,
:
: I saw your web page today and need advice.
:
: I developed posterior tibial tendonitis in
: both ankles during a 4 month period of
: taking ketoconazole (nizoral). I was feeling
: good the first two months with training and
: having good workouts and then began to feel
: weakness. Two months into the treatment, I
: had done a couple of days of high impact
: exercise indoors and some leg kicks with leg
: weights when it was rainy last winter. My
: right ankle swelled up with no pain, but I
: was having knee pain , so my knee go the
: RICE treatment and I eased into walking and
: backed off all high impact ex. That happened
: in January. March came and I couldn't walk
: after beginning to ice my right ankle. A
: week later, I tried to walk barefoof and my
: feet literally fell apart. I could not walk.
: Now, each time I have transitioned out of
: bedrest with theraband and ROM exercises I
: begin to barely walk without pain and I
: become reinjured. I have been receiving
: physical therapy since March (infrared
: muscle stimulation, ultrasound, some
: chiropractic as he oversees the therapy). An
: MD has diagnosed me with tendonitis, but I
: may need a second opinion. Two weeks ago, I
: started walking again, but only achieved
: some activities of daily living (still
: sitting in the shower) and began walking
: straight lines at home or outside for a few
: minutes at a time. Then I got into a pool
: and walked more. It was there that I have
: reinjured myself once again over two months
: of dealing with this. Now my left leg is
: also affected, both ankles have pain upon
: any load, I cannot stand without pain and
: both calves have knots in them (left is new
: from the pool and the right leg knot is old
: from ???). Do you have any suggestions
: regarding transitioning to walk once I start
: again or eccentric exercises for my
: posterior tibial tendons. I have a good arch
: and am not flat footed. I am back to Rest,
: ice, compression and elevation and
: therabands again and crawling around my
: house on contractor knee pads. For my right
: leg I have an ankle brace and a walking
: cast. For my left leg I am wearing a
: different ankle brace for a swollen tendon
: on the outside ankle and a cho pat for my
: calf knot that happened 4 days ago. I broke
: down and began taking Ibuprofen, but will
: likely do this only temporarily.
:
: Any transitioning to walk protocols would be
: helpful. I have a pedometer and will try to
: start measuring my steps when I try again.
: Any eccentric exercises for the ankles would
: be appreciated. Are the therabands
: eccentric?
:
: Thanks for your time. This has been a long,
: complicated road, so I tried to give you
: enough background. Jen
:
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