Ankle pain (OMG not again)

[ny biker]

Okay, four weeks have passed.

For the first couple of weeks, I had various aches and pains when I wore the boot, but felt okay when I took it off. For the last couple of weeks, reverse that. Pain all around the area of the posterior tibial tendon, up the side of my shin, sometimes the achilles tendon felt stiff, if I wasn't wearing the boot. No pain with it on. So my foot and leg adjusted to the motion of walking in the boot.

I typically put an ice gel pack on it when I go to bed, held in place with an Ace bandage. I just go to sleep with it on, then remove it when I wake up a few hours later. The other night (after removing the gel pack) I turned my foot inward in my sleep and something hurt enough to wake me up. Not sure exactly what was hurting, though. Since then I've left the gel pack and bandage on all night since it acts like a soft brace to keep me from turning my foot while I'm sleeping.

So, today. Day one without the boot! My plan was to just do minimal walking around the office. I had hoped to ride the bike on the indoor trainer tonight, just slow easy pedaling for a half hour. I'm wearing sneakers with Superfeet insoles. Things were fine until late afternoon when my leg started to hurt above the spot where I had the surgery and up the side of my shin. I put an ice pack on it for a while and that helped. Meanwhile I have a terrible cold. So I've decided no bike tonight, my trip to the gym to do upper body weights (I considered putting the boot back on so I could get in a short workout). Just sitting, driving home, sitting again, going to bed. Icing it again and leaving the gel pack on.

Tomorrow I'm supposed to meet up with cousins who are in town for the weekend with some friends. Word is that one of the friends broke her foot and is in a boot. I'm sorry she's hurt but am thinking it will make it easier for me to say that I want to sit and rest for a while, since she'll probably not want to do lots of walking.

One day at a time. Hoping for the best but who knows what will happen...

[Crankin]

I hope you feel better, NY. It must be frustrating.

[Catrin]

Feel better soon NY Biker!

[ny biker]

Two weeks without wearing the boot after four weeks with it. In general, the ankle is worse now than it was before I wore the boot. Before, after the first few days where it hurt a lot, the pain subsided and it mostly did not hurt, except for one night in my sleep I turned my foot wrong and the pain woke me up, so I went to the doctor. Now, it hurts on and off when I walk or drive. Some days are very good, some are very bad, some are on-and-off pain. On the very bad days I wore a certain pair of suede "comfort mocs" from LL Bean with Superfeet insoles in them. On the other days I have worn sneakers with Superfeet insoles. At this point I plan to wear sneakers every day indefinitely. I have two old pairs of the same New Balance running shoe, one white and one gray; I just ordered a new pair of the same model in dark blue and plan to order new pairs of the white and gray soon. So I'll have three pairs of brand new sneakers that should be as comfortable as I can get.

I am very angry and frustrated and worried that it is worse after wearing the boot.

I have an appointment to see the doctor early next week. I am already planning to seek a second opinion. Today I went to the website for the surgeon in NY who performed the original surgery and sent a message via the "contact us" form, asking if they could recommend a doctor with expertise in posterior tibial tendon dysfunction in DC/VA/MD. I included a brief summary of my history (surgery in 1993, excellent results, no pain until recently.)

Whatever happens next, I expect that this is going to cost $$$. In addition to the copays to see the doctor (and possible second or third opinions from out-of-network doctors) I may be facing an MRI, custom orthotics and physical therapy. My health insurance includes a series of $1000 deductibles on durable medical equipment and PT as well as limits on the number of covered PT appointments. And a $200 copay for an MRI.

Last week I rode 40 miles on the indoor trainer and on Sunday I did a flat 30-mile bike ride; both times my my ankle felt fine. Tonight I'm going to try a short ride with hills. Even if it doesn't hurt at all, I am very worried that the doctor will say that I can't ride my bike anymore. Also worried that he will say I can't drive -- if I have to be trapped in my apartment with the stomping elephants upstairs and no ability to exercise I will go completely insane. For the first time ever I am using cruise control in the car. It seems to help, though often there is too much traffic to use it. (Also it feels weird and I can't figure out where to keep my foot while it's on.)

I know more than one of you knows what this is like. Maybe it will improve over time, I hope so. But then again I went through all this before and ended up on the operating table with a long recovery period.

Sigh.

[Pax]

I hope you get an easier fix than PT and MRI's and all the expensive stuff.

Mine seems to be improving by leaps and bounds with my new tennies (Brooks Addiction) and superfeet, and wearing my Olukai's around the house. The Brooks are hideous, but I'll deal rather than have that pain.

[ny biker]

Pax, I'm glad your tendon problems are improving. Thanks for mentioning Olukai. I've seen some styles of their thongs at a few stores; I can't wear thongs without getting blisters on top of my feet but I may order one or two of their other styles. Some other sandals I've found with arch support are Vionic and Sole. Rockport has some but they all seem to have high heels. Also there's a store near me called Abeo that sells sandals and other shoes with three different insole/arch shapes. You walk and stand on a special mat in their store and from that they determine if your arch is high, neutral or low. I bought some sandals from them, haven't worn them yet.

So. I went back to Dr #1 about 3 weeks ago. He said that the inflammation he had felt in the tendon prior to my wearing the boot was no longer there, and that I needed a few more weeks to adjust to walking without the boot. Gave me a handout with stretches and exercises to. I bought a Theraband for the exercises.

He also recommended custom orthotics. Long story short*, I didn't get them and I'm not going back to Dr #1.

A couple of weeks have passed since then, I've been using the Theraband, things are better. But there's still some pain in the same tendon, especially after I tried a 20-minute walk last week. I have researched different doctors, was about to make an appointment with one in Baltimore, but then I did a bike ride with someone who recommended a surgeon in DC who treated her broken foot a few years ago. I went to see him yesterday. I was told he tends to keep his appointments very short but if you tell him you have questions he will stay and answer them. I found this to be true. Overall it went well. He said that my foot looks good on the x-ray, did not think there is anything seriously wrong, and recommended PT and 30 days of Celebrex to get the inflamed tendon to calm down. I have a follow-up scheduled in 5 weeks and he gave me a script for an MRI if it's not better in 3-4 weeks. He works with a medical assistant who gave me her card so I can contact her if I have any questions.

First PT appointment is scheduled for late next week. Just took the first Celebrex with my lunch. Am cautiously optimistic.

Oh and Dr #2 said "cycling is good." He is the foot and ankle specialist at an "orthopedic surgery and sports medicine" practice. They don't participate in any insurance plans so they're not the least expensive option, but so far I like them better than the first place I went.


*Custom orthotics, long story long: Dr #1 is at an all-in-one foot and ankle practice. Surgeons, podiatrist, PT, custom orthotics, small shoe store in the waiting room. On the surface this seems convenient, but..... For orthotics, they don't give you a prescription, they give you a form with specific insurance questions that must be filled out before you can see the orthotics person. Does your insurance cover them, if so what percent, is there a deductible, etc. Because they expect you pay up front before you get the orthotics. Combine this with the shoe store in the waiting area, and you feel more like a credit card than a patient. But wait, there's more. If you go through insurance they charge $1500 for the orthotics. Under my plan my out of pocket would be almost $1000. If you don't go through insurance they charge $530. And they repeatedly encourage you to go through your insurance. Holy crap. So I said, I really need to talk to the orthotics person, I am not even sure I want to get them. Amazingly, they did not make me pay to talk to her. She was very helpful and nice. I was very upset. I told her that I tried custom orthotics years ago and still ended up on the operating table. So for the time being she recommended OTC orthotics from Sole, for $50. They can be heat-molded using your oven or worn as-is. And Sole has a 90-day return policy if you wear them but don't like them. They felt like better support than the SuperFeet so I bought them. So far I like them. And BTW they are available from various stores including REI. And Sole also has various styles of shoes and sandals on their website.