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PTTD Stage 2?

Discussion in 'Ask your questions here' started by Ankle_Pain, May 18, 2018.

  1. Ankle_Pain

    Ankle_Pain New Member

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    Hello All,

    I posted quite a while ago about bilateral foot/ankle and leg pain that I was having that had begun over a year ago. It came on after a long and stubborn bout of diverticulitis in which I had 4 months of mostly bed rest and had begun to become active again. My legs were extremely atrophied so I attributed that to part of my problem at the time.

    I was originally diagnosed with mild pttd and given custom orthotics. I wore them at 15 minute increments 3 times a day and by the third day, I was in tears from the pain. I was given Powersteps in which the Pod built up but the pain continued and worsened.

    Over the past year, I've seen about 50+ specialists. Neuro's, Neuromuscular's, Rheumatologists, Vascular, certified Foot and Ankle Surgeons, additional Podiatrists, Spinal Surgeons, Neurosurgeons and the list goes on. I was MRI'd from head to toe, blood work, etc. I wouldn't be surprised if the total for all of those appt.'s and tests exceeded $300K. Nothing was ever found.

    During the past year, my legs have atrophied even more. I'm about 115 lbs., 52 and am ashamed at how I look. I've tried PT on 3 occasions which always made my pain worse, so various physicians told me to discontinue therapy.

    What's strange is this all presented as outer ankle pain (peroneal) and went up the side of my calf a few inches. Within a month, the other foot/ankle and leg had begun to hurt in the same places.

    I'm only "on" my feet about 30 minutes a day. My pain is still bilateral causing both feet to hurt, my sinus tarsi, achilles, peroneals and calves. Oddly enough, I've never experienced pain in my Post Tib around my inner ankle nor have my arches hurt terribly.

    I can't walk stairs, squat down to pick something off the floor and many other things that involve the feet and ankles. I find the best position when sitting is to have my feet flat on the floor, as this causes the least amount of pain.

    I do have a pronation problem, more so on the left foot. My ankle also rolls in as I walk. I have flexible flatfeet and my ankle slides inward but in no way goes anywhere near the floor. My arches aren't like a pancake, either. I can slide my fingers under my inner arch while bearing weight. I've had 2 MRI's in which no tears or inflammation was found, as well as an ultrasound of both ankles to look at the integrity of the tendons, ligaments, etc. Both of those tests proved to be normal. I can do a single heel raise on both feet with no problems, either.

    At this point, I don't understand how I managed to go from mild pttd to Stage 2 within a year's time while mostly being in bed.

    My Podiatrist is in the process of making me a new pair of orthotics to help with the pain/stability. He used plaster instead of the foam foot boxes. He said these will stabilize my feet and not allow my ankle to pronate inward which he believes will help me. I truly hope so because the pair that I had last Summer brought me to tears within 15 minutes and I had much less pain back then.

    I do apologize if this is all over the place, my mind is just going in all directions as I can't imagine having to have flatfoot reconstruction surgery on two feet. I've already lost over a year of my life due to this and can't imagine surgeries due to my mental state at the moment, which I'm sure that many can understand.

    This problem has also caused my knee to pronate inward and I've also begun to experience extremely tight muscles around my hip that cause me some grief.

    I see a Chiropractor for my hip which he adjusts, but unfortunately the relief is short-lived. It tightens back up within an hour. I have had luck with Massotherapy in which she works with my feet, calves and hips. The relief lasts the evening. I did try acupuncture, it did nothing for me except leave me with bruises on my legs.

    Has anyone with Stage 2 pttd experienced all of this without any pain, swelling or tenderness along the course of the Post Tib or arches? I'm just so perplexed as to why all of my MRI's/ultrasounds have been clear, I can do single heel raises, yet have Stage 2 pttd.

    Could atrophy be a contributing factor in all of this? (I have a very significant amount in my legs) Would gaining some muscle help my situation? I'd be willing to try just about anything but it's hard trying to find an exercise (or even strengthening) that can be done from a bed or while sitting without much foot/ankle movement.

    If you've made it this far, I'm grateful. If you have any thoughts, no matter how insignificant you feel they may be, please feel free to tell me your thoughts.

    My heart goes out to all of you that suffer from foot/ankle issues, as well as other medical problems.

    Thank you.
  2. Cassidy

    Cassidy Member

    First I'm sorry you have been dealing with the affects of leg and foot pain. Is the podiatrist saying you have stage 2 pttd because your foot is more collapsed than before? What other clinical evidence do they have regarding pttd? I would get other Ortho foot and ankle specialist and podiatrist opinion before deciding surgery especially if your symptoms don't mirror what is typical for that. I know from experience that surgery is not a fix all and if areas of pain are not addressed then it's possible you will be in the same or worse place after surfers than you are now.

    Those are my 2 cents for what it's worth, I to have been dealing with issues for a couple years and it is exhausting, just feel as sure as you can before going forward with any care plan.

    Best regards
    Ankle_Pain likes this.
  3. Craig Payne

    Craig Payne Active Member

    I consider stage 2 PTTD to be a "medical emergency"; in that if its not stopped at that stage and progresses, then you invariably need reconstructive surgery.

    At stage 2, typical 'foot orthotics" are not usually an option as it has progressive too far. Almost all need something like a Richie Brace which includes a very supportive foot orthotic: https://www.richiebrace.com/ talk to your podiatrist about that option.
    Ankle_Pain likes this.
  4. Ankle_Pain

    Ankle_Pain New Member

    Thanks for your response.

    Would I consult with my podiatrist or a certified foot and ankle surgeon regarding a Richie Brace?

    I can't believe that I've seen several Podiatrists and Foot and Ankle surgeons nearly a year ago when this all first began and was given a clean bill of health from all of them.

    I'm so frustrated and feel that I'm in a race against time at this point.

    Thank you again.
  5. Ankle_Pain

    Ankle_Pain New Member

    Thank you for your response, Cassidy. I really appreciate it.

    I have absolutely no idea why this podiatrist is suggesting that I've progressed to Stage 2 pttd. When I first saw him close to a year ago, he said it was mild. I don't understand how only being on my feet less than 30 minutes a day could cause it to progress so quickly. My muscle atrophy has certainly progressed though and I had a significant amount to begin with last year. I realize that I've had a lot of medical appt.'s this Winter, but I mostly navigated to them in a wheelchair and not on my feet.

    While at the podiatrist's office, I did show him a video of me doing single heel lifts on both feet relatively easily but he didn't seem all that interested. He always seems to be in a rush and my questions go unanswered. I feel that my foot and ankle pronation looks no worse than nearly a year ago.

    Due to the seriousness of all of this, I am taking your advice and getting several other opinions. I did some research today and did find 2 podiatrists that I'd like a second opinion from, as well as a certified foot and ankle surgeon. I'll be making those tomorrow as I certainly don't want flatfoot reconstruction surgery. I've read too many horror stories (and there are plenty of them) nor do I think that I'd be a good candidate for them.

    Thank you for your kind thoughts and good advice, it's appreciated greatly.

    My heart goes out to you dealing with pain for years. I really hope things improve for you soon.

    Take care,
  6. Cassidy

    Cassidy Member

    Usually one of the things they look at is the ability to do heel lifts along with xrays and clincal presentation, I believe usually an MRI or other diagnostic scan is done to check the state of the ptt.

    I'm so glad you are seeking other opinions, I have been through 3 midfoot surgeries and 1 reconstruction surgery with another in october to correct what wasn't corrected in the last surgery, you definitely don't want to jump to Surgery if you don't have too. Also a brace like a Ritchie brace or AFO can help a lot too.

    Good luck to you I hope you get answers and options!
    Ankle_Pain likes this.
  7. Ankle_Pain

    Ankle_Pain New Member

    I'm so sorry to hear that you've been through so much with more surgery on the horizon. I hope this next surgical revision goes well and gives you a good quality of life. I really feel for you. Not only does the pain cripple you but not being able to do simple things in life can really make you depressed. I can't say that I know how you feel on a surgical level but pain can do a job on you.

    I picked up my new custom orthotics on Friday. I was expecting them to be like the first pair that I had, pain-causing. (these were rigid, had great arch supports and deep heels cups) Much to my surprise, they've been great! I had mild ankle swelling in the front of both ankles, which I assumed was due to to my ankles pronating. It's gone! My sinus tarsi pain and much of the other foot pain that I was experiencing is gone, as well. This was within the first day and a half. For the first time in over a year, I walked half way up the street and felt alive again.

    That was on Saturday, then Sunday came and I really hurt. Not really my feet/ankles but my calves. I should've listened to my podiatrist when he said to wean into them (30 minutes a day to start) but I was too excited. He did warn me that if I did more, my feet/ankle and legs would despise him and he was certainly right.

    So, I'm going to follow the weaning in period from now on but am cautiously optimistic about these new orthotics. I was nearly pain free for nearly a day and a half and am hoping in time, I'll see those days once again.

    Thanks for your message. You're in my thoughts and prayers.

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