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I haven't been posting updates on the ankle pain, I guess since the second round in the boot (air cast) after an MRI showed a very small tear in the achilles tendon. That was May or so. Unfortunately the lack of updates was not from lack of pain, but from lack of progress--I continue to have this low-level pain in the right ankle off and on. About 6 weeks ago, it started up in the left ankle as well.

The last round with the podiatrist had me trying to start walking some--that is, walk for exercise in addition to normal activity--and try a brief period without the custom orthotics in case that was the problem. Neither of these were an immediate success, so (again on the podiatrist's advice) I'm keeping the orthotics in but continuing the walking as long as it doesn't make the pain worse. Straight walking usually isn't painful, you see--things hurt when I turn the ankles in different positions when sitting, and if I stand for long periods as when baking, and stuff like that.

The latest diagnostic attempt was to get a vein study--by where the pain is located, it's either the tendon (but the tear is not in the right place to be the source of the current pain), a nerve, or the vein. Thursday I hied myself over to the Emory Clinic Cardiology Department for a look at my leg veins. It's an ultrasound test, it turns out--I found it interesting to turn my head and watch the tech find the vein, measure it, squeeze my leg above or below the measurement point, and measure again. The legs ended up rather messy with the ultrasound goop, but beyond that it was a low-annoyance test as such things go.

And the result? My veins are fine, and are not the source of this problem. One vein was showing a little sign of aging in that the diameter increased slightly "downstream", so the Nurse Practitioner recommended wearing support socks to try keep that from getting worse. Never saw the cardiologist whose name was on my referral, and indeed didn't need to--as it turned out, he wasn't even in that day.

I'll go back to the podiatrist next week, and meanwhile will keep walking. If the pain stayed at the level it is most of the time, I'd be willing to just wait, keep up the exercise, and see if it eventually heals. (Other times, I'd say this is uncomfortable enough I'd like to fix it soon.) The podiatrist, though still without a firm idea of the source of the problem, feels that it will likely get worse and not better. I'll see what her next suggestion is on Friday.
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Dr E. was busy having a baby on Thursday when I went in for a check after a week in the walking cast boot. (Apparently her due date was Friday.) Instead I saw Dr. S., a fill-in (Dr. E. has a solo practice), who was quite harried trying to see a full schedule of patients with no prep and deal with an office computer system and files she was unfamiliar with. The staff was harried trying to get Dr. S. to do things their way. <g>

I tried to offer a summary of my problems, but got cut off in favor of a few directed questions, an out-loud reading of the MRI report, and a brief physical exam in which Dr. S. was somewhat frustrated because nothing hurt. I told her that was the way it went--when I'm not hurting, generally no pressure or movement will hurt. When I am hurting, there's a definite are and type of pain...until it stops again.

Anyway, we didn't discuss any treatment except continuing the walking cast/boot for at least a 4-week period, then see if it was ready for PT. She suggested I try to sleep in the boot, keep it pumped up tight to really restrict all movement possible, and try getting an elastic ankle brace for additional support. All these are underway--sleeping in the thing is...OK, the ankle brace was bought yesterday and is now on for the first time, and I'm keeping more pressure in the boot except for occasional rest breaks where I'm careful not to move around. We'll see how this goes.

Don't know when Dr. E. will be back. I asked the receptionist, but she said they were playing it by ear. That could mean weeks or months, I guess, but I'd assume she will try to get back in the office quickly given the one-woman operation it is.
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MRI at 9 this morning: let me just say I hope I never have to have one of these over more of my body than the lower leg. It's amazingly hard to stay absolutely still for an hour--things want to twitch involuntarily. At least my body does.

Dr. E called mid-afternoon with preliminary results, mostly to make sure I was in the boot already and to make sure I stayed there. I have a partial "intrasubstance rupture" of the achilles tendon involving about 10% of the cross-section of the tendon. Translation: it's where the tendon attaches to the bone, not the muscle, and this is good because it's much easier to treat.

The options are
-get back in the boot for 4-6 weeks, more rigorously than before. IOW: don't get out of bed without it (though she didn't say I needed to sleep in it), and I can still take it off to drive.
-get a cast to limit movement even more. Dr. E was not enthusiastic about this one, as she said "I have more patients injure themselves using crutches..." I'd be unable to drive.
-surgery, option a: full repair of tendon, then would be in a cast while it healed.
-surgery, option b: "oblation" of the area (making micro-cuts, I gather), which is less invasive, the goal being to stimulate blood flow and promote healing. Poor blood flow to this area is a big problem with this type of injury, making things slow to heal. Oblation would be done outpatient, but would still mean no driving for the first 2 weeks after surgery.

I'm starting out in the boot, and will see Dr. E next Thursday to see how things are going and to go over all this in person (and based on the final radiologist's report). I'm leaning towards trying the boot alone, and if it's not progressing, consider the oblation surgery. Must coordinate this with various work activities (trip to Denver in early June, short trip to Washington DC in late June) and the schedule of the folks next door, whom I would need to lean on if I end up with a period when I can't drive.
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At last update I had a tentative diagnosis of tarsal tunnel syndrome as a cause for my ankle/lower leg pain, and had had a cortisone injection. There was no relief from the cortisone shot, and actually things got a little worse--more frequent pain, a little more severe, and in a little larger area. All that wasn't immediately after the shot, and certainly worsened while I was in Columbus. Travel with its forced walking, lugging of suitcases, and so forth probably aggravated whatever it is.

I called the podiatrist from Columbus to check in, and we decided to move my appointment from next Monday to today. (I got back last night.) With the lack of response to cortisone, tarsal tunnel is probably out, and this is good. She says TT is very hard to manage without surgery. It looks like I'm headed back into the boot for a while, but first I did opt for an MRI to see if it will show the problem. Dr. E admitted that the results of the MRI are not likely to affect the treatment, but both of us would like to know what the problem is. I told her the boot would be more tolerable if I felt like I was on a definite treatment path for a known injury. In today's exam she thought she might be feeling a ksmall not on the achilles tendon, and definitely thought the area where I'm having pain was a little puffy.

I'll get the MRI tomorrow. The appointment was scheduled for 6 (AM!), but I got a call while in the grocery store after work (maybe 7 PM) saying they had a cancellation, and would I like to come at 9 instead? When I agreed, the scheduler said "the ladies will appreciate it", so I guess no one really wanted to get started that early. Dr. E said she should have a report on Monday and will call me. Meanwhile, she told me to wear the boot during Saturday's yard sale, and I think I will extend that advice and also wear it during tomorrow's garage-cleaning and other sale preparation. (I'm trying to get rid of several pieces of furniture to make room for stuff from Moultrie, and sister-in-law is doing the same. The neighborhood sale came along at just the right time for everything except for enough prep time, so we'll get together what we can. Every item sold will be a plus.)
nlbarber: (Default)
I haven't been posting updates on the ankle problem--it has not gone away despite 4 weeks in the air cast, 4 weeks (overlapped by a week) of 2x/week PT, and now 3 weeks breaking in and using the new cu$tom orthotic$. The current symptoms are these occasional stabbing or burning pains just behind the right inside ankle, sometimes spreading upward a little toward the tendon.

Today was the "how are the orthotics?" visit with the podiatrist. I told her that the orthotics themselves were fine--I'm past the stage of foot fatigue, have no issues walking in them, but....there's still this pain. She poked around a bit and proposed that this could be tarsal tunnel syndrome, possibly caused by varicose veins in the area. I've recently noticed some small varicose veins around that ankle, and it appears that you can have other varicose veins that don't show on the skin at all. The choices she offered for treating TTS were a compression sock, which I'd tried briefly after the last visit and stopped because it was so uncomfortable, or a cortisone injection.

After some discussion, I took the cortisone. (After I decided, Doctor said that in her experience, the compression sock people are back in 2 weeks for the shot.) On the pessimistic side, she also said "if it improves with the cortisone, we'll know it's TTS." I went off to my office with a chill pack for a 20 minute application, and just repeated that this evening. Only one round of burning pain post-injection so far, about 30 minutes ago.

I sure hope this works. I desperately need to get back to regular exercise, for both weight control and general health. I think I may have to admit that regular Jazzercise is just not going to be possible for some time longer, and go find an alternative. That I'll do regularly--that's the hard part.


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