T Nation

Help With My Foot


#1

I have been dealing with a painful foot for over 3 years now.

List of what I have done:

-Orthotics
-Immobilization initially for possible tear of medial deltoid
-R.I.C.E
-Brace
-Resistance training with bands
-Soaking in Epsom salt
-Fish oil, nsaids, Boswellin, SuperCissus (3 btls), more fish oil, completely revamped diet to emphasize lots of vegetables and omega 3s.
-A.R.T for 9 sessions with no noticeable results.
-Have been to a doctors.
-I do foam rolling daily
-Bought lots of different shoes that supposedly help with foot problems, everything from minimalist footwear like Vibram Five Fingers to shoes with Springs to the best rated shoes for walking.

When is pain triggered / where is pain?

-Pain is mostly in the top of the foot, around the talus / medial deltoid ligament. Also some where the posterior tibalis tendon wraps around underneath the foot (right where people experience pain with platar fasciitis )
-It hurts most when I lift up on the ball of my feet.
-Hurts to just walk, haven't been able to run in a long time.
-Hurts performing inversion.
-Achilles tendon also hurts sometimes.

Report from MRI (I'm not really sure what all of this means, maybe someone could help me intepret this?):

There is considerable abnormal osseous edema and marrow edema
involving the talus, navicular, and portions of the anterior talus.
The anterior talus shows some signal distortion which might indicate a
fracture of an anterior talar region especially as it abuts the
subtalar joint line anteriorly. There seems to be some fragmentation
here. Osseous edema would indicate significant contusions of the
posterior talus, navicular, and the subtalar joint line region of the
calcaneus. There is no other presumed fracture. Joint effusion is
noted within prominent synovial collections posteriorly and medially.
Deltoid ligament complex is very indistinct and very likely torn here.
Lateral ankle stability ligaments appear intact as visualized. The
tendon structures appear to be intact and normal with no thickening or
suggestion of tendinopathy.

What can you guys suggest that I do to help get rid of my foot pain? Also my foot always appears to be swollen, so I'm sure scar tissue is still there probably preventing blood flow. I read a lot of people suggesting to get the "Dont Ice that Ankle Sprain" kit so I just ordered that. I'm willing to do just about anything to get this problem to go away. I really don't want to get any surgery unless it is absolutely the last thing possible that I can do. I am willing to devote any amount of time, dedication and resources necessary to get this corrected asap.


#2

When was the injury and what specifically happened? Eversion mechanism of injury?

When was that MRI taken? Basically from those MRI results, you have/had a fracture to the talus, significant contusion to the talus and neighboring tarsal bones and calcaneus. Also, the results show a likely torn deltoid ligament (medial ligaments of the ankle). The ending statement shows states there was no significant damage to the tendons of the ankle, including the post tib.

You said you were immobilized...how long and when were you immobilized? What type of therapy did you receive post-injury?

There is a lot of information needed before anybody could give you quality advice. I really like the "Don't Ice that Ankle" book and highly recommend it to people. It is very helpful to a lot of situations, but not to 100% of them, and it depends on the time frame whether it should be done or not.


#3

I really don't recall a specific injury or event that happened to cause the initial flare up of this injury. I was with my gf in Boston and one day and when I got to her place from the airport it started to hurt. I got it diagnosed immediately and the doctor told me it was a medial deltoid ligament sprain. I got crutches and stayed off of it for a few weeks, and performed RICE.

After I flew back home to go to college it still hurt. So I got it checked out again and they suggested that I put it in a boot for a few weeks, so I did. I stayed off of it completely for 4 weeks and when I got out of my boot, I went to PT for 4 weeks and continued to do the therapy suggested by them for another 6. My pain has always been inversion. The PT suggested was resistance band exercises along with a couple of sessions of ultrasound therapy. While continuing PT on my own, I met up with an A.R.T specialist certified in Biomechanics and followed his suggestions for exercises that I could also do. It was also at this point that I recieved my orthotics to correct overpronation. Also note that I have a falling arch in my injured foot.

The pain bothered me all sophomore year and the beginning of junior year of college. Then it started to get a lot better. I was even able to start running some. I started to train legs again and do squats and calf raises without pain. Second semester of junior year I didn't have much pain at all of my foot. Throughout this past summer I backpacked through Europe for 6 weeks and had no problems with it. Then after I returned recently it started to flare up again.

The MRI was taken about 10 months ago.

On another note, I was reading here: http://www.arthroscopy.com/sp09017.htm that sometimes talus injuries can be recurring and flare up without a known cause. I really don't remember a reason why it started hurting. I know that I wasn't doing anything intense on my foot the day it was hurting. No sports or training.

I think right now I should focus on getting the tendons and ligaments as strong as possible to take stress of of the talus joint.


#4

Also I thought I should note some of the things that makes it feel alot better:

-Sleeping with books underneath the end of the bed to keep my foot raised at night.
-Keeping my foot wraped with ace bandage wrap all day.
-Getting out of a warm shower.
-It also feels better after I do some resistance training on it.
-Sometimes my foot will hurt right at the achilles tendon until I pop it.


#5

It sounds like there may be an underlying tendinopathy occurring. You may have been correct in your posterior tibialis statement in your first post. MRI's aren't 100% perfect. I would keep doing what you have been doing to make progress. Check back with your doc if things continue.

You may want to look into some mobility drills for your feet and ankles to help. I know z-health has some really good stuff.


#6

What can I do to help treat the tendinopathy?


#7

Depends on the severity of the pathology occurring at the tendon, if there is any. If it is pretty significant, it usually starts with a boot to let the tendon settle down. After that, you most likely need some mobility work at your foot/ankle and proper activation drills of the smaller muscles/tendons of the foot/ankle. Without being able to assess you, I can't give anything very specific. I would look for a coach/therapist in your area that should be able to help.


#8

I'll go see someone shortly. While I do, what type of mobility exercises and treatment should I give assuming its not torn?


#9

Search for ankle mobility drills here on T-Nation in the articles. There are plenty of examples.