Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old

by Dee
(USA)

Hi Joshua, I have been dealing with severe peroneal tendonitis (MRI diagnosis) in both feet for the past 5 months.


I began PT 2-3 weeks after the pain started. I also see a podiatrist who made me custom orthotics, which I wear every day. (I wore bilateral aircast walking boots for 6 weeks straight to rest the tendons, after therapy only seemed to be worsening things.)

Now in therapy I do 10 min of recumbent bike to warm up the lower extremities, ultrasound to the tendons, some balancing exercises, light resistive eversion and inversion, then ice cup.

In daily life, I can make it through a grocery store trip, walking very slowly, but that is about all. Could not take a 15 minute walk with my dog.

I previously worked out 6x a week: walked dog 10 miles/week, ballet class for 90 min 1-2X/wk, latin dance aerobics, strength class, and cardio class/lo impact, and one yoga class.

I have not been able to do ANY of this for the past 5 months. I do go to the gym and do the upper body machines and now am able to do 12 min on the recumbent bike at the gym.

Some days I can add 10 min on the elliptical without too much pain.

Nutritionally, I eat a wide variety of foods and take calcium (700mg), Magnesium (750mg), vitamin D (1150iu). I am not sure about my vitamin D levels, but I don't do much sun, so it is possible I am low. How much Vit D do you recommend for a 120 lb female?

I have read about your plan of ice dips and massage. I will try ice dips every day for a week, followed by ice massage.

I had been religious about ice massage a few months ago, but then gave it up as it didn't seem to be doing much.

I have never tried the ice dips though. In a perfect world, how many dips/ how many times a day?

I will try whatever you recommend- I just want to get better!

I would be so happy to be able to walk my dog again! My kids and husband would be so happy to have their mom back!



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Joshua Answers:


Hi Dee.

Ouch.

Ok, let's see here.

1. Yes, invest in/experiment with Ice Dipping for a solid week.

Make sure to get as high up the lower leg as possible. 5 gallon bucket or some such.

As a general rule, the more you hurt, and the longer you've been hurting, and the faster you want to get out of pain, the more you want to dip.

If I were you I'd shoot for 50 dips throughout the day, each day, however you want to manage it.

It's triage (if that is the right term). You just rolled in, in trauma. Ice dip. Ice Dip. Ice Dip. Knock down the Process of Inflammation. Start reversing the Pain Causing Dynamic, and thus start reversing the Tendonitis dynamic.


2. Vitamin D. It's VERY likely that you are Vitamin D deficient. Most everybody is.

Check out Kerri's Vitamin D Requirements page.

I'd get my level checked. And while I'm not going to tell you how much Vit D to take since I'm not a doctor or nutritionist, I'll definitely suggest that you take more.

1,000 i.u.'s/day is a maintenance dose for an infant. (I'm not calling you an infant, I'm saying that's a research based/recommended level for infants).


3. What kind of Magnesium are you taking? Anything but Magnesium Oxide is good.


4. On the ice massage. Where exactly were you getting ice massage?


5. You eat a wide variety of foods. How many calories were you eating at your exertion level? How much protein?



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Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com
















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Comments for Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old

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Jan 03, 2010
Rating
starstarstarstarstar 		PART 2 - thanks for your response! - Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old
by: Dee

Hi Joshua,
Thank you very much for your prompt response. I have now done the ice dips for 3 days straight. I have come across a great container~ a Fresh Step Cat Litter plastic tub, cleaned of course!
It is really deep and I can submerge up to mid calf. Today, I have been dipping every 10-15 min all day. It still only added up to 30 dips, but I have another few hours left in my day...

And now to answer your questions, copied and pasted below;

2. Vitamin D. It's VERY likely that you are Vitamin D deficient. Most everybody is.
?I am going to get my vitamin D level drawn tomorrow. I will follow up with appropriate supplementation if needed.

3. What kind of Magnesium are you taking? Anything but Magnesium Oxide is good.
?Mine is magnesium citrate

4. On the ice massage. Where exactly were you getting ice massage?
?Right along the length of the tendon, on both feet, continuing up the outside of the ankle and lower leg some. Only a couple of times a week though, when at PT.


5. You eat a wide variety of foods. How many calories were you eating at your exertion level? How much protein?
?I have no idea how many calories I was getting. I am not a calorie counter at all. I guess I get about the right amount of calories for my activity level because my weight stays stable in the 117-120 range.
?I eat something every 3 hours to be sure my blood sugar doesn't drop during the day. For breakfast I get protein through daily oatmeal with soy milk, blueberries and some pecans in it. I usually eat a handful of mixed nuts for a mid-morning snack, plus a big cup of hot tea with some soy milk in it.

Lunch is either a salad with some deli turkey/chicken on it, or half a PBJ made with organic, unsweetened PB. My afternoon snack is usually a carb, along with carrot and celery sticks. Always a protein at dinner as well- either beef, pork, chicken, fish, or shrimp- along with a veggie or salad and a carb of some kind, usually bread/olive oil dip.

I ordered marrow bones today at the butcher and plan to make the bone broth. Besides rice and eggs, any other suggestions for how to use it?

I also did ice massage today and tried to get in there and slightly irritate the tendon a little. That went fine.
I really appreciate your help and will recommend your site to others. Thanks again~

Jan 05, 2010
Rating
starstarstarstarstar 		Part 3 - Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old
by: The Tendonitis Expert

Joshua Comments:

Hi Dee.

Ok.

1. Kitty Litter Dip. Perfect!


2. Let me know your Vit D level, just for fun.


3. Magnesium Citrate, cool.


4. Ok. There's a missing link there. It's great to ice massage the tendon. And, ice/massage all the way up the MUSCLE that attaches to the tendon. Trace it up. (assuming it's one connected piece that we're talking about here)

Sometimes the tendonitis problem isn't the tendon per se, it's the TOO TIGHT muscle CONSTANTLY pulling on the tendon.


5. I don't count calories either. Well, I do just enough to have a general idea of what I'm taking in.

Here's a hypothesis: You are/were very active. You eat the low end of the calorie range, just enough to sustain your weight/energy. The protein you are eating is used for fuel, and not for repair.

Increase your protein intake.


6. Long story short, bone broth is one good way to do that. I'd throw in some coconut oil for fuel, and some more egg, cottage cheese, protein powder, etc too just to make sure.

You either have a tendon damage tendonitis, or a too much tension on the tendon from too tight muscle and thus irritation, or both.

Experiement with more protein.

Broth over rice, poach eggs in it, soup, I poured a huge thing of it over my Thanksgiving stuffing (it ended up too wet, but it was TASTY!), consume (broth with onions, cilantro, hot sauce, whatever else you want to throw in), eat with bread like au jus. Lots of room for creativity.

You can also simmer it down to make a thick, almost cheese-like base to toss into stuff. Do that with something like thyme (or sage, rosemary, or whatever you like) and it gets really interesting.


7. Irritate the tendon with ice, great. I suspect you need to start digging into and under the calves.
Jan 05, 2010
Rating
starstarstarstarstar 		PART 4 - response! - Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old
by: Dee

Great suggestions.

I will try implementing all of them. I might have overdone it just a touch on the ice water dips the past few days. My skin is irritated on top of the foot and at the ankle. I might have had the water too cold? I dipped for 15 seconds, 20-30 times a day. It has been my "full time job" this week:)

Interesting theory on the calf muscle pulling on the tendon. I do/did do a fair amount of stretching of the calves after workouts and dance. My achilles always felt tight to me, so I would do a deep calf stretch+ a good achilles stretch. Hope I didn't overdo those?

I will have my PT work deep on the calves tomorrow. He did Graston tools on my tendons Monday. Ow-wee, but it did really get in there and stir things up.


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Joshua Comments:

Great. Keep it up.

You can't have the water too cold. I have a guy in Canada using snow from outside to make a slush dip. That's just fine for 10 second dips.

Having said that, cold water can strip the fats from your skin, some people get this, some don't (I don't, for instance).

So make sure to put on a good oil or lotion, eat more good fats too (That's good anyway).

If you meant something other than skin irritation, let me know.


And it's great to work the tendons. But if your Peroneals are too tight and the connective tissue wrappings are constrictive, they need to get opened up.

All the work in the world on the tendons themselves won't un-restrict the muscle structures.

And it's possible you've been stretching the calves, when it's the Peroneal muscles that have been needing it. (They probably -all- need it.)

Stretch light and easy and repeatitively. I'm more a fan of specific massage to stretch that tissue.

And like you said, don't overdo it. Pay attention:)


Did the ice dipping help pain levels?


Jan 11, 2010
Rating
starstarstarstarstar 		PART 4 - response! - Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old
by: Dee

Joshua- great thought on the snow "slushies". We have plenty of snow right now, so I started using snow instead of ice. I love it. Much more fun to do a slushie dip than to hit those hard ice cubes:)

I took your advice and am slathering my legs and feet with cocoa butter to give my skin a barrier. It seems to be helping. I am also putting on a thick shea butter cream at night.

I have started massaging the calves in addition to the tendon area. Great suggestion. My PT is also now tending to the calves. Today he said they were quite tight. I am going to add in a weekly appt with a massage therapist to work on the calves.

Haven't gotten the vitamin D level checked yet because I am still waiting on my new insurance card to come. I did make the bone broth and am drinking 2 ice cubes worth of it daily. I will also up my protein intake per your suggestion.

I am making progress and I thank you very much for your continued suggestions and concern! I am bound and determined to heal!


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Joshua Comments:

Great!

If you're bound and determined to heal, I'm here with you till the bitter end.

(That's really not the best phrase....but it sounds significant, I like it, and you know what I mean:).
Jan 19, 2010
Rating
starstarstarstarstar 		PART 5 - Peroneal Tendonitis- update - Bilateral Peroneal Tendonitis For 5 Months In A 21 Year Old
by: Dee

Hi Joshua,
I got the results of my vitamin D bloodtest back today and my levels are normal.

I started with a massage therapist who specializes in AIS last week. She works with a lot of elite runners/triathletes in our area. She found a lot of tightness in my ITB, piriformis, TFL, psoas ,glut medius, and quads and thinks that this has been affecting both lower extremities in a significant manner.

My soleus are also both very tight. The rest of my flexibility was very good. She plans to teach me specific stretches for those muscles. She is also massaging my calves/feet.

I have had some issues with my toes in regard to the ice dips. Besides the dry skin/rash, I also developed very sore spots on both big toes and several smaller toes. I talked to my podiatrist about it at my appointment today and he said with my decreased circulation in hands/feet ( a little bit of Reynaud's going on), he thought my toes just probably couldn't take the cold temperature.

He recommended just using a gallon ziploc bag full of ice and ace wrapping that around my foot/ankle. Twice daily, 10-15 min per side. This way I can avoid the toe area. I am going to try this. I have been massaging my feet and calves twice daily. I am working very hard on getting excellent nutrition right now. Bone broth every day~2 cubes. It's so good, I just drink it in a mug!

Found lots of great ideas for protein and have really upped my intake. Also lots of fruits and veggies. I also started an anti-oxident supplement.

Today the doctor prescribed an oral steroid for me (medrol pack). He thinks it has a good chance of helping.

That's about all that is new for now. Thank you for your help!


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Joshua Comments:


1. When you say 'normal' level, does that mean betweet 40-80? Many labs rate 20-100 as normal, but you want it up to at LEAST 40.

2. On everything else, GREAT! Sometimes you just can't beat a hands on assessment/work from somebody with skill. Over the internet has it's disadvantages....

3. Don't think you told me about the cold hands/feet. The ice pack alternative is good. I'm curious what would happen if you did hot/cold/hot instead of just cold.


Glad it's progressing! Keep me updated.


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