Is it possible to correct Flexor Hallucis Longus Tendonitis and if so how?

by Shawna

I joined the military with no foot problem that I was aware of.


I was required to run many times every day for 6 weeks. I not only ran "accidently" in sneakers for flat footed people but also in combat boots.

I have very high arches. I'm 23 and no history of injuries. It is occuring in both of my feet. I've been tossed from doctor, to doctor, to physical therapist, to podiatrists, to some more doctors and back in physical therapy.

The podiatrist seemed to be the only one with a clue and then I PCS'd to another base.

I have custom made insoles to support the arch.

The doctors first believed it was plantar fasciitis and once the podiatrist said Flexor Hallucis Longus tendonitis they agreed with him.

I've had the extremely painful shots into the tendon protruding from the bottom of my arch.

I've had little electrical pads stuck to the bottom of the arches with constant low charges. I've had massage therapy. I've done different stretches. I've had ice(very painful). I've also had heat. The heat and massaging felt pretty good but it was just temporary relief. The cold even just weather seems to tighten the tendon and make it very stiff and painful.

I now have running shoes for high arches but it is still painful to run and my feet hurt for days after. I cannot wear my insoles in my running shoes because the pain becomes almost unbearable.

The insoles in my boots don't seem to be doing a whole lot. They were made for support of my arches not comfort.

My most recent doctor suggested memory foam insoles and to just discard my support insoles.

The physical therapist said the other insoles weren't working so try soft ones.

I have heard there is debate on long term and short term effects of soft insoles. Is there some kind of treatment I can mention to the doctor or physical therapist or stretches that will make a difference or maybe just some insoles you can suggest?

I'm desperate. They are putting me through physical therapy one more time then they are going to discharge me medically if I don't show improvement.

I don't know if I left anything out.

Please let me know if you need more information or if you
can suggest anything.

Thank you-- Shawna



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Joshua Answers:


Hi Shawna.

The quick answer to 'how' did you get this tendonitis is...'you suddenly started running everyday, multiple times, in flat shoes and combat boots'.

Lots of other variables, of course, but that seems like the obvious, general on. But you knew that.

I'm not going to investigate the direction too far.

The other quick answer is 'Yes, it is possible to correct Flexor Hallucis Longus Tendonitis.

Tendonitis is the Tendonitis Dynamic, no matter where exactly the pain shows up

See: What Is Tendonitis?



I'm going to go with what the podiatrist said. Flexor Hallucis Longus until I see/hear otherwise..

Soft inserts, hard inserts, I don't know. I've never really heard much great about them. Granted, I mostly only work with people that everything else has failed them.

The one line you said of built for support and not comfort....that seems like a bad idea. The body does not like discomfort or pain.

Thanks for all the details by the way. Details GOOD.

Not surprised by anything about the rest, doctors and PT and such. Hopefully the new PT you get will be able to get better results and do things differently than you've experienced.




Questions:

1. Describe the massage you received for this. Where did they work, how did they work, etc. Details.

2. What about icing was painful? How did you ice, exactly. How did it hurt?

3. Describe the pain. Where exactly. When exactly (ie, only when you're on them, even when your off them, at night in bed, etc)


Answer the above, and we'll go from there.




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
















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Dec 18, 2009
Rating
starstarstarstarstar 		PART 2 - Response - Is it possible to correct Flexor Hallucis Longus Tendonitis and if so how?
by: Shawna

They massaged from the edge of my heel up to where my toes begin. It was a circular motion with low to moderate pressure. Mostly focusing on the swollen tendon. I do this myself at times. It seems to relieve pressure(the throbbing).

The heat was like a heated ultrasound wand with jelly moving back and forth along my arch. The ice was shaped like a small cup but rounded on the end. I was instructed to slide it back and forth along the arch. I'm not exactly sure why the ice makes it hurt. It is most likely that the tendons are swollen and the ice makes them want to tighten rather quickly.

If I stay off my feet all day they don't hurt. My job requires me to stand a majority of the day. Just standing makes them hurt. I can't stand still for more than 5-10 minutes without teetering back and forth from one foot to another.

Jumping and running obviously hurts the most.

Walking for a prolonged amount of time also makes them hurt. This may not be helpful but running barefoot in the sand does not make them hurt.

Depending on the distance it may be a very dull ache after. The stretches range from laying down with a piece of rubber wrapped around the bottom of my foot and extending my feet, to pressing half of my foot against the wall and moving my waist towards the wall and the same but bending my knee and moving it towards the wall and holding it for 30 seconds.

I was instructed to do this for 5 minutes 5 times a day.

The stretch with the rubber doesn't bother me but the stretch with my foot against the wall just makes the top of my foot that connects my toes to my foot hurt more than the arches. I stopped those because then my whole foot is killing me instead of just my arches.


Dec 18, 2009
Rating
starstarstarstarstar 		PART 3 - Is it possible to correct Flexor Hallucis Longus Tendonitis and if so how?
by: The Tendonitis Expert

Joshua Comments:

Just from what you've said, they've missed a vital part of all this. Seriously missing the boat.

They're working the tendon, but not the muscle that attaches to the tendon.

You HAVE to work the muscle and connective tissue. It is TOO TIGHT, connective tissue is shrinkwrapping and trapping it too tight, and that is putting constant tension on the tendon and attachements, and then the whole ecology of the foot/lower leg is responding to that.

Here's what you do, intensely for the next week.

1. Get a 5 gallon bucket and ice dip as described on the How To Reduce Inflammation.

As many times as possible per day. Morning noon and night if possible.


2. Do the massage, and even ice massage if you want, up the tendon to the muscle. For right now, don't worry about the tendon. Worry about the muscle. Trace the tendon up to muscle, and work the entire body of the muscle, and anything around it.

You do it, and/or get a friend or massage person to work your entire lower leg and especially the FHL belly and attachments and surrounding tissue.

Shift your focus from the foot to the lower leg.

Much of the time, where you hurt isn't the source of the problem.


3. Read this Magnesium for Tendonitis page and then my Kerri's Magnesium Dosage to find out what kind of mag and how much to take. Work up to your tolerance level and stay there.

It will be worth it for you to also get this Magnesium Oil and apply it to the FHL/lower leg area, and the foot too. (It's the best and cheapest you will find.)



I'm not saying the above is a total answer, but it's the answer for right now to lower your pain levels.

Go full tilt at this for the next 7 days.

* Ice as much as possible.

* Massage in little bits, frequently and repeatedly, even while you're standing there at work, reach down and rub the FHL for 10 seconds. Repeatedly.

* Magnesium, and increase your protein intake too.


More questions, more answers. And, updates please.


Nov 21, 2010
Rating
starstarstarstarstar 		FHL pain in foot
by: Anonymous

I came across this site while looking for info on FHL tendonitis. I thought that what I had was plantar fasciitis, but none of the treatments (strassburg sock, golf ball rolling, etc.) have helped, plus the pain/tenderness is only on the medial part of my arch stretching from under the big toe to below and behind the ankle bone.

My question is what else, besides what you've listed above, can be done for this?

I'm a runner, would putting the foot in a boot for a few weeks help?


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Joshua Comments:

Ahhh! No! No Boot!!!

Granted, that's just my personal/professional opinion.

You have pain because something(s) is TOO TIGHT. IF you immobilize it in Das Boot, then it gets no lengthening or shortening, and connective tissue shrinkwraps the half squeezed sponge of the muscle even more than it already is.

Then you'd have a too short, too tight structure that puts even MORE tension on it's connections with every step.

So no, I don't suggest immobilization in the boot.

Sure, I have other things I could suggest. But my question to you is, have you done what has been suggested in this thread?

If no, do them and check back in later.

If yes, then describe what exactly you did, and the results.
Jan 15, 2011
Rating
starstarstarstarstar 		barefoot training and kickboxing, now arch pain
by: Fipzee

hello, I stumbled acrosse this page while searching for answers about my strained arches. Very good advice here!!

I have been training Muay Thai kickboxing for the past 3 years and have returned to training after a 3 month layoff. We train barefoot on a padded floor, however after 3 sessions in a week and a half i had to stop because of what felt like a pulled arch. I do have fairly flat feet and wear custom orthotics in my shoes and haven't had issues training before. I think it's due to the return to barefoot training. During the 3 months off I was still running and exercising though.

It has been 1 week and I have been icing and doing self massage, no stretching yet as it is slightly painful when stretched still. My question is should I be stretching the arch during recovery and about how long would you estimate this will take before I can get back to training? (only thing i've been doing is swimming in the meantime)

p.s. I am a 37 yr old male

thanks for the help!


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Joshua Comments:

Hi Fipzee.

I wouldn't worry about the arch so much, I'd work on the back of the lower leg.

It's a big shift to go from shoes to barefoot training. So while you feel it in the feet, and it possibly is the feet, but I bet it's more a function of lower leg structures that connect down in the feet.

Release those tight structures, happier feet.


Yes?
Feb 09, 2011
Rating
starstarstarstarstar 		It's working! (slowly)
by: Fipzee

Hi, thanks again for your advice. I have been stretching and rolling my lower legs daily. I have also been stretching the plantar fascia and i try and do strengthening exercises like walking on toes etc. I think all this is working. It has been 4 weeks now since hurting the arches and they definately feel better but not 100%

I wouldn't say i have anymore PF "pain", however they are a little tight in the morning and maybe slightly tender when pushing my thumb on it.

I'm wondering when is a good time to start back with short runs? I not even considering kickboxing for a while.

thanks,
Alden


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Joshua Comments:

Great!

Are you rolling/working/stretching the backs of your lower legs? I'd hit that before running. It's great to open up the plantar fascia, but if you don't open up the back of the lower leg.....
Mar 01, 2011
Rating
starstarstarstarstar 		Posterior Tibialis Tendonitis Misdiagnosed?
by: barefoot

Just came upon your page here. I too have had very similar symptoms and been in the same situations as Shawna. I too have high arches, been in the military, have issued custom made insoles which I do not wear because of discomfort. Love to be barefoot at home, not a big fan of wearing shoes and socks after hours. Recently about 4 weeks ago was on my feet for several hours in boots shoveling out from the two feet of snow here in the Midwest. Later that evening I went to stretch up my foot and felt a severe 2" inch tear on the inside of my ankle. Saw my Ortho and told me I had PTT, was referred to PT 2 X 3 weeks. During PT of Massage, Ultrasound and Icing experienced much pain and discontinued therapy after 2nd session. Went back to see Ortho and felt that a Richie Brace and returning to PT would help. My ankle is still pretty active as far as pain level of 7+. During PT was told I have tight muscles and still guarding. I am considering having a MRI done to see if something was missed. Would very much like your opinion on my situation. Thanks!


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Joshua Comments:

Hi Barefoot.

It would be very useful to know whether or not you actually do have a tear or not.

It's either VERY tweaked and unhappy, or there's a tear.

The treatment methodology is similar for both, but depending on the specifics of the tear, or if there -is- a tear or not to ligament or connective tissue or tendon, that does change the game as far as how one looks at what's going on in your feet.

Aside from that, yes absolutely your muscles are tight and guarding.

What are you doing about that?

Also, when you say 'inside the ankle', does that mean in the meat of the foot, or on the bony area on/below the ankle bone?
Feb 20, 2012
Rating
starstarstarstarstar 		2 1/2 years!!
by: Anonymous

I just wanted to share a condensed version of my story. I've been dealing with the same arch pain for about 2 1/2 years following a rolled ankle. Went into the walking boot for about 8-10 weeks( stress fractures) and when I came out of the boot the arch pain was 10 times worse than the stress fractures and it has lingered and turned into other problems.

The good news is that I have a rather obsessive personality and was/ am determined to fix this. I have discovered that a great deal of the pulling of the tendon at the ankle and heel (which has lead to a stiffening of my big toe) has a large part to do with what is going on at the very top of the fhl tendon at the top of the leg.

With the proper walking and alignment mechanics the hip should be turned out a bit as you walk thereby giving length to the tendon. Also my back and hip are crunched over and pinching it which is also restrictive.

My wife has shown me a few yoga poses which to my amazement have given me relief(during the poses).

I am now starting yoga and PT with a sense of extreme optimism.

Good luck to you all.



Feb 21, 2012
Rating
starstarstarstarstar 		Tarsal Tunnel Release/Bone Spurs
by: Barefoot

Just saw your comments to my post of March 2011. Here is an update on my condition. Back in April 2011 I had a Tarsal Tunnel Release done with good results.

The MRI I had done did not show a tear however, it did show that I had spurs on the insertional part of my Achilles Tendon and several micro tears.

I did extensive therapy for eight weeks afterwards consisting of Stretching, Strengthening exercises and building up my calf muscles. My ankle has been pretty quiet until recently.

Lately, I have been experiencing a somewhat painful tearing sensation when walking or standing on occasion (barefoot & in shoes)at the back of my heel (A/T area). The only thing right now that gives me some relief is a Dr. Scholls insert for heel spurs and plantar fascitis.

Really do not want to seek medical attention if I can avoid. Any suggestions would be appreciated.


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Joshua Comments:

Hi Barefoot.

1. My Reversing Achilles Tendonitis ebook or 'The Plantar Fasciitis Treatment That Works' DVD and the Quick Start Companion ebook that comes with it will go a long way towards rehabbing the ecology of your lower leg.

Stretching and strengthening will never work, because the problem isn't something Stretching or Strengthening can fix. You're feeling tearing again because all the same factors that caused the bone spurs and microtears in the first place were not fixed with surgery nor PT.


Did you have the bone spur's removed?

I need to do a page on bone spurs...


Depending on your motivation levels, what I REALLY suggest is The ARPwave System. That will fix the SOURCE of the problem, which is NOT the bone spurs or micro tears, etc.
Mar 05, 2012
Rating
starstarstarstar 		Achilles Tendonitis/Bone Spurs
by: Barefoot

Very much appreciate your updates to my feet concerns. Such some additional info - it is only effecting my right foot (odd?) not sure. Also, my pain issues seem to really get worse when walking up and down stairs especially and of course being barefoot on my hard floors. No I did not have the bone spur's removed, perhaps I should have? Not sure. Thanks for the suggestions I most certainly will look into obtaining the information you mention above and look forward to reading about your page on bone spurs.


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Joshua Comments:

Bone Spur page
Nov 26, 2012
Rating
starstarstarstarstar 		Did this work?
by: Interested

Hello - can you give an update as to if the suggested treatment for FHL (as asked by the original poster) worked?

Thanks
Mar 24, 2013
Rating
starstarstarstarstar 		results?
by: Anonymous

I have been doing the Insanity video no socks and jogging on my treadmill barefoot but with socks. I haven't been dealing with this pain 2 years but it's going on 2-3 months and recovery is so slow it's not seeming likely unless I put my foot in a cast.

My left leg has some tendonitis but not as bad as my right..it would be nice to see feedback of what has worked for others..started for me every other day I'd workout to Insanity video no socks and I stepped it up to where I was sometimes jogging on treadmill or interval sprinting on my non-video days.

I think I just overused the muscle..but I starting noticing bc I would get charlie horses so bad during the video I had to stop. I was eating less than ever too but taking vitamins.. I wanted to lose weight and was having a hard time..I started giving myself a week break btw workouts bc the charlie horses were SO bad.. and I started introducing everything recommended to treat muscle cramps into my diet like spinach, red meat, fish, sesame seeds, dried apricots etc.. but this didnt seem to fix the charlie horses during the workout video..and the last workout was the last straw.. intitially I thought sciatic nerve bc the workout caused my butt muscles, thigh calves to be soar..then it became my calves and my arches of my foot and big toe and somewhere btw my little toes..I started to think it was a nerve..primary care dr apt as it is taking 2 wks to fit me in.. so I have yet to diagnose and take antinflamattory meds and properly diagnose it.

Haven't worked out in about 3 wks, I do still wear high heeled boots to work but I sit all day and only get up to visit the fridge or potty breaks at work, and to travel to and from my car btw leaving work. Otherwise I spend most of my time laying around.

I would THINK recovery would be faster...I have taped my arches the last week and tried taping my foot like I am a ballerina today.. I may find out more information from my primary care doctor..but I wish I could find more answers hear..at worst I might buy some crutches however both my legs have it somewhat mostly my right.


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Joshua Comments:

The body can't recover if it doesn't have (enough of the) the neccessary building blocks.

See: Magnesium For Tendonitis

Not enough magnesium causes muscle twitch, spasm, cramp, charlie horse.


Also, were you used to going barefoot during activity? Or did you just all of a sudden start not wearing shoes to work out?
Mar 07, 2014
Rating
starstarstarstarstar 		12 year old daughter dx with FHL tendinitis
by: Kenja

I, too, stumbled across this page while searching for info on FHL tendinitis. I have a 12 year old daughter who was running in gym class and out of the blue, the back of her left ankle (like where the Achilles Tendon is) started hurting very badly and she says that every time she takes a step & has to push off, it hurts.

It's slightly swollen. She's has had this problem before when it started about 1.5 years ago when she started playing soccer. Before, with rest, it just gradually went away but it hasn't this time. Sometimes, both ankles hurt in the same spot just one worse than the other.

She went to an Orthopaedic Dr who dx her with FHL Tendinitis. She has a very high arch & wears chuck's (low top chuck taylor shoes) or a different pair of high top sneakers (don't know the name right off). What is the best kind of shoe & what exercises will be best? (We're talking about a highly ticklish little 12 year old girl & I'm not sure how effective any exercises will be if she's too ticklish).

Also, should I take her to get fitted for custom insoles (the chuck's have no arch support in them at all & her high-tops don't offer much support either).

Thank you very much!


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Joshua Comments:

Hi Kenja.

1. I"m not a fan of insoles or inserts. Sometimes they can work out fine...but I'd prefer to fix the problem/get the body working how it's supposed to.

'High arches' aren't in and of themselves a problem. The problem is, muscles aren't working properly so pain develops.

2. Rest doesn't make the problem go away, but it does reduce new irritiation to an already irritated.


What does her nutritional intake look like?
Oct 01, 2014
Rating
starstarstarstarstar 		FHL Tenosynovitis and still in pain after multiple surgeries
by: Anonymous

I was diganosed with FHL (flexor hallucis longus) Tenoysnovitis in 2012 after having an os trigonum excision. Two FHL tenosynovectomies surgeries later (December 2013 and July 2014), I still continue to have chronic pain. I have been to seven different doctors to try to fix this problem.

I have been booted, given custom orthotics, soft tissue massage, heat, TENS Unit, stretching, isometrics, icing, ultra sound, and injections.

Do you have a specific program for FHL injuries or have an suggestions?


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Joshua Comments:

Hi Anonymous.

Your scenario is involved and significant so I'm not going to give you a tip or a trick, because that wouldn't work.

The best I have for you is 'The Plantar Fasciitis Treatment That Works' DVD and the Quick Start Companion ebook that comes with it.

You need a complete plan of attack that deals with your foot and lower leg and entire system (for certain factors). Post-all-these-surgeries you also need to deal with the repercussions of the multiple surgeries that have caused damage and injury.

Unfortunately surgery doesn't deal with what caused the tenosynovitis in the first place. So that's part of what the plan of attack deals with.

Due to the surgeries that have damaged and rearranged and weakened your structures, our goal is 1. reduction of pain and symptoms then 2. see how good we can get your function and pain levels.

What did you have the first surgery for?
Nov 11, 2014
Rating
starstarstarstar 		Is this Flexor Hallucis Tendonitis?
by: Tiffany

I have a quick question for you... While I continue to have pain and issues after my tibial sesamoidectomy, bunionectomy, and fusion of second toe procedures (from April of 2013), I have been pushing along using orthotics, TENS, stretching, PT, etc.

I find that trekking in woods or doing some hikes (granted, I have been learning my limits...) is easier than walking on flat land, as I don't have to push off as much... I also row, use weights, and do Pilates/yoga to stretch and strengthen...
M
y PT thinks I need to focus more on using my ankles/other muscles instead of my toes as much when I walk. With my high arch, I realize that I will continue to have issues after all of the surgical procedures, but I will live with it.

That said, I am curious--my last MRI from a couple of months ago showed that I had "thickening of the flexor hallucis tendon near the lateral sesamoid", which is thought to be due to "chronic stress injury and/or post-surgical changes."

This was shown on the MRI from April as well. Can this be considered flexor hallucis tendonitis? I am just trying to figure out how to approach it at this point, as when I have very bad pain cycles, the first met head (right in ball of foot) is very painful to the touch, and feels inflamed constantly.

It hurts no matter what I do. So when I am active, I make SURE to sure to use orthotics or rocker shoes, apply Voltaren gel, etc. Thank you for any input/ideas you might be able to offer!

This has been a long and frustrating process, and it's pretty difficult to rest my foot now that I am no longer willing to wear Das Boot! ;)


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Joshua Comments:

Hi Tiffany.

There's a variety of things I could say, but let's start with: Do you have any specific questions for me?
Nov 12, 2014
Rating
starstarstarstarstar 		FHL tendonitis?
by: Tiffany

Yep! The title of my post--"Is this FHL tendonitis?" is probably what I'd most like to know! I'm open to any suggestions, too!!


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Joshua Comments:

Hi Tiffany.

Well I can't diagnose for a number of reasons legal and otherwise..

If you have pain and problem with your Flexor Hallucis then it's safe to call it tendonitis. Which techinically means that there's inflammation of the tendon, but realistically means that muscle and connective tissue are too short and tight, that there's an inflammation process making things hurt worse, and nutritional insufficiency.

You had surgery and had things removed, so absolutely other structures are going to be working harder, thickening, working less well, etc.

Surgery didn't fix the factors that caused the original problems, so that's still in play too as well as everything that happens post-surgery.

Point being, maybe yes a doctor might call it flexor hallucis tendonitis, but the reality is, there's a bigger picture than that at play (which your doctor doesn't know about and can't help you with, and maybe a REALLY good PT can help you with).

Personally I would get my Reversing Achilles Tendonitis ebook and apply everything in it to your foot/lower leg/upper leg.

You MUST do the nutrition, deal with chronic inflammation in the foot and lower leg, and do the specific massage on lower leg and upper leg as well.

You have a lot going on. I suggest you cover the necessary basics that have been neglected, get the benefits from that and see what happens with that, and then we can re-evaluate.


Feb 15, 2017
Rating
starstarstarstarstar 		FHL Tenosynovitis /FHL tenopathy
by: cazzyclay

Hi Tendonitis expert,
Like all these other people I too came across this thread whilst looking for help/advise on my current injury.

It started as pain in the big toe joint/first metatarsal joint and I noticed it coming on when hiking/walking, and first put it down to hard skin on the side of my big toe, but eventually when I went to see my GP with pain in my thumb joint I mentioned my toe pain and went under numerous blood tests and examinations for osteoarthritis.

It turned out I did have early osteoarthiris in my right thumb and I was reffered to specialists in hospital orthopaedics on the NHS (UK) from Jul 15. I saw an ‘extended physiotherapist’ who suspected sesamoiditis told me he would try and get me an MRI but I would have to make sure it was as sore as possible to show up on the scan, which I did around Oct 15, it came back as ‘inconclusive probable damage to plantar of foot’ and I was offered a cortisone injection into toe joint Nov 15 which I took and it was relatively successful.

I’m guessing now just masking the pain around that area.

I continued training on it all this time high impact 1hr 5/6 days a week, and even began running again Dec 15, and started high intensity classes Jan 16.

Pain returned increasingly from Mar 16, and I asked to be seen again and eventually got to see the orthopaedic surgeon/foot & ankle specialist around May 16 who could not find what was wrong, but we were under the impression it was musculoskeletal and I was probably looking at arthirits and toe joint bonding operation, however Xray Jul 16 no arthritis so as last resort offered Ultrasound with possible cortisone injection depending on outcome.

Had this end of Sep 16 and at last the FHL tenosynovitis was found, the swelling and fluid around the tendon said to be from tip of big toe to halfway up my foot arch, cortisone injection into the tendon which hurt more than hell on earth.

I stopped all high impact training obviously way too late but from Sep 16, had some temporary pain relief from the cortisone but this time only for about 1 month before it started coming back. I haven’t gone back to the previous pain levels but now I knew it was the tendon I stopped pushing it.

I was told after one month I could gradually return to impact sport but each time I tentatively tried I got pain so I would pull back.

All this time i have had custom made orthotics being continually revised, from hard carbon fibre, to toe post support.

They were typically too large and cumbersome to fit in most my shoes, pushing my foot out of the footwear causing other issues, or such a solid arch support I was overpronating outwards.

Eventually I found an orthotist who slimmed them down enough to fit in my trainers and have been able to use them for workouts since Dec 16, but again if I push the tendon too far it gives pain.

I have high arches and was told this injury was all down to biomechanics of overloading my first metatarsal joint but also overuse injury combined, and the orthopaedic surgeon seems to have no more solutions for me than to use the orthotics and even instructed me to push the tendon now when I saw him 2 weeks ago, which i am not doing as i know when i do i struggle to walk for days!

How did i get this i hear you ask? I do have high arches and suffered shin splints some 10 years ago from running which i then got custom made running orthotics for after some physio, and this seemed to cure all.

Money being tight and those orthotics being extremely expensive i wore them into the ground and only removed them from my trainers the past 3/4 years when they started rubbing on my instep from deteriorated surface.

I think it is around this time the injury to my FHL tendon started to grow, but also 3 years ago I took on a high energy dog and started having to walk her for 2 hours/day on top of my already demanding high impact workouts that i was doing 5/6 days a wk for 1-1.5hrs.

It is walking that to this day irritates it the most, the rolling of the foot motion. I continue to train but avoid doing any impact and anything that bends my foot but only since Sep 16 and the injury has not had a chance to recoup, I can walk but depending on what I have been doing the previous days it can be as little as 10 mins and the pain will kick in.

I only walk altering my gait so as not to bend my foot and wear stiff sole shoes with insoles – my big toe will not contract now anyway as it has become too stiff.

It has ruined my training, my previous hobbies of hiking, dancing, I am having to rehome my dog as i cannot keep up with her exercise needs despite attempting to cycle her where possible and recruiting help of walkers where available.

I am out of work with long term health issues the main cause being depression/anxiety/eating disorders and exercise is my key vice for coping with these mental health issues so yes i am addicted and have continual sports injuries as a result but this is the worst to date, and although I have reduced impact this past 6 months it feels too little too late. Now my workouts are boring, low impact, i cannot take part in classes, i cannot hike for mood lifting outdoors - i can cycle and i do this when i can as keeping my foot flat seems ok, but when i tried spinning i found that loading the foot too much and standing on cycle made it hurt again..even if i do static weights/kettlebells any load on the foot seems irritate it.

I recruited the help of a sports masseur Apr 16 who massaged the plantar fasiclis and said it was tight but it made my foot so painful i could barely stand on it for days, then my finances were reduced by ¾ and I could no longer continue to employ him - that was before the diagnosis, i went to see him once since diagnosis sep 16 and like you have mentioned previous he worked the muscle in my shin, despite my thinking please, work my foot! it didnt seem to do much for my pain albeit my shin was bruised for a week and ridiculously tender, he did say it was tight.

I would see him once/wk or fortnight could I afford it but also i need to know what not to do in training to undo any work he does.


I am so confused. On finding your page i have started freezing freezer packs for ice bucket, still trying find bucket deep enough to submerge up to knee, i ordered magnesium supplement and been taking 400mg the past week but it has played havoc with pre-existing bowel issues i have, plus i just read today its dangerous for those with slow heart rate and i have brachydria so thinking i will have to stop that.

How do i get over this on a budget? i have now lost faith in the whole orthopaedic team and feel i have to manage this myself as i have had symptoms since Jul 15 and it is now Feb 17 and im barely better.

The surgeon kept pushing me to have another cortisone injection before we had even ultrasounded again when i last saw him 2 wks ago, and i had to insist on the ultrasound to see if any progress ..results are, it has 'barely' improved since the last ultrasound in sep 16, and contrary to the last time when they said the tendon itself was good no damage, this time they said it is thicker than in the other foot -

HOWEVER last time the other foot was not ultrasounded for comparison so it could always have appeared in tact.

And this is with me pulling back on impact training – 5 months and barely improved?? I have been icing it all this time it is the only pain relief that worked, however I had only been strapping an ice pack to the base of my foot, or around the toe area, not the whole lower leg.
Please what to do now? i want my foot back and use of it again.

This has plagued my life for far too long now.
Feb 15, 2017
Rating
starstarstarstarstar 		Reply to Cazzyclay
by: The Tendonitis Expert

Joshua Comments:

Hi Cazzyclay.

1. First off, it's not a 'tendon problem'. The tendon pain etc is a symptom, not -the problem-.

Thus it's valid that you've lost hope in your orthopedic team, as they've been (and always do) focus on the wrong things.

You have decreased muscle function/ability to function, thus the tendon hurts and it's not getting better.

The massage hurt you for days, because the whole ecology of your lower leg is poor.

It's reversible if you do the right things.


2. Do you have a low heart rate because you're a runner, or do you have some medical issue that has you have a low heart rate.

Have you always had low heart rate, or is it recent and a result of your poor health? (Yes you have poor health, as evidenced by damaged gut ecology.)

Magnesium can be problematic for people on blood pressure meds...but then a huge number of people on blood pressure meds have high blood pressure because they're short on magnesium.

For athletes with low heart rates due to being in awesome shape, magnesium is a help and not a problem.


Did you experience something negative from taking 400mg/day?


3. "5 months and barely improved??"

Humans have this inborn belief that pain will/should just go away over time. But that belief is not a match to reality.

If you step on a nail, yes it will heal.

If you have the multiple factors of the tendonitis dynamic at play, A. there's nothing to 'heal', and B. those factors over time make things worse not better.

That MRI kind of confirmed that you don't have any actual injure. You're suffering from loss of function.

As your lower legs work less and less optimally, you experience more and more pain.


4. Tenosynovitis is super painful, and stubborn to 'calm down', but again it's a symptom of the factors of the tendonitis dynamic.

The corticosteroid injection never had a chance of fixing the problem. At best it was going to reduce pain for a while.


5. You need to fix your damaged gut ecology as well. That causes systemic inflammation and nutritional insufficiency/deficiency (which results in more pain, less function in lower legs, less ability to 'repair', depression, all flavors of anxiety, etc).

Is your 'depression' due to the recent pain etc, or is it ongoing? And is it from nutritional insufficiency/deficiency?


6. "How do i get over this on a budget?"

Get the Reversing Achilles Tendonitis program (see links in this thread).

It's the complete plan. YOu don't have achilles tendonitis per se, but the program applies to the entire lower leg no matter what exact structure in there is doing the hurting.

Might require a phone consult somewhere in there as well since you're on the more complicated side of things.
Feb 15, 2017
Rating
starstarstarstarstar 		Reply to Cazzyclay by: The Tendonitis Expert
by: cazzyclay

Hi Joshua,
Thanks for the prompt response. In response to your questions:

2. I have bradycardia/low heart rate they suspect because of my high cardio regime – it has never been confirmed but I have seen cardiologists several times to discount the bradycardia causing other health problems, and they have deemed it needed no action at present – I have had a slow pulse for 20 odd years but it was only confirmed as bradycardia the past 10 years, so no its not new.

I’m not on any meds for it but I do have to avoid meds that slow the heart rate for obvious reasons.

I did message Kerri on the magnesium pages at the same time as you, and she did say magnesium can cause bradycardia so its not advisable for someone with it to take it without the go ahead of a cardiologist.

The problems thus far are loose stools but I’m already on meds to ensure loose stools to avoid exaccabating a rectal issue, so it went without saying it would increase this.

It's hard to say what else as I have been ill with tonsillitis this past week so it could of masked it, or vice versa, but I have felt unwell as in fatigue, confusion, glands up, dizziness, nausea, headache.

How is it that "For athletes with low heart rates due to being in awesome shape, magnesium is a help and not a problem" yet its inadvisable for general slow heart rate?

Also I was taking it in powder form as I thought it would be easier to increase/decrease dosage as needed, but I have been mixing it in my morning porridge with protein powder to save drinking it neat with water – not a great taste but could that affect absorption?

I have asked Kerri how you get around being magnesium deficient if you can’t take supplements. Having a limited diet and issues with food all my life it is more than likely I am magnesium deficient but can you fix tendonitis without it? Its not the cause is it? Just one of them?

3. I say 5 months and barely improved as I significantly decreased all impact and kept pain to a minimum, however remember I have had this pain since early 2015.

It is not giving me significant pain currently as I don’t push it to this point, plus there is still corticosteroid masking it in there.

Up til sep 16 I trained through the pain – stupid I know but I thought was arthritis therefore could only be fixed with surgery and was forever and so I thought training would just have to be painful rather than stop altogether.

4. Tenosynovitis is the key diagnosis of what I have here. What is the difference to this occurring over tendonitis?

5. The depression has been all my life so no its on going, obviously restricting my mobility has added to it – could it be nutritional insufficiency/deficiency – its more than possible –

I try to work on a healthy diet daily but there is plenty of room for improvement.

So am I beyond the ice bucket etc? I will check out your reversing Achilles tendonitis program but it does seem overwhelming to tackle it all online on my own.

Should i be recruiting the help of a private physio at this stage regardless of not being able to afford it? i just know from previous experience 1 hour goes so fast and time is not cheap...ive come so far with this now i dont want time wasters nor money wasters proclaiming to fix me.


----


Joshua Comments:

2. If you have low heart rate from being in awesome shape, then there's nothing wring with having a low heart rate, and your doctors are scaring you with a 'brachycardia' diagnosis.

In that scenario, there's no downside to taking magnesium.

If you have bad health and a bad heart that's beating slowly, then magnesium can be bad if it lowers heart rate more (if that causes any actual problems) even though magnesium is super important for good health/healthy heart, so you have to figure out what your deal is, and weigh the facts. If you can't get healthy without taking magnesium, and taking magnesium doesn't cause any problems, then it's not a problem to take magnesium.

If you take magnesium and it causes problems (makes heart rate lower and you feel bed from that), then that's obviously a problem and you need to not take magnesium at all or take little tiny bits and slowly increase that over time keeping yourself from having and negative response.


Why would you take meds that lower heart rate?


3. Sure. But again, you're (I think) assuming that taking 5 months off from activity -should- make things better.


4. There is no functional difference between those two occuring. Tendonosis is pretty much always present with tendonitis.

If you took levaquin or cipro or other fluoroquinolone then that can kill tendon tissue.

But the factors that cause tendonosis and tendonitis are the same.

I advise people to focus on the factors, not the 'diagnosis', as the only way to get rid of the diagnosis is to reverse the causative factors.




"Should i be recruiting the help of a private physio "

If they can help you, sure. Have doctors fixed anything so far?



What's going on with your gut/digestion?

What does your 'healthy diet' look like?
Jul 31, 2017
Rating
starstarstarstarstar 		Plantar Fasciitis and Big Toe pain
by: Ashley

I'm reaching out to see if you can help me with my pain.

I was diagnosed with plantar fasciitis and was ultimately given a cortisone injection for it.

Due to a cortisone flare, I walked on the ball of my foot for 2 weeks and then started to get pain above my sesamoids, in between my 1st and 2nd toe.

It was diagnosed as sesamoiditis and I was given another cortisone injection.

This resulted in stiffness and pressure in my MTP joint as well as tenderness under the arch, below the sesamoids.

The doctor said it was just inflammation from the sesamoidtis and gave me a coritisone injection into my joint.

I recently had an MRI done that did show I had plantar fasciitis. There is no concern of arthritis in my big toe as range of motion is normal and there's no arthritic change in the xray or MRI.

I'm still dealing with a lot of pressure and discomfort in and around my joint, especially when trying to flex my big toe and just walk normally.

Is it possible that all of this could be an issue with my FHL?

Or is the discomfort and stiffness due to loss of muscle and function from 2 months of walking with a limp and trying to avoid bending my big toe?


----


Joshua Comments:

Hi Ashley.

1. Maybe no more corticosteroid injections.

If for no other reason that because they don't fix anything.

You were diagnosed with plantar fasciitis. You were then given an injection in the HOPE that that would help. But it could never have fixed anything, because it can't.

Then the injection caused you to walk funny which bruised your sesamoid(s). So of course the 'solution' was another injection of corticosteroids.

And then another. (You should already be running [limping] away from that doctor. If he wants to do another injection, you should know that that's a bad idea as even the AMA puts a limit of 3 [due to the harmful effects of corticosteroids on connective tissue etc]).

So my help starts off with a friendly suggestion that maybe....no more injections.


2. Plantar Fascia is a problem of the lower leg. Focus on the foot itself isn't likely to remedy the problem.


3. "Is it possible that all of this could be an issue with my FHL?"

Unlikely. It's almost certain that it's a problem with the entire ecology of your lower leg and now your foot too. Lack of nutrition, inflammation, too tight muscle and connective tissue, pain, compensation, etc, etc.

Plus a Bone Bruise on/around the sesamoid joint(s). That's going to hurt for a while.

The trick is, you have to make everything around it better so it can get better, otherwise every step irritates it a little bit (more).


4. "Or is the discomfort and stiffness due to loss of muscle and function from 2 months of walking with a limp and trying to avoid bending my big toe?"

That's certainly a big player. See: #3.



More questions, more answers.
Mar 11, 2018
Rating
starstarstarstarstar 		PTT not recovering
by: Anonymous

Hi,

I came to this thread looking for a solution to a similar problem.

I've sprained my lateral ankle ligaments twice. The second time was in May 2017, and was a lot worse than the first time (as expected).

Had physio a few times after, but the damage to the ligaments recovered within about 6 weeks. It seems that I have developed secondary issues as a result of this.

Firstly, I have anterior ankle impingement, which I believe to be caused by scar tissue. No signs of bone spurs on the X-ray. This doesn't bother me too much, as I only feel pain when going into dorsiflexion whilst standing.

This is the big issue though:Since around August 2017, I have noticed pain around the medial maleolous. The pain is at a specific place; directly below the medial maleolous. I received a kick to this exact spot twice during football, which is what has caused these two sprains.

The physio suggested I have posterior tibial tendinitis. The physio referred me to a biomechanics specialist, who I would not see until Jan 2018.

In the mean time, I decided to try a few things. Ice, heat, supplements, exercises (eccentric loading). Also, had some massages done on my calf muscles, normal and graston technique (3 sessions in total). Finally, had some ultrasound therapy done. None of this did anything.

Eventually so the biomechanics specialist, she suggested I put in anew insert. It raises the arch and the heel. I didn't want this, as the pain was still there in January, with no inflammation. So I said it is clearly tendinosis and not tendinitis, therefore, the insert will no reduce the inflammation (as it doesn't exist).

She basically said, "just give it a go, and see what happens". I've got a follow up appointment next week.

So this is where I am with this. The lack of knowledge and competency from the medical professionals has been tough for me. I've had no scans done, so they don't know for sure if it actually PTT.

I know there are a number of tendons that run through the tarsal tunnel,so it could be something else. I don't feel much pain during plantar flexion or when inverting the foot (tiny bit). So I'm just so confused.

Any help or advice would be much appreciated.

Thanks.



----


Joshua Comments:

Hi Anonymous.

1. Tell me what you think anterior ankle impingement means, so we can for sure be on the same page.

2. "I've sprained my lateral ankle ligaments twice"

How badly? Did you permanently stretch them (bad strain), or did it just result in pain? Presumably you twisted your ankle?

You said there was 'damage' that healed. Was their actual damage?
Mar 15, 2018
Rating
starstarstarstarstar 		PTT not recovering
by: Anonymous

Hi Joshua.

1. Anterior ankle impingement: when I put my foot in dorsiflexion, I get a sharp pinching pain across the front of my ankle.

2. Both sprains were classed as grade 2. The second time was extremely painful, I could not walk. I went to the hospital to make sure I had not broken my ankle. Had an x-ray to confirm I hadn't. I needed crutches to help me walk for a few days.

What do you mean by 'actual damage'?

The ankle was swollen for about month. Extremely tender to touch etc. So I would say the ligaments were fairly damaged (I.e. stretched and partially torn).

Thanks,

Jewel.


----


Joshua Comments:

By 'actual damage', I mean actual rip/tear damage. Or in teh case of ligaments, actual stretch of the ligament (which generally is a permanent lengthening of the ligament, which is certainly possible in the case of twisting an ankle).

From what you said above, that sounds reasonable that you have/had some 'actual damage' (as opposed to just pain...one can have even disabling pain without any actual damage).


Which makes sense why you're still in pain.

The problem with stretching ligaments is that that's the new length (basically). So the joint loses stability. Notice how the second incident was more painful than the first.....that's because of all the below plus less stability and another forced stretch event on the already unhappy and frightened ligament(s).

And that 'stretching' is essentially rip/tear injuring the ligament in that lengthening/torn longer than it wants to be kind of way.

So there's that.

There's also all the inflammation etc from the initial incident. Plus the tendonitis dynamic that kicksinto high gear (too tight muscle and connective tissue, inflammation process including swelling, nutritional insufficiency...all of which work together to make more pain/problem).


"The lack of knowledge and competency from the medical professionals has been tough for me."

Yeah...... :(


So. -Maybe- there's a specific muscle that's 100% responsible for the impingement...but having been told that, that's part of the lack of competency you're referring to.

The body doesn't work in isolation. It's never just one thing.

You have:

- a tendonitis dynamic making muscle tight and everyting hurt
- some amount of instability of the joint, which the brain and everything else has to respond/adapt/adjust for (often poorly)
- lack of nutrition, which makes it hard to recover like you think you should
- weight on an unstable joint does all sorts of not-optimaly things to the entire system
- internal swelling is possibly a player, and can help account for that impingement when you move a certain way.
- etc
- etc

Yes you might have specific ligament injury, and, even if so, realistically you have a 'problem' with the ecology of the entire lower leg (let's arbitrarily say knee to toe).

There are multiple factors to deal with. And you have to deal with all of them, and -adequately- deal with all of them.

There's a lot to say about what to do to get this all feeling/working better. Thus I suggest you get my Reversing Achilles Tendonitis program.

You don't have Achilles tendonitis per se, but there again, Achilles Tendonitis is an issue of the entire ecology of the lower leg.


We're dealing with the causative factors here, not the achilles tendon or your ligament or single spot of impingement.

Let me rephrase that, you want to be dealing with the causative factors, not any individual location.

It's the basic work you need to do. It will make everything feel better (if you do it and do enough of it), and then we can take a more specific look at anything you have left if there's anything left.

* Obviously the program says 'achilles' a lot in the content, but look past that for the bigger picture.


Let me know if you have any questions.

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