Re: Nonhealing Lower Leg Injury

February 28, 2006

,

How is your sleep? Nutrition? Have you considered seeing a

Naturopath to get your nutrition/diet evaluated?

Be Well,

Mike Reid

Gothenborg, Sweden

February 28, 2006

,

Wow I feel for you man, you have been thru the whole ordeal, and at

only 22 years old, damn brother that is hardcore.

The areas that I would get SEVERAL MEDICAL opinions are:

1) Your orthotics. You stated that they now are a necessity and

you cannot wear them without getting worse. I would have

anticipated that, and I think you MAY have some minor abnormalities

in the alignment of those bones and joints. Check into another

Podiatrist if your not happy with the one you have.

2) Your diet!! This is not an area of expertise for me, but I

would think you may be assisting this chronic inflammation with a

lack of some various minerals/vitamins, etc. I would consider

looking into it.

3) Have your blood ran. Have a full male panel done to verify if

all of your levels (i.e cortisol) are within nomral limits. This

may also have something to do with a chronic state of inflammation.

4) Go see a sports medicine SPECIALIST ( I seen that you made an

appointment with one....good!)that has dealt with similiar cases as

yours. Call up, and ask around for someone in your area or even out

of your area if they come highly recommended. If you find one, have

your general practioner give you a referral if need be.

5) Have the rest of your body checked for imbalances which may be

indirectly/directly related to your problem. Consider a highly

recommended Chiropractor in your area, who can see if there is

something, that you may be missing.

I would agree with your denial of the Medrol dose pack, I have

patients who HATE it and LOVE it, but all agree it leaves you nearly

anable to function worth a darn. Also with the steroid injections.

Although that is a personal choice, if your not healing, and your

dietary intake is sufficient, and you have no abnormalities with

your blood work, I would strongly encourage you to consider trying

the injections at least ONCE. I have had patients, you have had

chronic inflammation, only able to get rid of it after a injection.

Albeit, these were much OLDER patients....so that one is really your

call.

Also, do you have a history of injuries that are related to this?

And does anyone in your family (biological family) have a history of

chronic illness(s) or syndromes? i.e. rheumatoid arthritis? or

Fibromyalgia syndrome?

Yours in health,

Forbes

OrthoPro101

Tualatin, Or.

armonal includin

>

> I am 22 years old and a (former, I think) serious amateur track

> athlete.... five or months ago I attempted to resume training

after

> a 30 day layoff and quickly incurred an injury to both lower legs

> which I identified as classic medial tibial stress syndrome. I

have

> not run a step since September and the injury has still not

healed.

> It's like I'm trapped in the acute or subacute stage- my legs

simply

> won't heal no matter how much I rest or how loudly I yell at them.

> My condition has degenerated to the point where I am now having

> difficulty walking.

>

> I went to a (fairly prominent) physical therapist about three

months

> ago and was completely disappointed. They had me doing all this

> generic stuff like picking up marbles with my toes and gripping a

> towel with my feet; it was so worthless that I nearly refused to

> pay.

>

> I subsequently consulted a podiatrist. He ordered an MRI, which

> revealed swelling around the tibialis posterior muscle and tendon,

> and possibly within the tendon. It showed no bone or periosteal

> abnormalities. An X-ray also was negative for stress fracture. My

> podiatrist put me in custom orthotics, which didn't help at all

with

> the pain, but had the undesirable effect of making me utterly

> dependant on the support; in other words, after a few weeks of

> wearing the orthotics, I became unable to walk without the

orthotics

> without aggravating the injury.

>

> When the orthotics didn't work, he put me in fiberglass casts

(both

> legs) to immobilize my subtalar joints, and I endured that misery

> for 21 days. The casts seemed to help and I experienced complete

> relief from pain while wearing them. Only a few hours after I got

> the casts removed, however, the injury began flaring up again, and

> two days later I am in about as much pain as I was when I first

had

> the casts put on. Worse, my feet and lower legs are severely

> weakened- I have easily lost several inches off of my calves, and

my

> feet are so weak that it hurts my entire plantar surface to bear

my

> full weight on one leg.

>

> This situation is bizarre and ridiculous. I am largely debilitated

> right now- I can neither work nor go to school, nor do any type of

> exercise other than weight training (elliptical training and

cycling

> both aggravate the injury, and I don't have access to a lap pool).

> Also, I can't squat or deadlift or do anything else that requires

me

> to bear the weight on my feet.

>

> I am totally lost at this point and my faith in the medical

> establishment's capacity to help me with this issue is nearly

> exhausted. The medical treatment that I have received thus far has

> only resulted in a deterioration of my condition. Before seeking

> help the only thing I couldn't do was run; now I can barely walk.

In

> conjunction with the fact that it will probably take weeks to get

an

> appointment with another specialist anyway, I am extremely

> discouraged.

>

> I understand that, having not responded to conservative treatment,

I

> may be a candidate for surgery that this point. The problem is...

> TPT surgery is usually only performed on women over 40 who have

> either tendon fraying or rupture. I have no structural problems;

> only some edema. Additionally, lacking the absolute necessity to

do

> so, I am concerned that cutting into that tendon may cause more

harm

> than good. I have been offered cortisone injections, but I have

read

> that TPT injection creates a very high risk of rupture so that it

> probably not something I want to do. Also, I am generally opposed

to

> the use of anti-inflammatory drugs, particularly of the steroidal

> variety, because my research indicates that they do not facilitate

> the healing process and may even inhibit it. The side effect

profile

> of steroidals is also unacceptable. I refused to take Medrol when

my

> doc recommended it and consider him incompetent for having done so

> (considering that it was the first thing he wanted to try).

>

> I am concerned that my injury has progressed to tendonosis or some

> other degenerative condition that is going to take many months to

> recover from. I also worry about permanent injury due to scarring.

>

> This is not even about running anymore. I do not expect to return

to

> running anytime soon and may not attempt to resume the activity at

> all if this is the kind of risk it carries for me at this point. I

> just want to regain normal functionality and be able to exercise

> without having to rely on artificial support in the form of casts,

> orthotics, etc. Running would be great but, again, I'm not even

> entertaining that idea right now. It's almost intangible.

>

> Any advice as to how I should proceed would be greatly appreciated.

>

> Gates

> Gig Harbor, WA

>

February 28, 2006

Hello ,

Unfortunately the tyranny of distance disallows any intervention from

here, but, purely on the basis that there may be someone in your area

who is operating Bio Mechanical Muscle stimulation devices (BMS), I

would suggest you consider another option.

I have been applying mechanical vibration to this condition for a number

of years with considerable and measurable efficacy.

Your description of the condition is detailed and ideal for diagnosis,

so I would not hesitate in assuming that because of the inflammation and

oedema there will be delays in recovering from the discomfort.

MY first approach is to reduce the oedema by applying vibration at 24 HZ

(5mm) to the plantars distally for about 3-4 minutes with a subsequent

application of 28 HZ for 4-5 minutes throughout the tibialis as a means

of reducing the discomfort of spasm and proprioceptive interference.

This approach for 3 days over the first week is normally adequate to get

the desired results.

Once the oedema subsides and the pain relieves, the application of

vibration at 26 HZ with resisting stretches (PNF), mostly all cases resolve.

Skeptics exist but results are often enough.

It's an option .

Alan BROWN

MELBOURNE

suprbrian wrote:

>I am 22 years old and a (former, I think) serious amateur track

>athlete.... five or months ago I attempted to resume training after

>a 30 day layoff and quickly incurred an injury to both lower legs

>which I identified as classic medial tibial stress syndrome. I have

>not run a step since September and the injury has still not healed.

>It's like I'm trapped in the acute or subacute stage- my legs simply

>won't heal no matter how much I rest or how loudly I yell at them.

>My condition has degenerated to the point where I am now having

>difficulty walking.

>I went to a (fairly prominent) physical therapist about three months

>ago and was completely disappointed. They had me doing all this

>generic stuff like picking up marbles with my toes and gripping a

>towel with my feet; it was so worthless that I nearly refused to

>pay.

>

>I subsequently consulted a podiatrist. He ordered an MRI, which

>revealed swelling around the tibialis posterior muscle and tendon,

>and possibly within the tendon. It showed no bone or periosteal

>abnormalities. An X-ray also was negative for stress fracture. My

>podiatrist put me in custom orthotics, which didn't help at all with

>the pain, but had the undesirable effect of making me utterly

>dependant on the support; in other words, after a few weeks of

>wearing the orthotics, I became unable to walk without the orthotics

>without aggravating the injury.

>

>When the orthotics didn't work, he put me in fiberglass casts (both

>legs) to immobilize my subtalar joints, and I endured that misery

>for 21 days. The casts seemed to help and I experienced complete

>relief from pain while wearing them. Only a few hours after I got

>the casts removed, however, the injury began flaring up again, and

>two days later I am in about as much pain as I was when I first had

>the casts put on. Worse, my feet and lower legs are severely

>weakened- I have easily lost several inches off of my calves, and my

>feet are so weak that it hurts my entire plantar surface to bear my

>full weight on one leg.

>

>This situation is bizarre and ridiculous. I am largely debilitated

>right now- I can neither work nor go to school, nor do any type of

>exercise other than weight training (elliptical training and cycling

>both aggravate the injury, and I don't have access to a lap pool).

>Also, I can't squat or deadlift or do anything else that requires me

>to bear the weight on my feet.

>

>I am totally lost at this point and my faith in the medical

>establishment's capacity to help me with this issue is nearly

>exhausted. The medical treatment that I have received thus far has

>only resulted in a deterioration of my condition. Before seeking

>help the only thing I couldn't do was run; now I can barely walk. In

>conjunction with the fact that it will probably take weeks to get an

>appointment with another specialist anyway, I am extremely

>discouraged.

>

>I understand that, having not responded to conservative treatment, I

>may be a candidate for surgery that this point. The problem is...

>TPT surgery is usually only performed on women over 40 who have

>either tendon fraying or rupture. I have no structural problems;

>only some edema. Additionally, lacking the absolute necessity to do

>so, I am concerned that cutting into that tendon may cause more harm

>than good. I have been offered cortisone injections, but I have read

>that TPT injection creates a very high risk of rupture so that it

>probably not something I want to do. Also, I am generally opposed to

>the use of anti-inflammatory drugs, particularly of the steroidal

>variety, because my research indicates that they do not facilitate

>the healing process and may even inhibit it. The side effect profile

>of steroidals is also unacceptable. I refused to take Medrol when my

>doc recommended it and consider him incompetent for having done so

>(considering that it was the first thing he wanted to try).

>

>I am concerned that my injury has progressed to tendonosis or some

>other degenerative condition that is going to take many months to

>recover from. I also worry about permanent injury due to scarring.

>

>This is not even about running anymore. I do not expect to return to

>running anytime soon and may not attempt to resume the activity at

>all if this is the kind of risk it carries for me at this point. I

>just want to regain normal functionality and be able to exercise

>without having to rely on artificial support in the form of casts,

>orthotics, etc. Running would be great but, again, I'm not even

>entertaining that idea right now. It's almost intangible.

>

>Any advice as to how I should proceed would be greatly appreciated.

>

> Gates

>Gig Harbor, WA

March 1, 2006

Gates wrote:

" my faith in the medical establishment's capacity to help me with this issue is

nearly exhausted. "

This may ruffle some feathers, but you have not exhausted the medical

establishment's capacity until you have seen a " doctor " . While PT's

and DPM's are well-trained, they do not have as extensive of training

as MD/DO's do. Have you tried an orthopaedic surgeon? Seeing them

does not imply an operation, just focused expertise on your types of

problems.

Mike Riggenbach

Dayton, Oh USA

March 1, 2006

Thanks to all who have replied. I guess I should have indicated in my

original post that I do not believe in naturopathy, chiropractic, or

any other type of alternative medicine. I do not believe that

professionals in these disciplines could tell me anything I haven't

already read about nutrition or other lifestyle issues- and I am

critical of most of what I read on those subjects. With no disrespect

intended to anyone, I post here seeking well-informed opinions from

legitimate medical and rehabilitation professionals, and perhaps

insights from athletes and coaches who have experienced similar

problems.

Gates

Gig Harbor, WA

March 1, 2006

Point taken, sir (I think I was hyperbolizing anyway).

Gates

Gig Harbor, WA

>

> " my faith in the medical establishment's capacity to help me with

this issue is nearly exhausted. "

>

> This may ruffle some feathers, but you have not exhausted the

medical

> establishment's capacity until you have seen a " doctor " . While

PT's

> and DPM's are well-trained, they do not have as extensive of

training

> as MD/DO's do. Have you tried an orthopaedic surgeon? Seeing

them

> does not imply an operation, just focused expertise on your types

of

> problems.

>

> Mike Riggenbach

> Dayton, Oh USA

>

March 1, 2006

-

What qualifies you to diagnose your own injuries and disregard the program

of therapy recommended by a licensed physical therapist? What

activity/exercises have you been using most recently as part of your recovery

plan?

I recommend that you seek further assistance and get several opinions. It

may be possible to find a way through that does not require surgery, but only

direct medical evaluation and treatment will be able to provide the type of

assistance you need.

Good luck!

kson, CST

Minneapolis, MN USA

In a message dated 2/28/2006 12:17:02 P.M. Central Standard Time,

suprbrian@... writes:

<<<I am 22 years old and a (former, I think) serious amateur track

athlete.... five or months ago I attempted to resume training after

a 30 day layoff and quickly incurred an injury to both lower legs

which I identified as classic medial tibial stress syndrome. I have

not run a step since September and the injury has still not healed.

It's like I'm trapped in the acute or subacute stage- my legs simply

won't heal no matter how much I rest or how loudly I yell at them.

My condition has degenerated to the point where I am now having

difficulty walking.

I went to a (fairly prominent) physical therapist about three months

ago and was completely disappointed. They had me doing all this

generic stuff like picking up marbles with my toes and gripping a

towel with my feet; it was so worthless that I nearly refused to

pay.

I subsequently consulted a podiatrist. He ordered an MRI, which

revealed swelling around the tibialis posterior muscle and tendon,

and possibly within the tendon. It showed no bone or periosteal

abnormalities. An X-ray also was negative for stress fracture. My

podiatrist put me in custom orthotics, which didn't help at all with

the pain, but had the undesirable effect of making me utterly

dependant on the support; in other words, after a few weeks of

wearing the orthotics, I became unable to walk without the orthotics

without aggravating the injury.

When the orthotics didn't work, he put me in fiberglass casts (both

legs) to immobilize my subtalar joints, and I endured that misery

for 21 days. The casts seemed to help and I experienced complete

relief from pain while wearing them. Only a few hours after I got

the casts removed, however, the injury began flaring up again, and

two days later I am in about as much pain as I was when I first had

the casts put on. Worse, my feet and lower legs are severely

weakened- I have easily lost several inches off of my calves, and my

feet are so weak that it hurts my entire plantar surface to bear my

full weight on one leg.

This situation is bizarre and ridiculous. I am largely debilitated

right now- I can neither work nor go to school, nor do any type of

exercise other than weight training (elliptical training and cycling

both aggravate the injury, and I don't have access to a lap pool).

Also, I can't squat or deadlift or do anything else that requires me

to bear the weight on my feet.

I am totally lost at this point and my faith in the medical

establishment's capacity to help me with this issue is nearly

exhausted. The medical treatment that I have received thus far has

only resulted in a deterioration of my condition. Before seeking

help the only thing I couldn't do was run; now I can barely walk. In

conjunction with the fact that it will probably take weeks to get an

appointment with another specialist anyway, I am extremely

discouraged.

I understand that, having not responded to conservative treatment, I

may be a candidate for surgery that this point. The problem is...

TPT surgery is usually only performed on women over 40 who have

either tendon fraying or rupture. I have no structural problems;

only some edema. Additionally, lacking the absolute necessity to do

so, I am concerned that cutting into that tendon may cause more harm

than good. I have been offered cortisone injections, but I have read

that TPT injection creates a very high risk of rupture so that it

probably not something I want to do. Also, I am generally opposed to

the use of anti-inflammatory drugs, particularly of the steroidal

variety, because my research indicates that they do not facilitate

the healing process and may even inhibit it. The side effect profile

of steroidals is also unacceptable. I refused to take Medrol when my

doc recommended it and consider him incompetent for having done so

(considering that it was the first thing he wanted to try).

I am concerned that my injury has progressed to tendonosis or some

other degenerative condition that is going to take many months to

recover from. I also worry about permanent injury due to scarring.

This is not even about running anymore. I do not expect to return to

running anytime soon and may not attempt to resume the activity at

all if this is the kind of risk it carries for me at this point. I

just want to regain normal functionality and be able to exercise

without having to rely on artificial support in the form of casts,

orthotics, etc. Running would be great but, again, I'm not even

entertaining that idea right now. It's almost intangible.

Any advice as to how I should proceed would be greatly appreciated.>>>

March 1, 2006

Dear ,

I've followed your problem and responses thus far and I find the

bottom statement you made pretty incredible--that MONEY would be a

defining barrier to you finding a solution that worked?

As another person has noted, you would do well to consult an

experienced sports medicine physician as a start, primarily to

evaluate if something he/she can actually deal with is going on. The

real truth is, however, that " conventional " medicine has very

definite limits to its effectiveness as well: I have experienced

those limitations first-hand, both as a patient and with my clients

as a personal fitness professional. You've already refused some of

the treatments recommended by " conventional " practitioners: I can't

believe you'd prefer an invasive procedure like some kind of surgery

whose outcome can be very uncertain if there was a chance to solve

your problem non-invasively. The very fact that you've come to this

forum (and you've stated so already) means that you are looking for

effective alternatives because medicine hasn't helped you.

I humbly suggest that you open your mind to complementary and

alternative medicine possibilities if " conventional " medicine fails

to provide a satisfactory solution to your problem: it often does

fail. Many here and I myself can attest to the fact that such

practitioners can often effectively deal with problems that

mainstream medicine can't.

Of course, you are free to manage your own medical care as you see

fit. But you also have the RIGHT to learn about, understand, and

evaluate ALL treatment options, free of bias so you can make an

INFORMED (again, INFORMED) decision.

Merrick, M.A.

ACSM H/FI, NSCA CPT/CSCS, NASM CPT

Bellevue, NE

> No. Just because conventional treatments have not been helpful does

> not mean that anything within the realm of alternative medicine is

valid. Quite honestly, I'd rather sit in wheelchair for the rest of

my life than put money into the pocket of a naturopath,

chiropractor, CHEK practitioner, etc.

March 2, 2006

>

> -

>

> What qualifies you to diagnose your own injuries and disregard the

program

> of therapy recommended by a licensed physical therapist? What

> activity/exercises have you been using most recently as part of

your recovery plan?

****I didn't diagnose the injury; my podiatrist did, and an MRI

confirmed the diagnois. Furthermore, I can palpate and feel the

swelling in and around the injured tibialis posterior tendon.

As for my evaluation of the physical therapy proram, I have a fairly

intuitive sense of what is useful and what isn't. It was obvious to

me that those little foot exercises weren't doing anyhing to repair

my damaged tibialist posterior tendons nor reduce the strain on them

when standing and walking. In conjunction with the fact that I stuck

with the program for about three weeks and only got worse during

that time, I genuinely felt that it was a waste of my time.

I am not currently doing any type of rehabilitative exercises. I

stress, as I did in my original post, that I CANNOT stress the area

at all without aggrovating the injury. Even simple

inversion/eversion exercises HURT.

Gates

Gig Harbor, WA

March 2, 2006

I neither said nor implied in that money is a limiting factor in my

willingness to find a solution; that is a crude misrepresentation of

my comments. On the contrary, I would drop $25,000 right now without

hesitation for a guaranteed recovery. What I'm not willing to do is

reward someone for marketing pseudoscientific nonsense.

And I certainly never said that I prefer surgey to non-invasive

treatments. I did, in fact, explicitly state that I am all but

unwilling to go under the knife and that I think it would do more

harm than good. Reading comprehension.

Gates

Gig Harbor, WA

>

> > No. Just because conventional treatments have not been helpful

does

> > not mean that anything within the realm of alternative medicine

is

> valid. Quite honestly, I'd rather sit in wheelchair for the rest

of

> my life than put money into the pocket of a naturopath,

> chiropractor, CHEK practitioner, etc.

>

March 3, 2006

In a message dated 3/1/2006 9:11:07 A.M. Central Standard Time,

suprbrian@... writes:

<<<Thanks to all who have replied. I guess I should have indicated in my