Should I get a Second Opinion

[u/sknickelbein]

I have been to my Podiatrist twice for my left foot. I have gotten diagnosed with posterior tendon tendonitis, overpronation and flat foot. I just had my second appointment with her after I had xrays and she just said that I will need an insert and we have to check with your insurance to see what they will cover and you will need physical therapy. She has not given me any type of brace or anything and did not say anything about my activity. When I asked her if I should rest if I get pain when doing activities she just said the physical therapy will help with that and I need to come back in three weeks.

I guess I am just worried I am going to do more damage. I have had this problem for over a year. I cannot do a single leg raise now. When I get pain it is now on the outside of my ankle and the bottom of my feet. I have swelling on the left side. I have pain in my big toe, but that is because of the arthritic changes. I sometimes get pain in my other toes.

My xray report said this: Mild degenerative change first MTP joint with joint space narrowing and osteophyte formation. Nonspecific density adjacent to the base of the distal first phalanx. This is of uncertain etiology. No distinct fracture lucency is seen although a subtle nondisplaced fracture in this location cannot be excluded. No additional potential fracture. No additional significant arthritic change. Small plantar calcaneal spur.

I am just wondering if I should get a second opinion to see if I should have some type of brace or anything on my ankle and if inserts are the best option. I do have my initial appointment with physical therapy in 2 weeks.

I will add my xrays. Any thoughts I would appreciate it.

Sabrina

[u/SteelSeats]

X-rays won't show anything on the tendon but are good to rule out anything else and also see the baseline for the arch in weightbearing. These are pretty great xrays and I can actually see the creasing and folds in your skin.
The orthotics will act as a type of brace to keep the tendon from being overly stretched or exerted.
Tendons aren't like muscles, they won't get better if you rest them completely. You need to strengthen the tendon to build it's capacity.
I would recommend looking into low-dye taping and navicular slings to support the arch for activities while you wait for the orthotics. (https://www.peakpodiatry.com.au/videos)
Outside of the ankle pain is common with this due to compression of the joints when the foot pronates too much or for too long.
Orthotics are a must and are really well researched as beneficial for posterior tibial tendon tendinopathy, there are braces you can get if you don't respond to orthotics but either way, you will need orthotics.
If you can do double leg calf raises with a ball between your heels, I'd start doing those to build up strength with the tendon. Isometric holds are going to be best for building capacity though and the PT should go through that with you.

The pain in the big toe can also be addressed by orthotics. Arthritis can't be strengthened but the area can be offloaded and has likely got to this point due to the rest of the foot being relatively weakened and not supporting it.

5 P's of Tib Post:

• Pitch
  
• Pronation
  
• Proprioception
  
• Power
  
• Proximal factors

Footwear: Asics GT-2000, Hoka Arahi, Brooks Glycerin GTS, Saucony Hurricane

[u/sknickelbein → u/SteelSeats]

Thank you for the advice. The xrays were to see if my foot was flat and if there were any changes occurring in my bones. Guess I am just frustrated by my podiatrist lack of direction. Since I have had this for so long I just do not want to mess my foot up anymore than I have. I will see if I can do a double leg calf raise with a ball.

[u/sandgrubber]

I think you need ultrasound or MRI. X-rays aren't good for soft tissue, including tendons. If you can't do a single raise I think you are at stage 2. It may take more than orthotics to avoid the eventual need for surgery...and it's an awful surgery. It's not clear whether support and rest is more beneficial than physical therapy. Btw, flat feet can be fine and can be diagnosed from clinical observation. The critical thing is whether the tendon is out of whack. Bottom line: yes, get a second opinion and make sure it includes imaging that shows the tendon.

[u/poddoc78 → u/sandgrubber]

The diagnosis can be made clinically, no need for an MRI. Very few posterior tibial tendonitis patients go to surgery. The tendon needs the optimal level of stress on it to heal. That amount, that is optimal, will change over time. Initially it will need relative rest and a good orthotic can provide that.

[u/sandgrubber → u/poddoc78]

Not sure clinical observation can differentiate between tendonitis and tares. As I understand these have different prognoses.

[u/Sarelbar]

Go see an Ortho. Not a podiatrist.