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Chronic Posterior Tibiialis / Subtalar Pain + PRP
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Hi there:

I've been dealing with a long-term foot injury originating with a navicular stress reaction from 2011 (saga is posted on this thread here). While the bone is apparently strong, the tenosynovitis in the PT area and corresponding pain within the subtalar can often be unbearable, and I can really only realistically run 1-2 / week, and the walking in between training runs is really tough.

For background, I've done everything with this outside of surgery (which is kind of a non-starter for me): CAM boots, anti-inflammatories, medrol dose pak, PT (and all exercises/stretches therein).

I'm going in for an ultrasound in the next week, at which point I may entertain Platelet-rich Plasma (PRP) injection(s). Was wondering if anyone's had experience with this for this type of chronic pain issue? My understanding is it really helps reboot the healing process. I'm looking to understand 1) probability of success, 2) side effects, 3) best practices to maximize recovery (e.g., time period to rest, return activities etc).

Thanks!
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Re: Chronic Posterior Tibiialis / Subtalar Pain + PRP [JakeJones] [ In reply to ]
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Thankfully never had that specific issue but have had many others. Most recently did do PRP for severe plantar fasciitis and Achilles. Worked great and would highly recommend doing PRP but be smart and have a solid plan going in to get back to racing shape. I had no side effects and am not aware of any.
  • PRP - best to boot foot for a couple weeks (but consult doc). No ice, no ibuprofen, etc. Let the body heal itself.
  • Rehab after PRP - start slow and have a game plan. I waited 2 months to start rehabbing. Give yourself enough time for your body to heal and think of this as a rebuild.
  • I would strongly recommend trying to rule out other variables and strengthen surrounding/supporting muscles given that you will be down for a while. Something could be causing this - scar tissue, mobility, hip alignment etc etc.

In my case did 2 injections at same time (plantar and Achilles). Rested for a good 2 months before any rehab then took it very slow. Slept in boot for the following year and wore Ecco shoes to alleviate foot pain. Worked through other potential causes of the issue - had A.R.T. done through calf, hammy's and glutes, did yoga 1-2x week, and focused on strengthening core & balance. Went very slow when starting to run 4-5 months later - .5 miles and 1 mile runs but 6 times a week. Ran frequently but short allowing body to adjust and strengthen. Built mileage no more than 10% a week with my long run being no more than 30% of total weekly mileage. Also, went to a more padded shoe that was not a low heal to toe drop - Asics Nimbus (road tested everything in the store to see what fit best).

Worked with a very smart coach who kept me on track. PR'ed at my next IM.

Hope that is helpful.
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Re: Chronic Posterior Tibiialis / Subtalar Pain + PRP [JakeJones] [ In reply to ]
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I had a serious problem with posterior tibialis tendonitis years ago. I was running > 80 miles/week, which degraded to only being able to run a few miles, once or twice a week.

For me the solution is RIGID orthotics; not soft orthotics. With them, I've been trouble free for > 20 years, and have sustained > 100 miles/week. I did spend a LOT of time figuring out the solution. That included getting a Certified Pedorthist credential, and making my own orthotics. (I didn't need the credential, but I really wanted to know enough to know that my self treatment was the proper thing to do.)

There is a lot of mis-information out there about orthotics. Rigid orthotics work because they are uncomfortable when in contact with your foot. You will develop a different stride and supporting muscles in an effort to avoid the contact with the orthotic. (Soft orthotics cannot have this same affect.) I can stop using the orthotics for short periods (a month or two), but then bad habits and the tendonitis come back.

If you have not tried rigid orthotics, made from a neutral suspension slipper cast, I would recommend that IF pronation is at all a factor in the the tendonitis. All that said, my credential long ago expired.

2015 USAT Long Course National Champion (M50-54)
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Re: Chronic Posterior Tibiialis / Subtalar Pain + PRP [ In reply to ]
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Hi all:

I wanted to bump this post back up, as I'm now two years removed from my PRP injections + rehab, but still haven't gotten over the hump / put this issue behind me.

I continue to have chronic issues with my foot and ankle around the affected area, and want to begin thinking of how to attack this over my offseason (live in the midwest, so tend to shut down the running and focus on bike trainer during the winter).

These are the questions I'm pondering:

-Training / rehab:Are there particular trainers or coaches (in terms of discipline) that people would recommend?

-Orthotics: I've used custom orthotics from my podiatrist for a while, but they don't make a major difference in terms of pain reduction. Specifically, I feel considerably more pain while walking in between runs than I do when actually running (frustrating in itself).

-Recommended Routine: At this point I think I have too much information. Having gone thorugh multiple PTs myself, I have lists of exercises and stretches, but it's almost too much and I'm not sure what will create the largest gains. If anyone has had this issue and has a recommended, structured regimen, I'd be grateful.
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