I'll lead off with the question - has anyone ever had a really long split tear (9cm) of the posterior tibial tendon (as seen on MRI), but been able to run pain free and to do things like multiple sets of single calf raises? If so, how did you handle it?
History:
So... I have a long history of instability in my right ankle, with damaged ligaments. In 2014, I did several rounds of PRP and prolotherapy, and that fixed stuff up.
Starting late last summer, I started to have some posterior tibial pain on that right side. It was never awful - the pain was at most a 3 out of 10, and I could do sets of single calf raises on that ankle, though it was slightly weaker than the left. So I got it checked out by a podiatrist, who wasn't too worried about it, and then did some PT. It never stopped hurting, but never threw off my gait or hurt that badly, so I just stuck with the PT, kept running, and even ran some PRs.
It kept burning, so late last year I went back to the podiatrist - he ultrasounded it, and noted that the tendon looked really good, though there was a small bit of fluid near it - nothing concerning. He also noted, oddly enough, what looked like an accessory post tib tendon. But overall, it looked fine - just one of those things that might be painful for a while. I also went to the doctor who had done my previous PRP/Prolo - he examined me and thought the ankle was fine.
The ankle kept burning on and off, with the specific point of pain starting to move around - it'd be in front of the medial malleolus, then behind, then up on the shin behind the tibia. Then gone for a while. And it didn't really correlate with intensity of exercise, while it would start to throb when I lay in a certain position. All of which pointed to a back issue. At the same time, I was also having repeated bouts of left leg posterior pain, triggered while running, that would come and go. I was doing PT regularly, but not seeing much progress.
So we decided to get a lumbar MRI. And also an MRI of the right ankle, just to be complete.
While waiting for the MRI appointment, my PT decided to try a different taping technique - basically Mulligan taping, but starting on the medial malleolus, rather than the lateral. It was a game changer. Left leg pain disappeared, right ankle burning disappeared - yay. But I got the MRIs anyway, just because.
I got back the MRI reports a few days ago - the lumbar back looks totally fine. But the right ankle is a disaster on image, with the highlight being:
"Severe tibialis posterior tendonitis with longitudinal split tears involving the distal 9.0 cm, moderate grade at the level of the talus and the calcaneus, with mild tenosynovitis. Small spur along the posterior medial tibial metaphysis, at the tibialis posterior tendon groove which can be associated with PTT dysfunction.
"Chronic high-grade anterior talofibular ligament sprain, with at least partial tear. "
I'm told this is the MRI of someone who should be struggling to run on this ankle, but I'm currently doing very well. Running is fine. I did 4 sets of 25 single calf raises on it this morning, no pain. The only issue is that my balance on the right is not as good as on the left.
Right now, the plan is to keep on with the PT, to get an MSK ultrasound to get another look at the posterior tib, and then do another round of PRP on the ATF ligament and possibly the PTT (depending on what the ultrasound says). My PRP doctor thinks surgery would be a really bad idea, and I am really disinclined to even consider surgery when conservative measures seem to be working well right now and I've got pretty good functionality.
But my question to the smart folks here - has anyone else had this type of tear, and had the clinical presentation be so different from the image results? Has anyone else just stuck with conservative measures for a tear like this?
(46 years old and female, if it matters)
History:
So... I have a long history of instability in my right ankle, with damaged ligaments. In 2014, I did several rounds of PRP and prolotherapy, and that fixed stuff up.
Starting late last summer, I started to have some posterior tibial pain on that right side. It was never awful - the pain was at most a 3 out of 10, and I could do sets of single calf raises on that ankle, though it was slightly weaker than the left. So I got it checked out by a podiatrist, who wasn't too worried about it, and then did some PT. It never stopped hurting, but never threw off my gait or hurt that badly, so I just stuck with the PT, kept running, and even ran some PRs.
It kept burning, so late last year I went back to the podiatrist - he ultrasounded it, and noted that the tendon looked really good, though there was a small bit of fluid near it - nothing concerning. He also noted, oddly enough, what looked like an accessory post tib tendon. But overall, it looked fine - just one of those things that might be painful for a while. I also went to the doctor who had done my previous PRP/Prolo - he examined me and thought the ankle was fine.
The ankle kept burning on and off, with the specific point of pain starting to move around - it'd be in front of the medial malleolus, then behind, then up on the shin behind the tibia. Then gone for a while. And it didn't really correlate with intensity of exercise, while it would start to throb when I lay in a certain position. All of which pointed to a back issue. At the same time, I was also having repeated bouts of left leg posterior pain, triggered while running, that would come and go. I was doing PT regularly, but not seeing much progress.
So we decided to get a lumbar MRI. And also an MRI of the right ankle, just to be complete.
While waiting for the MRI appointment, my PT decided to try a different taping technique - basically Mulligan taping, but starting on the medial malleolus, rather than the lateral. It was a game changer. Left leg pain disappeared, right ankle burning disappeared - yay. But I got the MRIs anyway, just because.
I got back the MRI reports a few days ago - the lumbar back looks totally fine. But the right ankle is a disaster on image, with the highlight being:
"Severe tibialis posterior tendonitis with longitudinal split tears involving the distal 9.0 cm, moderate grade at the level of the talus and the calcaneus, with mild tenosynovitis. Small spur along the posterior medial tibial metaphysis, at the tibialis posterior tendon groove which can be associated with PTT dysfunction.
"Chronic high-grade anterior talofibular ligament sprain, with at least partial tear. "
I'm told this is the MRI of someone who should be struggling to run on this ankle, but I'm currently doing very well. Running is fine. I did 4 sets of 25 single calf raises on it this morning, no pain. The only issue is that my balance on the right is not as good as on the left.
Right now, the plan is to keep on with the PT, to get an MSK ultrasound to get another look at the posterior tib, and then do another round of PRP on the ATF ligament and possibly the PTT (depending on what the ultrasound says). My PRP doctor thinks surgery would be a really bad idea, and I am really disinclined to even consider surgery when conservative measures seem to be working well right now and I've got pretty good functionality.
But my question to the smart folks here - has anyone else had this type of tear, and had the clinical presentation be so different from the image results? Has anyone else just stuck with conservative measures for a tear like this?
(46 years old and female, if it matters)