I went to see a podiatrist at the hospital who told me my achilles problem is mechanical, not RA related but didn't suggest any insoles or anything - just to maybe try trail running shoes. I got a couple of pairs which felt good to start with (see my previous blog) but gradually, I realised that they still had a heel counter with a lip at the top that was digging in.
I've googled continuously and found absolutely nothing that is going to help me with outdoor walking. Even all the comfort shoes and specialist walking shoes still have high heel counters. The only suggestion I've had which is the best, but not perfect, solution is from runners who have the same problem. They said they'd cut off the top of the heel counter. I've done this with a pair of the trail running shoes but now the heel counter on those is ragged and unstable. I might try duck tape! It made no difference on my Salomon walking shoes - they still left me in agony. Even Goretex trail running shoes aren't going to be good for winter walking though.
I agreed to be one of three guinea pigs when my RA clinic was holding a foot and ankle ultrasound afternoon for medical professionals. One of the guys running it was the boss of the podiatrist I saw at the hospital and he confirmed that my tendinopathy (as it's now known) was not RA related but mechanical. He told me the tendon in my left ankle, in particular, was very swollen - twice its normal size - and that I should think of it as a fraying rope. Lovely! He also said not to waste money on orthotic soles as the best and only treatment is to keep up with the stretching exercises I was given.
I've just cut down the heels on another old pair of trainers and it looks like this is all I can do.
Completely and totally fed up. Dog walking is a good part of what I do for a living and I'm wondering how much longer I can go on if the problem doesn't get better.
Losing the blooming will to live with it now.
Written by
whitedog
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Sorry to hear that you are having a lot of pain. I have attached a good web site with lots of good tips and treatments. So don't loose hope.
I too suffer from the same affliction. And it is painful. Pointing your toes forward relaxes the tendon and takes the strain off it. So I do these exercises forward, point toes pull toes towards chin. With a towel without straightening knee.
I try to on these 3 to 4 times a day, 1St thing in the morning.
The exercises they told me to do were the one where you pull up with a towel or something similar before you get up. I use my football scarf.
Also dropping your heels on a step and doing the stretches against a wall with leg bent halfway and fully. I do them as often as I remember - maybe not enough.
Ask your rheumatologist to have a really close look at the ultrasound scans of your achilles, and get them to confirm whether it is enthesitis rather than tendinitis (enthesitis is right at the point where it joins onto the bone, whereas tendonitis can be anywhere along the tendon). If its enthesitis, then its definitely inflammatory arthritis related and if its flaring you need more aggressive antiinflammatory treatment.
I wouldn't expect a podiatrist to understand the connection between enthesitis and inflammatory arthritis - but a rheumatologist should.
If you can get to see your rheumatologist soon, specifically ask them to examine the area and see if its possible that its enthesitis - they should know exactly how and where to press to tell the difference (enthesitis you have to press at the right kind of angle to positively identify the enthesitis point, which is a bit different to just pressing to see if it hurts generally).
Thanks. My rheumy doc and the ultrasound guy did do a scan at my last appointment and I think they confirmed then what the podiatrist had said, that it wasn't RA related. They were also involved in the foot and ankle ultrasound course where I was volunteer guinea pig and so they've had a good look.
On my left ankle, which is the most painful, there is a kind of lump on the left side of the tendon. Apparently there are signs of some tearing in the past and I have had problems with both achilles on and off for years. It's never been this bad though. I've been in pain since last winter when I had to ditch the walking boots eventually.
I'm actually going for an appt on Tuesday - but predominantly for a routine blood taking/xray/questionnaire etc session that I signed up for (it's an RA research centre). Assuming I'll also see my doc at some point, I'll get her to have another look.
The sit down office jobs that I vowed I'd never go back to, look kind of appealing again now!
Thanks again.
I think it's really strange the way these people know what is and isn't RA. I had something for about 4 months in my left ankle - around the outer ankle bone. It hurt badly and became very swollen for a few days. I asked my physio and she said it was Synovitis caused indirectly by RA but it wouldn't be doing any damage to the joint. When i was examined by someone for my consultant they didn't even check this swollen area out - just felt on the other side of my ankle which they declared was fine. I pointed out that this wasn't the bit that hurt or was swollen but she said that it was the joint they were examining not soft tissue or tendons. But I was told that tendonitis can be and often is part of RA? Very confused about all this but I've never yet been tested by ultrasound for inflammation - only my blood and very few examinations.
Have you thought of asking for advice on a jogging site perhaps? I'm glad you've been given some good exercises at least - hopefully they will start to make a difference if you do them regularly. Tilda
It is amazing what the docs can see and tell. And I agree, it is confusing. When I look at the ultrasound screen it just looks like a load of moving shapes and flashing lights.
I've been searching running sites and shoe sites and the only thing I can really deduce is that it's from wearing walking boots and other ankle boots over the years that have dug in.
I was reading some stuff presented by an Australian woman who is a foot health professional and she was basically saying that so much footwear - even sports footwear - is the cause of people's problems. Runners get the problem for the same reason, I think, that the top of the heel counter often protrudes forwards and digs in.
Cheers
Roz
When you think of running, even when people are a light frame, the impact on the ankles of the body weight hitting it with every step must take a toll I feel. Oh dear I'd better put my boots away in favour of ordinary showes I think - I can see how they dig in a bit now you mention it? Good luck getting on top of it by daily exercise I guess? Tilda xx
Yes - I really need to do the stretches everyday. It wouldn't be so bad if I didn't have to go out in the mud and rain with snow to come. Otherwise I can cope just padding about in slippers and light shoes.
Thanks - I just needing to let off a bit of steam.
i will go with earthwitch 100 persent on this sounds like enthesis to me
kind of what happens is the ankle terndon attachment point gets inflamed so the support is not as good to the ankle.
the next thing you will experience is when you get up out of a chair and use pressure on this the Achilles tendon might hurt you may see that looking at it from the back it feels like its moved over slightly or looks to be.
good one for this is rubber band round foot and press down
this will strengthen the ankle and the achiles tendon
hard but you got to persivere at first low reps.
should have been able to see enthesis on the ultra sound scanner im told.
low foot ware is the order of the day also nothing that will put you like in heels that would kill.
massarge also the ankle with fingers at night and back of heel helped me to
and always try to walk proper on it dont limp on it put the foot through normal motion as much as you can
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Horrible Heel Pain
