achille’s tendons anyone?

[Lydia08]

I was doing great on 5 mgs prednisone and feeling like my old self. Frankly thought I was on my way to remission. Went to 2.5 mg. Okay for a couple days then my left ankle became tender and started swelling. I’d been doing some heavy lifting and moving of furniture so I chalked it off to that. BUT the Achilles tendon swelled to the point little movement of foot was possible without huge pain. Went back to 5mg. No improvement and other ankle began the same thing. Frustrated, went to 10mg. So far no better. Usually, for me, upping prednisone has given relief within a short. Not now. Any thoughts or similar experiences?

[SnazzyD]

Pred can make your tendons much more prone to injury. Somewhere under 10mg my achilles’s gave up the ghost and I was hobbling for months. Ended up at physio after an ultrasound scan via my GP but after no improvement a podiatrist sorted me out. They gave me orthotics but mainly exercises for weak hips and thighs (I had lost muscle mass) that made a big difference. You need some professional input I think. The ultrasound was able to show where there was damage or just inflammation.

[Lydia08 in reply to SnazzyD]

thanks SnazzyD. Interesting the exercises for hips and thighs.

Thinking myself a bit wet, I made myself continue some activities which may have further stressed those tendons. Maybe that’s the reason prednisone hasn’t righted me. Much as I hate it, if it’s not better after the weekend I’ll try to consult my gp.

[DorsetLady PMRGCAuk volunteer in reply to Lydia08]

Maybe that’s the reason prednisone hasn’t righted me.

Pred is not a magic bullet -it only works on part of your PMR -the inflammation produced by the underlying disease.

You have to manage the rest of your illness -be that less resilient muscles , fatigue, or whatever it throws at you…,

[GerriMc in reply to SnazzyD]

yes, agree! For me it was plantar fasciitis. I was attending a physio but was really sore. I mentioned it to my rheumatologist and he did an ultrasound and it showed that there was a lot of swelling of the tendon. Rest and a cortisone injection seems to have done the trick.

[DorsetLady PMRGCAuk volunteer]

If the increase to 10mg hadn’t done anything … then something other than, or as well as PMR.

But if you dropped down from 5mg to 2.5mg in one go that’s very risky in itself.

[PMRpro Ambassador]

Hi and welcome!

For a start - halving your pred dose from 5 to 2,5mg at this stage really isn't a good idea since it isn't just PMR that is in the game now, adrenal function is also a major factor. They have been asleep for as long as you have been on pred and now have to come out of hibernation and work for their living. They don't do that overnight! The lower - the slower, is a mantra that really does work very well.

However - although a strange effect to suddenly appear like that, being on high dose inhaled pred can lead to atraumatic achilles tendinitis and there is evidence it also happens with oral steroids. If you were doing activities that put stress on the achilles tendons, it could upset them. Another factor can be a history of taking quinolone antibiotics (ciprofloxacin), especially in combination with corticosteroids. Doesn't have to be recent.

sciencedirect.com/science/a....

You do need to be VERY careful, achilles tendons are very delicate when inflamed and even a slight trip can be enough to cause a rupture which can take a long time to heal or require surgery.

mayoclinic.org/diseases-con...

Do scroll through the following pages too.

I would reduce that pred dose back to 5mg, it is unlikely to help and may hinder. I was given a small boot to wear to take the stress off the tendon and it did help a lot. I also used crutches - and I warn you, it took months before the pain was gone and I felt confident walking without.

You need medical advice - as soon as possible.

[PMRpro Ambassador in reply to PMRpro]

PS - could you PLEASE complete your profile about your PMR history. It really does help us to help you.

[Lydia08 in reply to PMRpro]

I appreciate what you've said. I think a major contributor to my current dilemma was feeling so good- back to my old self and plenty of energy. I tackled some furniture moving, etc. I suppose it's possible that the painful Achilles tendon was due to the strain and not the PMR.

I returned today to 5mg and plan to get in touch with my GP after the weekend. I got a referral to a rheumatologist 6 weeks ago but the soonest i could see him is another month away.

Will try to finish my profile. Thanks very much.

[PMRpro Ambassador in reply to Lydia08]

It was orthopods who saved my tendons!!!! The first time was due to a daft GP giving me cipro for a UTI and within a couple of days my achilles was sore. I looked it up, turned up on her doorstep and she sent me to the ED for crutches and they supplied the ankle support. Years later and the other ankle played up - so I do have a matching pair now for the next time!

[sdowney717]

I would go back to 5 then try the 2.5 again as upping prednisone did nothing for the ankle, it is another issue than pmr. Lower prednisone is a good thing.

[PMRpro Ambassador in reply to sdowney717]

It is - but below 5mg you need to go slowly to allow adrenal function to return, Below 10mg it is advised to only drop 1mg at a time.

[sdowney717 in reply to PMRpro]

Yes, I have noted that myself. Definitely go to 5 as it was working.

I am at 7.5 and plan to go back to 5 in a few days. It did sort of work for me at 5, except for my fingers were worse. Thing is will the methotrexate and hydroxychloroquine make an improvement at 5 for my fingers.

Only way to know is to try

[Bridge31]

The only thing that cured my chronic post PMR Achilles pain was a visit to the podiatrist and custom made inserts in my shoes. I suffered for several months before I found the solution.

[PMRpro Ambassador in reply to Bridge31]

Mine has improved after eye-wateringly expensive insoles - still taken ages though.

[Stills]

after taking pred for Stills Disease, which for me manifests as RD, between the ages of 17-25 I now have recently developed severe tendinitis with constant pain and wear a supportive brace as my wrists are too sore to use crutches. I moderate all physical activity to accommodate joint pain and immobility from Stills and now this blooming ankle as well. The brace really helps and normal/regular footwear is a no no no with wide low 3cm wedge the easiest to walk in.

[Gimme]

I have had trouble with my achilles on and off aswell, it started last year before the pred though. I have found that wearing supportive shoes with a slight raised heel relieves it a bit, even around the house. A good quality running shoe that supports and cushions the foot and corrects the gait will often suffice. Definitely nothing totally flat, such as bare feet or flip flops. Multiple physios have hammered home the dangers of flip flops (though I am not suggesting that is what is affecting you). The last physio I saw reckoned that a lot of other knee/leg/hip problems come from the ankle and not having a supportive shoe that tracks the foot correctly. That makes sense for me for people like us who may have also lost some muscle strength.

But specifically for you, I really would get someone to check it out for you, to determine the cause and so that you can treat it correctly. If you have difficulty getting access to a doctor, you can go to a sports physio for an assessment. I've always found that I got more sense out of them with my wonky body anyway. Whenever it has been something that needs a doctor, they have been quick to move me on and it means that I have been able to tell the GP what I want them to do about it.

[PMRpro Ambassador in reply to Gimme]

It is said that if all over 60s wore trainers there would be a lot of problems solved at a stroke!

[Gimme in reply to PMRpro]

And perhaps the under 60s, in my case (going back).

[PMRpro Ambassador in reply to Gimme]

Certainly a lot of appalling footwear in terms of healthy feet!

[Lydia08 in reply to PMRpro]

I’ve gone bare foot as much as weather permits - to the horror of many. PMR changed that. I’ve been wearing Kidziks which are the most stable sneakers I’ve ever worn. Has anyone else tried and liked them?

[PMRpro Ambassador in reply to Lydia08]

If you want an answer to that you will need to repost as a thread in its own right so it is seen by others.

[Lydia08 in reply to PMRpro]

thanks. Learning the ropes

[Lydia08 in reply to Gimme]

good advise as getting in to see a doctor around here can come AFTER the coroner’s been called!

[PMRpro Ambassador in reply to Lydia08]

They always get the right answer though!

[Nightingales]

Your post is quite a coincidence because I was about to post about my tendinitis. I was doing so well after my hip replacement. Walking like a human being instead of a penguin! Feeling hopeful, went back on Leflunomide ready to battle this darn PMR and pred. A week later I had severe inflamed left ankle tendons, no injury recalled. My handout and NICE guidelines say that this is a common side effect from Leflunomide, 1 in 10. My rheumatologist says it’s very rare, one in a million. I haven’t heard back from him since I sent screen shots of the evidence. So now back in my usual position stuck between a rock and a hard place. Seeing physio on Monday but I don’t know whether to stop the Leflunomide. So demoralising and painful too.

[PMRpro Ambassador in reply to Nightingales]

I can't find much about it - except that it is a risk. It is also a risk with pred, Have you ever been given ciprofloxacin in the past? That is also a risk factor in combination with pred, Add them all together ...

[Nightingales in reply to PMRpro]

I am not aware of having ciproflaxin but I am 76 and had many ops in my youth. I always joked that my ankles were the only healthy things I had left! The stats came from the leaflet that was with the Leflunomide.

[Joseph14612]

Funny I saw this post and caught my attention....I recently ruptured my achille's tendon...Mine had been a problem for some time and was going to physical therapy for months to deal with the pain...Mostly what they had me do was stretching exercises ( which later on doc said it probably made it worse) Anyway, it just ruptured getting on the lawnmower, and to make a long story short, doctors put it in a hard cast, now I am in a boot and slowly getting better. It's the prednisone....I probably should have just used proper inserts and proper shoes... but most of all not taking my body for granted on what it used to do...now it's slowly and carefully...especially with prednisone..

[Lydia08 in reply to Joseph14612]

Thanks Joseph- when I was young we were told to “Just get it done!” Living alone on a farm im beginning to realize the -just do it- mantra is getting me into trouble. But it’s tough to ask for help.

[Joseph14612]

So sorry, I know that mantra very well myself, but do it slower and a little TLC on the body.

[Chiqui1950]

I hope you feel better soon Lydia! SnazzyD gives us wisdom and hope!!😍