Ankle pain and knee pain

[EnyaBlue]

Started on 15mg of pred at end of March 2023, now on 7mg after tapering advice on this forum and doing OK. I swim twice a week and do either Pilates or yoga once a week. I also walk up to 2 miles on a couple of days a week, if I feel OK. I am managing the off days with resting or having what I call 'slow days' . However, I have 2 niggling issues which bother me and I would like advice as I am not sure if PMR is hindering the problems or its something I have to put up with or perhaps I need another session with physio or osteopath.

In Oct 2023 my ankle pain was diagnosed as peroneal tendonitis. I took advice on footwear and did some exercises in the pool. The pain then moved around, under my foot and to my shin. I saw an Osteo in Jan/Feb and got some specific exercises. It seemed to get a somewhat better, but has never gone away, but I started back to yoga after a 3 week break. However, the discomfort is now annoying especially when I am walking as it now is on top of foot at ankle and and inside lower shin. Have I over stretched the soft tissue in yoga? Should I see physio/osteo again?

Likewise, my right knee is playing up again. I fell on the ski slope last year before I had PMR diagnosis. It wasn't a bad fall and after physio, rest etc it seemed by Nov 2023 to get near back to normal. For the past 2 weeks or so the same problems have returned and bending at the knee is uncomfortable. Again it was soft tissue damage.

I have no arthritis or joint problems and am wondering if after a year on pred this might have an impact on the soft tissue as I seem to remember someone mentioning this previously. Maybe some gentle physio might help, not sure? Will it all go away eventually or is this wishful thinking?

[PMRpro Ambassador]

Difficult to say - PMR does like to prod any weak spots! I also had achilles tendonitis in the right ankle which was just resolving when peroneal tendinitis developed in the left foot. It took a good year for the pain to go when walking. I got personally fitted insoles which have made a big difference. Worth the price thought they were gold-plated! I have considerable back problems, also associated with the PMR and you end up walking "wrong". I also mangled my right knee skiing and although there is no sign of OA, it isn't right and steps/stairs are a nightmare. There was a problem with the same knee when PMR first started. It is swollen - sure there is some fluid in there but I forget to mention it when I see my wonder-rheumy! Don't like to ask for too much at once and it was the sacroiliac joint last time which was far and away the worst item!

It might be worth speaking to a physio - if they are good they may have some pearls of wisdom.

[EnyaBlue in reply to PMRpro]

It is my right knee that was also 'mangled' just before I got the PMR diagnosis. Very swollen at the time and I could not bend it and yes stairs were a nightmare. I think fluid has returned, perhaps it didn't go, but stairs are becoming a bit more tricky so may go back to the knee strengthening exercises given to me by the physio. I wear 'off the shelf' orthotic insoles as my sister who has had ankle problems for years said that the custom made ones were not great, but I could go down that route. I have L4/L5 spondolitholosis which was caused severe sciatica in my butt, legs to the soles of my feet 10mths prior to PMR diagnosis. Left SI joint very tight and has also caused problems in the past. Probably all this is adding up and been extra highlighted and prodded by the PMR. The osteopath said in Feb that the tendonitis associated pain could take up to a year so ho hum, just hold tight and carry on, but many thanks for your thoughts and words of wisdom. Always good to know I am not alone with these additional problems

[PMRpro Ambassador in reply to EnyaBlue]

We sound a bit twinnish!!!!! Orthopaedic shoemakers here are very good although they do vary,

[SnazzyD]

I’d be thinking about a podiatrist. I had to go down the same route due to Achilles issues and they identified various issues in muscle tone upstream and also gave me insoles to adjust my gait. Basically my lifelong habits were beginning to show with all the reconditioning that had occurred during GCA/Pred. No matter how much the osteopath and physio adjusted things, their work was just being undone.

[EnyaBlue in reply to SnazzyD]

I think you are correct. Life long habits and upstream issues may be the problem along with additional issues that I know about regarding my back. 14 years in teaching with a lot of standing, stress and bad posture probably created some of the issues. Also, I have always had flattish feet which are wide at the front and very narrow at the back. Age hasn't helped as my arches have dropped and my feet have gone up at least half a size, not great as I was always a UK size 8. Now most comfortable with men's trainers with an orthotic support, but take your point about seeing a podiatrist. Will do some research. Thank you for your insight and thoughts.

[Seekingasolution in reply to EnyaBlue]

I had pains in the centre of my feet on the underside of the ball of the foot and was walking very badly , also right knee and ankles and sometimes felt my leg was going to give way. I bought comfy bendy shoes and went to see a podiatrist. He thought it was due to the PMR but told me to buy shoes that supported my foot with soles that didn’t flex. I bought some reiker pumps and they made a remarkable difference.

[whitefishbay in reply to EnyaBlue]

I have arthritis in my feet with bone spurs on the top of my feet so walking is painful. I have insoles and found ON shoes (cloud runners on.com/en-gb/products/cloud... really great as they are roomy and not too clunky but very light. I think PMR had nothing to do with my foot problems. My ankles hurt often too and I just think it is how it is. I had steroid injections in my feet a month ago (thank you NHS) and that helps. I just have to keep moving and I like to travel so I walk, not fast, but on a good day 20K steps. Good luck.

[Suedeshayes]

Hi there. PMR and the taking of steroids, is directly related to weakening your tendons and care must be taken if you have pain in any of them, as you risk rupturing them. Excesses must be done gently and advice from physio is an excellent idea. This is my experience. S.

[Elvied in reply to Suedeshayes]

I have just bought a vibrating plate to stand on Vibration therapy is very low impact but moves all your muscles . Good for osteoporosis.

[howtotaperdown]

Suedeshayes has a good point about tendons, yoga and chi gong exercises which I have been doing for years - fairly vigorously - I now have to do very softly! or a lot will hurt afterwards., effecting sleep again. also strange pains have set in since PMR started 20 months ago, which I care for with rest, massage some visits to an osteopath, and bio freeze. and also old pains. I did have a steroid jab in my knee last year - I had torn the meniscus 10 years before and it felt like it was back, - that helped and as the rheumy said better to take a shot locally than take in more orally.

[EnyaBlue in reply to howtotaperdown]

I have been doing yoga for over 25yrs, so in my head I think I can do everything in the same way. But sadly I'm coming to the conclusion that it's not possible. I think the current ankle issue might have been started with overstretching in a yoga class, that's my only explanation.

[howtotaperdown in reply to EnyaBlue]

sounds familiar! I have done a lot of chi kung... 'you are as old as your tendons'.. rather than muscle work, and now I have to do less or not as forceful, a big (normal) session can leave me with pain going thru them all night, even though it feels revitalising too

But PMRPro said PMR doesnt often hurt at night, whereas that has been the worst for me lately...

through a sedimentation speed blood test, my French GP showed me I no longer have inflammation... so not sure where the pain is from, there is still a lot I don't undesrtstand .. doing all I can to taper pred as I really have the impression it makes me feel worse... but I suppose it cant create pain can it?

[Birdfriend]

I was diagnosed with GCA in-April’23. Started at60 mgs now down to 5mgs. I have frequent leg pau but have an especially painful lower left leg above the ankle. It’s nerve pain and canbe excruciating. I finally had a nerve conduction study this week and it confirmed a neuropathy. Ugh. Lots of physical therapy ahead. I’m actually going to force myself to do regular gentle swimming. And I hate swimming😐

[EnyaBlue in reply to Birdfriend]

Oh dear, sounds painful. I'm a waterbaby so no problem with swimming. I'm a great believer in doing physio exercises in the water if possible as it's more supportive. You could try aqua aerobic classes, a friend with OA finds them very helpful.

[PMRpro Ambassador in reply to Birdfriend]

As EnyaBlue says - aquafit starting very low level and building up slowly is probably better. Especially if you do breaststroke when you swim - awful for PMR knees.

[PMRnewbie2017]

I took up swimming and found it very beneficial. However after about 8 months I developed knee pain and swelling. I can only do backstroke and breaststroke. Turns out the breaststroke had messed with my knee and an MRI showed that I had developed something I had never heard of:Pes anserine bursitis. No sign of osteoarthritis. No MCL or ACL issues. Perhaps Google it and see if your knee problem is that?

[EnyaBlue in reply to PMRnewbie2017]

I should own up to having been a swimming teacher 25yrs ago hence my passion for water based exercise. Never start off with breast stroke because of the forces on knees. For back problems lie on your back, kicking legs up and down gently and use a float or other water aid if you can't easily move arms. Otherwise treading water or just walking in water can be a good start to water therapy.

[Birdfriend]

great tips/thanks everybody!