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Peroneal Tendonitis/Tendon Subluxation?
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Jul 21, 2014
Thanks a lot Jim,

I really appreciate for your quick reply !

Was that Ironman taking a bath?! =) Love the Red and your supporting crew! It is amazing to see how strong your are mentally and physically. No way people believe you are at 60s!

Wish I can be so strong like you once I finished my ordeal.

hopefully my Primary Dr will give me suggestions and recommendation on the surgeons and take MRI and see how bad my ankle is. I hope it will be a very simply fix like Dave Bacon.

I believe my hamstrings & quads and calves are in quite bad shape as I didn't do much exercises after 2 years ago. probably I won't take a bath until cast off as I need to climb up and down stairs on my bedroom and bathroom. Most likely I will stay on my sofa I believe. Knee Scooter sounds good, I wonder if you or anyone try iwalker 2.0? people said it is better than traditional crutches. Thank positive and be happy is one of the main key on recovery.

Thanks again Jim and everyone. Wish me luck!
Dave N
Joined Jul 17, 2014
0 points
Jul 21, 2014
Red Rock Canyon
Dave,
I’ll share my experience as well and try to answer your questions. About 16 weeks ago I had surgery to repair my retinaculum, peroneus brevis, and a Brostrom procedure to tighten the ligament. I dislocated my peroneal tendons and tore my peroneus brevis when I rolled my ankle in a fall. I already had a weak ankle from many years of ankle sprains, so that was a factor.

Weeks 1-4: non-weight bearing in a cast. I was on pain meds for five days straight and then on and off as needed during the next couple weeks. The throbbing was bad and I needed to keep my foot elevated pretty much 24/7. You’ll need lots of pillows to elevate your foot. I even slept with my foot on at least 4 pillows.

Weeks 5-6: Walking boot and transitioning to weight bearing. It took me two whole weeks to transition to weight bearing and the process was painful. PT started once the cast came off. I had terrible muscle atrophy in my entire leg, despite trying to exercise my quad while still in the cast. Knee also hurt badly once I started putting weight on that foot again.

Weeks 7-10: No more walking boot or crutches, although I was walking with a limp; PT twice a week, lots of stiffness and swelling, but not nearly as much pain.

Weeks 11-16: Walking without a limp and pain free; Started top roping easy climbs at the gym at about 13 weeks. Knee pain mostly gone at week 16 after lots of squats and exercises to strengthen my VMO.

• Costs: I think my insurance was billed 14k from the surgery center, 8k from the doctor, 2.5k for the MRI, and maybe 1k so far for PT. I think those are the full costs, not the costs negotiated by my insurance company. I had to pay a high deductible and then 100% was covered after that.
• Pain: Pain during the first week was pretty bad… my cast felt too tight and terrible pain when my foot would randomly twitch. Majority of pain gone after 2 weeks. I went back to my office job after 1.5 weeks.
• Depression: Not being able to walk is depressing and isolating. No doubt about that. I had plenty of frustrating and poor-me moments. That’ll happen. However, you will get better. It helped me to focus on the longer term progress, rather than comparing the day-to-day. I learned to enjoy the temporary slower pace, rather than the normal go go go.
• Showering: I used a bath seat and removable shower head for almost two months. I wrapped my cast in a garbage bag and hung my leg outside the tub. I think I began showering (seated) at day 5 after surgery.
• Preparation: I used crutches and thought they were fine. You’ll want lots of pillows for elevating. I spent a lot of time watching Netflix and reading library e-books. You’ll need lots of easy meals that you can make with minimal standing.

Good luck!
sarahd
From Lakewood, CO
Joined Feb 8, 2006
10 points
Jul 22, 2014
Sprained my ankle last year in May, and have had issues with a pain in my foot/ankle since. I've been to two different podiatrists and they both say it is peroneal tendonitis. I don't think I have any subluxation.

It seems to be a cycle. I feel better so I go out and push it, only to further aggravate the tendons. A couple of weeks ago it flared up pretty bad after a weekend of climbing, and now I am on anti-inflammatory medication and wearing an ankle brace. The doc does not think I have any ruptures in the tendon, only some minor tearing. He thinks after a few weeks of the medication and wearing the brace I can then start strengthening, but will not need surgery.

Anyone had luck treating peroneal tendonitis without surgery?
Ashort
Joined Apr 3, 2014
28 points
Jul 22, 2014
Thanks a lot Sara!

Glad to hear you fully recovered and Great sharing! Nice pictures too =)

So the whole bill for the surgery is like 14+8+2.5K? which is about 23K in totally?

@Ashort: from what I heard and researched, there is about 50/50 chances the tendons will heal themselves, so surgery is the solution.
Dave N
Joined Jul 17, 2014
0 points
Jul 24, 2014
I went to my PCP yesterday, I was being told that it was a minor thing after ankle sprain, and the so call subluxation (she mentioned that the term is too serious for my case) may be caused by ankle instability or I didn't use much my left ankle after it sprain for 1.5 years. She mentioned that she doesnt even think I need to do surgery, nor MRI but simply go for PT to strengthen my ankle... she did check a bit my ankle by asking me to push turn left and right, up and down towards her hand... also see if I feel any pain. I havent felt any pain after I "recovered" back in 1.5 years ago.

I was being told that if I got anything torn in my ankle (such as SPR, or retinaculum), or the perondeal tendon subluxation, I would have been really painful and no way I can walk easily. I am really confused now as what the hell is the thing that moves nearby my Fibula if not Peroneal Tendon(s)?! Superior/Inferior Peroneal Retinaculum? any other muscles or scar tissues that I don't know???

Sigh... hope I can get a better answer from a specialist or surgeon... I guess no matter what I should better check MRI or another x-ray and Ultrasound..
Dave N
Joined Jul 17, 2014
0 points
Jul 24, 2014
Dave N wrote:
I went to my PCP yesterday, I was being told that it was a minor thing after ankle sprain, and the so call subluxation (she mentioned that the term is too serious for my case) may be caused by ankle instability or I didn't use much my left ankle after it sprain for 1.5 years. She mentioned that she doesnt even think I need to do surgery, nor MRI but simply go for PT to strengthen my ankle... she did check a bit my ankle by asking me to push turn left and right, up and down towards her hand... also see if I feel any pain. I havent felt any pain after I "recovered" back in 1.5 years ago. I was being told that if I got anything torn in my ankle (such as SPR, or retinaculum), or the perondeal tendon subluxation, I would have been really painful and no way I can walk easily. I am really confused now as what the hell is the thing that moves nearby my Fibula if not Peroneal Tendon(s)?! Superior/Inferior Peroneal Retinaculum? any other muscles or scar tissues that I don't know??? Sigh... hope I can get a better answer from a specialist or surgeon... I guess no matter what I should better check MRI or another x-ray and Ultrasound..

If its still popping the retinaculum is most likely town. Mine stopped hurting after a few days and I didn't even know I had torn anything. The best way to observe is dynamic ultrasound, not MRI. I could walk around fine 4-5 days after but it would still pop in weird positions. It won't likely heal on its own or with PT
redlude97
Joined Jun 21, 2010
8 points
Jul 24, 2014
redlude97,

Agree. Will wait for the referral letters and hopefully the foot specialist can check everything.

For MRI I think it can see many other things just in case.
Dave N
Joined Jul 17, 2014
0 points
Administrator
Aug 7, 2014
JSH @ home  photo courtesy of Gabe Ostriker
I went to my PCP yesterday ... I was being told that if I got anything torn in my ankle (such as SPR, or retinaculum), or the perondeal tendon subluxation, I would have been really painful and no way I can walk easily.

This is untrue, or at least not uniformly true. My ankle subluxates ~daily, and while the pain varies to barely-any to moderate-ish(1), and can walk easily. Just last weekend did a 3-hr hike. The most reliable prompt for subluxation is going down stairs -- seems like weighting it as I'm stepping down and flexing the ankle is a good recipe. Some yoga poses also do it. Slab climbing moves.

It's likely that your PCP isn't too well versed in orthopedics (which isn't unusual or bad, unless she/he won't refer you to an actual orthopod for real evaluation).

I'm planning on having mine fixed in late November. Will update here after that (remind me if I don't, but I should have time aplenty, eh?).


1. I really, really hate trying to quantify pain. hate.
JSH
Joined Apr 3, 2007
1,068 points
Aug 11, 2014
Just saw a podiagist few days ago referred by my PCP. He suggested me not to go for surgery if I don't feel any pain. He said it is not 100% fix. Quite stressful as I felt my ankle is so weak. :(

Will make another appoint w an orth dr later on.
Dave N
Joined Jul 17, 2014
0 points
Aug 15, 2014
I had a follow up with the doc this week. The pain has pretty much gone away. Wearing a brace, taking anti-inflammatory, and not doing any hiking or climbing probably helped. The doc estimates that I should be hiking and climbing in 4-6 weeks. That really depends on me keeping up with stretching and strengthening exercises. I've been through this before, so I know not to jump back in too soon. In the past the pain went away so I just started climbing again. This time I will wait until i get more strength.

Overall I think that my injury is less severe than a lot of others in this thread. I have no subluxation in the tendon, just tendinitis and inflammation. Still, sucks to be injured during prime climbing season.
Ashort
Joined Apr 3, 2014
28 points
Aug 15, 2014
Aleks
there's really not much you can do when you get tendonitis in the perineum area. Aleks Zebastian
From Boulder, CO
Joined Jul 3, 2014
61 points
Administrator
Jan 7, 2015
JSH @ home  photo courtesy of Gabe Ostriker
Update 1: I had surgery 12/11, a bone block procedure to repair and anchor the retinaculum that added two headless titanium screws to my lateral malleolus. Doc said that this was necessary because it had been 3 years since my initial injury. I was non-weightbearing for 4 weeks, and yesterday I graduated to 50% weightbearing, in the aircast + a crutch still. My xrays show good fusion progress. I won't start PT for two weeks yet. I'm pain free for now. JSH
Joined Apr 3, 2007
1,068 points
Jan 7, 2015
JSH: Glad that you are pain free =) Wish you Speed Recovery. Dave N
Joined Jul 17, 2014
0 points
Jan 7, 2015
JSH: Good for you in taking the plunge. You sound like you are on track to recovery and will provide the necessary rehab focus to bring it back. Good luck! jim best
Joined Mar 20, 2013
36 points
Administrator
Feb 20, 2015
JSH @ home  photo courtesy of Gabe Ostriker
Update at 10 weeks: I'm good to go!

I'm still in PT, but it's going very very well. I can do a full heel raise easily now, which I never could before. I have no real pain, just achy muscles as I rehab it. Even as weak as it is now, it's already better than before - it would randomly flip out and collapse coming down stairs before (not good), and now it feels rock solid. It looks like I will have full range of motion by the time I'm discharged from PT.

I was 4 weeks NWB in a cast, 2 weeks 50%, 2 weeks in the boot, 2 weeks in a splint. I think at every step I healed faster than expected, so that may be an overly rosy outlook; my surgeon had said to expect 6-8 weeks NWB, but now at 10 weeks said I can climb (carefully!).

To answer Dave's earlier questions:
Cost: don't know yet, but in-network and covered.

Pain: the usual post-op, but I was pain-free pretty quickly (a week or so?). They did a nerve block for surgery, and kept me for a day after for pain control -- when the nerve block wears off, it can be brutal. I'd had a very bad time with that transition before, so they kept me overnight to give me IV meds when it hit, which worked very well.
One note for sleeping: it can be difficult when the cast comes off, as the covers press down on your very weak foot. My doc gave me the back half of the cast he'd cut off (so it fit my foot perfectly) and I ace-bandaged that back on for sleeping for a week or 3. That was the perfect solution there.

No complications: my incision healed very well (I moisturized the skin daily for several weeks before). Doc had me take aspirin, and off birth control pills, to prevent clots.

Depression: well, it's tough being inactive, but ... better than the alternative. It's finite, and spring will come.

Bathing: I had this routine down from before, but: shower chair, hand-held shower sprayer with long nozzle (need to install before), and they sell cast protectors. Took a shower the first night I was home.

Make sure you have the PT at the hospital show you how to do stairs on crutches -- all three ways.
JSH
Joined Apr 3, 2007
1,068 points
Feb 20, 2015
Aleks
climbing friend,

Good news, may you soon be crushing of the climbing rocks.
Aleks Zebastian
From Boulder, CO
Joined Jul 3, 2014
61 points
Feb 20, 2015
JSH: Congratulations! Way to keep our success rate up there! Only warning is not to take it out too fast. You're in it for the long haul and patience seems to be a virtue in this case. Good luck! jim best
Joined Mar 20, 2013
36 points
Feb 23, 2015
Aleks
yes climbing friend,

do not take it out to fast. The climber of female type would not like this.
Aleks Zebastian
From Boulder, CO
Joined Jul 3, 2014
61 points


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