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Good Day. I am a 67 year old woman. I

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Posted on Thu, 14 Feb 2019
Question: Good Day.
I am a 67 year old woman. I was diagnosed with posterior tibial tendinitis, right leg. It started out as pain around the bone on the left side of my right ankle, but the entire ankle eventually became painful, after a couple of months of trying to ignore -- my error. My primary care doctor had x-rays taken, but they were of the foot, not the ankle. She referred me to a podiatrist. He initially had me use a Levamen (Medi) brace, for about a month. It helped, but the initial site was still very tender. I have been using a Low Tide Pneumatic Walker for about 4 days. The ankle is immobilized, and the pain is much less but is still there.
I was told to use the pneumatic walker until I have no pain for 3 days. I can then stop using the walker.
How long should this take to heal? If it is more than a week or two, should I make sure that the shoe on my left foot is balanced in height with the walker?
Are there any exercises that would help strengthen the area? The receptionist who answered the phone when I called the doctor’s office today said that there were exercises to do, but I was not given them at the office. She is going to mail them to me. Would guidance by a physical therapist be better than following a sheet of exercises?
The main disadvantage to using the walker is that I cannot drive. Both the technician at the surgical supply store and the receptionist at the doctor’s office said that I can take the pneumatic walker off when I want to drive, and put it back on when I am not driving. Will the motion of flexing my ankle to use the gas and brake pedals slow my recover? Right now, my husband is driving me to and from work, but I am not able to get to occasional meetings that are at different locations during the day.
I am a pastoral minister for a large Catholic parish. I do spend a fair amount of time at a desk – but do have to walk around and be on my feet for a couple of hours a day.
Any clarification and guidance will be appreciated.
Thank you.
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Follow up: Dr. Antoneta Zotaj (48 minutes later)
Additional Question

I was told to use the pneumatic walker until I have no pain for 3 days. I can then stop using the walker.

Is this correct?
We had a friend who also used a pneumatic walker, and he used it for longer than three days.

If the purpose of the pneumatic walker is to promote healing, wearing it for only three days seems too short a time
doctor
Answered by Dr. Antoneta Zotaj (1 hour later)
Brief Answer:
Detailed explanation for the questions below

Detailed Answer:
Hello,

Thank you for asking at "Ask a Doctor" service. I carefully went through your query.

General information:
Posterior tibial tendinitis treatment can be treated with different conservative measures like braces, orthotics and boots (plus elevation, ice, NSAID drugs to help with pain) especially in stage one.
If conservative treatment should be used depends on a few things:
- Stage of the disease: Stage two can also be treated with conservative measures but in many patients from stage two to four surgery is needed.
The stage of the posterior tibial tendinitis is decided during physical examination that your doctor did in the office.
- Timing of the disease: As a general rule conservative treatment can be tried up to 4 months, some say up to 6 months, and if no improvement the patient needs surgery

Related to your questions:
- pneumatic walker (which is a boot) should be used 6-8 weeks to immobilize the ankle and reduce the movement in the area reducing inflammation. Sometimes may be needed to be used a bit longer and it is the symptoms that will guide the timing but generally 6-8 weeks is needed.
- you might need to talk with your doctor related to the stage of the disease: stage one conservative treatment with boots can help, stage two conservative treatment can help but many need surgery and stages three and four always need surgery (deformity of the foot is developed and boots, casts, orthotics and other conservative treatment do not help)
- if you take it off for a while during the day while you drive but ware it during the rest of the day, it might not be a problem if you don't drive too long and if you notice no worsening of your symptoms with this approach.
- physiotherapy is important as well as it helps strengthen the tendon. Taking a sheet of paper with the exercises might help but it is best to see a physiotherapist which can guide you and tell you if you are doing the exercises correctly, at least seeing the physiotherapist once might be very beneficial.
- as for the left foot and need to have higher heels on that side to balance the height of the right foot- this might be needed (but rarely) especially if you notice that you are developing pain in the left foot, lower back or hips but need to discuss this with the doctor that is following you up.
- you are already taking NSAID drug to help with pain and swelling (meloxicam) so continue it and make sure you take it after food to protect the stomach and any stomach pain or dark stools should prompt a visit with the doctor.

I hope I have answered your query. Let me know if I can assist you further.

Regards,
Antoneta Zotaj,
General & Family Physician



Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Antoneta Zotaj

General & Family Physician

Practicing since :2004

Answered : 4408 Questions

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Good Day. I am a 67 year old woman. I

Additional Question I was told to use the pneumatic walker until I have no pain for 3 days. I can then stop using the walker. Is this correct? We had a friend who also used a pneumatic walker, and he used it for longer than three days. If the purpose of the pneumatic walker is to promote healing, wearing it for only three days seems too short a time