Foot Pain, Arch Supports and the Elusive Diagnosis…”Posterior Tibial Tenosynovitis”
Monday, March 23, 2009 20:47This is a post about my struggle and healing from foot pain, which turned out to be a different kind of repetitive stress injury: posterior tibial tenosynovitis. Scroll to the bottom if you’re looking for a list of good brands for arch support and good shoes.
(Or you can read the full version for all the juicy details on the different treatments I’ve been suggested over the years.) This story starts with the question many patients have asked…How hard is it to find a doctor who actually listens?
Before I had arm pain, I had foot problems. It may have started when I walked around barefoot in my college days on the UC Santa Cruz forested campus, or maybe it was just the structure of my feet from the beginning. The area beneath my ankle bone, on the inside of my feet would swell up and ache, and the swelling would spread throughout my feet. Ow. For a long time I slept with my feet on pillows to help the swelling drain, and wondered what to do. I had a lot of health problems for a 20-year old…
I did find solutions, but it’s an ongoing process…
Over the years I talked to doctors to find out what was going on. There was a Planned Parenthood doc I saw once, when I was sans insurance. She said the foot thing could be a venous insufficiency, meaning my veins were leaking blood and not pushing the blood back to the heart properly.
So I started wearing diabetic compression stockings, to help the blood move through the legs. They helped, a little, but mostly compressed other areas of my legs rather than my feet. Strangely, they started giving me bruises, in areas where the blood was less compressed and pooling. That was…less than ideal.
The next doctor I asked just told me I ought to stretch my calves more. He was also the doctor that gave me asthma inhalers that made me stressed and nervous all the time… basically, useless advice. To be fair, there are some kinds of foot pain that result from leg tension, but my case was far beyond that.
That was about the time I was working and my arm pain was getting very bad from the repetitive stress junk. I finally quit the job that was stressing me out and causing pain, and took some time off.
Ironically the catalyst for solving my problem was a terrible acute foot injury. One night I was watching movies with some friends one night, and making tea. I had this travel mug that I’d carried everywhere (even to Germany for 8 months), and the mug’s handle had had enough. I’d just poured the tea, the handle broke off, and boiling water spilled on my socks and feet. I had blisters the size of small pancakes.
I ended up at the hospital overnight, signed up for Cobra insurance the next day, and took the next doctor they assigned me, wishing for the best. She happened to be attentive, caring, and knowledgeable. She didn’t stop with healing my blistered feet. She found inhalers that controlled my asthma, gave me the right meds for my allergies, and sent me to physical therapy for my ongoing foot pain. Basically, she restored my faith in the medical system.
Her first diagnosis was plantar fasciitis. That’s the swelling of the area on the center of the bottom of the foot just above the heel. It’s common in older people, but not younger people. My PTs didn’t think that was right, and their treatments only helped a little. So I got sent to a podiatrist.
Podiatrist dude spent half an hour watching me walk, then telling me my feet were just flexible and flattening, and the solution was arch supports. He wanted me to get custom supports, but I never followed up because the simple solution—over the counter Superfeet brand supports—started relieving the pain from day 1.
They’re relatively cheap, fit in all my sneakers and some nice shoes too, and made most of the pain disappear. However, finding supports for dressier shoes and sandals has been an ongoing issue. Over the past four years since I saw the podiatrist, I’ve visited biomechanic shops that specialize in supports, and had them sell me orthotics that hurt terribly. And I’ve purchased many shoes hoping they’ll work with my supports, only to find they don’t.
But orthotics and arch supports are becoming more popular, and more brands are available now than before. I’ve seen the drugstores like Longs and Walgreens start to sell more varieties and solutions over the past few years, and some of them help a little in dressier shoes.
Mostly I have been pain-free, but I tend to have arch pain right around my monthly period, and anytime I try to wear shoes without significant support. Lately this is a problem since I have been trying to go to dances, especially Friday Night Waltz or the Gaskell’s ball, along with a local irish Ceili dance. Nothing like 6 hours of waltzing and standing around to make your feet into balloons.
So, sitting with my feet up earlier this week, I finally dug out some old medical records. A couple years back, a cousin of mine needed my medical records and I had the docs’ offices send me a copy. So it was only incidentally I ever got a copy of my podiatrist’s report, and I was really surprised when I found that he had actually made a diagnosis instead of merely suggesting arch supports.
I’m sure he didn’t share the diagnosis with me because he didn’t think it would help much, but being me, I like to know these things. So the verdict is something called Posterior Tibial Tenosynovitis, and apparently I tend to walk in a way that leaves my feet shuffling out and pronated, because I have flexible flat feet. All this seems to mean from the consumer perspective is that it’s mechanical support I need, rather than any medications.
Below I’m going to share my list of helpful foot and arch support brands, for anyone else looking for solutions.
I’ve also looked into making my own, and found one potentially useful web site that describes how to do so by making a cast of your foot with cheap sculptural supplies. Another web site I saw suggested using Sculpey, the clay material you can harden by baking it in an oven, but I suspect that would get brittle and fall apart too quickly.
So here is my list of helpful brands…
Sneakers–New Balance supposedly has some models very good for flat feet
Nicer shoes – Ecco, Dansko, Clarks
For higher arch support, I’ve found a couple Dansko models work but mostly those brands don’t give enough support for me.
For better support, I’ve had luck with Finn Comfort for high-quality casual sandals, and Naot for some VERY comfy, and nicer sandals. They aren’t cheap, but it’s worthwhile.
I recently found a local store in Berkeley that has other good brands. I suspect the key is shopping around to find those stores that have really supportive shoes, and trying on new styles regularly, until I can find the ones that are both cute and comfy. It’s rare, but I’m beginning to suspect it’s not as impossible as I once thought. Hurray!
Now if I can just find good dance shoes with arch supports I will be a happy camper…or dancer, really.
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Brian says:
March 25th, 2009 at 12:07 am
I was waiting for it, and eventually it popped out. An observation I’ve made about most joint pain is that it almost always ties back to faulty biomechanics. Runners, for example, are notorious for knee and hip injuries. Most of the time it’s not because they run on hard surfaces or just run too much, it’s because they run poorly. Padded shoes don’t help either, there have been studies that conclusively proved that padding in shoes had no relation to injury prevention–in fact runners with excessive shoe padding tend to get injured more often.
The biggest problem with the medical industry is that they either simply don’t understand biomechanics, or they just treat the symptoms and don’t bother to tell you the real problem–like over pronation when you walk. Unless you fix the root causes of pain the issues just keep coming back. I’ve grown fond of the Alexander Technique’s way of re-educating us on proper joint use and how to move correctly for the basic activities of life like sitting, standing, and walking.
I particularly find the foot-ground interaction interesting. I’ve noticed that when I wear thicker soled shoes my right knee and ankle tend to hurt, but the pain goes away as soon as I take my shoes off. Your situation makes me curious if you still develop the same aches and pains after walking around in shoes as after walking around barefoot. Dr. Romanov, running specialist at PoseTech, said something that resonated with me. He was saying that thick soled shoes mask the foot-ground interaction. Since you can’t “feel” the ground you wind up developing bad habits that you wouldn’t running barefoot because they would hurt. He also blamed excessively cushioned shoes for causing people to develop “lazy arches.” His recommendation is very thin-soled shoes that put a minimal layer of material between your foot and the ground. This restores your ability to “feel” the ground and helps strengthen your arches.
You might find Alexander Technique methods of walking and PoseTech methods of running interesting areas to explore in finding less equipment-dependent methods of relieving foot pain.
Amy Hengst says:
March 26th, 2009 at 4:31 am
That’s interesting, Brian, thanks for your comments.
You asked about whether I was wearing too much cushioning in my shoes. Actually, when I first developed pain, I was going barefoot often, or wearing minimal footwear as you suggest. I was walking around between college classes in a redwood forest (on the University CA in Santa Cruz campus). I walked on concrete too, and I had calluses so thick I could walk across hot concrete in the sun without much pain. (Sometimes I cheated and used the white painted lines).
According to some doctors I’ve spoken with, going barefoot too much could have caused impacts that caused or worsened the problem. I always wanted to think that it was better to be barefoot, but sadly it’s no longer the case. Everything I’ve read, and my experience now, tells me I absolutely need arch supports. The only way I could avoid pain this last week was walking around in sandals with good support in them.
I would like to learn more about the Alexander method –I’ve heard good things about it, and it sounds something like Feldenkrais which has been recommended to me.