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Medical Forum / Diseases and Disorders / Arthritis / August 2007

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Akilles problems

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Aina Nilsen - 12 Aug 2007 18:04 GMT
I've have RA since 1999 and have had problems with a knee since February
and in May the Achilles tendon on the same leg started to hurt. I was able
to do a lot of walking and exercises in warm water for two weeks in July and
that seemed to take the knee pain, but my Achilles kept getting worse. I
ended up getting to see the on duty doc at the Rheumatologist department two
weeks a go, and after using ultrasound she could tell me that the tendon had
inflammation all the way trough and at first she was unsure about what she
should do. She said that cortisone short could make the tendon break, but
after she called the Orthopaedist on duty, she still decided to give me a
shot behind the tendon, hoping it would help. If it didn't get better in a
month, I was to call and get another appointment, then for surgery.  I tried
to ask what to do in the mean time, and all she said was do not walk too
much. I have and office job, so the first week I just sat on my chair and
had a colleague bring me anything I needed, basically just walking to and
from my car parked near by and to the restroom. Last week I did walk a
little more, but I'm still not walking much. The tendon does not hurt all
the time now, but is still quite swollen (making a lump on my heel) and it
does hurt when I am walking.

Can you tell me if you have had similar problems and what you did to solve
them? I rather not have to have an operation, since I assume it would put me
out of action for some time? I'm supposed to go for two weekend trips early
September, and would hate to cancel them.

Aina

The lurker in Norway
Kelly - 13 Aug 2007 17:19 GMT
Try putting a heel pad under the heel to raise it a little.  This will take
some of the pain away with luck and will take some of the pressure off.
Always wear some kind of foot wear inside and yes rest and ice will help.
Slow down your walking a little and do gentle very gentle stretches after
and before walking.  Make sure your RA is sort of under control as much as
possible.

Achilles Tendon problems can take lots of time to disappear so patience is
one of the things you need.  Cortisone shots can do more harm than good and
my rd refuses to give them (he insisted he needed one once and apparently
the tendon did tear - took longer to get over than rest so he learnt his
lesson the hard way - especially since he knew the considerable risk.)  Make
your walks in smaller amounts - maybe 5 or 10 minutes at a time if that
doesn't hurt 3x a day or to whatever level doesn't hurt too much but
increase frequencies until again you reach a level that doesn't hurt.  If it
hurts then rest a bit.  Try some physio - that sometimes helps as well.

I do know when I had the trouble heel lifts helped immensely while the
achilles were heeling.  I had to fool around with the amount of lift for a
bit but just a tiny bit of padding in that heel helped. An occupational
therapist helped me with this - but a good orthotic shoe place should be
able to assist.  The lifts were just pieces of felting or the compressed
orthotic foam cut to size and tapered down.

Good to see you posting Aina.  Is your RA in general doing a bit better?
What meds are you taking?

Kelly in BC Canada
>  I've have RA since 1999 and have had problems with a knee since February
> and in May the Achilles tendon on the same leg started to hurt. I was able
[quoted text clipped - 23 lines]
>
> The lurker in Norway
Aina Nilsen - 13 Aug 2007 18:50 GMT
> Try putting a heel pad under the heel to raise it a little.  This will
> take some of the pain away with luck and will take some of the pressure
[quoted text clipped - 25 lines]
>
> Kelly in BC Canada

thank you Kelly!
I've changed to shoes with about  a 1/2 inch heel from my summer time
Birkenstocks that did seem to flat after my visit with the doc. I'm not sure
if this is enough or not? I do not walk without shoes at the moment, but
even going from sitting all the time to walking a little around the house
seems to trigger the tendon at once. As mentioned I did my own errands at
work last week, but even that is just a few minutes walk every time. I do
have some lifts that I bought a few years a go, and did use them the last
time I had a problem, but back then it went away after a short time.

My RA was a bit out of control this spring, making me ask for partial sick
leave for the first time since 2001. I'm on 15 mg Methotexate a week, 100 mg
Sandimmune Neoral (cyclosporine) as well as 5 mg Prednisone each day now. I
did get my Predinisone down to 5 mg and 3,75 mg alternatively last summer,
but apparently that was not enough this winter.

I might have been a bit too stubborn wanting to remain on that schedule with
the prednisone after an episode with the US medican system last Christmas.
We went to the USA visiting my in laws and it was at the airport in Oslo,
with no time to go back to get the backback, that we realized that the
backpack with medication, jewelry and our rental car voucher was at home in
the entrance. A misunderstanding between us had left it there. It was not
time to go back, so it would either be no trip at all due to our cheap
tickets or going and solving it in the USA. We went and I paid some $$$ to
see a doc and get the meds I needed. The doc seemed chocked when I told him
that I had been on Prednisone since 1999.

Here in Norway, they seem to feel that anything under 5mg is ok, even long
term. I did ask a specialist in May, but she just said not to change
something that had worked quite well so far.

I did go up to 7,5 mg of Prednisone for a short time this spring, after
seeing a specialist, but after that I've been on the 5 mg. Right now I
wonder if I should have pushed it again this summer, with the hurting
tendon?

Aina
the lurker in Norway
spodosaurus - 14 Aug 2007 04:17 GMT
>> Try putting a heel pad under the heel to raise it a little.  This will
>> take some of the pain away with luck and will take some of the pressure
[quoted text clipped - 64 lines]
> Aina
> the lurker in Norway

Aina, have you had a bone density scan done recently? Prednisone can
cause osteoporosis/osteopaenia. A couple of years ago I had over a dozen
(we stopped scanning at that point) stress and compression fractures due
to osteoporosis yet as a 30 year old male being treated with drugs that
should have the side effect of strengthening my bones the doctors didn't
check for nine months. If you have osteoporosis from the long term
prednisone, and the swelling is mainly at the attachment of the achilles
tendon to the heel, then the tendon may be slowly pulling at the
weakened bone surface causing micro-fractures and edema. I had this
happen in both thumbs.

Ari

Signature

spammage trappage: remove the underscores to reply
Many people around the world are waiting for a marrow transplant. Please
volunteer to be a marrow donor and literally save someone's life:
http://www.abmdr.org.au/
http://www.marrow.org/

Aina Nilsen - 14 Aug 2007 21:43 GMT
>>> Try putting a heel pad under the heel to raise it a little.  This will
>>> take some of the pain away with luck and will take some of the pressure
[quoted text clipped - 79 lines]
>
> Ari

I actually did ask for one this spring, since it was several years since the
first one. I had lost a little bone, but not to the point of osteoporosis.
The first scan after about 4 years of prednisone had me on normal to high
density for my hips and normal for my spine. The results this time was
normal hips and slightly into osteopaenia for the spine. The specialist
didn't seem too worried about this, other than checking that I was taking
calsium and vitamin D.

The swelling on the heel has gone down a bit, but it still is there.  Would
the untrasound not show at least the edema if I had that?

Aina
the lurker in Norway
jofirey - 13 Aug 2007 18:55 GMT
>  I've have RA since 1999 and have had problems with a knee since February
> and in May the Achilles tendon on the same leg started to hurt. I was able
[quoted text clipped - 23 lines]
>
> The lurker in Norway

I know I'd want to see an orthopedic guy personally about now.  But I'd be
very leery of surgery.  I mean surgery isn't going to help inflammation is
it?

My worst joint is my right knee, and when its acting up it shares with
everything on that side.  My foot swells my hip hurts, everything.

I've even found having the knee injected usually helps the foot.  A
preemptive shot in your bad knee before your trip might help.

Jo
Aina Nilsen - 13 Aug 2007 21:43 GMT
>>  I've have RA since 1999 and have had problems with a knee since February
>> and in May the Achilles tendon on the same leg started to hurt. I was
[quoted text clipped - 36 lines]
>
> Jo

The RA doc said that suregery would help getting a better blood stream to
the area and that they would "clean out some inflammation". I'm afraid I
didn't question that part.  At he moment my knee is not hurting at all, that
got better with all the walking in the water, the problem right now  is
"just" the akilles.

Aina
the lurker in Norway
sweetpickleNO@SPAMknology.net - 13 Aug 2007 23:49 GMT
Good to see you again, Aina, but sorry you're having these problems.  I have
no information to share, but wanted to welcome you again.
Gwen

>  I've have RA since 1999 and have had problems with a knee since February
> and in May the Achilles tendon on the same leg started to hurt. I was able
[quoted text clipped - 23 lines]
>
> The lurker in Norway
Aina Nilsen - 14 Aug 2007 21:30 GMT
Thank you, Gwen!

Unfortunately I mostly do not have the time to read this group every day, so
I tend to catch up on the weekends. This makes it too late to respond to
most of the messages in here, but I do read them and send good thoughts,
even if it sometimes is a little after the fact. Also, if I were to respond
to many of them, I would not have the time to read them all.  After all,
this place is often quite active :-).  But I do love the information and
wisdom you all have and often pass on things to others, both facts and some
of the fun stuff.

Aina
the lurker in Norway

> Good to see you again, Aina, but sorry you're having these problems.  I
> have no information to share, but wanted to welcome you again.
[quoted text clipped - 28 lines]
>>
>> The lurker in Norway
spodosaurus - 14 Aug 2007 04:06 GMT
>   I've have RA since 1999 and have had problems with a knee since February
> and in May the Achilles tendon on the same leg started to hurt. I was able
[quoted text clipped - 23 lines]
>
> The lurker in Norway

I've had problems at the heel attachment for both of my achilles
tendons. Both tendons required two cortisone shots each, with each shot
followed by rest, then stretching, then strengthening of the leg
muscles. Personally, after the first week or two I would think walking
would be fine, just not power walking, jogging, running stairs, etc.

Ari

Signature

spammage trappage: remove the underscores to reply
Many people around the world are waiting for a marrow transplant. Please
volunteer to be a marrow donor and literally save someone's life:
http://www.abmdr.org.au/
http://www.marrow.org/

spodosaurus - 14 Aug 2007 04:10 GMT
>>   I've have RA since 1999 and have had problems with a knee since
>> February and in May the Achilles tendon on the same leg started to
[quoted text clipped - 32 lines]
>
> Ari

Also, I used ibuprofen. This was all before I had reason to join this
group, though (when I was a distance runner).

Ari

Signature

spammage trappage: remove the underscores to reply
Many people around the world are waiting for a marrow transplant. Please
volunteer to be a marrow donor and literally save someone's life:
http://www.abmdr.org.au/
http://www.marrow.org/

Aina Nilsen - 14 Aug 2007 21:37 GMT
>> I've had problems at the heel attachment for both of my achilles tendons.
>> Both tendons required two cortisone shots each, with each shot followed
[quoted text clipped - 8 lines]
>
> Ari

My doctor never mentioned a second shot, as mentioned she was a bit hesitant
about giving me the first one. I was in the hot water pool for the first
time after their summer closing, and did try to do most exercises without
using the tendon too much. I have not streched much, since everybody seems
to agree that using lifts or shoes with higher heels, I was not sure if
streching was a good idea.

I'm wondering if I should try to use a bit of the dicofenac (Voltaren) I
have, on top of the other medication?

Aina
the lurker in Norway
 
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