Medical Forum / Diseases and Disorders / Arthritis / August 2007
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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