Achilles tendonitis and podiatry 

People who have been following this blog for a while may remember that back in December I was diagnosed with Bilateral Achilles Tendonitis (a fancy way to say inflammation of both tendons at the back of the ankles). I got my Achilles Tendonitis diagnosis just 3 weeks after I had been diagnosed with an Autoimmune disease so the thought was that it could be my autoimmune disease causing the inflammation. Makes sense huh? Well it isn’t quite that simple. Achilles Tendonitis can be caused by an autoimmune disease BUT it can also be caused by mechanical problems such as flat feet etc. And I do have flat feet. So my Tendonitis could be caused by my flat feet or by my autoimmune disease or both. 

My Rheumatologist referred me to a podiatrist that specialises in Rheumatology for some exercises/insoles that in theory should help strengthen position my feet in a way that reduces the strain on my tendons therefore preventing them from becoming inflamed because of my flat feet. But a podiatrist can not do much for inflammation caused by my autoimmune disease. The first podiatrist I saw believed that my autoimmune condition was the cause of the Tendonitis and it had nothing to do with the fact that I have flat feet because I already had insoles. I have given exercises to do and told to come back in a few months.

Those few months passed quite slowly. Although the Tendonitis was resolving, it was taking a long time and so by the time I saw the second podiatrist, I was better but not 100%. This time they decided to have a look at my insoles. It turns out that the hard plastic material my insoles were made out of couldn’t even support the weight of my podiatrists hand and would flatten out. Meaning that my insoles were pretty much useless as they couldn’t hold their shape when I stood on them. The plan from there was to get molds of my feet (involing me standing in a shoe box full of foam) and to get custom insoles which I should be getting tomorrow.

It took over 6 months for my Achilles Tendonitis to resolve, or almost resolve because I still had a few days where they were sore. But since the start of this month my heels have been getting progressively more sore. Not a good sign. As a physiotherapy student I am able to do a mini assessment (I can’t do everything because it’s actually surprisingly hard to assess your own feet) which is telling me that it’s quite likely my Achilles Tendonitis is back, and based on the area of my tendon that hurts (the insertion site) it’s quite likely that it is because of my immune system rather than if a different area of my tendon hurt which would be more likely a result of strain or injury.

Something that we also found with my tendons is that one is thicker than the other. This is usually a result of inflammation, so the 6+ months of inflammation I had earlier this year have caused scarring at my Achilles tendon causing it to become thickened. There isn’t an awful lot I can do about that unless it becomes so bad that surgical intervention is needed, which is not necessary right now. But hopefully with the help of these insoles we can reduce any inflammation caused by my flat feet and that won’t become any worse. 

I see my rheumatologist next week, on the 29th, and this will be another thing we have to discuss. I am getting worried now that the combination of me having more inflammation at my tendons and already having one ankle that has lost a significant amount of movement is going to cause problems for me. Walking is hard mainly because of the pain so I am back to taking Naproxen 500mg twice a day and topping up on Paracetamol as needed but that is only doing so much. Walking is also hard because of the lack of movement in my right ankle which means that walking on uneven ground or up steps that aren’t level is quite difficult because of the lost flexibility. I don’t think I wrote about the problems my ankle has been causing me when I was on placement (part of the physiotherapy course is called placement, where you go out into a hospital and learn how to apply the skills learnt at Uni in a hospital setting with real patients). With most patients I was okay to treat them while I was standing up which is perfectly fine for me, but for a few patients their treatment involved me kneeling. My ankle is not flexible enough for me to kneel, and at one point the pain caused by my needing to kneel resulted in me nearly passing out and almost being physically sick. This is a major problem because if I can not kneel, working is going to be difficult. I am terrified that I won’t be able to work in the future because I won’t be able to sit in the positions that I need to, to treat patients. I’m terrified that the Plaquenil/Hydroxychloroquine medication I am on is not helping me sufficiently so that I know I will be able to work when I qualify, and I know I will be able to finish my course. And I am really angry that my joints have got this bad that I am terrified about my future. This should never have happened, I should have started physiotherapy as soon as it was apparent I was loosing range of movement instead of being in the position that I have lost the range of movement and I don’t know how easy it is going to be to get back. Physiotherapy is definitely one thing that I am going to ask my Rheumatologist for. Along with discussing whether the Plaquenil is working sufficiently to help reduce the inflammation in my joints even though I am still swelling and sore and stiff.

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