(Lengthy) Question for Podiatry nurses

[RNikkiF]

I am a floor RN in a very busy but small specialty hospital.

Nine days ago (a Thursday), right at the end of my shift, I noticed that the posterior portion of my right arch was sore.

At the time I thought nothing of it because I had just worked two days (We're nurses... our feet are going to hurt sometimes).

I have had this happen before (to a MUCH lesser extent than what I'm about to describe), but I always would just rest the next day and the pain would be gone.

That night, I iced and elevated. I was still able to walk, but it did hurt some when I did. The next morning, I was still having pain and difficulty walking, but it seemed to get better as the morning went on. By that night, the pain was severe and walking was even more difficult. By that Saturday morning, the pain was unbearable with any movement of my foot and I couldn't walk at all. My foot was also swollen.

My husband took me to urgent care. Xrays were negative for fx, tenative dx: tendonitis. I was given crutches, an ace wrap, offered vicodin (which I declined and was told to take nsaids), and a note to return to work on crutches that Monday (?!?!?) and to see my PCM if no improvement or worse by Monday or Tuesday.

By Sunday night when I still couldn't walk and there was no change, I just called in for Monday and told the charge what was going on. Monday am: no improvement, swelling is worse. Saw my PCM who agreed with tenative Dx and referred me to podiatrist.

Saw podiatrist Thursday (7/25), who immediately says he thinks it could be a posterior tibial tendon tear (either partial or full) or severe posterior tibial tendonitis, and he ordered an MRI (still waiting on someone to call and schedule). Podiatrist gave me an aircast, which has greatly improved the pain, UNLESS the area (which is still swollen and slightly red) is pressed on directly, or if I've been still too long or move wrong (in these cases, the pain is largely tolerable, but firm palpation sends my pain to 10/10 instantly). The swelling is generally localized to the posterior part of my arch, but if I keep my foot down too long or if I've been sitting a long time then suddenly stand, the whole foot will swell.

I would think that (from what I've read) that pain from a tear would be more generalized throughout the foot rather than localized. I have also read that most people can continue to walk (although likely with difficulty), whereas I can not walk at ALL.

I do not work in podiatry, nor do I see a lot of patients with foot issues. If someone could please discuss posterior tibial tendon tear symptoms, course (and length!) of tx, I would be grateful! I have been all over the internet looking for resources, but no where have I seen that someone has gotten to the point of not being able to walk (although I'm sure it happens).

I'm getting worried that I'm in for a long-haul recovery here. MD wouldn't even let me return to work with restrictions (desk work) for the next 7 to 10 days minimum and at that time we will reassess after the MRI. Everything I've seen online says that recovery time is anywhere from 1 week to 1 YEAR! That's quite a range!

Sorry to be so lengthy... the info I'm looking for (to sum up) is:

Typical s/sx of posterior tibial tendonitis/tear

Course and length of typical tx (MD discussed this some and said tendonitis/partial tear would be "conservative" (aircast) tx, and partial tear (if severe enough)/full tear = surgery!).

Is it abnormal that I am unable to bear ANY wt on my right foot at ALL??

In addition to all of that (as if that isn't enough). My aircast has been hurting my heel d/t being in constant contact with hard plastic (a PT that I work with put some foam in the boot to "float" my heel which has helped some, but since I'm non-wt bearing, it still comes in contact and hurts (worried about pressure ulcer!)). The cast also makes my toes go numb at times and I have to frequently adjust the cast, esp after position changes or being up moving around. Any tips to fix these two issues are appreciated as well.

Thanks!!

[Esme12, ASN, BSN, RN]

I am so sorry you are hurting.....but we cannot offer medical advice as per the Term of Service..

[h=3]Medical Advice:[/h] ALLNURSES.COM, INC or it's members do not offer medical advice. Any requests for such will be taken down. If you have a medical problem, please seek attention from your health care provider. You are not allowed to ask for medical advice related to a health situation that affects you, a family member, or someone you know

I am sending healing thoughts and prayers. Follow up with your specialist PCP is the best advice.

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