A Little More Whining About that Ankle...Questions for the Group

So passing the two month mark on that ankle - had an xray, no fractures (thought it could be a stress fracture). No event caused the ankle pain. So - left ankle very painful and now my right knee is pretty upset, guess I’ve probably been walking funny. Now I’m really walking funny. Kind of feel like I’m falling apart - also a couple of cracked teeth getting fixed and the usual aches & pains. What’s new about all this is that normally I can dial it back a bit, brace things or whatever and they “magically” get better. This is different - the ankle pain is worse than ever and I’m waiting on an MRI - which could take forever (ok, months).

I have an appointment with my MD tomorrow, I need a new prescription for pantaprazole since I’ve decided to take NSAIDS (ibuprofen) to hopefully beat down the inflammation. It’s been almost 2 days of that. I will try to get that MRI marked as urgent as I’m not sure I can keep working (I only work 3 days a week but each shift is 3 hours on my feet).

Options I will discuss with her…

-should I see my rheumie (4 hours away, with no appointment in the near future) to re-examine my meds ? (currently on Rinvoq which has helped fatigue tremendously, my little bit of psoriasis is gone, and while I’m not pain free I am able to do things…or I was anyway, been on it almost a year)

-should I do a prednisone taper (just got diagnosed with osteoporosis in my spine during a bone density test, awaiting follow up imaging on that)

-should I just wait it out, keep resting it, taking NSAIDS and hope for the best ?

-should I get a boot ? see a physio ? is there anything else I can do to help myself ?

Thoughts ???

OK here are my thoughts.

I went through something similar but with my Achilles tendon when my PsA med was otherwise working well. The issues lasted 6 very long months. Tendon issues don’t tend to resolve fast and you really can’t medicate your way out of them to any great success. I was helped by seeing a podiatrist and using a couple of different temporary insoles which really helped take the pressure off my Achilles tendon and to allow it to heal better. Some temp insoles would help your peroneal tendon to heal too. Thereby getting your knee better because you won’t be walking so funny. Seriously without the temp insole you won’t be able to shift your weight and pressure to give things a break. But you need to see a qualified podiatrist for this. And it will help with 3 hour shifts on your feet too.

The boot idea or physio idea might also help but I would also favour a podiatrist over them really. Most physios know sweet nothing about autoimmune inflammatory conditions and often make things far worse consequently.

Ibuprofen is a really really harsh NSAID to take even with pantaprazole for an extended time. Your MD can prescribe far far more effective ones which still need pantaprazole but will help you a lot better like Arcoxia/etoricoxib or Celebrex. And these are less harsh on your GI tract.

Do you swap ice and heat on the tendon? As in every 5 mins for about 30 to 40 mins at a time? That can also disrupt the ongoing inflammation which gives things a break.

I’m afraid you’d be incredibly stupid to take a steroid taper given the osteoporosis diagnosis. And in fact any medic would be negligent in prescribing them for you. Why are you wanting for MRI imaging on that? You need osteoporosis meds regardless. Sadly I developed osteoporosis at the same time as PsA. Suffered 7 unexplained fractures one after the other but started taking osteoporosis meds and within 2 years my bone density was back to normal. You must take osteoporosis meds for 5 years though but you can imagine my delight at my bone density being back to normal and despite stupidly falling over, I’ve not suffered a fracture since. So with that diagnosis already confirmed you need osteoporosis meds asap. And steroids are off the table until your bone density is back to normal. There are no ifs or buts about that medically. Please get you MD on the case about the osteoporosis meds too.

As I said you can’t medicate your way out of tendon issues like this so seeing your rheumy can’t really help that much. If they are good enough they will suggest all I’ve suggested above.

And I totally get how fed up you are. I was the same with the Achilles tendon issue too. It feels neverending but it does eventually resolve but it does take months. Even last year I suffered another foot tendon issue which again I needed temp insoles for and it took about 7 months to just go away. It was less acute than the Achilles tendon issue but it threw out my opposite hip as well which just made me really irritable.

Hope this helps.

Thanks for understanding my irritability Poo, and taking your time to add your ‘to the point’ comments. This is incredibly frustrating.

The bone density thing is new - just had the scan and apparently in Canada it is procedure to follow up with an xray of the lumbar and thoracic spine to look for any fractures once your diagnosed with osteoporosis. My xray is on April 16, I am assuming (and will follow up) that osteo meds will follow. My Grandma was on Fossomax, dunno if my mom is on anything. The MRI is for the ankle.

From what I’ve read it does sound like a peroneal tendon issue, it’s very painful, esp. first thing in the morning. I will ask my MD about a better NSAID and a referral to a podiatrist. I guess with the boot I’m still trying to be functional somehow. Will try the ice/heat combo more as well.

A couple of questions - any side effects from the osteo meds ? When did you first find out you had osteo (I’m 54, always wondered if PsA excelerated it)?

In the UK I self refer to a podiatrist - I specifically choose the sports one who look after runners as they understand tendon issues the best, given runners often get tendon issues and in PsA patients our tendons often look like runners tendons too. Runners from overuse often produce the same sort of tendon issues we get from PsA inflammation. So there is lots of similarity there from the podiatrist’s point of view which means helping your tendon issues better. Just my tuppence worth on how to find the right podiatrist. And you only require temporary insoles just like the runners do too, not permanent ones so that should keep the cost down. Another note to remember.

Now to osteoporosis issues. I developed sudden onset PsA aged 54. Really stupidly spent the first year on steroids and lo and behold started the first two of the 7 fractures (these were in my pelvis) the year after. Initially my DEXA scan said I had only just hit the osteopenia index. However given I then so painfully compressed fractured three of my lumbar spine vertebrae it was certainly time to think osteoporosis meds (I was also stupidly a bit wary of them too - I had so much to learn really). Oh and I also managed to fracture a rib in the MRI machine believe it or not too. The standard one they choose is a weekly one called alendronic acid, but you must take it first thing in the morning on an empty stomach and sit upright thereafter and not eat or drink anything but water for the first 30 to 60 mins. I need my coffee if I’m going to do that, so I persuaded them to put me on a monthly one instead, same thing of taking it first thing etc but only once a month instead of once a week. I seriously consider life is for living and my meds must fit around me as much as they possibly can too. My one is called ibandromic acid.

It has worked a charm because since the first tablet I’ve not fractured anything ever again. And I’m clumsy so I bash into things and my worst habit is tripping over something because I’m in a day dream walking the dog and then falling over. You stay on osteoporosis meds for five years straight. After two years they DEXA scan you again and my DEXA scan then, showed normal bone density again which frankly I thought was pretty miraculous. I finish this med in July 2025. Then I’ll have another DEXA scan and hopefully that’s in. And no I’ve not noticed any side effects other than the first couple of doses made me more tired.

One very important thing to do before starting osteoporosis meds is get all and any teeth work done before you start. There’s a huge palaver to go through otherwise with a dentist given how they affect teeth etc.

Hope this helps. I was amazed how incredible easy it is to treat osteoporosis issues and how amazingly the meds work too. We don’t sadly get that easy result on PsA meds. It seems criminal to me more of us hitting middle age don’t have regular DEXA scans (since they are so simple too) so as to catch it early enough. And to give you a smile I now walk around being my clumsy self sometimes thinking I’m invincible on the fracture front too. It amuses me anyhow. :rofl:

Hey @Poo_therapy, with a bit of engineering, I’m sure that a whole body protection suit based on automobile air bags would be just the thing for you (us?). When you fall, it inflates in a nano second upon impact with the ground. It would be incorporated with your clothing and very fashionable until it deflates…then there might be an awkward moment of walking home with it all dragging behind. BUT, it would keep you safe!

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Hello everyone, i can relate to everything that has been said on this thred. Im currently in what I think is the worst flare ever. Im flat on my back. 2 ER visits and a 2 night stay at the hospital. The MRI showed Sacroilitis L> R wirh superimposed degenerative changes. Degenerative disc disease everywhere and a whole host of other issues. I’ve been out of work for over 2 weeks and I barely remember much of any of it. It seems my brain/cognitive is off as well. I see a spinal Dr today. I will let you know what he says. Pain management on wednesday. Im hoping for a flouro guided steroid injection into the SI joint . Seriously, Sacroilitis is excruciating!! Sorry for the rant. Im in so much pain at the moment. Once again, I have to thank you guys on this forum. Most of thd drs i see here in the US are not familiar with Psoriatic arthritis. I went to my rheumy the 2nd day this started and he said he did not think it’s a flare. I couldn’t believe it. I have been to so many drs looking for help. It’s ridiculous. Im scared I might not be able to go back to my career as a Respiratory Therapist. Its a very demanding job. Im just a little scared.

Please keep us updated. I’m glad to hear that your seeing the right people this week

I saw the spinal dr and he said i need the 1st of the flouroguided injection for my cervical spine ASAP . I get the 1st injection tomorrow. Fingers crossed. Then he will work on the lumbar and sacroilitis. I see a new Rheumatologist in april. Maybe she can connect the dots. As my current rheumy said ot was not a PSA flare. SMH. Im scheduled for an EMG next week. My left arm and leg are still weak and vibrating. It literally feels like a cell phone vibrating in my thigh. So strange.

Sometimes our flares are a sprint and at other times they are more like a marathon. It seems like you are in a marathon that will take a lot of energy over some time. For those of us still needing and trying to make a living, the stress of being laid up can really add to the mental hoops that we have to jump through as we navigate many health concerns. But you are far more than your vocation/career and perhaps you will just have to rest from that part of your life so that your body can heal…it wants to. I find that part of the problem with any sort of spinal pain is that it is central to so many body parts and “unseen” by us. We can touch and observe most of our extremities which gives me a bit of a sense of control and involvement but it is pretty hard for you to do much self care on a SI joint or spinal deterioration once it is as bad as yours is. It sounds like you are getting adequate care and that the solutions will be a best attempt to help you. Once the pain is under control, you’ll likely find that your practical mind will kick in and you’ll be able to handle each day…one at a time. We are all sorry for your pain and struggle, may you find quiet moments even in the storm and mental rest is very important for physical healing.

I’m so glad you’ll be able to get the first injection so quickly! That should get you some relief in a matter of days.

You clearly have a lot more ahead of you but at least you’ll hopefully be a bit more comfortable going forward

I went to pain management today. She scheduled my lumbar injection for 5/20/2024 and she prescribed muscle relaxers. This pain is relentless. I can’t wait that long. Im hoping the spinal dr can get me in sooner. I will ask tomorrow. i just want some relief. Im exhausted

Thank you everyone for your kind words and suggestions. I listened

Would they or have they prescribed morphine…patch, self monitored etc?

I don’t think so. All our pain management will give is muscle relaxers and offer epidural injections. Im scheduled to go to the spinal center to get my 2nd injection into the Left SI joint. Im scheduled for another MRI of my brain with contrast. If nothing shows up. Next is a spinal tap. The neurologist is ruling out MS or an infection. My brain is not right. Still feels like I have dementia. My new Rheumatologist said part of its my psoriatic arthritis, but there’s mote going on. She ia ruling out lupus . I believe the cimzia did a number on me! Old Rheumatologist did not agree with me. Every since I caught covid in january I have declined. I became crippled literally felt like overnight. This is a living nightmare. Thanks for reaching out. I will keep you posted