Managing Severe Foot & Ankle Pain With The Richie Brace
Gina is a lovely 75-year-old lady that loves golf and gardening. She’s been wearing orthotics since 2017 to help keep her feet comfortable and supported, so she doesn’t develop avoidable foot pain from the way her feet naturally sit.
Gina’s Ankle Pain Returned
Unfortunately, after not wearing her orthotics nearly as much as she should have throughout summer, Gina started suffering from pain on the inside of her right ankle. She came into the clinic immediately, remembering how bad the pain got last time and wanting to stop the problem from progressing.
Gina’s Pain: Posterior Tibial Tendon Dysfunction
At her assessment with us, Gina’s pain was isolated to her posterior tibial tendon, which runs down the inside of the leg, around the inside of the ankle, and beneath the arch to attach to a bone on the inside border of the midfoot. She had all the classic signs and symptoms of early-stage posterior tibial tendon dysfunction.
“Posterior tibial tendon dysfunction (PTTD) occurs when the PT tendon, which is one of the major tendons that supports the foot arch, is injured, meaning it can no longer do its job of supporting the foot and each step can become painful and uncomfortable. It is very important to treat PTTD in its early stages as the problem can quickly worsen, shifting from occasional pain to being unable to bear any weight on the affected foot.”
During this same appointment, we immediately increased the level of support in Gina’s existing orthotics to better support her heel and arch, and instructed her to wear her orthotics every day while the tendon was healing. As a big part of the problem was Gina’s sandals, which could not accommodate any orthotics, we discussed some stylish and comfortable orthotic-friendly sandal options to get her through the warmer months. We gave Gina compression socks to wear for when her pain flared up, or when she was playing golf, even without pain. We booked her in for two weeks to check her progress and make any updates to her treatment plan.
Progress: Two Weeks
Two weeks later, Gina was doing really well. Her pain had decreased and she described the feeling in her feet more as fatigue than pain. She planned on resuming her exercise that week.
Gina’s Painful Garden Slip
Shortly after her two-week check, Gina had a bad slip in her garden and returned with pain that she described as worse than it had ever been before. We referred her for an ultrasound that showed a partial tear in her posterior tibial tendon.
We set to work quickly, as timely treatment is a key indicator for success in these cases. We used the Bodyflow, which helps improve blood flow while decreasing pain and swelling, in weekly sessions. We also cast her for a custom Richie brace, which was ready three weeks later.
The Richie Brace is a very specialised ankle-foot orthotic that is proven to be effective in helping the recovery from PTTD - especially where there is a tear present. It has a slimline design and is lightweight - and our patients achieve great results with it. It is made uniquely for a specific foot and leg, relieving pressure and tension away from the posterior tibial tendon while it repairs.
Two weeks after the brace was fitted, Gina reported that she walked the furthest she had in a long time, and was virtually pain-free whilst wearing the brace. At this point, we implemented a tendon rehab exercise program, using a combination of semi weight-bearing, weight-bearing and Theraband strength exercises.
Four weeks later, Gina was still progressing really well. She had dropped down to wearing the brace 70% of the time, and was not in any pain when she wasn’t wearing the brace, showing us that the tendon was healing very well. We continued her exercise program, increasing the challenges for her foot.
Three months after the injury, Gina came in for her check and had rebuilt fantastic strength in her ankle. She had no pain at all when we pressed on her posterior tibial tendon, and only reported occasional pain on uneven ground. The plan for Gina is to continue to wear the brace at least 50% of the time for the next three months, but to have some time in her sandals and her orthotics too.
We will see Gina in three months, and she will continue her exercise rehab program over this time.
Long term, we don’t believe Gina will need to continue to wear the brace, however, with her history of posterior tibial tendon dysfunction prior to the tear, it will be a powerful preventative tool that she can use during exercise in the future.