Hi, all. This is my first post to this forum so if I get something wrong, please forgive me. I'm hoping this is the right section in which to post my issue.
A little bit about me. I received my pedorthics training (105 hours) through the Robert M. Palmer Institute of Biomechanics about 4 years ago. For the past 4 years I have been employed by Dr. Kevin Hearon, a chiropractor here in Boise Idaho. Dr. Hearon is an extremities practitioner, and his protocols were incorporated into a post-graduate educational curriculum for chiropractors, and they are certified as "CCEPs" (Certified Chiropractic Extremities Practitioner) through the Council on Extremities Adjusting. Long story short, I feel that I have received an abundance of knowledge through the practice of pedorthics and by working closely with Dr. Hearon.
Now, here's the issue we have been dealing with, I hope that some of the great minds here can help. A male patient came to us complaining of bilateral shin pain that is atypical. I say "atypical" because his symptoms do not correlate with medial tibial stress syndrome (shin splints). He had seen two other doctors. One diagnosed him with posterior tibial tendonitis and put both his legs in casts for 6 weeks. After the casts came off he felt the same. The second doc told him that he had post tib tendon dysfunction, and told him that he'd have to "live with it."
Well, the first thing that we did was to make a pair of biomechanical orthotics for him, and told him to ice it, take it easy, and gave him the usual advice for adaptation to his orthotics. But yet, while the orthotics helped a little, he is still complaining of this pain. So then we moved him to a form of electronic stimulation called "ARP" (Accelerated Recovery Performance - http://arpwave.com
) to see if that would help. We've been doing that once a day for the past 15 days. Results are confusing at best - sometimes it looks like he's improving, other times he's back to where he was, or worse.
Now, everything that I see
points to post tib tendon dysfunction. However, he defies they typical ortho tests. ROM is fine, he can stand on his toes and hold it just fine. In short, his PTT is strong. Inflammation is not visibly apparent, and icing doesn't seem to help anyway.
So I am personally at a loss to figure out what's going on with this guy. I'm hoping for some good feedback from you folks. Have you ever had a case like this, or have you ever seen a situation like this? What has worked for you?
Beau B. Avery