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Topic ClosedThe Tendonitis Update -> Orthotics while Riding

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pibimbap View Drop Down
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sleeping at mammoth...

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Direct Link To This Post Topic: The Tendonitis Update -> Orthotics while Riding
    Posted: Sep/15/2011 at 4:58pm
Hey all. You guys might remember I posted a while back about how I messed up my achilles tendons in both feet while weight-lifting & wearing vibrams. That was probably about 4 months ago... I started going to physical therapy 9 weeks ago, and I'm finally starting to regain the ability to walk normally after about 14 sessions. I'm now able to, with the help of NSAIDS, do about 15ish calf raises a day, and I can walk normally for about a quarter mile with the help of orthotics. I remember there were a handful of you who had the same problem, and so, if you haven't been treated already, here are a few things that helped me a shit ton. Just thought I'd share since you were all so supportive throughout my more painful stages of recovery.

1. The Podiatrist - my doctors said not to worry about going to a podiatrist, unless the pain gets significantly worse. Most doctors will give you painkillers, tell you to get comfortable shoes, and call it a day. But if your condition is worse than they think, which mine was, putting off rigorous treatment will just make it worse. But I luckily decided for once in my life to be proactive. So I went to the podiatrist anyways, and it was probably the best possible thing to do. Go early. It really helped. He set me up with a very strong anti-inflammatory drug, some custom orthotics, and a non-invasive steroidal physical therapy treatment.

2. NSAIDS - People will tell you to take these to keep the inflammation down. The problem is, the inflammation isn't the root of the problem, so getting rid of it won't necessarily fix anything. Also, you run the risk of ignoring the pain, and moving around more than you otherwise would, making the condition worse. However, as far as I can tell, the reduction in inflammation is definitely good, as long as you don't equate no pain with completely healed. Meloxicam was the drug the podiatrist prescribed me, and it was crazy effective.

3. Iontophoresis with Dexamethasone - this is a special treatment that a podiatrist can prescribe for you. You get a little bottle of this steroidal stuff that you bring to the physical therapist, which they then pass through your tendons via electricity. Ever since they started doing this, my legs started feeling a ton better. There's also a decent peer-reviewed study on the effectiveness of the method, and, although the study's sample size is small, the people who had the treatment tended to show better long-term improvement.

4. Orthotics - this was definitely the best. You need like... a really specific kind of shoe, and a really specific insole (the orthotic), but if you are having trouble walking, this should definitely make it much easier. It's definitely a step up from simple heel lifts that the PT will make for you.

Anyways that's really it. My PT thinks I'll be ready to snowboard by December, thank God. But yeah, it was really sucky thinking I would never heal, but things are starting to look up.

And, aside from this really long update, I was wondering if you guys had any experience with snowboarding with orthotics?
I'm thinking of trying it this season to relieve the stress on my achilles tendons, but I'm afraid it might be a bad idea, especially if I go off any big jumps...

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Direct Link To This Post Posted: Sep/15/2011 at 10:39pm
holy crap man...the meds your on sound crazy enough...
and yes, watch for treating your symptoms over treating the underlying cause...that is good lookin' out for yourself you have there

good to know you'll be back on your board sometime this season!...hell, even at all!
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Direct Link To This Post Posted: Sep/15/2011 at 11:09pm
Glad to hear you're doing well!
I've used Superfeet green which is for medium-high arches, and I don't have any complaints about them as far as riding goes.
When I used them in my walking shoes they were a huge pain.
The weird part is that I found out I have low arches according to a machine that tested my feet. 
I have no idea how or why my feet didn't hurt more when I was riding but I'm definitely not using the greens anymore.

I've been interested in Remind insoles because the insole forms to your foot and they were started by snowboarders, which is pretty sweet too.
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rye View Drop Down
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Direct Link To This Post Posted: Sep/16/2011 at 2:19am
l was reading how they put steroids into your tendon  with electricity. l know you can pass through electricity but how do they put the steroids through it also??
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sleeping at mammoth...

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Direct Link To This Post Posted: Sep/16/2011 at 4:11am
Originally posted by seacow234

holy crap man...the meds your on sound crazy enough...
and yes, watch for treating your symptoms over treating the underlying cause...that is good lookin' out for yourself you have there

good to know you'll be back on your board sometime this season!...hell, even at all!


Yeah they're some pretty serious stuff lol. I only had to do all this crap because I ignored it all for so long. But yeah! I'm ready to hit the slopes again haha

Originally posted by Jigkidd

I've been interested in Remind insoles because the insole forms to your foot and they were started by snowboarders, which is pretty sweet too.


Yeah I've been looking at those too. I'm trying to figure out what size to get though. I'm like right in between 8.5 and 9. Ack.

Originally posted by rye

l was reading how they put steroids into your tendonĀ  with electricity. l know you can pass through electricity but how do they put the steroids through it also??


It's this weird method called Iontophoresis. Basically they put this pad on your ankle - it looks like this:


You can kind of see there's a little plus and minus sign on each end of the bad. Underneath the + side, they put saline solution, and on the - side they put the medication. It's sort of technical, but the permeability of the skin (how easily stuff can pass through it) increases when electrical charge is applied. So basically, you electrically charge the foot a little bit, and the medicine on the pad goes through your skin more easily.

But yeah. It blew my mind. Apparently certain things can pass through your skin easily if an electric charge is applied.

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jenni View Drop Down
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Direct Link To This Post Posted: Sep/16/2011 at 4:54am
wow this looks intense. couldnt you take a more passive approach for it to heal itself instead of taking steroids? or is that because you just want to heal faster in time for snowboard season?
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Direct Link To This Post Posted: Sep/16/2011 at 5:30am
^^ well he said that he couldnt really walk properly after 4 months, so i dont think a passive, rest a home approach will help the problem
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Direct Link To This Post Posted: Sep/16/2011 at 5:59am
2 things: 
1- That is some crazy sci-fi goodness about the electrically charged permeability! I wonder what else we'll be taking in that way someday.
2- Although it is by no means an orthodic, I do use a 3/4 insole from walmart in by boots.  It was the $10 one I think?  It just adds some support in the arch and cushion in the heel.  It totally changed the comfort level of my boots.
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Direct Link To This Post Posted: Sep/16/2011 at 6:08am
you mention vibram's are you talking about the five toe'd shoes?  
-zakk

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Direct Link To This Post Posted: Sep/17/2011 at 6:12am
How long did you have the Vibrams before you tried working hard in 'em?  I've been in minimalist shoes mostly for the past year or so, but it was several months of getting used to them before I ran and lifted in them hardcore.  Could definitely feel the difference in my achilles and calves, so waited for a bit more musculature to develop in the lower leg before I tried anything.

Originally posted by pibimbap

Originally posted by rye

l was reading how they put steroids into your tendon  with electricity. l know you can pass through electricity but how do they put the steroids through it also??


It's this weird method called Iontophoresis. Basically they put this pad on your ankle - it looks like this:


You can kind of see there's a little plus and minus sign on each end of the bad. Underneath the + side, they put saline solution, and on the - side they put the medication. It's sort of technical, but the permeability of the skin (how easily stuff can pass through it) increases when electrical charge is applied. So basically, you electrically charge the foot a little bit, and the medicine on the pad goes through your skin more easily.

But yeah. It blew my mind. Apparently certain things can pass through your skin easily if an electric charge is applied.
I had this done when I had IT band syndrome.  Very cool procedure.
ROLL ON, BISHES.
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Direct Link To This Post Posted: Sep/17/2011 at 10:03am
Originally posted by kimchijajonshim

How long did you have the Vibrams before you tried working hard in 'em?  I've been in minimalist shoes mostly for the past year or so, but it was several months of getting used to them before I ran and lifted in them hardcore.  Could definitely feel the difference in my achilles and calves, so waited for a bit more musculature to develop in the lower leg before I tried anything.

Originally posted by pibimbap

Originally posted by rye

l was reading how they put steroids into your tendon  with electricity. l know you can pass through electricity but how do they put the steroids through it also??


It's this weird method called Iontophoresis. Basically they put this pad on your ankle - it looks like this:


You can kind of see there's a little plus and minus sign on each end of the bad. Underneath the + side, they put saline solution, and on the - side they put the medication. It's sort of technical, but the permeability of the skin (how easily stuff can pass through it) increases when electrical charge is applied. So basically, you electrically charge the foot a little bit, and the medicine on the pad goes through your skin more easily.

But yeah. It blew my mind. Apparently certain things can pass through your skin easily if an electric charge is applied.
I had this done when I had IT band syndrome.  Very cool procedure.


cells can align to electric fields just like electrons, which increase permeability, just like opening up a gate.  this is actually how each individual cell controls what goes in/out via the cell membrane.  do a google search on "sodium potassium pump" for more detail on this mechanism and you will get the idea for this patch.
be talkin to ya
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Direct Link To This Post Posted: Sep/17/2011 at 10:25am
You can find patches that will help, but do it with non-steroidal drugs to treat inflammation (i.e. - ibuprofen and heat stuff like "IcyHot"), which does not have as much of negative long-term effects.  Probably a lot cheaper too.
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Direct Link To This Post Posted: Sep/17/2011 at 11:19am
Take it easy man... don't injure it to the point you can't board later on =(
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Direct Link To This Post Posted: Sep/17/2011 at 12:43pm
There is actually very little to no scientific evidence that iontophoresis with Dex is beneficial for achilles tendinopathies.  There are a couple of studies that make some claims but are of very poor study design.  

Eccentric loading programs have been shown to be very effective.  I hope your PT is getting you on a solid home exercise program for return to sport, otherwise they are doing you a huge disservice.  Orthotics are nice but also will not solve your problem.  Proper strengthening and footwear will solve your problem.








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Direct Link To This Post Posted: Sep/17/2011 at 12:57pm
Listen to her ^
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sleeping at mammoth...

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Direct Link To This Post Posted: Sep/21/2011 at 8:35am
Yeah I'm on a home exercise program, but the problem is that my achilles tendonitis is insertional, so eccentric loading is not as effective.

We'll see how it goes. :) I'll update again in a few weeks, now that I'm off NSAIDS.

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