Սիմպտոմատո - արագ առողջապահական խորհրդատվությունների օնլայն ծառայություն

Hello!

Here’s an explanation of the findings from your MRI report:

Osteochondral damage to the medial talus block in the early stages: This suggests the presence of early degenerative changes in the joint, although there is no significant destruction yet.

Minimal tendosynovitis of the peroneal tendons: This indicates a mild inflammation of the tendons of the short peroneal muscles.

Paratenonitis of the Achilles tendon: This refers to inflammation of the tissue surrounding the Achilles tendon.

Moderate muscle edema (in the gastrocnemius, long flexor, and extensor of the big toe, and the abductor of the big toe): This could be a result of overuse or strain.

Increased fluid in the ankle and subtalar joints: This indicates the ongoing inflammation within these joints.

Partial, chronic damage to the tibio-navicular ligament: This is likely a residual effect from the initial injury.

In summary:

Your symptoms are likely due to residual effects from the injury, including ligament damage, inflammation in the tendons and joints, and resulting periodic flare-ups.

Tendinopathy and muscle overload could be attributed to improper load distribution or compensatory mechanisms during walking.

The main issue appears to be the osteochondral damage to the talus, which is likely hindering your recovery process.

Regarding the injections your physiotherapist recommended:

Exoblast: This is an injection composed of exosomes and growth factors aimed at promoting tissue regeneration and reducing inflammation. It may be useful for treating degenerative processes and cartilage damage.

Sanakin: An autologous therapy based on anti-inflammatory cytokines, commonly used for conditions such as osteoarthritis, tendinopathy, and chronic inflammation.

Peptis: These are collagen or peptide injections designed to support the healing of connective tissue, potentially aiding recovery of ligaments and tendons.

These injections may help reduce inflammation and support regeneration of damaged tissues, particularly for tendinopathy and cartilage degeneration. However, the effectiveness of these treatments will depend on how your body responds. Peptis, if it involves collagen therapy, could assist in maintaining ligaments and tendons, but there is limited evidence supporting its efficacy in the treatment of osteochondral damage.

It is important to note that none of these treatments are guaranteed to restore cartilage or fully resolve your condition. While they may provide temporary relief or support regeneration, significant clinical improvement is not always assured.

I would recommend consulting with an orthopedist to determine if the injections are necessary or if continuing conservative treatment would be more appropriate. This consultation can be done remotely, and I would advise reaching out to ********* for a further evaluation. You will need to provide the MRI images for this consultation, so I recommend uploading them to a file-sharing platform beforehand.

Continue with your rehabilitation, but proceed with caution. Physiotherapy can sometimes exacerbate inflammation temporarily, which may lead to minor flare-ups after treatment.

Carefully monitor your physical activity and consider wearing the orthosis even for shorter walks, not just when walking over 3000 steps.

I suggest a follow-up MRI after 3–6 months to assess the progression of the osteochondral damage. Monitoring the changes in the joint will be important.

In addition, a CT scan or ultrasound may provide more detailed insights into the cartilage and bone damage.

You may also want to explore the use of orthopedic insoles or specific exercises aimed at reducing strain on the affected structures. These interventions can be arranged at the ******** clinic, and custom insoles can be ordered through ********.

To summarize:

Your condition remains unstable, but there has not been significant worsening.

Injections may provide some benefit, but there is no guarantee of success.

It may be worth considering alternative treatments, such as PRP (platelet-rich plasma) therapy, which has shown more consistent results for similar conditions. If your treating physician agrees, this could be an option worth exploring.

Hello!

It is very important to understand how elevated the levels of parathyroid hormone and calcium are. A diagnosis of hyperparathyroidism is not made based on a single elevated indicator, as parathyroid hormone can increase not only due to diseases of the parathyroid glands but also, for example, due to kidney problems or vitamin D3 deficiency. It is essential to gather a full medical history (symptoms, family history, age at menopause, fractures, kidney stones, chronic diseases, etc.).

When parathyroid hormone is elevated (at least in two tests), it is necessary to exclude disorders of phosphate-calcium metabolism. The following tests are recommended: 24-hour urine for calcium and phosphorus, blood test for calcium adjusted for albumin, kidney function tests (creatinine, urea), alkaline phosphatase, and vitamin D3 levels. It is also advisable to conduct an osteodensitometry of the lumbar area and the femoral head (at least one).

If the diagnosis of primary hyperparathyroidism is confirmed, imaging of the lesion should be performed. The first stage usually involves a parathyroid scintigraphy or SPECT (Single Photon Emission Computed Tomography). MRI and contrast-enhanced CT are used less often, as the second stage of diagnostics. Unlike CT, the first method uses radionuclides, which help not only to identify the focus in the parathyroid gland but also to detect its ectopic location. If scintigraphy or SPECT is unavailable, a contrast-enhanced CT, particularly 4D CT, is preferred as it provides a clearer image of the anatomy and helps detect adenomas. MRI can be helpful if there are contraindications for contrast-enhanced CT.

How does parathyroid hormone affect the body? Increased levels can lead to bone destruction, fractures, and kidney stones. High blood calcium levels can cause muscle weakness and weight loss, and critical calcium elevation can provoke issues with the central nervous system. You can live with this condition, but without treatment, the quality of life gradually worsens, and serious complications may arise.

Treatment for confirmed hyperparathyroidism depends on many factors. If a lesion is found, surgery is most often indicated. If no lesion is detected and parathyroid hormone and calcium levels are not too high, vitamin D3 in therapeutic doses is prescribed, and monitoring continues. Kidney diseases, if present, are treated, and parathyroid hormone levels are monitored dynamically. Every case is unique, and it is difficult to predict exactly how your condition will develop. We recommend consulting with Dr. ***********.

Additionally, we can help find a Russian-speaking consultant online, but this would be advisable only after the necessary tests have been conducted. Without them, it is difficult to provide detailed and useful advice.

Dear Viktoria! 

Your symptoms suggest a chronic knee issue—most likely related to cartilage wear (such as patellar chondromalacia or osteoarthritis), meniscal degeneration, or patellofemoral pain syndrome. The increasing pain, difficulty bearing weight, and your previous MRI findings all point in this direction.

1. MRI of the Knee: Non-Contrast vs. Contrast

For suspected cartilage damage, a non-contrast MRI is typically sufficient. This examination will allow us to assess:

• Cartilage: Look for thinning, softening, or outright damage.

• Menisci: Identify any tears or degenerative changes.

• Bony Structures: Detect stress injuries or early signs of arthritis.

• Ligaments and Tendons: Evaluate for any injuries or strains.

A contrast-enhanced MRI (using gadolinium) might only be required if there is a suspicion of inflammatory arthritis (for example, rheumatoid arthritis), if there’s a need to evaluate the vascular supply to the cartilage (a very unlikely scenario), or if previous imaging has been inconclusive.

Given that your condition is most likely due to a mechanical injury of the cartilage, a non-contrast MRI is the best initial step.

2. Where to Obtain an Affordable MRI in the ****

Since you do not have insurance, you might consider the following options:

• Private Diagnostic Centres: These are often more cost-effective than hospital imaging departments.

• Cash Payment Discounts: Some centres offer reduced rates for cash payments, with MRI costs ranging from approximately $300 to $600.

• Online Services: Providers such as Radiology Assist or Green Imaging offer discounted prices on MRI scans.

3. Assistance with Interpreting Your MRI Results

Once you receive your MRI results, you can upload the images to any file-sharing service and contact Dr**********. He can advise you on the appropriate next steps for your situation.

Treatment may involve conservative measures—possibly including intra-articular injections—or, if the damage is significant, surgical intervention. In most cases, this would involve minimally invasive arthroscopy to remove the damaged portion of the meniscus or smooth the cartilage, although more complex procedures to restore joint alignment might be necessary in some instances.

Your question is totally valid, and the discomfort you’re feeling is definitely worth paying attention to. 

Even though there’s no pain, that sensation under your toes could be due to a few different things:

Morton’s neuroma – thickening of the nerve between the bones in the foot, often between the 2nd and 3rd toes.

Metatarsalgia – overload of the bones in the ball of the foot, which can be common in active people.

Age-related changes in the foot – thinning of the fat cushion under the bones in the foot, which can cause discomfort.

Flat feet or foot deformities – these can affect how pressure is distributed across your foot.

Footwear issues – especially if your shoes have hard soles or don’t distribute pressure properly.

Unfortunately, an online consultation might not be the best choice here. To get a proper diagnosis, it’s important to have someone examine your foot in person and possibly do some additional tests, like an ultrasound or X-ray, to rule out a neuroma.

I’d suggest starting with a consultation with a podiatrist (a foot specialist). They’ll examine your feet, look at your walking pattern, and recommend things like orthotics or exercises. If the discomfort doesn’t go away, they might suggest getting an ultrasound, and an orthopedic specialist can help with that.

Since you’re in ****** and prefer an English- or Russian-speaking service, here are a few options:

Terveystalo – a large healthcare provider that offers online consultations as well.

Doctena.eu – an international platform where you can find doctors, including podiatrists, orthopedic specialists, and physiotherapists, with online consultations.

DocOnline or Qare – international online services where you can find English-speaking specialists.

If you’re open to traveling, you might also want to consider visiting Latvia – there are a lot of Russian-speaking podiatrists and orthopedic specialists in Riga who could help with your issue. We can provide you with some recommendations if needed.

Things you can try on your own:

Keep massaging with the ball, but also add some foot-strengthening exercises, like calf raises or picking up small objects with your toes.

Check your shoes: you’ll want ones that have cushioning in the forefoot area and soft insoles.

Consider getting custom or ready-made orthopedic insoles, especially if you have flat feet or age-related changes in your feet.

I understand your concern.

Transient synovitis of the hip joint is a temporary inflammation of the synovial membrane, which is most commonly seen in children aged 3-8 years, often following or alongside a viral infection. It is the most common cause of sudden limping in children. In most cases, synovitis resolves on its own within 1-2 weeks.

Regarding the ultrasound: inflammation typically lasts longer on the ultrasound than it does in terms of clinical symptoms.

Is this progression normal?

Yes, it is. In most cases, transient synovitis does resolve within 1-2 weeks or even a few days, but in some children, the fluid may persist for up to 4-6 weeks, even if clinical symptoms have already disappeared.

Does he really need to be on strict bed rest?

Yes, one of the factors for faster recovery is resting the joint. However, bed rest for a 5-year-old child who isn’t complaining is probably harder on him than the condition itself. Typically, when there is no pain and the child is active, it's recommended to limit physical activity moderately (for example, avoiding jumping, long walks, and not riding a bike or skiing during this time). It’s best to keep the child engaged in calmer activities like quiet games or watching cartoons to reduce pressure on the joint.

The issue with this condition is that if the synovitis isn't fully treated, it may relapse with subsequent respiratory infections because the synovial membrane is still somewhat predisposed to reacting to infections. For this reason, treatment is continued until there’s clear improvement on the ultrasound. If the fluid hasn’t completely resolved, the risk of relapse during a viral infection increases.

Should ibuprofen or Nurofen continue?

Ibuprofen is traditionally used to treat transient synovitis of the hip joint. However, if there’s insufficient improvement, it might make sense to switch to medications with stronger anti-inflammatory effects, such as naproxen or meloxicam (Movalis).

Next steps:

Avoid excessive physical strain (no running, jumping, or bike riding).

Don’t completely restrict movement if the child isn’t complaining.

Re-evaluate in 2-3 weeks (you can repeat the ultrasound later if changes persist, but only if clinical symptoms don’t worsen).

Watch for new symptoms: if there’s any pain, fever, swelling, or movement restriction, a follow-up examination is necessary.

Conclusion: In your case, since your child feels fine, has no complaints, and is still full of energy, but the ultrasound shows a slow reduction in fluid, strict bed rest isn't mandatory. You can limit active play and sports, but there’s no need for full immobilization. A follow-up in 2 weeks is reasonable, but if your child remains active and symptom-free, strict bed rest isn’t required.