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Message Number 239535
Posted by Tara W on 11/16/07 at 04:13
>Dr. Goldstein<br>I am researching having tarsal tunnel release and I have a few questions. Here is my situation and problems first. I am 21 year old with Crohn's disease. I have kidney problems and now tarsal tunnel. I have had heel pain for 4 years now and have done cortisone shots for 2 years. The cortisone is not taking affect anymore. I can not take oral medications due to my crohn's disease. I am having a EMG done on Monday but the doctor that I have seen (the second) tells me that I need tarsal tunnel release because there are not much more he can do with me considering my crohn's. He also said something about cutting my calf muscle because it is pulling. I am just looking for some other advice and discovered this website, so if you have any please share. Other than that my major concerns are that I will have worse pain after than before, due to scar tissue or just the surgery in general. My best friend had a tumor removed from her ankel and the surgery from that caused tarsal tunnel syndrome. She then had to go back in and have the release done but it damaged the nerve even more and she has pain clear up to her knee now. She has no other options left other than living with the severe pain and the only things that tend to help that she has not wore out yet is compound creams and strong meds such as morphine. I do not want to end up like her. What are my chances?
Result number: 1
Posted by >Dr. Goldstein</b> on 9/10/07 at 18:54
Dr. Wander you keep harping on what you percieve. I said the idea of documented surgical studies that show that a gain in weight was idotic however you keep twisting the story as usual. You must have a very large inferiority complex. If you feel the need for validation then keep harping on the same things day after day. The boy who crys wolf eventually gets ignored.
Result number: 2
Posted by >Dr. Goldstein</b> on 9/10/07 at 15:02
Scott: differences of opinion can be a healthy thing. People who are passionate about what they believe in, have strong convictions. It is OK to diasgree as it can become a learning experience for us all. I do not like being threatened by anyone under any circumstances as that is not necessary. To me by the next day it is over and it is time to move on. Those who continue to holds grudges or personal vendetta need to most on as well.
Result number: 3
Posted by >Dr. Goldstein</b> on 9/09/07 at 17:22
Anti-inflammatory medications taken orally can be of benefit provided you have no contraindications for taking them like allergies, previous or current stomach ulcers etc. If you can take them take 2Aleive 3x/day for a total of 6 pills per day which will almost get you to the prescription dose level alieve is 220mgs. of naprosyn each
prescription naprosyn comes in 375mg and 500mg tablets SO taking 2 at the same time is 440mg. which gets you into the theraputic range take 2 after breakfast 2 after lunch and 2 after dinner for 5-7 days and see if that helps
Result number: 4
Posted by >Dr. Goldstein</b> on 9/09/07 at 10:34
Whatever floats your boat! and there you go again with your idle threats your last line, ' For your sake, I hope our paths don't cross ant time soon.' Are you going to come after me with a dremel? I do not take threats from anyone especially a pathetic little podiatrist like you so bring it on big guy!
Result number: 5
Posted by >Dr. Goldstein</b> on 9/08/07 at 15:47
Joanie: most boots can be worn on either foot they are almost never foot specific
Result number: 6
Posted by >Dr. Goldstein</b> on 9/08/07 at 15:46
many patients have bilateral heel pain however for both of your heels to start hurting at the same time is certainly interesting. make an appointment with a podiatrist for a complete evaluation.
Result number: 7
Posted by >Dr. Goldstein</b> on 9/08/07 at 15:44
you can also have a neurostimulator implanted in the spine that can be controlled with a handheld remote. I just came back from a seminar in LA where a pain management specialist spoke on this very subject. The procedure takes about 2 hours to perform. The dr was Andrew Enger,MD from beverly hills
Result number: 8
Posted by >Dr. Goldstein</b> on 9/08/07 at 15:37
David: Thank you, unfortunately we are both strong headed about our opinions and that is not a bad thing and it is OK to have totally opposite opinions. There have been times were we are in 100% agreement. Let us try not take any disagreements personally. I hold absolutely no grudge. If your were not a good doc you would not be so passionate about your feelings and I am sorry if I offended you. Hey I admit my typing sucks guess what I try to type too fast and make many typos or things come out they may only make sense to me. With having only a handfull of docs who give up their time on a consistant basis we certainly do not want this number to get smaller. I hope this will show you that time even if a short period heals all wounds mental and physical. I hope you agree.
Result number: 9
Posted by >Dr. Goldstein</b> on 9/08/07 at 11:56
NOTHING ELSE NEEDS TO BE SAID, THIS SAYS IT ALL!
Result number: 10
Posted by >Dr. Goldstein</b> on 9/08/07 at 11:53
David: calm down, gest some rest, and move on. I did, so give it a try, life is far less stressful that way. You can delete everyone of my posts, if that proves something to you. My temper is just great, and frankly I find your carrying on quite amusing. Only you are upset and agitated, NO ONE ELSE is, so MAYBEYOU TRULY HAVE A PROBLEM, I AM GOING FOR A MASSAGE AND STEAM, BOY LIFE IS GOOD!
Result number: 11
Posted by >Dr. Goldstein</b> on 9/08/07 at 07:23
Dr. Wander I went to be after my last post. You are the most paronoid person I have ever met when you think someone is attacking you personally. Are you for real. What is with your petty challanges anytime you feel you are being attacked. Look who started making idle threats. Only someone with no self confidence would resort to the tatics you so condone others from using. Remember sticks and stones may break my bones but words will never hurt me. This is a lession YOU need to observe and pay attention to. If you want to stop your threats as to do not challange me and things of that nature then I will talk to you in a rationale manner. You fly off thehandle when ANYONE challanges anything you say. You have done this numerous times with Dr. Zuckerman. You challange does not make you a man but a baby. Grow up and pick your fights when they need to be defended. No one threated you except your own mind telling you you were threatened. if the written word gets you all hot and bothered what happens when someone disagrees or challanges you face to face! One could only imagine. Take a Xanax and move on!
Result number: 12
Posted by >Dr. Goldstein</b> on 9/07/07 at 20:54
what better way to start a dialouge than to have the ability to disagree with another member of our profession. we all learn something as long as profanity and vulgar language is not tolerated. If we always agree with what everyone says, no one would benefit from what either of us has to say. Continue to disagree in the hope that the readers will gain an education and come to their OWN conclusions. remember david I would not get too worked up over this it is an educational forum NOT a court of law
I invite you to attend our teaneck seminar in october and here some of our distingushed faculty speak
Drs. Block, dockery, zuckerman, kalish, guiliana, kesselman, mcnerny, zelen, slomovitz, morgan, kravitz have to say
i can even provide you with a front row seat as i have connections here
Result number: 13
Posted by >Dr. Goldstein</b> on 9/07/07 at 20:42
how much weight is too much by your standards 20 pounds overwight 50? 100?
what scientific research to you utilize to determine that a patient's weight is the causitive factor.
If you only get 50% results on an overweight patient then maybe there is a problem with the procedure you have choosen or you technique. No where in 27 years of training and attending seminars 8-12 times per year have I ever heard any podiatric surgeon use weight as a reason as to not try to treat a heel pain patient.
I have never seen any study as you like to refer to that said lesws than optimal rewsults are obtained on overwight patients so do not operate on them for heel pain.
what scientific test do you use to acurately determine if weight is a deciding factor? do you use calipers to measure body fat.
A 100 pound patient that gains 50 lbs. is a higher risk patient than a 300lb patient that gains 50 pounds based on the total percentage of weight gain.
All i said is show me scientific proof that a person's weight effects the outcome of a procedure like an epf. eswt or cryo! This is absolutely idiotic and has zero percent merrit
Result number: 14
Posted by >Dr. Goldstein</b> on 9/07/07 at 20:29
David: we are really not in disagreement here. My only point is tat everything that is written is not always the only point even if it was written by someone touted to be considered an expert. many times experts in our fiels disagree with one another and because someone well known writes something that does not pursuede me to believe it is correct because it was written by dr X. I think all literature has its pros and cons no matter who writes it. Basically the written word is the opinions and observations of the author. When studies are performed data has away of fairing out to the intent of the author. How many articles have you ever read by an author condeming his or her own work. I take all literature with a grain of salt. the only reason I referenced the 2 articles is that your statement said no publications have been authored to date and i was simply letting you know they are forthcoming. Personally i find a 97% success rate hard to swallow as I have done more than most and after talking with over 100 of the countries best cryosurgeons no one else gets these results so i question the validity of his manuscript no matter what is stated.
Result number: 15
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:45
Hi Doc G how are you doing? I only hear great things about your cryo expertise
Result number: 16
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:43
Topaz has had a greater use in chronic achilles tendonitis from the perspective of some of the well known podiatrists using this. It certainly has its place but the same way cryosurgery and ESWT has been put through the wringer this too deserves a final rinse cycle to earlt on to say it is the greatest thing since sliced wonder bread
Result number: 17
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:37
i for one never ever doubted your capability to exceed in your designated field. many kudos to you because passing any kind of exams these days really means something. mazel tov
dr s. goldstein
Result number: 18
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:29
Hi CRYOMAN, how are you
Result number: 19
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:26
I new you were stalking around out there. Send them to my home address, i will email you with it
thank you for your expertise and effort!
Result number: 20
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:24
excellent and honest advice provided to you by dr. wander I could not agree more.
Result number: 21
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:21
NEVER EVER rely on someone elses experiemce especially when it comes to driving after foot surgery where you can be the person that causes a serious even fatal accident because of poor judgement on your part. Leave this question and answer for YOUR doctor no one else!
Result number: 22
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:18
Hey Doc what is with this extended vacation? you better get back to reality as I am depending on YOU to give the best ESWT lecture the country will ever hear at The teaneck MARRIOTT at GLENPOINTE october 28, 2007 invited guest faculty Dr. david Zuckerman the 'Z' man himself! i for one am looking forward to it. I invite any podiatrist to come and hear Dr. Zuckerman speak.
Result number: 23
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:08
Thank god we live in america where everyone is entitled to their opinion and we have freedom of speech. i disagree with what you say but i will defend to right to say it. if I dicounted surgery on every overwieght patient in my practice many would have continued suffering for no just cause. Send the ones you do not want to treat to someone else who may offer them hope and not a diet book.
Result number: 24
Posted by >Dr. Goldstein</b> on 9/07/07 at 18:01
Jill please read my response to dr wanders post in ask the foot doctors. I do not think I really can vouch for anyone of these physicians as I do not know them. This certainly does not mean that they may not be extremely proficient in their craft. i cannot give a recommendation for someone I have know knowledge of personally.
Result number: 25
Posted by >Dr. Goldstein</b> on 9/07/07 at 17:56
I have never seen or heard of any patient that developed a tract of scar tissuebecause that does not happen unless someone performing the procedure does not know what he or she is doing. Cryosurgery eliminates scar tissue but the inherent nature of the freeze and procedure so i beg to differ. 2 papers have been submitted to the journal of foot and ankle surgery by 2 different cryosurgeons one from arizona and one fron texas with an 1800 patient study showing 90 and 97% success rates. It is hard to say when they will be published. Even if they are, everyone thinks that things that are published are gospel. Nothing can be further from the truth. When Dr. Dockery from Seattle washington published his paper on using alcohol sclerosing injections for treatment of neuromas with an 87% success rate, numerous other podiatrists aroungd the country tried this and never came anywhere close to the success rates reported by my dear friend Dr. Dock as he likes to be called. Do I believe he actually obtained these results ofcourse I do in his hands but not in everyone elses. I know doctor wander loves to use articles and studies in his opinions and that is fine but others try things for themselves and then make their own conclusions hopefully not biased one way or the other. I never use the writings of others to act as an authority as this is the way to hang oneself in litigation because then anything said in the text that differs from your opinion will be used against you. Texts may help one form an opinion but as soon as you preach them asthe bible you are held accountable to everything they say. I have written numerous articles on cryosurgery does that make me the expert? definately NOT they are my OPINIONS based on MY OWN experiences and that is they way all writtings should be looked at. If a text says something and I try it and it does not work in my hands does that mean I/m wrong and the text is right of vice versa. I think not.
Result number: 26
Posted by >Dr. Goldstein</b> on 9/07/07 at 17:40
Anne: i have seen heel pain in every shape and size patient. Some of the worst cases have been in very thin patients. Botton line the extra weight may exacerbate ones symptoms but does not cause them. I have as I am sure many others can state that having operated on heavier patients does not fall in line with how good the success of the procedure is. many overwight, obese, heavy, etc. patients do extremely well for variouys heel spur procedures whether they be open, EPF, ESWT, Cryosurgery, Topaz etc. It is easy to say weight was the problem in a heavy patient where the surgical result is not optimal. Personally that is a way of taking the blame off the doctor and placing on the patient's shoulders. If a doctor has that belief then maybe he/she should not operate on these patients, as for me it is never a factor in my surgical planning or decision. Dr. goldstein
Result number: 27
Posted by >Dr. Goldstein</b> on 9/07/07 at 17:32
Anytime a wound has not healed in over 2 months no matter how it was caused or created a biopsy of the wound should be performed! return to your doctor and question him/heron this a 2or 3mm punch is all that is needed takes 2 minutes to perform and may give you the appropriate info to heal the wound make senseto you?
Result number: 28
Posted by >Dr. Goldstein</b> on 9/07/07 at 17:29
Jill: my experience with cryo is approximately 4 years. The main difference is this, alcohol or phenol injection is associated with post operative neuritis. This chemical irritates the nerve and may be quite painfull or require multiple treatments given 7-10 days apart. There will be some that say there is no pain but i find that to be the rareity here. Cryoabaltion freezes the nerve and scar tissue and does not cause post op neuritis. It may take 2 treatments given 6-8 weeks apart. Many of the patients I treated were stump neuromas from prior traditional surgery. I won't mention numbers cause everytime I mention the cases I have done it is considered bragging or patting myself on the back by my detractors. Please contact me at stevefootdr1 at cs.com and i will provide you with indepth answers.
Result number: 29
Posted by >Dr. Goldstein</b> on 8/29/07 at 08:52
Margaret:No pats on the back are needed as this post was for other podiatrists who read it and attended a free workshop. They benefited, no one else. Please find yourself another agenda.
Result number: 30
Posted by Dr.Goldstein on 8/23/07 at 12:24
you should have an EMG/NCV test to check for tarsat tunnel syndrome or anything steming from your back such as lumbar radiculopathy or spinal stenosis
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Result number: 31
Posted by >Dr. Goldstein</b> on 8/20/07 at 13:08
David I agree alcohol can be just as effective IF surgery was NEVER performed. But in my case as well as the poster surgery was performed and the amount if fibrosis and scar tissue is far too extensive for the alcohol to penetrate. previous open neuroma procedures that fail do very well with cryo. The ultimate decision is up to the patient. In my case the fibrous was so extensive Dr. mike Kowalski had difficulty pressing on the plunger.
Result number: 32
Posted by >Dr. Goldstein</b> on 8/19/07 at 19:56
First of all I would say that Peter Wishnie is an excellent cryosurgeon and is highly trained with much experience. There is a doctor in the buffalo area named peter Resnick who performs cryosurgery. The one difference between cryosurgery and alcohol injections is that if you have scar tissue, the alcohol will not reduce this, as its main fuction is to sclerose the nerve and nothing more. Should you have alot of scar tissue it will be difficult enough just to inject the alcohol. Alcohol scleroses the nerve should it even be there. It causes neuritis /neuralgia and may cause intense burning as it did for me when i had it injected 7 times for a stump neuroma of my own. So my take is somewhat different than dr dsw.
Result number: 33
Posted by >Dr. Goldstein</b> on 8/16/07 at 11:53
100% agree with Dr. Wedemeyer, they need to be adjusted or remade. My rule of thumb if I adjust 3x and they are no good, I remake at my expense
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Result number: 34
Posted by >Dr. Goldstein</b> on 8/16/07 at 11:44
my pleasure ask your oncologist about whether additional chemo treatments over time will make your neuropathy worse because that is usually the case as the chemo stays in your body for lond periods of time
Result number: 35
Posted by >Dr. Goldstein</b> on 8/15/07 at 17:19
FULL LENGTH ORTHOTICS MEANN THAT THERE IS AN EXTENSION OF A SOFT MATERIAL THAT GOES OUT TO THE END OF THE TOES. THE PLASTIC SHELL USUALLY STOPS JUST BEHIND THE METATARSAL HEADS. SO THE EXTENSION IS GREAT FOR A PAIR OF SNEAKERS HOWEVER FOR DRESS SHOES I GO WITHOUT THE EXTENSION BECAUSE IT MAKES THE SHOES TOO TIGHT. THE EXTENSION WILL NOT EFFECT THE FUNCTION OF THE ORTHOTIC DR GOLDSTEIN
Result number: 36
Posted by >Dr. Goldstein</b> on 8/15/07 at 17:16
ONE INJECTION WILL CERTAINLY NOT SPLVE THE PROBLEM AND EVEN MULTIPLE ONES MAY ONLY GIVE TEMPORARY RELIEF. ULTRASOUND USING A COMBINATION OF THE ULTRASOUND JELLY WITH A MIXTURE OF A STEROID CREAM MAY HELP BUT AGAIN DO NOT GET YOUR HOPES UP TOO HIGH. SOMETIMES ONLY REVISIONAL SURGERY WRAPING THE NERVE IN NEUROWRAP TO PREVENT SCAR TISSUE FROM GETTING REATTACHED TO THE NERVE IS THE ONLY TRUE FIX DR GOLDSTEIN
Result number: 37
Posted by >Dr. Goldstein</b> on 8/15/07 at 17:11
mOST IMPORTANTLY IS TO LOOK FOR THE PRESENCE OF ANY OPEN SORES OR BLISTERS THAT MIGHT BE OOZING. PROVIDED YOU ARE NOT ALLERGIC/SENSITIVE TO SULFA SILVADENE CREAM WOULD BE A GOOD CHOICE. YOU WILL NEED A PRESCRIPTION FOR THIS. WHITE COTTON SOCKS SHOULD BE WORN NO COLORS. IF THERE ARE NO BREAKS IN THE SKIN JUST IRRITATION/INFLAMMATION NEUTROGINA MAKES A GREAT FOOT CREAM. SHOULD YOU BE GETTING NEUROPATHY SENSATIONS YOU SHOULD CONSULT WITH A NEUROLOGIST OR SOMEONE IN PAIN MANAGEMENT ASAP BECAUSE THE LONGER YOU DO NOT TAKE ACTIVE APPROACH TO TREATMENT THE WORSE YOUR SYMPTOMS GET FROM THE CONTINUED CHEMO DRUGS IN YOUR SYSTEM. DRUGS LIKE LYRICA, CYMBALTA, NEURONTIN, ELAVIL MAYBE NECESSARY TO COUNTERACT THE CHEMO DRUGS. THIS HAPPENED TO MY MOTHER SO i COMMENT FROM PAST EXPERIENCE. DR GOLDSTEIN
Result number: 38
Posted by >Dr. Goldstein</b> on 8/12/07 at 20:32
contact me at stevefootdr1 at cs.com
Result number: 39
Posted by >Dr. Goldstein</b> on 8/09/07 at 19:59
Although one can have multiple neuromas I have never seen every interspace of which there are 4 per foot all have neuromas. The most common site is between the third and 4th toes then 2nd and 3rd and less often the other 2 sites. Many times MRI's do not show unless the neuroma is large or sometimes it is up to the skill of the reading physician. Since the procedure is done somewhat blind as well inser the probe through a stab incision i could not say if this effects the overall success rates. There is no additional danger. Dr goldstein
Result number: 40
Posted by >Dr. Goldstein</b> on 8/09/07 at 19:54
Although I have personally retired from practice as of June 1st. I would be more than glad to answer your questions and refer you to one of a number of fine cryosurgerons around many parts of the US that may suit your needs. contact me at stevefootdr1 at cs.com
Result number: 41
Posted by >Dr. Goldstein</b> on 7/30/07 at 17:30
I would refer you back to your surgeon however I would be suspicious of a possible medial plantar nerve entrapement based upon your symptoms. You may need an emg/ncv test to confirm the diagnosis.
Result number: 42
Posted by >Dr. Goldstein</b> on 7/30/07 at 17:24
Dr. Ed: I agree with you here but many times patients dictate the plan of action to thier doctors and when it comes to these tests doctors do not want to be put under the microscope if the miss something. I have never orderes an MRI for a mortons neuroma in my 26 years of practice.
Result number: 43
Posted by >Dr. Goldstein</b> on 7/30/07 at 17:22
Scott: Depending upon the magnitude og the tear can determine what course of treatment is needed in response to the amount of pain. I have treated from a soft cast and surgical shoe all the way to a non-weightbearing cast. If you have a complete ruputure in a competitive athlete, surgical intervention may be a more appropriate course of action.
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Result number: 44
Posted by >Dr. Goldstein</b> on 7/29/07 at 18:47
This needs professional evaluation with possible xray and MRI to make the diagnosis before any treatment can be offered
Result number: 45
Posted by >Dr. Goldstein</b> on 7/27/07 at 20:04
your questions are excellent but since we cannot examine you or look at your MRI to see the extent of the tear it would be difficult to give you an expert opinion.
However my thaughts are this: In an older patient that is not physically active I tend to be more conservative and cast for a minimum of 8 weeks to try and avoid surgery. Even surgery may not alleviate all pain. After cast removal an AFO or custom made orthotic with a high medial flange is usuallu in order and a repeat MRI at 12 - 16 weeks
Result number: 46
Posted by >Dr. Goldstein</b> on 7/27/07 at 19:56
Although orthotics can be helpfull, remember they ACCOMODATE the symptoms and do nothing to resolve the problem. Cryosurgery has been able to completely eliminate or reduce the size of the fibromas to such an extent, that are become asymptomatic
Result number: 47
Posted by >Dr. Goldstein</b> on 7/26/07 at 18:22
Mark there is no reason why it would not work here as well
Result number: 48
Posted by markb on 7/26/07 at 12:42
Thanks for the response. I'll contact Dr. Nordyke and get an appointment with him. Regarding my hand (I know you are not a hand Dr.), do you think the cryo would work the same as in the feet or are their other structural issues in the hand that would make it not applicable? Thanks
Result number: 49
Posted by >Dr. Goldstein</b> on 7/25/07 at 19:47
go for the appointment and get a propper evaluation and diagnosis so the right treatment course can be recommended
Result number: 50
Posted by >Dr. Goldstein</b> on 7/25/07 at 19:41
if neurontin is not doing it then it is better to switch to cymbalta or lyrica as they have a little different mechanism of action. Ultracet in connection with lyrica seems to be what alot of the pain management guys recommend. if the nerve pain does not increase in intensity it will usually deminish with time 2-3 months is not unusual. Partial weight bearing with cruthches would help take some pressure off your foot. dr goldstein
Result number: 51
Posted by >Dr. Goldstein</b> on 7/25/07 at 19:35
Renee: This is one of the prime indications for cryosurgery as it will both reduce the size of the tumors and treat the nerve involvement at the same time with FAR less risks and complications and immediate weight bearing. dr goldstein
Result number: 52
Posted by >Dr. Goldstein</b> on 7/24/07 at 20:08
Since none of us has had the opportunity to examine you or look at your radiographs it is hard to give an expert opinion. with that being said, it is worth a try with orthotics with a mortons extension or reverse mortons extension first before one contemplates surgery.
Result number: 53
Posted by >Dr. Goldstein</b> on 7/24/07 at 20:04
The moral of the story is we treat patienrs' not MRI's whether they show the neuroma or not. The patient's pain and its location is far more important to me than any picture/test. Otherwise do we tell the patient since your MRI is negative we have decided not to treat your symptoms?
Result number: 54
Posted by >Dr. Goldstein</b> on 7/24/07 at 20:01
Dr. K : i have found that even when the nerve is stimmed and you think you are dead on, there are instances where it does NOT alleviate all the patient's pain and another treatment maybe needed. This has been my personal experience. There are times when I have not stimulated the nerve and alleviated all the pain with one treatment, just goes to show medicine is an art not an exact science.
Result number: 55
Posted by >Dr. Goldstein</b> on 7/24/07 at 19:57
In my hands the answer has been yes.
Result number: 56
Posted by >Dr. Goldstein</b> on 7/24/07 at 19:54
this can happen as a result of this type of surgery. You should consult with you surgeon. If the nerve pain gets worse, lyrica or cymbalta for short term helps with this type of pain.
Result number: 57
Posted by >Dr. Goldstein</b> on 7/23/07 at 20:37
complete stripping of the plantar fascia can lead to more complications and nerve entrapments. Cryosurgery or 'freezing this tumors ' has been working extremely well over the past 3 years. It only requires a small puncture with no stitches and one can shower within 24 hours. look at the www.cryotechllc.com website for further information
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Result number: 58
Posted by >Dr. Goldstein</b> on 7/23/07 at 20:31
Most patients usually benefit from a second procedure in the 3 years that I have performed cryosurgery 90 plus percent have benefited from a second procedure. I almost always recommend it.
Result number: 59
Posted by >Dr. Goldstein</b> on 7/16/07 at 18:24
YOU MAY HAVE VERY WELL RUPTURED SOMETHING. FIRST FOLLOW REST ICE ELEVATION FOR THE FIRST 48 HOURS TAKE AN ANTI-INFLAMMATORY PROVIDED YOU HAVE NO MEDICAL CONTRAINDICATIONS WITH THAT IF NO RELIEF SEEK PROFESSIONAL HELP SOONER RATHER THAN LATER
Result number: 60
Posted by >Dr. Goldstein</b> on 7/16/07 at 18:21
WAS THE FOOT EVER XRAYED? UNFORTUNATELY IT IS HARD TO MAKE A DIAGNOSIS WITHOUT SEEING YOU AS A PATIENT. MY BEST ADVICE IS TO SEEK A PROFESSIONAL OPINION. I AM NOT TRYING TO BLOW YOU OFF BUT GIVE A SOUND MEDICAL OPINION
Result number: 61
Posted by >Dr. Goldstein</b> on 7/16/07 at 18:18
YOU MAY HAVE TO SWITCH TO OTHER FORMS OF EXERCISE TO STAY IN SHAPE LIKE STATIONARY BIKE AIRODYNE BIKE ETC VS. THINGS THAT REQUIRE POUNDING ON YOUR FEET
Result number: 62
Posted by >Dr. Goldstein</b> on 7/13/07 at 15:30
if you had surgery over a year ago then it will most likely not get better without further evaluation. New xrays are in order you may need orthotics with a 1st ray cutout to offload the pressure under the first met head. get a second opinion by someone else. it does not make any difference whether podiatrist or anyone else if the person is competant
Result number: 63
Posted by >Dr. Goldstein</b> on 7/13/07 at 15:26
Cheilectomies do not address all the problems of a true hallux rigidus as the only remove some of the dorsal spurring. If the joint space is severly narrowed and the cartilage is destroyed by osteoarthritis, the procedure may only be temporary at best it will not correct the problem entirely so be advised diabetes or not.
Result number: 64
Posted by >Dr. Goldstein</b> on 7/13/07 at 15:21
David: they reall were stollen. I was wondering if one my adverseries took them? As far as lecturing i will contact you shorthly
Result number: 65
Posted by >Dr. Goldstein</b> on 7/13/07 at 15:14
More often than not heel pain in a chuld of your age is caused by an inflammation of the growth plate in the heel called the calcaneal apophysis. The condition is commonly called Seavers Disease. It is usally treated by xray analysis and then orthotic shoe inserts. Ultrasound is CONTRAINDICATED in an area with an open growth plate.
Result number: 66
Posted by >Dr. Goldstein</b> on 7/12/07 at 10:49
The jury is still out for me personally as to which is better a top or bottom(webspace) approach. I have done the majority from the top. i reserved the webspace approach for stump neuromas which are always difficult to treat. The problem with the webspace approach for me is i seem ti hit a tiny vessel that bleeds so my bandage is much bigger and the webspace incision is more subject to infection or maceration.
Dr. John DeBello and his group from NYC told me they have almost 100% success rate coming through the interspace. It just does not always work in my hands. I believe you need to treat proximal behind the met heads as well as distally in the sulcus. Overall my success rate with neuromas is about 82%. I was always looking for a new angle or spin on things but now that I am retired I will have to let my fellow cryosurgeons carry the torch. Did you see my other posting that someone took my FOOTFREEZER license plates. Wonder who? know them, informed patient, it wasn't you?
By the way would you be interested in lecturing for me in NJ in October on ESWT?
Result number: 67
Posted by >Dr. Goldstein</b> on 7/12/07 at 10:32
Jen: i think I might have heard about this in some blurb somewhere but that's it. If you think circulation maybe involved a non invasive arterial test maybe the place to start then if something shoes an MRA thats correct MRA magnetic resonance arteriogram may be in order to flow the blow flow directly into the foot. Have you tried the MBT sneakers? When was the last MRI of the foot or diagnostic ultrasound to view the plantar fascia?
Result number: 68
Posted by >Dr. Goldstein</b> on 7/11/07 at 20:45
With all due respect to my friend Dr. Nordyke, cryo works better in my hands than the alcohol injections. This basically boils down to ask 10 different opinions and get 10 different answers. In order for the alcohol to be effective at the 4% concentration normally used, 5-8 injections 7-10 days apart is necessary. The alcohol can be uncomfortable and burn as it also causes some local neuritis. Cryo does not always work with one treatment. i have repeated 17% of over 500 i have performed. Some other these patients have had failed open surgery. it boils down to whatever you want to do. it's your foot, not ours. Either method has pros and cons and nomethod or procedure gives 100% success otherwise we would all be doing it!
Result number: 69
Posted by >Dr. Goldstein</b> on 7/11/07 at 13:22
Dear heidi: first off any competant podiatris can do the injections under the scar into the hard tissue as dr. ed and i have mentioned. that is the way to start for about 2 months, then if no better I would entertain cryosurgery. Do not waste your time with Vitamin E as I will do nothing to whatever is underneath the skin as it will NOY penetrate that deeply. i am disappointed in the response and attitude your doctor has taken and the information he has stated. You may have to travel if you need cryosurgery and I unfortunately no nothing about your insurance plan.
Result number: 70
Posted by >Dr. Goldstein</b> on 7/11/07 at 13:16
I recommend and MRI to see if one could differentiate the mass. If not a biopsy would be indicated plain and simple'
>dr. goldstein<!-- drz- all- cache-mtc-ab12.proxy.aol.com Mozilla/5.0 (Windows; U; Windows NT 5.1; en-US; rv:0.9.4.2) Gecko/20021112 CS 2000 7.0/7.0 216482 18.104.22.168 -->
Result number: 71
Posted by >Dr. Goldstein</b> on 7/11/07 at 13:13
Jen: so sorry to hear that nothing has worked which only leads me to believe the wrong diagnosis has been made. Usually if the treatments do not work your treating the wrong thing. I know your are fairly young but problems from the lower back such as radiculopathy, stenosis, can mimic heel pain even when patients have no back pain. Still tarsal tunnel or medical calcaneal nerve entrapement also cause symptoms of PF. Please do not give up and maybe you should investigate somewhat further. Be well Dr. Goldstein
Result number: 72
Posted by >Dr. Goldstein</b> on 7/09/07 at 17:31
Joann: you should investigate cryosurgery as another option for this problem minimally invasive no sutures no surgical shoe no non weightbearing. look around at www.cryotechllc.com for more info
Result number: 73
Posted by >Dr. Goldstein</b> on 7/09/07 at 17:24
A belated happy 4th to you david. By the way someone stole my footfreezer license plates. i wonder if any of my critics or disgruntled fans ripped them off. Since i am going to relocate to florida, i just put ordinary plates on for now. The plates have been reported stolen so I hope they do not show up on anyone's car we know!
Result number: 74
Posted by >Dr. Goldstein</b> on 7/09/07 at 17:17
David: i know you have asked me about this numerous times early on however then answer is still the same. here goes: After we use a local anesthetic to numb the fibroma, we next use a pointed trochar and make numerous punctures directly into the fibroma itself in a 340 degree fashion through one well placed puncture site. Since we know these tumors have a large blood supply that makes them continue to gro I freeze this tumor 12 or more times with a 2.6mm probe that makes an 16mm iceball inside the fribroma. Thje idea is ti repeadly freeze to help destroy the blood supply to the tumor. I know I have frozen if enough when the entire tumor is now soft and I can make an imprint just by pressing on the fibroma all around it. I finish off the procedure with atleast a ml. of kenalog 40 sometimes more if the tumor is large. Over the next 6-8 weeks the thing just gets smaller usually by about 50% if the tumor is large. then we give it another go. This may not be the most scientific explanation but whatever we are doing to disrupt the tumor it has worked extremely well in all the cryosurgeons that are trained to do this.
Result number: 75
Posted by >Dr. Goldstein</b> on 7/09/07 at 17:07
Jenna: you pose a good question and I will tyr and provide an honest answer. many people who may read this may say sure he does cryosurgery so he is biased that way. Bottom line. There are no recent studies out there that state that alcohol injections are better than anything else. There has been some controversy the last week on our own podiatry websites that the 4% concentration is not strong enough to cause a chemical neurolysis. Many insurance companies will not pay for multiple alcohol injections as with the 4% concentration many suggest 5-8 injections consistantly 7-10 days apart.
There are currently 110 cryostar trained surgeons around the US with over 5000 procedures performed to date. Success rates with one treament run 80-90%. many patients get partial relief after one however the made need a second 2 months after the first.
There are usually no sutures, crutches, surgical shoes used with this procedure and most patients can shower the next day.
Do you due diligence and investigate both methods and collect the facts and make whatever choice you fell is right for you. I have tried to be truthfull and have stated the facts as I know them to be. Dr. Goldstein
Result number: 76
Posted by >Dr. Goldstein</b> on 7/09/07 at 16:52
Heidi: it is not uncommon to develop some residual fibrosis during the healing phase I have seen this numerous times with patients that have this type of surgery. It is better to treat it aggresivley at this time otherwise it will just get worse. I agree with Dr. Ed inlection therapy would be beneficial, provided the incision is totally closed and their are NO clinical signs of infection. The shots are somewhat painfull but necessary. Are you sure your doctor said it would not come back, because they high a high reoccurance rate if you read ant text or article on this. This is the main reason I have stopped surgicaly excising them and freeze them with cryosurgery. Should your problem not get better DO NOT reoperate by cutting it open as you will only make it worse. Wait 2 months, have the injections, continue the ultrasound and if not better let us know and I will refer you to someone who does cryosurgery for this condition. Dr. Goldstein
Result number: 77
Posted by >Dr. Goldstein</b> on 7/09/07 at 16:41
Tammy: I have performed over 40 cryosurgeries for plantar fibromas and the treatment have eith irrdaicated the tumors completely oe have reduced there size draumatically. Go to the www.cryotechllc.com website and you will see a section on publications and you can print out the one on plantar fibromas. That patient had surgery in 2005 and her large tumors /fibromas have not returned. large fibromas usually need 2-3 treatments 2 months apart. No stitches, no crutches, no non-weightbearing. I could recommend someone to you that maybe close to where you live as I have retired 5 weeks ago. many of my fellow cryosurgeons use this technique and I love it and so do the patients.
Result number: 78
Posted by >Dr. Goldstein</b> on 7/06/07 at 18:29
The do not always take depending upon the depth of the wound, vascularity which means circulation they should not be put on if the wound is infected or if deeper tissues such as bone is infected. There are different thickness of the graft to consider as well. Even if all goes well they may not take 100% and sometimes they need to be regrafted
Result number: 79
Posted by >Dr. Goldstein</b> on 7/05/07 at 07:28
Mark: yes that is correct the are the same thing as a fibroma. The injections were actually mention by my friend Dr. Greg Mowen from Ventnor, NJ. He refers to himself as Dr. g. where I use Dr. Goldstein. In my 26 years of practice I have not seen much shrinkage with injections especially if the fibromas are large. Plus Dr. Mowen mentioned hyaluronidase which is hard to come by. This is strictly my take and Dr. mowen may have had far greater success with the injection therapy so hopefully he will see this and comment. The cryo works extremely well with an average of 2 treatments.
>Dr. Goldstein<!-- drz- all- cache-rtc-ab02.proxy.aol.com Mozilla/5.0 (Windows; U; Windows NT 5.1; en-US; rv:0.9.4.2) Gecko/20021112 CS 2000 7.0/7.0 216482 22.214.171.124 -->
Result number: 80
Posted by >Dr. Goldstein</b> on 7/04/07 at 17:42
The results over the past 3 years have been extremely successful. I have retired from practice however there are many excellent cryosurgeons that do this procedure.
Dr. Nordyke is in ventura CA
Dr. Holtz is in Viginia
Dr. Beresh is in Virginia
Dr. mowen is in NJ
Dr. Perez is in NY
Dr. Wishnee is in NJ
just to mane a few
most patients need atleast 2 treatment 2 months apart
Result number: 81
Posted by >Dr. Goldstein</b> on 7/04/07 at 17:37
David: based on the patients symptoms, I have done repeated treatments if the first did not releave all the pain, if prior open surgery has been performed. The most i ever due is 3 treatments then i feel you have to treat differently maybe an open release. I would like to hear what Dr. mowen feels about this
Result number: 82
Posted by >Dr. Goldstein</b> on 7/04/07 at 17:34
not always due to size and the expertise of the person reading the MRI
Result number: 83
Posted by >Dr. Goldstein</b> on 7/03/07 at 18:45
Bess: The success rates have been so high for plantar fibromas using cryosurgery it is worth traveling somewhat to either totally reduce the fibromas or atleast decrease the size so their is no pain but it usually takes 2 treatments given 8 weeks apart. I recommend this option highly. Dr. goldstein
Result number: 84
Posted by >Dr. Goldstein</b> on 7/03/07 at 18:45
Bess: The success rates have been so high for plantar fibromas using cryosurgery it is worth traveling somewhat to either totally reduce the fibromas or atleast decrease the size so their is no pain but it usually takes 2 treatments given 8 weeks apart. I recommend this option highly. Dr. goldstein
Result number: 85
Posted by >Dr. Goldstein</b> on 7/03/07 at 17:37
Todd: if he thinks you have an infection then did he place you on antibiotics or send you for a blood test?
Result number: 86
Posted by >Dr. Goldstein</b> on 7/02/07 at 19:58
Todd; This is very possible. assuming it could be that take 2 alieve with breakfast and 2 aleive with dinner. This is almost equivalent to the prescription dose of Naprosyn. Next try to go to a pharmacy and get a roll of a Coban 3 or 4 inch width. It is very thin but like an elastic bandage material that sticks to itself. Wrap it around the foot 2-3 times to keep the swelling down anout 5 bucks a roll. Ice the area at the end of the day also for 2 weeks if no better I will furthewr advise you.
Result number: 87
Posted by >Dr. Goldstein</b> on 7/02/07 at 19:52
I would recommend Dr. Randy Nordyke in Ventura, CA but I do not know how far that is away from you, otherwise go onto the www.cryotechllc.com website and look under the heading patients then our doctors and it will bring you up a list by state then by city.
Result number: 88
Posted by >Dr. Goldstein</b> on 7/01/07 at 08:59
Danielle: I made a typo it should be EMG/NCV eletromyography and nerve conduction study I di know of a Dr. gary Jolley who has an excellent reputation for doing this type of surgery. Possibly he is in Pennsylvania
Result number: 89
Posted by >Dr. Goldstein</b> on 6/30/07 at 21:23
Linde: first off you write just fine. I have to answer your question this way. We use the treatments for plantar fasciitis and plantar fasciosis, 2 somewhat different conditions more than we say heel spurs. This maybe somwehat confusing. the spur is never really the cause of the pain, it is the effect on the plantar fascia, fasciitis is an acute inflammation where by fasciosis is more of a thickening of the fascia with more damage to the fascia. based on this I cannot say which is better without my own exam or an ultrasound or MRI of the fascia. i am sorry i cannot give you a directed answer.
Result number: 90
Posted by >Dr. Goldstein</b> on 6/30/07 at 21:13
todd this does need further evaluation. It honestly does not sound like anything that would have developed d/t the cryosurgery. Get xrays to rule out a stress fracture as a baseline. Yon=u may need an MRI or bone scan from their.
Result number: 91
Posted by >Dr. Goldstein</b> on 6/30/07 at 17:00
It is tough when you have fibromyalgia which may exacerbate the symptoms you have. Surgery is not always the solution. I recommend the following. You should be wearing nightsplints which you can purchase off the website. A different anti-inflammatory may work better for you such as naprosyn. What if anything do you take for your fibromyalgia? patients with fibromyalgia seem to benefit from medications like Elavil. I have used ultracet with fibromyalgia patients as well. Physical therapy or biofeedback is helpful. Do you wear any type of orthotics? I think there are many other avenues for you to try.
Result number: 92
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:53
I myself have never heard of anyone referring to different stages although the degree of the patient's symptoms can sometimes give me an idea of how bad it may be.
Result number: 93
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:50
I agree 100% with Dr. Wander. This is why an EMC/NVC would be of bebefit to see if something like lumbar radiculopathy maybe the cause of your foot pain plus it can help diagnose tarsal tunnel syndrome as well. Should TTS be the problem seek out a doctor who has experience doing these procedures as they often can have less than perfect outcomes.
Result number: 94
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:46
Did you see a podiatrist or some other physician and have radiographs taken to see if you have heelspurs as someplace to start. With Ledderhose a softer orthotic to not put pressure over the nodule would seem more beneficial.
Result number: 95
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:28
Dear Cryoman: I think the best answer to your question would be for you to have an EMG/NCV test to determine if you have lubar radiculopathy and at what level. It can also help make the diagnosis of tarsal tunnel as well. As far as I have been able to tell, patients with radiculopathies that manifest themselves with heel pain do NOT get better with cryo. The pain has to be treated from the source. This means radiculopathy pain usually needs treatment with epidurals or some form of pain management. If you do have tarsal tunnel syndrome that would be something that could be treated with cryosurgery.
Result number: 96
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:22
Informed patient: have we heard from you before hiding behind some other persona? I did not ask anyone to come to my defense as I do not need to.
Whether you like or dislike my writing style is your choice. My postings deal with real patients and true experience. Since cryosurgery is a relatively new field in podiatry, I speak facts not fiction and have spent the past 3 years bringing this technology to the forefront. You percieve statistics and numbers as not being humble, again you perception. Numerous patients from around the United States, England, Puerto Rico, The Bahamas, and Alaska have benefited from all the doctors in podiatry currently performing these procedures today. If this appears to you as bragging then fine, move on and look for a better way to make use of your time. Negativity is a waste of one's time and counterproductive. Spend more time being posistive and try to help someone other than yourself. One has to have a big ego to think that he looks down on everyone else.
Result number: 97
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:11
Linda: it is very hard to give an answer to your question without examining you. I would be happy to recommend someone for you to see if I knew in what state you lived. Otherwise go onto the www.cryotechllc.com website and you can find a list of the currently trained doctors by state
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Result number: 98
Posted by >Dr. Goldstein</b> on 6/30/07 at 16:05
Todd: You pose an interesting question since the punctures we make on the top of the foot are so small I have never seen them become a source of irritation. My question is this? Due the orthotics make you shoes/sneakers very tight? Do you remove any additional materials from within the shoes to give you as much room as possible? Are the orthotics very bulky? Please help me help you if you could.
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Result number: 99
Posted by >Dr. Goldstein</b> on 6/26/07 at 20:12
Informed patient: i am sorry you have trouble understanding me as most posters do not seem to have this problem. i am not and do not have to pat myself on the back as you may think. it is the truth that i have the most experience with this procedure using cryosurgery and have trained everyone that is currently performing it. Writing propper sentances will not get you better, however experience in treating this disease will. You have a choice and if you are informed why would you need any information if you researched the topic throughly.
Bruce thank you for supporting me and I hope you are doing well.
If you decided to have the procedure done would you look for the guy who has done one or two or someone with the most expertise? Remember the decision is always up to you the patient.
Result number: 100
Posted by >Dr. Goldstein</b> on 6/25/07 at 20:01
Ann: sorry to hear that the cryo did not work in your case like others this does and can happen. You have nothing to lose but only gain from try anyother non-invasive treatment, so i say go for it. It works for some and others get no help but worth a try
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Result number: 101
Posted by >Dr. Goldstein</b> on 6/25/07 at 19:58
I appologize. No case is typical, meaning they are all different. The results are also different in each and every patient , so everyone is unique or atypical in their own way. hope this makes further sense. I treat every case as if it is unique or has its own difficulty level making none of them standard.
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Result number: 102
Posted by >Dr. Goldstein</b> on 6/25/07 at 19:55
Edna : i have been doing it for over 3 years and have performed over 40 cases with a satisfaction rate of near perfect. Either the tumors dissolve and disappear completely or if they do not fully disappear the pain is gone i refer you to the cryotechllc.com website where you can download a copy of an article i published over 2 years ago a CASE STUDY ON A PATIENT OR GO ONTO THE LEDDERHOSE.COM WEBSITE FOR RUTHER CRYOSURGERY BYTES
Result number: 103
Posted by >Dr. Goldstein</b> on 6/24/07 at 20:28
I have only had one patient who wad all her pain in the arch and it was successful
>dr. goldstein<br>one however really does not have any clinical signifigance like any procedure done with cryo anywhere in the foot and with over 1000 performed what is not typical or atypical are the results meaning everyone is different
Result number: 104
Posted by >Dr. Goldstein</b> on 6/17/07 at 13:05
It is not uncommon for increased numbness after the surgery until the nerve repairs itself 3-6 months time, I am not sure why the tinnels sign is more pronounced nowmaybe dr mowen has a better explanation for this and your decompression questions
Result number: 105
Posted by >Dr. Goldstein</b> on 6/15/07 at 07:06
Dr. Fellner you did not provide your email address?
mine is stevefootdr1 at cs.com
Result number: 106
Posted by >Dr. Goldstein</b> on 6/15/07 at 07:01
Having treated a large group of patients with this disease over the past 3 years, our success rates have been 95% sucessful in either totally irradicating or shrinking these tumors down to a non-painfull state. CRYOSURGERY is an excellent choice for this disease. One or two treatments can usually resolve the problems. I know there is a Ledderhouse website where some of the patients I treated showed before and after pictures. stevefootdr1 at cs.com
Result number: 107
Posted by >Dr. Goldstein</b> on 6/11/07 at 19:06
plantar fasciitis can take a minimum of 6-8 months to disappear or quiet down and in some cases it does not. At this point since you had 3 shots i recommend physical therapy, stretching, night splints, a course of oral anti-inflammatories. i recommend powerstep orthotivs which you can purchase directly through this website. Three shots is fairly routine treament and follows a normal standard of care so the orthopedists comments are not correct. If things do not resolve you need a diagnostic ultrasound or MRI of the plantar fascia. it is possible that cryosurgery, ESWT, topaz. or EPF may be needed at a future date.
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Result number: 108
Posted by >Dr. Goldstein</b> on 6/11/07 at 18:57
The best advice is to seek professional help and get an expert opinion rather than self diagnosis or self treatment. if it was that easy then we as podiatrists would not be needed. This is not meant to be rude so please do not take my advice that way, it just makes common sense.
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Result number: 109
Posted by >Dr. Goldstein</b> on 6/11/07 at 18:54
Dr. Mowen: The amount of open you do qualifies you to have more training and a better understanding of the problem than one who does 1-2 per year. You training at the dellon Institutue as well puts you in a class that many could never aspire too. You postings, cryo skills, PSSD testing all add to your greater understanding of nerve related problems in the lower exstremity. i just read your article in the latest issue of Podiatry Today. it was precise and informative. Again let me state I have has my best success with patients that have have already had failed open TTS procedures. i have evaluated a very difficult case of a patient we have both seen recently and have referred him back to you for possible surgical treatment. You can reach me at stevefootdr1 at cs.com for further details.
Result number: 110
Posted by Dr.Goldstein on 6/08/07 at 16:33
the reason they do not due cryo on TTS is because they were never trained how to do it or they do nto no how to do it. i have done close to 40 procedures over the past 2 years and have had about 70% success with one treatment. A 1/8 inch puncture behind the ankle bone with no stitches, crutches casts. i recommend this way first as you could always do the other and have a prolonged period of disability. the results statistically are no better.
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Result number: 111
Posted by >Dr. Goldstein</b> on 6/03/07 at 18:06
good luck on your upcoming surgery and a positive attitude help a lot i wish you well
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Result number: 112
Posted by >Dr. Goldstein</b> on 6/03/07 at 18:04
Linda: the best answer is which ever device enables you to get around better sometimes a walker is the best way
Result number: 113
Posted by >Dr. Goldstein</b> on 6/03/07 at 18:02
Dr. Ed : i agree that a surgical shoe and crutches will be adequate enough to solve both problems we mentioned.
Result number: 114
Posted by >Dr. Goldstein</b> on 6/03/07 at 12:26
John: Like I always say, place 10 podiatrists in a room and you will get 10 different opinions on how to screw in a light bulb. The ironic thing is that each believes his/hers is the correct way.
Result number: 115
Posted by >Dr. Goldstein</b> on 6/03/07 at 12:19
D : this goes against the principals i was taught. i let my patient walk on an EPF release immediately to let the fascia stay stretched and fill in with scar tissue
Result number: 116
Posted by >Dr. Goldstein</b> on 6/02/07 at 19:31
The description of your problems does sound unusually complex and without any disrespect to your surgeon, a knife cannot fix everything. Sometimes another approach is needed. have you tried a topical lidoderm patch, topical neurogel, possibly a pain management consult, accupuncture. The point I am trying to make is that repeated surgeries that you think may help one thing may only create other problems. The fact that you are in bilateral camwalkers says something?
Result number: 117
Posted by >Dr. Goldstein</b> on 6/02/07 at 15:56
Make sure to ask the doctor if he is only cutting the medial band which has markings inside of the canula used to do the procedure. I do the procedure reverse i start on the lateral side and come out medial so if I slip i still only cut the medial band where the othewr way if the knife slips it can cut the entire band and you can wind up with calcaneocuboid pain
Result number: 118
Posted by >Dr. Goldstein</b> on 6/01/07 at 18:50
sometimes if too much of the fascia is cut, more than the medial band lateral column pain can occur although I am not implying this has happened. chronic ankle sprains can cause this as well as sinus tarsi syndrome.
if you have orthotics the rearfoot posrt either has to be neutral posted or VALGUS posted. almost all orthotics are VARUS posted which will exacerbate your problem ask your treating podiatrist about this very important
try an injection directly into the sinus tarsi as well if this helps then cryosurgery directly into the sinus tarsi will be of much benefit
>dr. goldstein<!-- drz- all- cache-mtc-ab12.proxy.aol.com Mozilla/5.0 (Windows; U; Windows NT 5.1; en-US; rv:0.9.4.2) Gecko/20021112 CS 2000 7.0/7.0 216482 184.108.40.206 -->
Result number: 119
Posted by >Dr. Goldstein</b> on 6/01/07 at 18:44
Cora: when the surgery is performed only 14-16 mms. of the medial band of the fascia is cut/released and its purpose is to grow back together and scar tissue fills in the gap to lengthen the fascia. this happens early on after surgery not 4 years later so it is always possible to get recurrent heel pain. start ice, stretching, orthotics either prefabricated or custom
Result number: 120
Posted by DFellner on 5/11/07 at 03:49
Wishing you a happy retirment (?) and sustained health and prosperity. I do suspect you will find yourself busy as ever !
All the best
Consultant Podiatric Surgeon
Result number: 121
Posted by >Dr. Goldstein</b> on 5/05/07 at 06:24
Thank you both very much. I can be reached at stevefootdr1 at cs.com
Result number: 122
Posted by advertising on 4/02/07 at 13:16
Aleksa is my patient but I was away on vacation for the last fortnight. Thank you for stepping in with your advice.
Aleksa has marked metatarsal instability with significant saggital plan excursion of M2-M3-M4 which I plan to stabilize with a casted orthotic in due course.
To counter this problem you describe I am trying the heel probe with the greater freeze ball directed in an oblique direction dorsal distal to plantar proximal (deep to the TML) to freeze as much of the nerve along the distribution from the bifurcation, and then chasing the nerve.
Mr D Fellner
Consultant Podiatric Surgeon
Result number: 123
Posted by >Dr. Goldstein</b> on 3/20/07 at 17:49
ryan: you have not told me exactly what your problem is. so i cannot comment yet on whether cryosurgery is a possibility for you. I have performed almost 900 procedures in the past three years with an overall success rate with one treatment approximately 87%. Although there are not alot in the way of published studies because we do not have patients 5 or 10 years out most of the articles have been case studies. Collectively there are close to 100 cryostar surgeons across the US and Puerto Rico with approximately 4000 plus procedures performed. having only do 2 procedures does give one a good case to judge so early on. there are a few excellent docs in pennsylvania. I think i have trained them all and would recommend any one of them. go onto the cryotechllc.com website and you can locate the PA trained docs.
Result number: 124
Posted by >Dr. Goldstein</b> on 3/20/07 at 17:42
Jim: i have done many multiple neuromas between adjacent interspaces. You do pose a good question. I have not had one case of circulatory or vascular damage that I am aware of. I will tell you that if interspaces 2 and 3 are done at the same time the 3rd toe may stay whitish in color for up to 30 hours as it gets hit on either side. if one follows the standard freeze protocol it has not been an issue that I am aware of.
Result number: 125
Posted by >Dr. Goldstein</b> on 3/20/07 at 17:39
Dear Aleska: I have seen this happen to many of my own patients for reasons I cannot truely explain. Even though the initial pain was far behind or away from the toes, we would treat that area only then find shortly thereafter the patient developed pain in the toes or right under the toes in the area we call the sulcus. Since this happened to me frequently I started to freeze not only on the painfull site but then move the probe towards the toes and do that additional freeze in that spot even if the patient had no pain there. This has almost eliminated the problem. You will most likely need to have a repeat cryo procedure closer to the toes to get to the nerve were it splits into your toes. This has solved the problem for my patients that have had the similiar issue as you describe.
Result number: 126
Posted by >Dr. Goldstein</b> on 3/18/07 at 17:19
you can buy powersteps online for 29.95 average cost the full length ones
Result number: 127
Posted by >Dr. Goldstein</b> on 3/18/07 at 15:10
for sure you have a difficult case. i am not a rhematologist however i do you a lot of medrol however in your case the 4 mg pack is not strong enough and drops off to quickly. you may do better on 20 mgs per day for 1-2 weeks then SLOWLY weeening off. again i am a podiatrist but this is the way i would proceed
Result number: 128
Posted by >Dr. Goldstein</b> on 3/18/07 at 15:06
I think it maybe beneficial to see the neurologist first as dr z recommended then based on his findings let us know and we will try to help and let you know where to go from there
Result number: 129
Posted by >Dr. Goldstein</b> on 3/18/07 at 15:04
by monday if the swelling has not improved get checked out
I wish you well dr goldstein
Result number: 130
Posted by >Dr. Goldstein</b> on 3/18/07 at 15:03
give the orthotics 2-4 months before considering anything else if the orthotics do not works you have 3 other options CRYOSURGERY, ESWT, EPF procedure. numbers 1 and 2 are much less invasive you need to investigate pros and cons of each .
Result number: 131
Posted by >Dr. Goldstein</b> on 3/18/07 at 14:49
During this prolonged healing phase you may want to try Lyrica to deal with the nerve pain burning, tingling, etc but this does have side effects otherwise try Metanx a prescription vitamin for neuropathy that has folic acid , b6, and b12 take 2 daily for the next few months this has no ill effects dr goldstein
Result number: 132
Posted by >Dr. Goldstein</b> on 3/18/07 at 14:45
the wound should be cultured if there is drainage to see if you are on the correct antibiotic plus bloodwork should be done to check you white count the incision may need to be opened to let out any drainage or pus check to see if you are running a fever as well if it gets work act ASAP
Result number: 133
Posted by >Dr. Goldstein</b> on 3/17/07 at 19:12
the problem here is that there are numerous types of custom orthotics that are based on the doctors evaluation of your particular problem my lab has 4 different degres of rigidity for the same orthotic
flexable, semi flexable, semi rigid and rigid yet alone the type of material the orthotic is made of different firmness of arch fill get my point? since we really do not know with what you have it is hard to make a suggestion
Result number: 134
Posted by >Dr. Goldstein</b> on 3/17/07 at 19:06
are you getting the full length powersteps with the soft oval shapped blue material in the heel? these are the newer version and for 30-40 dollar investment it makes sense to replace them no less than every 6 months
Result number: 135
Posted by >Dr. Goldstein</b> on 3/17/07 at 19:04
I have never seen a brown colored liquid in a syringe that is a steroid. i mix vitamin b12 alot and the would be reddish or pink not brown. i would request an explanation from your doctor to tell you exactly what was in the syringe
Result number: 136
Posted by >Dr. Goldstein</b> on 3/17/07 at 18:58
every one heals at a different rate. are you using any orthotics?if not you should be. this may help decrease your pain, especially if there is a rearfoot post on the orthotic or 3/16 inch heel lift.
Result number: 137
Posted by >Dr. Goldstein</b> on 3/17/07 at 18:55
Do not panic!! the more you stay off of it now the quicker it will heal so crutches would be a big help if you see the swelling go down alot over the next 48 hours that would be a good sign if not get it looked at as opposed to ignoring it.
Result number: 138
Posted by >Dr. Goldstein</b> on 3/17/07 at 18:47
I would get radiographs of the ankles followed by MRI studies as the shot of cortisone is most likely like putting a bandaid on the problem. You may also want to get a blood arthritic pannel as well. You may be better off seeing a rheumatologist as well
Result number: 139
Posted by >Dr. Goldstein</b> on 3/17/07 at 18:43
Try and keep the foot elevated, take a ziploc bag fill it with ice and if you have an ace bandage wrap it around your heel to keep it in place. if you have no allergies to anti-inflamatories get a bottle of aleive and take 2 pills three times a day with food. the instructions on the bottle say one every 12 hours so it can be sold in non prescription strength naprosyn 220mg per pill
so you will be taking 440mgs. three times per day with food
this is close to the 500mg prescrption strength three times per day UNDERSTAND?
if now better please see someone within the next 72 hours even if you go the the ER
keep us posted
Result number: 140
Posted by >Dr. Goldstein</b> on 3/17/07 at 14:28
Assuming the diagnosis of stump neuromas is correct after you get another opinion or too or you have tests that rule out other factors. if in fact stump neuroma is the correct diagnosis, cryosurgery works well for this problem but usually requires 2 treatments per site. This is a far better alternative to plantar revisional surgery which will keep you non- weightbearing for 3-4 weeks with the potential to cause more scar tissue and further entrapment. I have performed 50 or so stump neuroma procedures with 85-90% relief of symptoms.
Result number: 141
Posted by >Dr. Goldstein</b> on 3/17/07 at 10:44
I do not personally know of anyone in canada that uses the cryostar cryoanalgesia system you may have to come into the US to have it performed and michigan maybe the closest place to go
Result number: 142
Posted by LF on 3/15/07 at 15:59
Since you have not responded, can I assume there are no doctors who perform cryotherapy surgery in my vicinity? The closest listed on their website is over 5 hours away in Smryna, TN.
I was hoping others had been added but just were not on their web site yet.
Result number: 143
Posted by >Dr. Goldstein</b> on 3/14/07 at 09:57
Your question has no bearing, because it all depends on the doctor's experience, and who you feel comfortable with.
Result number: 144
Posted by LF on 3/13/07 at 10:02
I live in Jonesboro, Arkansas which is in northeast Arkansas. I am about 1 1/2 hours from Memphis, TN or 2 1/2 hours from Little rock, AR.
Result number: 145
Posted by >Dr. Goldstein</b> on 3/12/07 at 18:23
if you tell me where you live i will recommend someone for you otherwise go onto the cryotechllc.com website and look under the our doctors portion to find the doctors listed by state
Result number: 146
Posted by >Dr. Goldstein</b> on 3/12/07 at 18:20
Hilary: it depends on where the pain is exactly and what the cause of the pain is stemming from.
Result number: 147
Posted by >Dr. Goldstein</b> on 3/05/07 at 14:40
Ralph: i do understand you point. I can tell you from my 26 years of experience that when patients come in with orthotics that are not comfortable that were made by other podiatrists I ask a few basic questions
who casted you for the orthotics the doctor or an assistant?
if you were not casted did you step in a box of foam to make a mold of your foot?
Usually one or 2 of these answers gives me a good idea of why the orthotics maybe problematic
lastly have the patient step onto their orthotics while barefoot and see if they are still pronating off the orthotics
this usually accounts for uncomfortable orthotics
Result number: 148
Posted by >Dr. Goldstein</b> on 3/01/07 at 13:37
Ralph you certainly post a good question but not every patient gives a completely honest answer especially when it comes to wearing a night splint. I do not know if you could really compile accurate statistics here
Result number: 149
Posted by >Dr. Goldstein</b> on 3/01/07 at 13:35
paul: even if youm truly have a neuroma no one can guarantee success with any treatment and I will tell you that with having done over 500 neuromas the success rate for me is about 82% with one treament some patients require 2 or 3 treatments to get it corrected especially if they have had previous open surgery
Result number: 150
Posted by >Dr. Goldstein</b> on 2/28/07 at 16:44
Jim: i also see no benefit to restylene injections as it has been shown that any of these type injections even silicone do not last very long as weight-bearing breaks this down rapidly. Most like this would also not be covered by your insurance so you are most likely looking at an out of pocket expense. orthotics made properly are usually beneficial for this condition and i do not want to criticise your doctor but a good understanding of biomechanics is needed here. Radiographs should be evaluated as they can lead to other causes of sesamoid problems.
Result number: 151
Posted by >Dr. Goldstein</b> on 2/28/07 at 16:36
Dr. g has given you good advice as it is not the spur that causes the pain it is the severe inflammation of the tissue that inserts into the heels or chronically inflammed nerve endings of small sensory nerve branches that innervate the plantar fascia Both cryosurgery and ESWT offer good solid alternatives without the downtime of traditional surgery.
Result number: 152
Posted by >Dr. Goldstein</b> on 2/28/07 at 16:32
David: i totally agree with you on this one. Remember there are 3 sides to every story the plantiff's defendant's and somewhere in the middle maybe the truth
Result number: 153
Posted by >Dr. Goldstein</b> on 2/27/07 at 18:09
Please do not take this wrong, but i feel these are questions you best ask your doctor who did the surgery rather than someone guessing or give you impropper information.
Result number: 154
Posted by >Dr. Goldstein</b> on 2/27/07 at 18:07
Ralph: the efficacy of the 3 machines is all the same as they all produce the same ice ball. the differences are the amount of tanks of nitrous oxide the machine can support at one time, automatic cycles vs. manual cycles and some machines have nerve stimulators and some do not.
Result number: 155
Posted by >Dr. Goldstein</b> on 2/27/07 at 12:11
Todd: currently 100 or so podiatrists around the country use the Cryostar brand or cryoanalgesia unit. There is another company that make a machine but I do not know how many podiatrists use their product. Because the cost of these systems is substancial, many are afraid to make this investment. They try and justify the cost vs. how many procedures need to be peformed just to cover their potential payment. Frankly the amount of excitement generated by this modality brings patients to the office. Not everyone has this mindset.
Result number: 156
Posted by >Dr. Goldstein</b> on 2/27/07 at 10:34
good luck to you
Result number: 157
Posted by >Dr. Goldstein</b> on 2/19/07 at 13:57
John: this is a common occurence from this type of surgery. Neurawrap is a collagen based product that goes around the nerve that protects the nerve from further damage, prevents scar tissue from attaching to the nerve, and will disolve over a period of time.
Result number: 158
Posted by >Dr. Goldstein</b> on 2/16/07 at 08:22
Scott: i do agree that Dr. wander is an excellent chice for that posistion and that ASK THE DOCTORS should be just that for doctors to respond to posters questions . Although some of the non medical posters do seem to have knowledge it should be placed under the specific topic or under the social message board. It is tough enough giving professional advice sometimes but even more difficult when others without a medical license make recommendations.
Result number: 159
Posted by >Dr. Goldstein</b> on 2/14/07 at 16:51
Jo: I know we spoke a few days ago and i hope i answered these questions. You will be able to walk on it immediately, bring a pair of sneakers. post operatively there is almost no discomfort. i have had patient feel perfectly fine the next day and as far as the airport always a good idea for the wheelchair, this never hurts see you soon dr goldstein
Result number: 160
Posted by >Dr. Goldstein</b> on 2/14/07 at 06:36
Liz: You pose an excellent question. One of the doctors i trained started doing cryosurgery ultrasound guided. His name is david Lombarski and he published an article on this subject January edition Podiatry Today 2007. The interesting thing is that even with direct visualization, he is getting about the same results as i am around 70% success.
Result number: 161
Posted by >Dr. Goldstein</b> on 2/13/07 at 14:35
Jim to date with the 35 or so cases I have performed for TTS we have only treated and the ankle level not high up.
We do not accept any out of state insurance. i can tell you my fee is 1500.00 per foot however should you need another treatment down the line I do not charge for this. example if you have cryo and are 50% better after one treatment and require another there would be no charge.
Result number: 162
Posted by >Dr. Goldstein</b> on 2/13/07 at 12:29
The answer to your question is yes we have treated patient even with normal findings because 30% of test come back normal even when something is wrong based on the expertise of the tester and the quality of the equipment they use. remember we treat patients and their symptoms NOT test results. the results are grear when they are positive but they do not always dictate what treatments are necessary or needed. I hope this provides some insight for you. Feel free to follow up with additional questions if you want further detail
Result number: 163
Posted by dfellner on 2/06/07 at 05:23
In using the plantar / dorsal approach, how certain are you about nerve location. The neuroma probe freeze ball is quite small so accuracy is key. Overlying soft - tissue padding various a good deal. There are no depth markings on the probe. Are you using ultrasound to assist probe placement? Are you laoding the intermetatarsal space with LA fluid to modify the size of the freeze ball? Have you found any differences when freezing under exanguination to reduce body heat?
Result number: 164
Posted by >Dr. Goldstein</b> on 2/04/07 at 09:43
Linda the procedure is done through a small stab incision that usually does not require suture closure. please narow down you geographical area so i may make the propper recommendation
Result number: 165
Posted by >Dr. Goldstein</b> on 2/03/07 at 14:57
Yes cathy I did very early on so he has alot of experience under his belt another good choice.
Result number: 166
Posted by >Dr. Goldstein</b> on 2/03/07 at 14:54
I will not hurt be has no real theraputic benefit
Result number: 167
Posted by >Dr. Goldstein</b> on 2/03/07 at 10:48
statistics show in the literature that the more releases performed on the same location the success rate decreases with each release due to the build up of scar tissue. If infact the cause of your TTS is nerves wrapped around the PT nerve then the release will be of little help. The veins must be stripped off the nerve and the nerve wrapped with a silicone sheathing call neurowrap. Dr. G is correct that more entrapement occurs at the porta pedis where the nerve passes through a small portal in the abductor hallucis muscle belly.
Result number: 168
Posted by >Dr. Goldstein</b> on 2/01/07 at 14:00
USUALLY A NEUROLOGIST OR PHYSIATRIST PERFORMS THE EMG/NCV TEST
Result number: 169
Posted by >Dr. Goldstein</b> on 2/01/07 at 09:52
KNOW THEM DID YOU READ SURGERY SHOULD BE THE LAST RESORT??? I AM STILL RECOMMENDING AN ORTHOTIC HOWEVER THE OTHER TYPES OF SURGERY CAN CAUSE FAR MORE DAMAGE AND COMPLICATIONS
Result number: 170
Posted by >Dr. Goldstein</b> on 1/31/07 at 14:09
Dr. Wander, i certainly understand the differenve between peer reviewed and publications like podiatry today and podiatry management. However there still is an editorial review process and many of the editors are editors for peer reviewed journals as well. Frankly with cryosurgery being a new modality the wait to get published was far quicker in podiatry today or podiatry management. However look very carefully over the past year or two and see how many well known and respected podiatrists have published here instead of ACAFS or JAPMA. I never inplied that may paper was a scientific study like Ralph implies but to compare it to a receipe his wife sent into a magazine?? maybe he is smoking smothing he should not be! The analogy is rediculous
Result number: 171
Posted by Dr. Z on 1/30/07 at 17:39
>Dr. Goldstein<br>Sometimes we aren't explaining this very clearly and if your aren't directly involved in the field of podiatry or some similiar medical field it appears that we are just trying out procedures such as cryotherapy on poor helpless patients. I would like to try and gave another possible example that might help to make this more clear
Today I used a laser called a Flashlamp Pulse Laser for the treatment of warts. It is FDA approved for vascular lesions and has been tested for that specific indication. It is however used for spider viens, dark discolorations of the skin tatoo's and other pigmented lesions.
I use if for warts because I understand and know the effects this specific laser has on specific pigmentations and therefore I am able to apply this to warts due to undestanding the specific effects this type of laser has on the skin .
So with cyrotherapy you are applying the effects that you know happen on other parts of the human body ie prostate cancer to the bottom of the foot ie plantar fibroma.
Dr. Goldstein experience with cryotherapy and understanding of the technology allows him to apply what he knows, has experienced to the foot
So cryotherapy can be used and applied to other parts of the body so long as you understand the benefits of its effect and it limitations.
Now as for the heel it dangerous and I would never use it due to its ability to kill the plantar fascia. Just joking I wanted to see if anyone is reading this beside Dr. Wander, Goldstein and Ralph and maybe Dorothy if there is a spelling problem Seriously I am very impressed with so far with the potential that cryotherapy has. One more thing. Dr Goldstein did you read Dr. Norykye sp post about his problems with cryotherapy and neuroma's I was surprised any thoughts??
Result number: 172
Posted by >Dr. Goldstein</b> on 1/30/07 at 12:38
I am not sure if there is someone in houston did you check on the cryotechllc.com website
Result number: 173
Posted by >Dr. Goldstein</b> on 1/30/07 at 12:36
Ralph : i have done over 30 patients over the past 3 years with almost complete resolution of all the fibromas to date. The fibromas i have done have been as large as 6.5 cms and as small as 3.0 cms. many patients with multiple lesions. The point of the article was to give the patient some idea of how the procedure is performed. By the way i was the first podiatrist to use cryo for this and have trained many who follow my guidlines. Frankly let the patient go where ever she wants to have it done. I do not need the business my schedule is always full. Whether you like the publication or not it was an article case STUDY DOCUMENTED BY NUMEROUS PHOTOS AND PRESENTED AT MANY PODIATRIC CONFERENCES.
Result number: 174
Posted by >Dr. Goldstein</b> on 1/17/07 at 11:59
it is really hard to speculate so I am sorry not to be able to provide further info without more clinical data
Result number: 175
Posted by >Dr. Goldstein</b> on 1/10/07 at 14:31
This is a quick fix that treata the SYMPTOM not the cause of the problem. like Dr. Ed said, these are temporary injections at best usually need repeating are not covered by insurance as they are considered cosmetic procedures. personally be very carefull here!
Result number: 176
Posted by >Dr. Goldstein</b> on 1/05/07 at 12:06
get another opinion and get it looked at after this amount of time additional waiting is pointless
Result number: 177
Posted by >Dr. Goldstein</b> on 1/04/07 at 08:49
mark: it is possible for a piece of suture or a suture knot that does not dissolve and can form a stitch abscess or cause a localized soft tissue infection. You should have bloodwork done to see if you have an elevated white blood cell count. do you have any fever?
do you see any small opening along the suture line?
even if all is negative it might be prudent to start you on a course of antibiotics after the blood test
Result number: 178
Posted by >Dr. Goldstein</b> on 1/02/07 at 07:31
I highly recommend dr randy nordyke he is worth the trip
Result number: 179
Posted by >Dr. Goldstein</b> on 12/28/06 at 16:14
Joyce: chris kringle is my holiday persona I certainly have nothing to hide nor gain from it. I would be more concerned about know them and the famous dr parker who are plain out nasty and vendictive those types are the ones to watch out for not chris kringle!!!!
Result number: 180
Posted by >Dr. Goldstein</b> on 12/27/06 at 18:04
Good Idea dr wander from chris kringle
Result number: 181
Posted by >Dr. Goldstein</b> on 12/24/06 at 13:22
Dr. Ed : i will try to elaborate. When we stim the nerve on sensory mode i try to evoke a sensation shooting up to the hallux, to the 5th digit, and the medial heel at the trifurcation about the level just above the malloli this is the location we i find the nerve trifurcates. I do not try to go into the porta pedis. If i can evoke a stim in those 3 areas i know I am anatomically just distal to the trifurcation. this is location we freeze at. Ironically my counterparts that do not have stim on their machines but do the procedure ultrasound guided, still get about the same success rates as i get with stimulation of the nerve. I assume when I do not get a successful outcome the problem maybe at the porta pedis and a release maybe needed there.
Result number: 182
Posted by dr goldstein on 11/24/06 at 12:55
Good luck and keep us posted
>Dr. goldstein<!-- cr- all- cache-rtc-ab08.proxy.aol.com Mozilla/5.0 (Windows; U; Windows NT 5.1; en-US; rv:0.9.4.2) Gecko/20021112 CS 2000 7.0/7.0 211156 220.127.116.11 -->
Result number: 183
Posted by Anne S. on 11/12/06 at 20:30
I was just wondering how long you have to be off your feet after Cryosurgery? I work retail and work on cement floors. Is it possible to wear a protective shoe or something so I don't have to miss much work?
And Im not positive if I have PF or a nerve problem. Do you have to have nerve testing done beforehand?
Thanks for your help.
Result number: 184
Posted by Kathyh on 11/12/06 at 10:40
>Dr. Goldstein<br> This is a continuation:
The pain got so bad in my right foot that when he said lets do the surgeery I thought it would cure it right away. In other words that was the impression he gave me.
I live in Mission, Texas (McAllen, Texas). Mexico, haha just joking but very close to the border.
Result number: 185
Posted by Kathyh on 11/12/06 at 10:18
>Dr. Goldstein<br> The freezes were about 3 or 4 minutes each.(Freeze, defrost, then freeze again). I have only had the procedure once. I do remember when the doctor was freezing he moved the probe what felt to be at least 1/2 an inch but I don't know why. The freeze was done in the middle of my heel.
After researching more about Cryosurgery I am wondering why my doctor was so quick to want to do the surgery instead of trying other things first. I went t see him on a monday and he scheduled the siurgery for 4 days later without explaining any other options to me. So I did not think their were other options. This procedure was done to my right foot and my left heel has been hurting since 2003 but it never got as bad as my right. Now it is because I am favoring it more. I went to this same doctor in 2003 and he wanted to do the cryo in my left foot right away also but I never let him schedule it. The
Result number: 186
Posted by dr goldstein on 11/12/06 at 07:43
Dr. G. since you mentioned in another post that you perform cryo, I was curious as to your identity. would you be from the pennsylvania area and someone who trained with me?
>Dr. Goldstein<!-- dr- all- cache-rtc-ab08.proxy.aol.com Mozilla/5.0 (Windows; U; Windows NT 5.1; en-US; rv:0.9.4.2) Gecko/20021112 CS 2000 7.0/7.0 211156 18.104.22.168 -->
Result number: 187
Posted by >Dr. Goldstein</b> on 11/05/06 at 18:18
for information i refer you to the cryotec website at www.cryotechllc.com or www.footfreezer.com
Result number: 188
Posted by >Dr. Goldstein</b> on 10/07/06 at 16:40
I would most likely send you for an EMG/NCV study at this point to make a more precise diagnosis as to what maybe going on rather than just guessing since a year has passed by since your prior surgery.
Result number: 189
Posted by >Dr. Goldstein</b> on 10/06/06 at 18:27
I hope your questions are answered after your visit, and maybe you will feel this is an approach is worth considering. I am performing 2 cases tomorrow on patients who have had faied open surgical procedures for TT. I hope I can help them.
Result number: 190
Posted by >Dr. Goldstein</b> on 10/06/06 at 18:22
it takes approximatelt 6-8 weeks to see what full bebfit one will obtain from cryosurgical procedures.
Result number: 191
Posted by >Dr. Goldstein</b> on 10/06/06 at 18:20
I did not want you to think i was attacking your expertise or credentials as you made it a point to inform me you are or were board certified. You do not need to prove yourself to me. i think you do provide detailed information that is well stated , WITH THE EXCEPTION OF BELITTLING those patients that do not have the expertise that you possess. If I am wrong why have there been so many negative comments about you by readers of this forum and so you seem to take pleasure in insulting these patients so that you seem to enjoy doing this. Why would that be? I respect your expertise but cannot respect outright hurting the feelings of patients that this forum is intended to help. Part of being a doctor is to show compassion and respect for the feelings of others however this does not come through in most of your postings. I do nto feeling attacking patients in any manner makes you better than they are. Do you honestly feel I am wrong, if so please explain your rationale to me.
Result number: 192
Posted by >Dr. Goldstein</b> on 10/05/06 at 18:37
I find it distasteful that there has been so much name calling and bad blood between Dr. Parker and Dr. Zuckerman. This back and forth tit for tat is very unprofessional and does nothing to help the patients that ask for help. Dr. Parker ever since I started reading your posts I feel as if you belittle the patients when they ask questions. Your advice is often excellent, however, the manner in which it comes out is poor. No one is questioning your credentials. Why did you start posting on the site over the last 6-8 weeks or so? If you are so busy in your practice where do you find the time to answer almost every question posted? Let us ALL put are EGO'S aside and answer the questions without turning this into a circus. I am surprized Scott has not intervened and as you to keep things under better control. All the doctors who posted have expertise in what they believe, how they practice, and give their opinions freely and with good will.
Result number: 193
Posted by >Dr. Goldstein</b> on 10/05/06 at 18:20
To : KNOW THEM
do us all a favor stay off the site and keep your sarcastic opinions to yourself.
Result number: 194
Posted by >Dr. Goldstein</b> on 10/05/06 at 18:18
I never infer that's not my style. Do not take things to personally from other doctors or patients on this site it does no one any good and wastes alot of time and energy. Stay loose no one is doubting or questioning your expertise, certainly not me.
Result number: 195
Posted by >Dr. Goldstein</b> on 10/04/06 at 19:09
You maybe an ideal candidate for cryosurgery to treat your TT as well as scar tissue. I performed 27 so far with article being published this month on the subject. It maybe of benefit to you.
Result number: 196
Posted by >Dr. Goldstein</b> on 10/04/06 at 19:06
I know a Dr. R. Rarker from Livingston NJ, would you happen to be him? You came on board over the past several months and seem to answer most questions. may I ask of you training and background?
Result number: 197
Posted by >Dr. Goldstein</b> on 10/04/06 at 19:02
I am not sticking up for any doctor per se, however information given by you does more harm than good and if you are not a physician or attorney then your opinion has no merritt no worth because you cannot render an expert opinion. I haver never seen a heel fat pad atrophy with the 26 years I practice and over 50% of my practice deals with heel pain as I specialize in cryosurgery for chronic heel pain and treat over 1000 patients per year with heel pain.
Result number: 198
Posted by >Dr. Goldstein</b> on 10/02/06 at 09:39
If you are having traditional open surgery to have the neuroma surgically cut-out then expect a minimum of 4-6 weeks before being able to return to regular shoes provided all goes well.
Result number: 199
Posted by >Dr. Goldstein</b> on 10/01/06 at 15:18
David: Since we do not know who John Doe is or is not, I think it is a waste of time defending yourself when asked these type questions from an unknown source. Believe me although the podiatrists he mentions are known there are others far more prominent in the filed. I personally know of all of them and have lectured at seminars wehere they have spoken. That does not make me a better podiatrist because I know them or they know of me. Not everyone goes on the lecture circuit for numerous reasons. Although I lecture constantly and its because I like to do it. This does not make me any more special than anyone else so I am not sure what John Doe's point is. David could you believe I am sticking up for you?
Result number: 200
Posted by >Dr. Goldstein</b> on 9/24/06 at 16:19
Thank you for asking. I have made a full recovery after being out for a full 2 months. I am no longer taking any pain medication however ultracet worked better for me than percocet and lyrica helped with my nerve pain.
Result number: 201
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