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Message Number 261782
Re: has anyone had APC injection ot autologous platelet injection? View Thread
Posted by Laurie C. on 11/06/09 at 12:32

I have had APC injections multiple times not due to PF issues into my joint, but have had them injected as any other injection - no meds needed to relax and done in the procedure room under xray.

Result number: 1

Message Number 261775

Re: Letter to the editor View Thread
Posted by Dr. DSW on 11/06/09 at 05:51

Marie,

The foundation of this country was found on only 'Christian' beliefs or maybe some 'religious' beliefs. I wasn't aware that the 'Christians' had a monopoly on ethical and moral issues.

Result number: 2

Message Number 261763

Re: please answer View Thread
Posted by JLO on 11/05/09 at 12:01

Thank you for at least giving me an idea of what to expect on the first visit. I have anxiety issues and it helps to know what I am getting into.

I do, in fact, have peroneal tendon subluxation. They took X rays, did an MRI, put a brace on it and I started PT this morning.

I go back in a few weeks for a follow up.

Again, thanks for easing my mind a bit.

Result number: 3

Message Number 261742

7 States View Thread
Posted by wendyn on 11/04/09 at 18:10

Rick. Dude - 7 states?

10 provinces and 3 territories. In Canadian math - that adds up to 13.

We know lots about America because we learn about a lot of other countries in school (especially our main neighbors to the south) and we get all of your major channels and TV shows. Many Canadians are more familiar with American history, celebrities and issues than they are about those in their own country.

Yes, that's a problem.

If you ever get up this way again you'll have to let me know. We are trying to get back to the Chicago area - maybe next summer. But we'll see. It always ends up being such a busy vacation seeing family - but I love Chicago.

How is the grandfetus now? We are at about 26 weeks and all is well.

My son cracks me up though. At one point he tried to convince his girlfriend to put off an exam until April because 'she'll be home with a baby all day so she'll have loads more time to study.'

When I gave him that look he said, 'What? Newborns sleep all the time.'

I laughed so hard that I almost cried. Parenting is such a fun learning experience.

Result number: 4

Message Number 261722

Tarsal Tunnel Hell View Thread
Posted by Josh M. on 11/04/09 at 09:34

HI everyone,

I just wanted to share my story. I was hit from behind by a small vehicle in summer of 08 and my right leg/ankle started twisting under the cart and I was able to twist myself out before I went completely under the cart. I ended up with a high/low ankle sprain. I did about 19 physical therapy sessions and by the end of that I felt something else was wrong.

My doctor ordered an MRI and found a newly formed Ganglion cyst attached to my tendon. I tried shots, drainage with no relief. He finally surgically removed the ganglion cyst off of my tendon. Well, 2 weeks later it was back. SO again, he tried to drain it. It didnt work.

I had another surgery to remove it. And again it came back. But another problem arose. Tingling of the bottom of my foot, especially if you tap the inside of my ankle. The bottom of my toes go numb along with a silver dollar size numb spot located at the bottom of my foot just under my arch. My foot throbs and throbs. Im starting to have issues with my calf for some reason. Walking makes it much worse or standing does also.

My doctor diagnosed me with TTS. I was hurt at work and WC has yet to approve the surgery for TTR that was set up 5 months ago. My condition has gotten worse and worse.

I do have lawyers and I hope to have TTR within the next 2 months.

Im just worried that the longer Worker Comp waits to approve the surgery, the less of a chance of it being better after surgery.

Thanks

Result number: 5

Message Number 261706

Jeremy View Thread
Posted by Stacy on 11/03/09 at 17:50

I had new othotics made following a modified kinder. Prior to posterior tibial tendon issues, I had plantar fasciitis. I found that Brooks ariel worked well for the plantar fasciitis. Now, the Brooks shoe would provide too much correction with the orthotic. The doctor wants me to get a good walking (stability) sneaker. What are some makes/models that you would suggest?

Thanks for your help

Result number: 6

Message Number 261676

Re: tarsal tunnel View Thread
Posted by als on 11/01/09 at 19:36

I have the same problem! I am beginning to think that I am the only one in the world that has painful, red feet when I am on them for longer than 45 minutes. I too was on Lyrica, but I started gaining weight. My doctor put me on Gabapentin which I think is a generic for a Lyrica type drug. I know that you posted about a year ago, but I was wondering what all you have had done...In hopes of solving my feet issues. I, too, am very active and want to be back to normal! Please let me know if you have solved your issue...and how.

Thanks!

Result number: 7

Message Number 261562

Re: Valgus, Medial Foot Swelling, Tingling; Is that TTS? View Thread
Posted by Dr. Wedemeyer on 10/27/09 at 10:44

This made for an interesting discussion Haisook.

An accessory FDL muscle has been indicated in TTS yes. Inflammation of the plantar fascia has also been shown to have this feature. Having dissected quite a few feet I can tell you that we are not all symmetric and identical in our anatomy. Some PF patients describe numbness and tingling of the foot although this is not considered pathognomonic for PF, it simply renders diagnosis more difficult (I have witnessed this numerous times in rotator cuff injury where the patient also complains of neuritis initially.

You have seen several types of physicians and obviously your complaints do not fit in a tidy clinical box. What bother me is your description of a bilateral complaint. You can obviously have TTS and/or PF in both feet but when patients complain of bilateral neuritis I think it is important to rule out a systemic complaint. You saw a rheumatologist, were any lab tests performed?

Dr. DSW has given you some excellent advice on what should be done from here to help localize your symptoms as well as treat the nerve issues.

Result number: 8

Message Number 261557

Re: Valgus, Medial Foot Swelling, Tingling; Is that TTS? View Thread
Posted by Dr. DSW on 10/27/09 at 07:00

Conservative measures at the present time can include oral anti-inflammatory medication if you have no contra-indications, ice 20 min/hour if you have no medical contra-indications and taking B vitamins which many believe are good for any nerve related pathology. Since the B vitamins are water soluble, you can't 'overdose' on the B's. Therefore, taking a good B complex vitamin may be beneficial.

For my patients I prescribe Metanx, which is actually a prescription. It has gained popularity for diabetics with neuropathy, but I use it for any patients with nerve related issues with significant success.

Result number: 9

Message Number 261532

Re: Dr. Wedemeyer and Dr DSW were right about Scholls View Thread
Posted by Dr. Wedemeyer on 10/26/09 at 18:11

Wearing an insole that does not fill the shoe appropriately can lead to callus among other issues. One option I have for patients who do not need a great deal of correction, just support, is a precut blank I can mold and add a topcover to. I cna also adjust the width readily.

This allows me to charge a price somewhere between a custom and on OTC product, about $200. I know, I know, PowerSteps are around $40 making the price attractive but they lose their shape rather quickly, so add several of these over a couple of years vs. a custom or customized device and you get what you pay for.

Right?

Result number: 10

Message Number 261506

Re: Could it be something else? View Thread
Posted by LindaM on 10/25/09 at 16:36

Thanks, Dr. DSW. I'm reluctant to take too much time off from work all at once, and both of these appointments would need to take place during the work day (in order to use my preferred local doctors). If I want to 'space out' these appointments, which would you recommend that I pursue first.....the EMG or the rheumatologist? I know this may sound somewhat silly, but I just don't want to be out of the office too much with my health issues.

Linda

Result number: 11

Message Number 261457

Re: From the UK on Prez Obama View Thread
Posted by john h on 10/22/09 at 12:44

President Obama was often criticized during the campaign for his lack of any worthwhile experience. His only job was as a community organizer in the city of Chicago and 2 years in Congress. Not much for a President. All this lack of experience is showing. His management style is by letting all his minions such as Rohn Emmanuel, Tim Geithner, and others run the country while he gives more speeches than any President in history. None of these speeches ever gives any real details and are more like campaign speeches. In fact, he remains in the campaign mode even now. He turned health care over to Congress who is run by the Democratic Liberals. He should have submitted his own health care plan. The Congress tried to rush through health care when the members were voting on issues they had ever even read. The people knew less than nothing about what was going on. To me, he has an arrogance about him which often conceals his concerns about doing his job. As a leader, he sure falls flat. What has he really done. We have the largest debt in history, unemployment approaching 10% and still climbing, indecision in Afghanistan and an approaching health care bill that will add over a trillion dollars to our debt and still leave 23 million uninsured Americans. The American dollar is almost half the value of the Euro and still going down. We own car companies, insurance companies, banks and now plan on controlling executive pay. Sure sounds like socialism any way you look at it. Was that his intent? I doubt it as his minions are making the calls as he has no experience in what is happening in our economy. He has killed our missile defense program in Poland and is letting Iran stall long enough to make a nuclear bomb. Jimmy Carter was a terrible President and I voted for him. He never really scared me. President Obama does in fact scare me as I think our enemies will roll him over. Graduating from Harvard does not provide you with wisdom.

Result number: 12

Message Number 261452

Re: tarsal tunnel post op View Thread
Posted by Dr. Wedemeyer on 10/22/09 at 10:46

VB I have previously read the threads that you have participated in where Laurie commented. You misread the tenor of her posts in my opinion. Also knowing her history you must know that no one could ever accuse her of not having endured a great deal of pain and suffering herself, or of being unsympathetic. She has been given oranges and has made orange juice rather than give up. I personally admire her for her positive attitude and tenacious nature in pursuing any and all remedies for her own issues.

You on the other hand continue to try to evoke sympathy and choose to point fingers and do not listen to the advice afforded to you by well meaning professionals and empathetic posters. Food for thought.

Result number: 13

Message Number 261449

Re: Does anyone here wear MBT shoes? View Thread
Posted by BERT on 10/22/09 at 09:53

I bought a pair of MBT shoes and regret it. I never had any issues with my feet until after I started to wear the MBT's. I now have Plantar Fasciitis on my left foot and can no longer wear these shoes. I wored them for about 3 month and slowy started to feel some pain on my heel.

Result number: 14

Message Number 261434

peroneal tendon subluxation View Thread
Posted by JLO on 10/21/09 at 14:17

Hello all. I am currently going through some issues with my left foot. It's hurt for three months and I'm fairly certain it's peroneal tendon subluxation (I'm a biology grad student so I at least have SOME background). I'm not trying to make a self diagnosis but more or less I just have questions.

My GP did not do much except give me a referral to a podiatrist. Mostly I want to know what to expect at the doctors visit (it's in a week and a half). In general how fast is it between visit and diagnosis and action (will I walk out of there in a brace, or what?). How fast is surgery usually scheduled, if indeed it is necessary? Is there anything I can do to alleviate the discomfort until the monday after next? As I said, my GP did nothing but hand me a referral, didn't even suggest an OTC brace I could get for myself.

As of right now I am sticking with rest and anti-inflammatories. There is only so much I can do since I walk to and from school/work and work in a lab that has me moving stations frequently based on whatever experiment I am doing that week.

Any advice, words of wisdom (like stop stressing about it hehe), suggestions are GREATLY appreciated.

-joDi

Result number: 15

Message Number 261422

Re: Graston View Thread
Posted by Dr. Wedemeyer on 10/20/09 at 13:39

Graston is an instrument assisted method of manual debridement of the soft-tissues. It works very well for fasciosis and tendinopathy. it is not a panacea but an option in chronic PF.

Result number: 16

Message Number 261363

Re: Why? View Thread
Posted by AllenF on 10/18/09 at 14:57

LOL. I love the way you mirrored my condescension back at me. It made me smile.

How do you know there are not any women that will 'take my side' on this? How could you possibly know that? Are you some kind of goddess that can tap into the minds of all women on earth with some sort of mystical powers? Its a shame you don't have some special foot healing powers. We would all worship the ground you walk on.

So you want to know why they voted the way they did? I will explain it to you as best I can. Our country, America, has the most litigious society on earth. We have more lawyers per capita than in any other country. People and businesses are constantly being sued. The main reason for this is that we do not have a loser pays civil court system like the vast majority of other countries in the world. In most other modern democracies if you sue somebody and lose you, and in many cases your lawyer, automatically have to pay the other sides legal costs.

In America you can usually sue and sue and sue as many people and businesses you want until your little heart is content and you will rarely ever be forced to pay the other sides costs no matter how many times you lose. All of this litigation in our country can be very harmful to many businesses and individuals which consequently puts downward pressure on our economy.

Arbitration is a form of alternative dispute resolution that was designed to alleviate some of these costs. Companies and individuals add them as clauses to many contracts to protect themselves from frivolous and expensive lawsuits. The arbitration clause by no means guarantees that a business will win a legal dispute. Arbitration is usually carried out by a highly respected third party that issues a legally binding, logical decision in a legal dispute.

Now back to your question. The reason it was a good idea to vote against this law is because it will increase the number of frivolous lawsuits against any company that wants to do business with the DOD. This means these companies will charge the government more for their services which is a cost that will be passed on to the tax payer. It also sets a dangerous precedent in the sense that it could bring more laws extending this law to all parts of the government and not just the DOD.

By the way, nobody forces you to sign a contract with an arbitration clause or any contract for that matter. You can refuse and work someplace else or become self employed or become a pan handler or whatever. What it basically comes down to is freedom. A company or person should be able to put into a contract whatever they want and whoever they are dealing with can decide to to sign it, negotiate for something better, or leave. If you allow people to be as independent as possible most will thrive and a few will wither. Its not perfect but its the best system around in my opinion.

Result number: 17

Message Number 261359

Re: Why? View Thread
Posted by marie:) on 10/18/09 at 07:56

Well i think I responded to your comments in my previous post. Come on Allen I think your smart enough to understand the gravity of rape. I also think your smart enough to know women won't take your side on this one. This, I thought was the most bi-partisan bill to hit the floor in a long time. there are just some issues that call for it. What is the real story? Why would they vote no to this bill? The author of the bill itself only used this case as an example. There are other stories and cases. So please explain to me their votes? Do you know why?

Result number: 18

Message Number 261346

plantar and calf interaction question View Thread
Posted by KevinB on 10/17/09 at 16:06

I'm going through an interesting bout of PF. At first I concentrated on the PF itself, massaging, rolling, night splint. One day I attempted to run a short distance during a workout and my calf cramped up something awful.

What is interesting is that as the calf cramped and got tight the PF went away almost immediately.

So I went to an active release massage therapist and within 2 weeks my calf was nice and loose. Tried a very short run again and immediately stopped as I felt the calf start to cramp. By the next morning the PF heel pain was back in full force.

So it seems as though the formula is:

Tight calf = No PF
Loose calf = Bad PF

I've rolled this ankle a lot in my life but never had any issues running. I'm at a loss as to next steps.

HELP !!!

Result number: 19

Message Number 261289

Re: Dr. DSW, Dr. Wedemeyer? View Thread
Posted by myelverton on 10/14/09 at 07:35

Hi Dr. Wedemeyer,

No, I've never had an MRI, and I find it odd that none of the podiatrists have suggested one - that's the main reason for my question here. Seems to me that it would be helpful. I've never had blood tests either, at least not as part of my foot treatments. I had a regular blood test in July as part of my annual checkup and everything came back normal except I was a little low in Vitamin D. I'm not aware of anyone in my family with Rhematoid or connective disease. My father was borderline diabetic, but I've not tested positive for diabetes. Also, I'm not overweight and in good physical condition, except for the feet.

Please let me know your thoughts on an MRI. And I will also pursue the other issues.

Thanks!
Margaret

Result number: 20

Message Number 261226

very warm foot View Thread
Posted by Brenda C on 10/11/09 at 02:31

I recently posted about being diagnosed with PF in my left foot/undergoing treatment while also getting treatment for a stress fracture to the tibia in my right leg. I had a short leg cast on for six weeks. During the first three weeks my casted foot/toes would occasionally get puffy, red, very warm. I asked the dr about it and they told me it was basically me flexing the muscles in my leg and foot while in the cast would push blood down into my foot especially if I didn't have it elevated and just wouldn't have a chance to drain out properly. I went back this last friday to get a new cast put on and they x-rayed it and discovered I have an OCD lesion on the talus.

The PA who I've been seeing for the stress fracture told me I'd have to consult with the surgeon (same office), so that appt is tues. In the meantime he left the cast off and put me in a walking boot and said no weight bearing. I can remove the boot to sleep, shower. My question is my foot is still red, a bit puffy, and very warm to touch. So what causes the redness and other symptoms? Is it because I'm not walking on it? I feel like I should walk on my foot and get the circulation going. It is stiff from being in a cast for three weeks which I expected, but is this a normal reaction (red, puffy, warm) to being in a cast? I've never had a cast before so I'm not sure. It also feels a bit tingly. Not numb, no burning, just tingly. I really hope this is not the beginning of tarsal tunnel syndrome. From what I've read so far about TTS, I didn't see any mention of red puffy feet. I will ask the surgeon about it, but I'm a little worried I have something else starting too. I want to prevent anymore issues. I've never had this many problems with my feet before. Thank you for any advice.

Brenda

Result number: 21

Message Number 261215

Re: Kooky Left and the Wacky Right? View Thread
Posted by marie:) on 10/10/09 at 09:52

?if by middle you refer to that real middle between anarchy and totalitarianism, then we share a strong bond. We can differ and argue passionately regarding where we should be on that contimuum, but on a fundamental level we are joined in a common cause, the American cause. Those that would attempt to trap you or I in the distorted distraction of what the left and right labels have become, add nothing to the political discourse.'

I agree with much of what you say. I see the polar opposites of our political spectrum as angry narrow minded folks who hate each other just for the sheer pleasure of it. That's why I don't read at many very liberal websites and only occasionally view far left talk shows....although there are times I agree with them on the issues. The 2 groups will never have a meeting of the minds. It's essential for members of both parties to engage in common sense practice to do what's best for their constituents and the good of all. It's unfortunate that the 2 parties have gotten to this point of uncivil discourse and it's time to recognize the damage done by both far ends of each party. It's time for average hard working Americans to be represented.

Result number: 22

Message Number 261156

2010 View Thread
Posted by john h on 10/08/09 at 13:56

From the Kiplinger News Letter. This sounds about right to me barring any thing like a war with Iran or a 9/11 attack on the U.S. on our soil.

Republican 2010 election prospects keep getting better as voters lists
of frustrations expand...lack of jobs, federal bailouts and budget deficits,
health care, climate change, financial market reform plus Afghanistan and Iraq.

The GOP is certain to make gains in congress, picking up 10 to 15 seats
in the House...more if the economy continues to ail. Republicans are also likely
to reclaim enough Senate seats to deny Democrats a filibuster-ending 6O votes.
But there's no chance of a Republican majority in either chamber.

Of the open seat races in the House...so far, 17 that will be vacated by members
who are running for other offices...11 are now held by GOPers. Because open seats
are more easily snatched by the opposing party, that works against Republicans.
Moreover, additional House retirements are more likely to come from GOP veterans tired of toiling in the minority than from Democrats enjoying being in the majority. In the Senate, The GOP has half a dozen vulnerable seats. Democrats half of that.

Republicans are enjoying a bump in fund-raising for this election, though.
Despite industry donations, which typically skew largely to the majority party,
this summer, GOP national fund-raising committees performed as well or better
than their Democratic counterparts. As heated partisann debates over health care
and other issues rage on, the GOP's success is likely to continue through fall.

Result number: 23

Message Number 261146

years of foot pain View Thread
Posted by Jewel on 10/07/09 at 23:31

First let me say that I have some sort of autoimmune disease. I've been to many doctors and none of them agree. The latest being where 2 highly regarded rheumatologists took a look at my records and gave their determination and both completely contradicted each other. The possible diagnosises are RA, Undifferentiated Spondy, CPPD, Reiters/Reactive arthritis, Lupus and fibromyalgia. So, really who knows. I'm partial to the spondyloarthoapathies due to my foot problems.

I've gotten this foot pain on and off since 97. It has come and gone of it's own accord despite treatment. But now, I've had pain in feet constant for the last 5 years. Terrible, excrutiating pain that has now rendered me immobile. No, I wasn't overweight when it started, yes I am now. The one podiatrist I went to kept saying it was PF. I did the stretching, PT, night splints, injections, custom oththodics and none of it worked. He finally said he couldn't help me. Yes, I do have heel spurs - quite large ones. Floated between several other doctors, had EMG's = negative. Finally the one I have now has Dx'd a haglunds (doesn't hurt unless you press on it) and achillies insertion tendonitis. PT isn't really helping much.

The pain is in the back heel in a horse shoe shape - just along the edge of the foot. Yes it hurts when you squeeze the heel. In addition, there's a bone on the side of the foot by the tarsals on one side of the 'tuberosity' and according to the PT and Podiatrist it's where another tendon attaches and its super painful too. The achillies is sore in the ankle areas going up the ankle sides into the calf. The peroneous tendons (?) are very sore from the foot all the way up to the knee.

The ball of the R foot has issues. Podiatrist thought there was a neuroma between toes 2 & 3 as it was super painful too. He injected it there 3 times now (cortisone, over the past 1.5yrs) and it has helped. However, MRI showed no neuroma. Now toe 2 has very quickly deformed curving toward the big toe and hammering out. The last time I was at the podiatrist he mentioned capsulitis in that toe. So, could it really be the autoimmune arthritis and not a neuroma? I don't know whether to let him cut me open or not.

Went to an orthopedic doctor who specializes in feet/ankle. He said I have tendonitis all over my foot/feet. Took an xray of the R foot ball and you can see that the toe has hammered, said he couldn't do surgery due to the inflammation in the feet = too much scar tissue would develope in my current state. I asked him if he ever saw something like this before. He said 'just a couple times and that I need to tell my rheumatologist to get my inflammation under control.'

Result number: 24

Message Number 261128

Re: New Post OP From TTS Surgery View Thread
Posted by Mary L on 10/07/09 at 15:28

Dottie,

Thanks for your response. Everything that my husband and I have read is that the recovery is pretty long. I'm going on 2 weeks post -op and I can honestly say I don't feel much better. I'm nauseous almost constantly and right now my life consists of pain pills and frustration. If I don't take the pills on a regular basis, I get sick and boy, does it come with a vengance! I'm not a pill taker, so it's diificult to keep taking them.
My hubbie has his own issues with several back injuries so it's difficult for him to do his own stuff, let along help me. He borrowed a wheelchair from his Dad and that's what I use when we go out, but my max is 2 hrs., then I need to get back to my chair...LOL!
I'm not one to sit around and I'm really becoming concerned about whether or not I will be able to work, as the crazy nerve pain hasn't improved....it's gotten worse. On top of THAT now my left leg is giving me problems. Oh the Joy!

Result number: 25

Message Number 261107

Re: Barefoot Running View Thread
Posted by Jav on 10/06/09 at 14:04

Thanks for the POSE method reference Dr. I found it (and the related 'Chi' running styles) rather baffling yet interesting. I never thought much about trying to adjust the body's alignment and foot strike positioning to such a degree (thinking that the body must naturally find the most efficient mode to move itself), but there is quite a bit of food for thought here, especially considering the number of injuries that runners sustain after years of hitting the pavement.

I would guess that younger runners might realize more benefits from starting out 'programming' all the muscles and tendons in a more 'proper' alignment, but I bet vets like myself would incur a whole raft of niggling ailments learning to re-train the musculature in such a radically different style. Then again, it might do wonders to older backs and knees to slowly adapt and introduce some of these methods in hopes of curing some classic running injuries (IO band, runners knee, PF etc).

That said, this running barefoot movement seems incredibly risky to me. Maybe if I wasn't a PF sufferer I'd be less wary, but as you point out, the minority of practitioners with perfect form will perhaps become raving advocates, while the majority of participants with even slight alignment issues likely would eventually fall foul of all sorts of 'issues'.

I'll monitor from the sidelines in my trusty, dusty Saucony Hurricanes for now :)

Result number: 26

Message Number 261090

Re: Dr DSW View Thread
Posted by AllenF on 10/05/09 at 21:31

Dr DSW,

Wow, you are quite the typist. I really do not have time to give you the dignified response I would like. When it comes to free wheeling places of anarchy like the Internet I guess I simply live by the policy of 'caveat emptor'. If people are going to completely change their doctor prescribed treatment routine, without consulting said doctor, solely based off of what some guy suggested to them on a forum then they have some serious issues.

I understand that not everyone uses common sense, but we should not limit ourselves because some information may be used in a bad way. Maybe scott should put something in huge bold letters that says something to the effect of 'Don't be stupid and change your DOCTOR PRESCRIBED treatment routine based off of what somebody tells you on the Internet' at the bottom of each message. Have a great day Dr. DSW and try not to get mad about what you read on the box in front of you. Anger is bad for the digestion don't you know.

Allen

Result number: 27

Message Number 261042

Re: which type of shoe best for pronation and PF? View Thread
Posted by Dr. Wedemeyer on 10/04/09 at 17:42

Brenda not every case of PF is due strictly to pronation issues, although it is a definite factor. If I feel that a patient truly needs custom orthoses and either they cannot afford them or their insurance does not cover the cost, I would not change their treatment plan to suit their budget.

I would and have however reduced the cost of these items on an individual case basis by having the patient verify their income and that to pay my regular fees would produce a 'financial hardship'. I feel that everyone deserves the same level of care regardless of their ability to pay, employment status or insurance benefits and make exceptions for those with limited incomes or who have fallen on hard times. I can only speak for my practice though, many doctors and providers will simply not do this. We keep an agreement and documentation of the reduction of fees/costs in their file as required by State law. I would ask your doctor if he or she maintains a similar policy.

As for the type of shoe that is truly needed in your case there is absolutely no way that we can help you with this online. Jeremy has given you excellent suggestions and I suggest that you follow them. A PowerStep in a well made and appropriate shoe may perform better for you than a poorly conceived orthosis in an inappropriate shoe for your foot and biomechanics.

Result number: 28

Message Number 261039

complicated..... View Thread
Posted by Jewel on 10/04/09 at 14:10

Hello Doctors!

Gosh am I glad I found you. First let me say that I have some sort of autoimmune disease. I've been to many doctors and none of them agree. The latest being where 2 highly regarded rheumatologists took a look at my records and gave their determination and both completely contradicted each other. The possible diagnosises are RA, Undifferentiated Spondy, CPPD, Reiters/Reactive arthritis, Lupus and fibromyalgia. So, really who knows. I'm partial to the spondyloarthoapathies due to my foot problems.

I've gotten this foot pain on and off since 97. It has come and gone of it's own accord despite treatment. But now, I've had pain in feet constant for the last 5 years. Terrible, excrutiating pain that has now rendered me immobile. No, I wasn't overweight when it started, yes I am now. The one podiatrist I went to kept saying it was PF. I did the stretching, PT, night splints, injections, custom oththodics and none of it worked. He finally said he couldn't help me. Yes, I do have heel spurs - quite large ones. Floated between several other doctors, had EMG's = negative. Finally the one I have now has Dx'd a haglunds (doesn't hurt unless you press on it) and achillies insertion tendonitis. PT isn't really helping much.

The pain is in the back heel in a horse shoe shape - just along the edge of the foot. Yes it hurts when you squeeze the heel. In addition, there's a bone on the side of the foot by the tarsals on one side of the 'tuberosity' and according to the PT and Podiatrist it's where another tendon attaches and its super painful too. The achillies is sore in the ankle areas going up the ankle sides into the calf. The peroneous tendons (?) are very sore from the foot all the way up to the knee.

The ball of the R foot has issues. Podiatrist thought there was a neuroma between toes 2 & 3 as it was super painful too. He injected it there 3 times now (cortisone, over the past 1.5yrs) and it has helped. However, MRI showed no neuroma. Now toe 2 has very quickly deformed curving toward the big toe and hammering out. The last time I was at the podiatrist he mentioned capsulitis in that toe. So, could it really be the autoimmune arthritis and not a neuroma? I don't know whether to let him cut me open or not.

Went to an orthopedic doctor who specializes in feet/ankle. He said I have tendonitis all over my foot/feet. Took an xray of the R foot ball and you can see that the toe has hammered, said he couldn't do surgery due to the inflammation in the feet = too much scar tissue would develope in my current state. I asked him if he ever saw something like this before. He said 'just a couple times and that I need to tell my rheumatologist to get my inflammation under control.'

I don't know what to do. I've lost my ability to walk. The wheelchair/scooter people came on Friday..... I'm hoping you can help.

Thank you,
Jewel

Result number: 29

Message Number 261037

Re: Dr DSW View Thread
Posted by Dr. DSW on 10/04/09 at 11:11

Allen,

I think you may have missed my point. For every patient like you that 'gets it', there are dozens that don't.

I've been participating on this forum for many, many years and have witnessed patients that DO take what others say as 'gospel' and change treatment regimens based on other patient's experiences.

Not everyone thinks as logically as you do and assimilates all the information or takes bits and pieces of information and utilizes what may be beneficial. Unfortunately, many patients that visit this site are very vulnerable and often will change direction and follow any 'advice' if he/she believes it 'may' help.

NO WHERE in my post did I ever state that this website or any other similar website wasn't valuable regarding obtaining useful information as you have pointed out. Obviously, if I didn't believe this site was of significant value, I would not associate myself with the site.

I believe this site is extremely valuable regarding the fact that many patients have been educated regarding the true etiology (cause) of heel pain, tarsal tunnel pain, etc., the treatment options for plantar fasciitis, fasciosis, tarsal tunnel syndrome, etc. I also believe the site has been valuable discussing various medications, new technologies, scams, treatment options, surgical procedures, conservative alternatives, insurance issues, etc.,etc.

I personally have been a VERY STRONG advocate on this site for patients rights. I often get very angered when patients come on this site and state that his/her doctor didn't answer questions, rushed out of the room, didn't discuss treatment options, wouldn't return a phone call, etc. It's my feeling that it's not my responsibility or the responsibility of any of the medical professionals on this site to answer questions that should have been answered by your treating doctor. I shouldn't have to interpret the findings of your x-ray, MRI or CT scan. I shouldn't have to tell you the possible complications of your surgery tomorrow, I shouldn't have to tell you how long your doctor plans on keeping you in the cast HE applied.

That is the RESPONSIBILITY of the treating doctor. It's not that I don't want to answer the question, it's simply that I want patients to learn to demand answers that they deserve from their doctors.

You wouldn't purchase an expensive TV from a store and then call another appliance store to ask them how to use the TV would you? You'd expect and demand that the store where you purchased the TV give you all the information. You should expect no less from YOUR doctor!!!

The web site is also an excellent 'support' site for those to discuss issues and understand that other patients also have similar concerns and symptoms.

However, I still caution anyone from attempting to 'compare' your symptoms and situation to another person. What may sound similar may in fact be completely different.

Result number: 30

Message Number 261018

Re: Posterior Tibial Tendon Dysfuntion Therapy View Thread
Posted by Dr. Ed on 10/03/09 at 00:54

Steve:

A major consideration is that stage of the PTTD. Other issues such as subtalar joint and ankle arthrosis? An MRI will often help answer such questions.

There are a number of brace/AFO designs to consider. A new design is working very well on advanced PTTD patients, the 'Turbo.'

See: http://www.advancedorthopedicdesigns.com/TURBO.html

Dr. Ed

Result number: 31

Message Number 261015

Re: Solutions to PF View Thread
Posted by Dr. Wedemeyer on 10/02/09 at 18:59

'Not stretching is the cause of most PF issues'

I disagree. Improper biomechanics and footwear is the cause of MOST PF (along with gastroc/soleus/Achilles tightness, sudden increase in activity, rapid weight gain etc). While a high number of PF patients exhibit equinus at the ankle and a tight GSAT complex, many do not and therefore stretching will not address their particular issue.

Result number: 32

Message Number 260984

Re: Solutions to PF View Thread
Posted by John from MN on 10/01/09 at 09:55

I tried rest, did not work either. Don't forget there is tissue damage. Rest does not fix this type of damage. You must breakup the scar tissue manually, then let it heal. Very important you must stretch your calf muscles, quads and hamstring 3 times a day. Not stretching is the cause of most PF issues.

Result number: 33

Message Number 260977

China and Canadia --Oil View Thread
Posted by john h on 9/30/09 at 22:09

It is no urban legend that China is on the move to gain some leverage on oil in Canada who happens to be our largest importer of oil. They have purchased a stake in an Alberta Oil Company for drilling in the oil sands. Does this bother you at all?

Published: Sept. 2, 2009 at 3:57 PM
Order reprints
CALGARY, Alberta, Sept. 2 (UPI) -- PetroChina's $1.9 billion venture into Alberta's oil sands calls attention to the value of Canada's oil sands but is raising alarm bells about energy security.

Under the deal announced by Athabasca Oil Sands Corp. on Monday, PetroChina will acquire a 60 percent stake in its MacKay River and Dover oil sands projects. It is China's largest venture in Canadian oil sands to date.

Both projects are situated on some 5 billion barrels of yet-to-be-developed bitumen, part of Athabasca's nearly 10 billion barrels of bitumen reserves. Calgary-based Athabasca will continue to operate both projects, which will cost between $15 billion and $20 billion to develop.

Commercial oil could flow by 2014, with an initial production of 35,000 barrels per day and subsequent phases reaching a total 150,000 barrels per day.

The PetroChina-Athabasca deal, expected to close Oct. 31, will bolster Alberta's investment arena, hit by about $100 billion in canceled mining and oil sands projects since last year. Canadian oil sands represent the second-largest oil reserves in the world.

'Given the sheer size of the Canadian oil sands, it's an area that cannot be ignored by China,' said analyst Lanny Pendill with Edward Jones in St. Louis, the Calgary Herald reports.

But Carolyn Bartholomew, chairwoman of the U.S.-China Economic and Security Review Commission, warns of a growing Chinese presence in America's 'back yard,' the Globe and Mail reports.

She said that state-owned PetroChina is a proxy of Beijing's Communist government and rejects the notion that it operates as any other commercial oil company.

'I think that an acquisition like this should raise national security questions both for the government of Canada and for the government of the United States,' Bartholomew said, calling for a thorough review by Ottawa that would include sensitive national security issues.

However, former U.S. Ambassador to Canada Gordon Giffin said he doesn't expect the Obama administration to oppose PetroChina's investment in the oil sands.

Ottawa has recently added a national security test to its Investment Canada Act, which reviews foreign takeovers above $600 million.

Prime Minister Stephen Harper Tuesday acknowledged that PetroChina's investment in the assets controlled by Athabasca is more controversial than a private sector, foreign investment in Canada would be.

'I will just say that there are laws in place to review foreign investment transactions when they meet a certain threshold and our government has strengthened those reviews by including a clause that allows officials to examine issues of national security,' he said, the Globe and Mail reports.

Athabasca Chairman Bill Gallacher said he was confident that Ottawa would give a green light to the acquisition.

'Whatever customary reviews are required, we're going to follow that path and make sure we have all the fulsome disclosure required to make this project move forward,' he said.

© 2009 United Press International, Inc. All Rights Reserved.

Result number: 34

Message Number 260941

Re: Roman Polanskii View Thread
Posted by Dr. Z on 9/30/09 at 05:34

I believe he left because the Judge ignored the plea arrangement that was made. I believe jail time was avoided and the judge gave him jail time.
I need to understand exactly what the legal issues were and are today to make any judgements I am still trying to understand how the lockerbee killer was released home due to his illness.
PS) I really think his movie talent is way over rated.

Result number: 35

Message Number 260930

Re: We are turning left -they are turning right. View Thread
Posted by marie:) on 9/29/09 at 18:39

Hi Max and John,

What you may not understand fully is that conservatives in Europe are different from conservatives in our country. Merkel supports UNIVERSAL HEALTH CARE and FREE COLLEGE Educations for all!

In fact all European conservatives support UNIVERSAL HEALTH CARE!!!

Give me European conservatives any day of the week! They=Moderate!!!! They don't have hang ups on social issues either. ;)

Result number: 36

Message Number 260919

Re: Iran View Thread
Posted by Rick R on 9/29/09 at 09:32

Marie,

If one were to believe that there are free and fair elections in Iran then our issues with the government become issues with the people. I do not see that as the case so it makes things more complicated. Sanctions will hurt the common folk and may galvanize them against us. I don't see a gas shortage impacting their involvement in Iraq nor do I see it impacting their nuclear missile program and desire to turn Israel into vapors.

I also see Russia continuing to support Iran. Russia does not want stability in the Middle East. The Russian economy is in a bad way and needs oil prices to rise. Instability in oil producing regions will boost the Russian economy. Like it or not for the near term the world runs on oil. Our reluctance to exploit our own resources is sucicidal.

Rick

Result number: 37

Message Number 260904

Re: Go, go Obama!!!!! Obama wins stricter stance on nuclear weapons at UN!!!! View Thread
Posted by marie:) on 9/28/09 at 17:59

Ok Rick I'm not saying ANY government can be fully trusted on secret security issues.........including us. Howsever, Russia is on board and that fact is what's incredible and should be a sign to you what's up. This announcement came before we, the people, knew about Iran's secret new uranium plant. I'm pretty sure Russia and China were briefed prior to this meeting. And since it began with the Bush administraition I have to give him credit were credit is due. Nice job Bush.

Result number: 38

Message Number 260893

Re: Dr. DSW: Do any of your TTS patients have a history of bulimia/anorexia? View Thread
Posted by Dr. DSW on 9/28/09 at 14:16

Dottie,

It seems as if you have a very astute podiatrist. I also utilize Metanx for any patients that have nerve issues/nerve related problems, not just diabetic neuropathy patients.

Although Metanx has been proven to be effective for the reasons you've already described, Metanx also contains the B vitamins that I believe are very helpful in many nerve related problems.

Many of my non diabetic patients have related significant benefits since taking Metanx. They did not receive the same benefits when taking OTC B vitamins (the Metanx literature or website will explain the reason). There are really very few if any significant side effects to Metanx since they are water soluble vitamins and are very safe, so there's really no 'downside' to trying this medication.

Result number: 39

Message Number 260892

Health care View Thread
Posted by john h on 9/28/09 at 13:30

The U.S. received a grade of 'D' along with England on health care. Canada ranked 10Th and received a grade of 'B'. The grades were based not just on health care but other side issues of health care. Americans themselves thought there health care was excellent. Perception is very important in any issue. They largely agree that our health care system is broke but cannot agree on how to fix it. The large amount of money to fix it and where this money will come from is the largest item in the on going debate. As it stands now the Speaker of the House is unlikely to let the public see their final plan prior to a vote. It is unlikely the Senators and House members will see the final plan when they vote and most will not have read it. I find it strange that they can call it- bi-partisan if only Olympia Snow votes for it. One vote makes it bi-partisan? To any thinking person this sound ludicrous since this represents 1/6Th of the total American Economy. Some members suggest that 3 days is enough time for the public to read the final bill and have recommended posting it but will have to fight House and Senate Leadership to do this. We should have something for Obama to sign by the new year unless the whole thing falls apart. From my point of view I will be a loser as the Democrats plan to finance 500 billion dollars from 'so called' Medicare savings in waste and fraud. If that much exist why have they not saved it before now? They will end up cutting the pay to Doctors and hospitals and we will have fewer who will accept Medicare just at a point when we need more Doctors in family practice. One clear savings would be tort reform which is an absolute no brain-er but even that is not likely to happen as these lawyers are some of the largest donors that exist.

Which ever way Olympia Snow votes I will be OK with it as I think this lady is level headed and looks after the people first and the politics second.

Result number: 40

Message Number 260812

Re: Att:Dr. Wedemeyer or other Doc/pro View Thread
Posted by Roger on 9/24/09 at 10:37

Interesting thread.

I'd say I to am in the fasciosis stage. Have been fighting this for 4-5 years.

I do not have morning heel pain as such. My pain and discomfort come interestingly if I am off my feet a lot, sitting, I have discomfort, pain in the bottom of the foot/fascia area, as well as stress in the calf. If I am on my feet too much, and particularly certain pairs of shoes, I have discomfort.

I partculary find that I am comfortable/out of pain more, if I do regular stretches and moderate exercise of legs (exercise cycle or walking). My issues seem particularly tied to tight calf muscles. Keeping the legs warm help immensely too. If I let my legs get cool during the night, my calf muscle will be very tight, my foot will be pulling down in the morning. A night splint for 15 min before I get up helps with that, and then stretching.

If I let myself get over exercised, or don't do stretches, then the discomfort starts spreading beyond discomfort in the bottom of the foot and starts hurting in the heel.

During my fasciatis stage, ART, ICE, stretching, taping and night splint were the primary things that helped me. Now mostly stretching, and occasional use of the splint keep me going.

Result number: 41

Message Number 260782

Re: Haglund's Deformity View Thread
Posted by cartera on 9/22/09 at 18:46

I too suffered from Haglund's deformity for over a year and a half, and I want to let you know there is a non-surgical method that works! Like you, I was terrified at the idea of surgery, especially after reading some of these posts. My foot doctor x-rayed me and gave me anti-inflamatories and steroid patches - no change. He said the next step would be surgery and I did NOT want to go there. I am a very active person who likes to play soccer, run, and do martial arts, and the pain was almost unbearable even when just walking. So I went and saw my chiropractor who is very into homeopathic remedies and is very anti-'modern' medicine. Let me just say that EVERY problem I have had, from shoulder pain, knee pain, constipation, breathing issues, and headaches have ALL been cured through chiropractic treatment. I know some people think it's not a real cure, but all I care about is results and it has worked every time for me.

Anyway, the first thing he did was show me how an overly-tight tendon in my hip was causing my right leg to rotate out, which caused severe over-pronation in my right foot. This was essentially the cause of the deformity, as well as severe knee pain when I ran. TWO stretches in his office and my foot turned the right direction! I continued the stretches each day and the knee pain vanished within a few days! The foot pain continued, but a few months later I got orthotics and proper shoes (Rockport World Tour Elite) and now, two months later, the pain is all but gone, the bump on the back of my heel is less than half of what it was at its worst, and I am running like I was before without pain.

When I learned that the 'growth' on my heel was basically a callus on my bone that formed from everything being out of alignment, logic told me that if I get everything back in place the 'callus' would go away. PLEASE consider this treatment method before you have surgery.

It works!

Result number: 42

Message Number 260726

Had f/up w/podiatrist - neuropathy, TTS, post surgical pain View Thread
Posted by 362 on 9/21/09 at 04:21

I see my surgeon regularly for a $25 chat (my insurance co-pay) and, as usual, he was kind & compassionate but had that look on his face that I know so well. I have no reason to believe that this man (nor the doctor who performed my first surgery) has done anything but the best he could under the circumstances. But truth is a cold 'muther' and my truth is very clear: there is nothing more that medical science can offer me at this point in time.

So we talked about acceptance. There comes a time for some of us when we have to just deal with the fact that we are in pain now and will probably be in pain for the rest of our lives. We have to wrap our brains around not only today's pain but the distinct possibility that tomorrow's pain will be even more terrible. That being said, what shall we do? I am in that rather dark place that has me emotionally paralyzed. My kind doctor told me that it was doctor's orders that I never give up my fight. It is hard. The pain is bad even with the pain pills and Neurontin. Tonight I have been dealing with feet that feel like they are sitting near a roaring fire. Then comes the crushing pain that can only be described as something akin to having my feet being smashed in the jaws of an invisible vise. As the Neurontin pulled back some of those feelings, I sit here and experience the odd sensation of my bones throbbing and the strange feeling of something alive crawling inside my feet.

Once I get the worst of it to a dull roar, I try to sleep. Not so fast! Then the feet begin to want to curl which causes terrible 'charley horse' like involuntary spasms. I often must jump up from whatever I am doing (I've had this happen from a sound sleep as well) and stand on my toes to keep the cramp under control. Yes, I have Flexeril. Does it help? Just enough, I think.

VB, I completely understand your frustration and anger. My fella tries to understand but he really can't. On my bad days, I just stay home & give some excuse not to go see him. I get tired of having to say 'I'm in too much pain tonight' because I am sure he is tired of hearing it. I get mad that he seems to 'forget' that I have these medical issues that have my life in a stranglehold. I don't 'look sick' enough.

What we are dealing with is cruel and unfair. We walk a tightrope with our meds...taking enough to be somewhat effective but not so much that we cannot function as human beings. We walk a tightrope with our friends & family as we try to remain civil and 'normal' when our minds are screaming from the pain. We walk a tightrope on the job trying to not screw up even though the agony we experience will not allow us more than minimal concentration on the tasks at hand. You are truly blessed to have such a large support system!

Well, my feet are back on fire (the Neurontin helped for about an hour) and I need to try to get a little sleep. Yeah, right!

Result number: 43

Message Number 260705

Re: Solutions to PF View Thread
Posted by Dr. Wedemeyer on 9/19/09 at 19:05

Alex it is basically transverse friction massage of the affected tissues. It is not advised to perform this as a layperson because some intimate knowledge of anatomy is crucial to doing it properly. If you have any physical medicine benefits available to you, I would suggest you seek out a good manual therapist.

Alex have you tried taping btw? You've been posting for a while now and it doesn't seem like you are getting any solid progress. I remember our discussion from this thread and unless I missed it I did not see taping listed as a treatment:

http://heelspurs.com/m/25/33/t61.html

Result number: 44

Message Number 260690

ankle pain View Thread
Posted by erma v on 9/18/09 at 19:58

my mri report joint effusion edema of the soft tissues, fluid within the peroneal and medial tendon sheaths consistent with tenosynovitis. signal abnormality of the tarsal bones, which may represent chronic changs. marrow edema cannot be excluded. clinical correlayion is recommended.what does all of this mean will my ankle and foot get better. the pain started last november I went to the dr in may of this year and he has been given me injection. may up until aug 1st of this year. i refuse to take any more injections do to my ankle and foot Ican't walk 3blocks.Ihave sugar and afraid. Please could you tell me something. thank you.

Result number: 45

Message Number 260681

Re: Joe Wilson? View Thread
Posted by john h on 9/18/09 at 11:49

I would not yell out you lie to POTUS under any circumstance Marie either in or out of the military. Even if it was Bill Clinton swearing he never had sex with that woman. He has lied many times but that is not the issue. Good manners is the issue. I do not think 1 person in 100,000 would approve of his yelling out.

Is it more offensive to do this to the President than if it were say the Leader of the House or Senate.? Not really as once again it is a matter of decorum,

Yesterday the President of Iran was once again spreading the word during holiday celebrations that there was no Holocaust. Does this guy really believe that or is he just using it? If he believes it then he is crazy and must be feared. If he is using it for political purposes then the people who believe him have some real issues.

If a person tells another person he is lying and he believes what he says is he a liar? Is there a husband who has never at one time lied to his wife? Are there big lies and little lies or is a lie just a lie? If you look at the dictionary a lie is a lie regardless of the consequences.

I do not really see anyone out there defending Wilson so people for the most part think he was wrong. I doubt any election is going to hang on this. The worst thing to come of this is that some people like Maureen Dowd is trying to make it a racial issue and sadly there are many who will believe her. You and I disagree all the time but neither of us has called the other a liar. We may say you are wrong but have not resorted to the liar name calling.

Result number: 46

Message Number 260675

Re: Need Help Fast have big plans suffering from Plantar Fascitis View Thread
Posted by Dr. Wedemeyer on 9/17/09 at 21:52

Kay you really should seek a second opinion and a good neurologist. We can speculate but since only a physician who can examine you in real time can effectively diagnose you and offer you the appropriate treatment. I feel that your problems may be a complex of issues and that your low back and other symptoms need to be assessed further and imaging/electrodiagnostic studies are warranted.

Result number: 47

Message Number 260662

Re: Need Help Fast have big plans suffering from Plantar Fascitis View Thread
Posted by Kay A on 9/17/09 at 17:32

Yes I have always had lower back issues since I was little. We purchase a sleep number bed and that has help me alot with my back troubles. So I have been really good up until this April when I started doing my spring gardening and I jumped out of the back of the pickup from off loading dirt. STUPID...I am not a kid anymore. That is when this all started this whole mess. I started going to the Chiropractor for adjustment and accupunture which really works great on me but didn't help with my back and foot pain. Accupunture in the bottom of the foot is not a real treat let me tell you. But I wanted to do anything to relieve the pain. Then I decided to see my podiatrist found out that I had done a really stupid thing and put my orthodics in the wrong shoe. Have a good laugh still not sure when I did it and how long it was that way, I don't think very long though. Amazingly enough my back troubles went away but not my foot pain. That is when the podaitrist put me in the walking boot and then fitted me for new orthodics since mine were 10 years old. Also notice that my arch on my left foot (problem foot) has dropped, so more reason for new orthodics. Yes, you are correct that I do have relief when I am not weight bearing now. It use to ache alot at night she put me on Naproxen right away which didn't help much but got me to sleep for a little while, and wearing the splint boot at night. Then it was in the end of August when she put me on the neurotin and I am still taking the Naproxen. So when you say mechanical in nature that this is something I have to give it time or surgerically fixable? I appreciate your time with this it is good to talk and to be able to vent and problem solve with another person that understands it what we are going through. Thank you.

Result number: 48

Message Number 260638

Re: Need Help Fast have big plans suffering from Plantar Fascitis View Thread
Posted by Dr. Wedemeyer on 9/16/09 at 22:38

Kay that's alright, I realize that many people who find this site are in chronic pain and frustrated. I imagine that it's difficult to focus and that after recounting your history multiple times that small details can get lost along the way. They are important though.

From what you describe I have to ask if you have any low back issues or have in the past, previous treatment for low back pain and has this been ruled out as a cause or concomitant?

What you describe is nerve entrapment. Being placed on Neurotin is not always a panacea for neuropathic pain, like everything it has a benefit and it also abject failures to mediate your pain. It is also not diagnostic.

Your description sounds a lot like lumbar radiculopathy AND Tarsal Tunnel Syndrome occurring concomitantly (double crush syndrome) but it could also be TTS and heel pain syndrome such as chronic PF, fat pad displacement or lateral plantar nerve entrapment at the heel (Terri) . Either way the etiology of your complaint sounds mechanical in nature since you do experience relief when you are not weight-bearing.

Result number: 49

Message Number 260625

Re: Republican Bad boys at it again................. View Thread
Posted by marie:) on 9/16/09 at 15:39

Again I only wish you the best Tammy. I understand you have some issues. That's evident. I'm glad you don't have foot pain. Who was making fun of your foot pain? Not I. Wishing you well. No desire to get involved with your quest of personal attacks. Stay well.

:)

Result number: 50

Message Number 260609

Re: cryosurgery View Thread
Posted by Dr. DSW on 9/16/09 at 06:29

Norm,

I may be wrong, but IF I remember correctly, you're a physician. I was involved with many of those infamous debates many years ago regarding some of the cryosurgery issues.

You correctly stated the main point that I was 'arguing' during that time when one of the doctors was exploring/utilizing cryosurgery for tarsal tunnel symptoms. And that was the claim that it was 'selectively' destroying (effecting)sensory fibers, while not injuring motor fibers.

I kept asking for an explanation, but never received what I considered an adequate answer. As you apparently know, the tibial nerve is a mixed nerve, meaning it is both sensory and motor, and I never understood how cryosurgery could selectively eliminate sensory fibers without injuring or POTENTIALLY injuring motor fibers.

Therefore, I felt that utilizing cryosurgery on a mixed nerve had the potential to be a disaster if the motor fibers were injured.

HOWEVER, after some research and an eventual explanation some time later by Dr. Carazos (sp) and his colleagues in Arizona and Florida, I began to understand that they really are NOT applying the 'freeze' to the actual tibial nerve, but are more accurately targeting the more terminal branches of the tibial nerve which are strictly sensory branches.

In my opinion, the success or failure of the procedure will therefore be dependent on the level of the nerve entrapment/involvement. If the involvement is proximal in the tarsal tunnel and involves the actual tibial nerve, my opinion is that cryosurgery has the potential danger of injuring motor and sensory fibers. If the involvement is distal and only involves the sensory nerves, I believe that the procedure is no more risky than other alternatives.

If my memory is correct, I also thought you were being treated for RSD/CRPS??? Prior to any procedure, I would attempt to determine whether the pain is from the potential nerve entrapment, RSD/CRPS (if you have this disorder) or both, and discuss all treatment options with your 'team' of doctors.

Result number: 51

Message Number 260595

Re: The Gang of Six View Thread
Posted by marie:) on 9/15/09 at 17:28

Well I have to repsectfully disagree with you on the public option. Polls still have it ahead.....although slightly. I'm thinking it will be present in some form but maybe not in the Senate Bill. If no Republicans sign on to Health Care in the Senate then I predict Dems will view as an obstructionist move towards ALL health care reform and the entire thing could change.

I do agree that we need to take a second look at nuclear power. It's not what it was 30 years ago. It's much more advanced and somewhat safer.

Not sure what I think about these trade issues. Still watching.

Result number: 52

Message Number 260546

Immobilization for Sesamoiditis and Morton's Neuroma View Thread
Posted by Robbie on 9/13/09 at 18:13

My doctor put me in a cam boot for sesamoiditis and morton’s neuroma and said no weight bearing for 6 weeks. I am removing the boot several times a day to ice and am taking 5 days of anti-inflammatories to hopefully jump start the healing process. I’ve had these problems for about 4 months now.

I suffer from other foot problems (arch pain for 5 years) and wanted to treat this aggressively. Before the boot we tried rest, ice, physical therapy (ultrasound and iontopheresis), custom orthotics – all this right at the beginning as I didn’t want another chronic foot pain. None of these helped and the pain continued to get worse.

Question, is 6 weeks long enough in this boot and a treatment for sesamoiditis and morton's neuroma? Should I be doing something else besides resting and icing? Does this treatment have success for these issues? I should add a MRI was done to confirm a fracture did not exist. I do realize when I come out of the boot I will need to continue with shoe modifications to avoid this problem again (problem is not from injury). I did ask these questions of my doctor, but would like the opinions of the doctor's here too.

Thanks for your input.

Result number: 53

Message Number 260503

Re: Why so quiet Republicans? View Thread
Posted by marie:) on 9/11/09 at 14:20

Well I can't argue with that point. I'm fairly moderate on many issues but definitely lean health`care reform. It's long overdue and I believe most Americans know it. I will be anxious to read the final bill.....once I get done with War and Peace. ;)

Result number: 54

Message Number 260501

Re: Stretch for 10 seconds, release, repeat 10 times or just stretch for 2 minutes straight? View Thread
Posted by Julie on 9/11/09 at 11:38


There is a difference. It depends on what stretch you're doing, why you're doing it, and what you hope to achieve by doing it. The stretch-and-release technique gives the tissues you are stretching a chance to release and relax in between stretches, and the stretch will be more effective.

Strictly speaking, what the plantar fascia stretch does is to gently restore all the tissues, including the Achilles tendon and the calf muscles, to normal length after they have tightened and shortened during the night. Holding it for 2-3 minutes might damage the injured tissues and would be counterproductive.

This is an oversimplification, but the gist of it is that the plantar fascia stretch is a gentle, passive stretch that is not meant to be held. It is a good exercise for PF.
.

Result number: 55

Message Number 260487

Why so quiet Republicans? View Thread
Posted by marie:) on 9/10/09 at 20:14

The president gives a joint congressional speech on health care reform and ya'll got nothing to say? ;)

I like this site called PolitiFact. You can fact check the speech there.
http://www.politifact.com/truth-o-meter/

....................................

Nurses are on the front line of health care. Nothing against doctors but we all know they are the ones who are there with us when we are the most ill and often with us during our last breath. I have great respect for their judgement on the issues and they don't have anything to gain or lose in the debate.

http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2009-PR/ANA-Supports-Obama-Health-Care-Reform.aspx
“As nurses, every day we see first-hand the heart-breaking consequences of our nation’s flawed system,” Patton said. “We see patients in danger when they can’t access or afford the care they need. We hold a patient’s hand when they learn that their health insurance coverage has been denied or cancelled. And we see the day-to-day human cost of this system -- in the eyes of our patients and their families.”

..............................

Are Republicans concerned about the fact they allowed nuts to frame their ideas on Healthcare? I think some will come around. They don't want to be associated with the crazies during an election year.

http://www.chicagotribune.com/news/nationworld/sns-dc-health-congress-final,0,5073210.story
Most Republican leaders Thursday continued to lambaste Obama's healthcare plan. 'It sounded very much like the Chicago politics that I know he's familiar with,' said Arizona Sen. Jon Kyl, the No. 2 Republican in the Senate. 'It appeared as if he was trying to ram something through.'

Privately, however, some Republicans worried that the party's unremitting opposition to the Democratic plans could boomerang in next year's congressional elections, especially if a far-reaching plan is finally approved.

............................

What are our thoughts on assisting doctors to prevent defensive medicine as a result of frivolous lawsuits? Good? Bad? Thoughts?

http://whitehouse.blogs.foxnews.com/2009/09/10/hhs-plans-to-announce-tort-reform-in-one-month/
An administration official told Fox Sebelius hopes to announce within a month the location and scope of demonstration projects to curb frivolous lawsuits and, possibly, reduce the use of so-called defensive medicine to avoid them.

No decisions have been made, but the administration is looking at two approaches: one is to have doctors admit and disclose a medical mistake soon after it occurred and having patients submit a potential malpractice claim to a mediator instead of filing a lawsuit; the other is have an independent panel of experts review the merit of a patient's claim and validate it through an affidavit before a lawsuit can be filed.

Result number: 56

Message Number 260479

Re: PF as an Autoimmune Disease/ Arthritis View Thread
Posted by Cee Gee on 9/10/09 at 12:50

I can't believe what i've just read. IT'S ME! I have been diagnosed with muscle spasms, neck pain, tendonitis, Raynaud's Syndrome, not to mention other stuff. I have had severe PF...cortisone..orthotics..night splint..physical therapy and even surgery. have it in both feet. it went away for sometime now and is back along with multiple other pains. right now im on celebrex 200 mg 2x a day and God help me if i miss one dose. I have spinal issues..and they 'THINK....fibromyalgia'. sometimes i feel like a chronic complainer. No, not sometimes...most of the time.

Result number: 57

Message Number 260451

Vernie - You are not alone! View Thread
Posted by Dottie on 9/09/09 at 10:43

I have been gone from this board for a long while and reading some of the messages here broke my heart.

I first passed thru the gates of Neuropathy Hell in 2000. I heard words I never heard before...ideopathic bilateral peripheral neuropathy. Later it was diagnosed as TTS. All three of the podiatrists I saw said that TTS does not always show up on a nerve conduction study. If there was a treatment 'out there' I tried it. Lotions, potions, pills, shots, nerve blocks in spine & tail bone, physical therapy, acupuncture, deep tissue massage, TENS unit, lidocaine patches...you get my drift. I finally had TTT/PF release on my left foot in fall 2007. It was a disaster. In early 2008 I had a new surgeon clean out the scar tissue and re-do the TTS. I had foot drop by this time so I needed Achilles tendon release as well. Last June I had TTS surgery on my right foot.

I cannot adequately describe in words what I have gone through. I fully understand how a poor soul who endures this constant horrific pain day in...day out might just give up. We are all different and for any one person to hurl a condescending comment (even if unintentional) toward a fellow sufferer's need for disability is cruel in the extreme. It's those thoughts and comments that keep the truly disabled feeling like they have done something wrong! The heck with that noise! I have a disabled rear view mirror tag. I admit I am ashamed to use it. I took a trip last month and my feet literally gave out on me and I ended up on a busy airport's floor. I was too humiliated to request a wheelchair from American Airlines. Most times my disability is invisible so others cannot tell immediately that something is wrong. I am in mental health therapy now to find ways to cope with constant agony. My therapist helps me accept my disability and teaches me to toss aside the 'guilt' over something out of my control. There are also various associations that assist those with chronic pain that you can Google such as the American Chronic Pain Association. Chronic pain is no joke!!!! It is real and it is disabling. To say otherwise is an insult to those of us who wonder every day if we can survive thought the pain. Nobody can know what another human being is feeling.

To those of you who have had fantastic relief from surgeries or other treatment, I applaud you. I would stand and cheer but my feet cannot hold me up right now. Point being, there are a certain percentage of us who have pain in extreme levels, unable to take the new drugs and perhaps have other medical issues in the mix. There is no blanket remedy for all of us. Making the choice to apply for disability is a tough one and a very personal one - I had to limp away from an almost 20 year career. More power to those who healed better than I did. But my surgeries were colossal failures. The surgeries made made the pain horribly worse. Every treatment failed. The side effects from the drugs almost killed me. One made me psychotic....I learned that the slide into madness can be so gradual that you don't even know it. Another class of drugs gave me involuntary clenching, spasms and symptoms of narcolepsy. I also sleep walked and sleep drove. I woke up one day in my car in the left turn of a busy intersection after a grocery shopping trip in my sleep! I still have many of those symptoms TO THIS DAY. I fell down a flight of steps while sleep walking and did something to my left hand which rendered it useless. A bone scan showed no break. I now have to take a narcolepsy drug morning and noon or else I pass out in my cereal bowl. For my personal body, most available 'ground breaking' drugs are toxic. I was ready to take a final bold step....a spinal cord stimulation implant.

I was referred to a rheumatologist. After all the surgeries and trauma, I found out I have fibromyalgia. Since fibromyalgia can create a myriad of symptoms for a patient, I found out that my neuropathy can be a symptom of that disorder. There is no surgery to correct the symptoms of fibromyalgia. An implant would not work. The neuropathy is now in my hands. As bad as the foot pain and inability to walk is, not being able to use a thumb without extreme pain is a real close second.

Good luck to you, Vergie. Ignore the haters. Do whatever is necessary to save your own life and your own well being. Find a doctor that understands the needs of the chronic pain patient. Like Tom said, a paper trail of medical records is a must. I've got a trail that started in 2000 and has more doctors than you can imagine. I can honestly say I've seen and done about everything under the sun. I had the good luck to work for a company that offered long term disability. They required that I file with Social Security which I did by telephone. I have a disability law firm working on my case. They get paid from the settlement if there is one. An attorney is a must....you can't fight this alone.

I know it is trite but I'll say it anyway...hang in there!

Result number: 58

Message Number 260411

Re: Mens Athletic Sandals with Custom Orthotics View Thread
Posted by Jeremy L, C Ped on 9/07/09 at 21:21

He could certainly start with some of the classic styles from Naot. The stock inlay is already well made and supportive, plus they permit the use of a custom orthotic. Avoid most of the sport category sandals now being produced; most are horrid, especially when the wearer already has functional gait issues.

Result number: 59

Message Number 260374

Re: The war on terror View Thread
Posted by Dr. Ed on 9/06/09 at 18:08

Julie:

One could go back in history to present the secondary motives behind various wars and illustrate those who profited from such wars. The oil companies were huge winners of WW2 as the US and it's allies vanquished the forces of Rommel, gaining enormous influence in North Africa. The United Kingdom and France carved up the remains of the Ottoman Empire after WW1 creating states with artificial boundaries such as Iraq, the consequences of which we are still dealing with today.

I do not have a scorecard to attempt to assess the virtue of the benefactors of the numerous wars we have fought. Certainly, the need to vanquish Hitler in WW2 was paramount. The issues in WW1 are a bit more unclear to me.

Saddam was a very bad dictator who murdered his own people and supported terrorism. He was offering families of suicide bombers checks for $25,000 when a family member strapped on a bomb belt and blew themselves up in Israel, killing innocent civilians. Saddam had a facility in Iraq to train airplane hijackers. Was that the facility used to train the 9-11 hijackers? Perhaps we will never know due to the Bush administration having to deal with the consequences of Clinton's hobbling of our intelligence gathering capabilities for 8 years prior. I am not going to second guess Clinton's motives but suffice it to say, he acted on the advice of inexperienced theorists who believed that Humint (intelligence gathering by agents on the ground) was not needed and could be replaced by Elint (intelligence gathered by electronic means such as satellites). It can take over a decade to repair Humint; Bush was in office for less that 9 months when 9-11 occurred.

The biggest loss that occurred by us eliminating Saddam was a counterbalance to Iran. We also did not have an effective long term strategy for stabilizing Iraq.

I would not want to tell the victims of terrorism that military efforts to eliminate terrorist bases and operations is a 'marketing ploy.' The deaths and injuries suffered by Americans in 9-11, the Israeli citizens for several decades as well as others are very real. We have every right to go after terrorists via military means and to deal with state sponsors of terrorism.

Ed

Result number: 60

Message Number 260336

Re: The war on terror View Thread
Posted by Rick R on 9/04/09 at 11:05

Julie,

In the states we have been using the 'War' label to justify actions that would otherwise be unacceptable. In the name of the 'Drug War' our property can be confiscated by government without due process. In fact, the level of suspicion that property was acquired by funds gained through the illegal drug trade need not even meet the criteria required to file charges, let alone meet the requirements necessary for a conviction.

From our 5th amendment: '..... without due process of law; nor shall private property be taken for public use, without just compensation.[1]' Oh well.

That said I'm not sure it's smart to ignore a declaration of war on the part of those that have attacked us. We ignored the 1993 attack on the towers considering the threat a law enforcement issue opposed to a military strike. That didn't exactly lead to a decrease in the Jihad. There's only one difference between the two attacks, one worked one didn't. I'm concerned with the arrogance of brushing off a 'war' declared against us.

But 'War on Terror' doesn't seem the correct term. How about war on Al Qaeda? But that wouldn't have justified going to 'war' with the Taliban now would it. A one size fits all term eliminates the need to explain and justify distinctly different initiatives.

There is no doubt in my mind that when a country goes to war or even strikes back on a limited basis to respond to a strike against them, initially more enemies are created. When our country decided to resist secession we energized common non-slave-owning folk and entire states to join the confederate cause. Was that the wrong thing to do?

I'm with you on your skeptisism regarding financial motivations and the opportunistic errosion of civil liberties. I don't claim to have the answers.

I protested the initial invasion of Iraq, but saw the second phase as an inevitable consequence of the bad decision to go to begin with. If you knock me down and put your boot on my throat you had better finish the job because if you lift that boot off you are going to get it. That was the lesson of the Great War. I'm in a bit of a minority seeing WWI & WWII as two phases of one war. That view muddies our pristine good vs. evil simplification of WWII. But I digress.

Kuwait was a golden opportunity for the Middle East to resolve their own issues given the common port access role that Kuwait served in the region. Perhaps Saudia Arabia pulled the strings and we jumped.

We in the U.S. have allowed ourselves to become 70% dependent on foreign oil up from 30% when we had our 'crisis' in the 70's. We should have taken a page from the UK's playbook regarding how you have avoided allowing foreign dependence for food. I don't claim to know who is pulling the strings but I don't like it.

For us to pour billions into the hands of people that supress others is not a formula for making freinds. On one hand we can claim to be 'spreading democracy' yet on the other finance dictators that happen to sell us oil. I suspect that the root of our troubles. But they had what we wanted to literally fuel our economies. So we are reaping what we have sowed, I suspect so.

We are where we are so we need to address the root cause and deal with the consequences of not doing so. I for one don't think either or any political force in the U.S. has faced up to the task.

Rick

Result number: 61

Message Number 260300

Related question for the doctors View Thread
Posted by Stacy on 9/02/09 at 19:35

Once you reach the fasciosis stage what treatments are effective?

I had cryosurgery about a year ago. Cryo was the ONLY treatment that relieved my long standing symptoms.

Seven months ago, I was diagnosed with posterior tibial tendonitis(accessory navicular). Non invasive proceedures did not work and three weeks ago I had a modified kidner. The MRI had shown minimal tearing at the insertion; however when the doctor went in, he discovered some large tears which he was able to successfully repair.
I know that I will have to continue with orthotics after I am recovered from the surgery.

Here are my two questions

Despite having symptomatic relief, a recent ultrasound showed that the fascia is still quite thick (7.5 mm). You stated that fasciosis is a degenerative process. Does this mean that I will be facing a rupture of the plantar fascia eventually?

I am guessing that the posterior tibial issues are related to the plantar fasciitis. Now that the accessory navicular was removed and tendon repaired and repositioned will that prevent the plantar fascia from getting worse as long as I wear good shoes/orthotics?

Thank you for your response

Result number: 62

Message Number 260299

Related question for the doctors View Thread
Posted by Stacy on 9/02/09 at 19:33

Once you reach the fasciosis stage what treatments are effective?

I had cryosurgery about a year ago. Cryo was the ONLY treatment that relieved my long standing symptoms.

Seven months ago, I was diagnosed with posterior tibial tendonitis(accessory navicular). Non invasive proceedures did not work and three weeks ago I had a modified kidner. The MRI had shown minimal tearing at the insertion; however when the doctor went in, he discovered some large tears which he was able to successfully repair.
I know that I will have to continue with orthotics after I am recovered from the surgery.

Here are my two questions

Despite having symptomatic relief, a recent ultrasound showed that the fascia is still quite thick (7.5 mm). You stated that fasciosis is a degenerative process. Does this mean that I will be facing a rupture of the plantar fascia eventually?

I am guessing that the posterior tibial issues are related to the plantar fasciitis. Now that the accessory navicular was removed and tendon repaired and repositioned will that prevent the plantar fascia from getting worse as long as I wear good shoes/orthotics?

Thank you for your response

Result number: 63

Message Number 260267

Re: going to try acupuncture tomorrow, any suggestions on what to ask for? View Thread
Posted by Dr. Wedemeyer on 9/01/09 at 17:33

William the term plantar fasciitis is really a misnomer. The plantar fascia is a tendonous aponeurosis at the origin and more closely resembles a ligament on histological examination distally. It is not a true fascia. It does exhibit inflammation in the acute and subacute stages which recedes and is then considered a chronic, painful noninflammatory condition termed fasciosis in later stages when unresolved. Fasciosis exhibits thickening of the tissues on ultrasound and MR/CT imaging.

Feel free to explore acupuncture William but I think your investment, time and feet would benefit more from following your own doctor's orders and considering injections, custom orthoses and immobilizing the foot for a period of time etc.. It takes some time to atrophy a healthy muscle with normal vascularity and nervous supply in a cast.

I would seek out Dr. Eric Fuller in Berkley CA if you are not satisfied with your current care. If you can afford Z-coils I feel that you can afford a good doctor.

Result number: 64

Message Number 260247

Re: Toddler with "sleeping" toe View Thread
Posted by Dr. DSW on 9/01/09 at 07:12

It may have something to do with his sitting habits or can be secondary to electrolytes or many other issues. However, this is something that should definitely be discussed with your pediatrician and/or your podiatrist and not ignored.

Result number: 65

Message Number 260241

Toddler with "sleeping" toe View Thread
Posted by kelleyd on 8/31/09 at 21:02

My 2.5 year old told me his toes were sleeping. When I pressed on it almost seemed as if his second tow was having a spasm, it looked like it was crossing over the third toe and then again the big toe. When I moved it he didn't seem to have issues, he did pull back but he doesn't like his feet touched very much.
I asked him throughout the day how his toes were. He said fine, until almost bedtime when they were'sleeping' again. I assume sleeping is numb. Should I be concerned??

Result number: 66

Message Number 260237

Re: going to try acupuncture tomorrow, any suggestions on what to ask for? View Thread
Posted by Dr. Wedemeyer on 8/31/09 at 20:00

William based on your previous posts I fail to see how needle acupuncture is going to benefit your PF issues specifically. Given what you describe temporary heel lifts and more supportive footwear based on when you wrote 'I feel better when i have a lot of arch support so that my heel doesnt have as much weight on it'.

What conservative treatments have you had thus far? What state do you live in and city, perhaps we can steer you to someone who can help.

Result number: 67

Message Number 260236

Re: Combine Heel cups and insoles View Thread
Posted by Jeremy L, C Ped on 8/31/09 at 19:35

The materials used for Aetrex's cushioned inserts make Tuli Heel Cups (I assume that's what you were provided) all but redundant. The heel cups work through the displacement of the molded squares underneath the device. If placed on top of your inserts, these would be absorbed by the foam cover and will not be able to work to their greatest capacity. If placed beneath, there may be fit issues. You'll just need to try, and see what works best for you.

Result number: 68

Message Number 260220

nodule under foot, sprained ankle and ball of foot problems View Thread
Posted by jo on 8/31/09 at 08:22

I twisted my ankle about 3 years ago which caused a pain from the inside of my heel across my sole to my little toe area. I treated it with stretches and ice, it settled down. Occassionaly since then I get pain on the bottom of my foot that moves about and a pain at the back of the heel, normally when resting. Pain is released by stretching and massaging the sole of my foot with a hockey ball. About a year ago I noticeed a nodule just under the skin in the middle of my foot that sweels some times, mainly after exercise, and is saw when pressed.

I am not flat footed but across the balls of my foot is flat, my Mum has this and says it is a flat metatarsal arch. I have always found shoes moulded to the balls of my feet more comfortable than others but I have difficulty finding such shoes. A year or so ago I developed a pain in the middle of the balls of my feet which hurts when pressed and recently was made worse by wearing inflexible walking boots on holiday. I run, do yoga, karate and other sports and I am over 40 and over weight.

I took it to the doctor who said that as it did not stop me exercising it was not important. I would like to deal with it now rather than risk future problems or be forced to stop exercising even for a while.

1, Initially I would like to try some self-treatment but if I try to get treatment privately what type of specialist should I see? What qualifiactions should they have? I am in the UK.
2, The nodule seems to tighten up the tissues that run across the sole of my foot so could this the underlying problem? or are there more?
3, Most foot supports are for the heel. Can I get supports for the balls of my feet?

Result number: 69

Message Number 260165

Re: 7 foot surgeries View Thread
Posted by Dr. DSW on 8/29/09 at 06:23

I'm not sure I understand what you're asking. Was the last surgery successful? Did the last arthrodesis/fusion with the iliac bone graft work? If it did, I'm not sure what you're asking other than what can be done regarding your shorter foot.

When the bone is fused, the surgeon usually attempts to use a graft to maintain the length of the first metatarsal. However, sometimes there is some resorbtion of the graft and it may shorten a little. The surgeon attempts not to make the graft too long because it can stress the soft tissues and cause compromise of the blood vessels.

The Weil osteotomies you had performed can also cause shortening of the other metatarsals, so your second surgeon may have taken that into consideration when he performed the second surgery on your first metatarsal.

If you are comfortable, but simply don't like the look of your foot, the only way to correct it at this bone is additional bone grafting to lengthen the bones, which I do NOT recommend, since the results are unpredictable.

If you have discomfort, orthotics may help and you should discuss your concerns with your doctor.

Result number: 70

Message Number 260164

Re: 7 foot surgeries View Thread
Posted by Dr. DSW on 8/29/09 at 06:22

I'm not sure I understand what you're asking. Was the last surgery successful? Did the last arthrodesis/fusion with the iliac bone graft work? If it did, I'm not sure what you're asking other than what can be done regarding your shorter foot.

When the bone is fused, the surgeon usually attempts to use a graft to maintain the length of the first metatarsal. However, sometimes there is some resorbtion of the graft and it may shorten a little. The surgeon attempts not to make the graft too long because it can stress the soft tissues and cause compromise of the blood vessels.

The Weil osteotomies you had performed can also cause shortening of the other metatarsals, so your second surgeon may have taken that into consideration when he performed the second surgery on your first metatarsal.

If you are comfortable, but simply don't like the look of your foot, the only way to correct it at this bone is additional bone grafting to lengthen the bones, which I do NOT recommend, since the results are unpredictable.

If you have discomfort, orthotics may help and you should discuss your concerns with your doctor.

Result number: 71

Message Number 260163

Re: 7 foot surgeries View Thread
Posted by Dr. DSW on 8/29/09 at 06:22

I'm not sure I understand what you're asking. Was the last surgery successful? Did the last arthrodesis/fusion with the iliac bone graft work? If it did, I'm not sure what you're asking other than what can be done regarding your shorter foot.

When the bone is fused, the surgeon usually attempts to use a graft to maintain the length of the first metatarsal. However, sometimes there is some resorbtion of the graft and it may shorten a little. The surgeon attempts not to make the graft too long because it can stress the soft tissues and cause compromise of the blood vessels.

The Weil osteotomies you had performed can also cause shortening of the other metatarsals, so your second surgeon may have taken that into consideration when he performed the second surgery on your first metatarsal.

If you are comfortable, but simply don't like the look of your foot, the only way to correct it at this bone is additional bone grafting to lengthen the bones, which I do NOT recommend, since the results are unpredictable.

If you have discomfort, orthotics may help and you should discuss your concerns with your doctor.

Result number: 72

Message Number 260162

Arizona Brace & RSD View Thread
Posted by JuLeen on 8/28/09 at 20:14

My Ortho Foot & Ankle specialist is requesting an 'Arizona Brace' to help support my foot and ankle since I am still having issues with the PTT and he is not going to do further surgery since the PTT is still intact. We're waiting on authorization right now.

How can this type of brace work with a person that has RSD in the medial area of the foot going up towards the top of my foot, in the arch and the ball of my foot? Is it just a matter of just having to deal with it or are there adjustments that can be made? I'm not that familiar with this particular brace.

He is trying to find an option to get me 100% out of the CAM Boot that I am still in.

Result number: 73

Message Number 260157

Re: DR.DSW View Thread
Posted by Dr. DSW on 8/28/09 at 17:04

I do not provide my advice regarding potential malpractice issues on this website. If you'd like my opinion on those types of issues, contact an attorney and he can hire me as an expert witness, where I charge a significantly high fee for that advice.

This site is not intended to provide legal advice or second guess why a surgeon performed a particular procedure in a particular manner. I was not there when the surgery was performed and have not reviewed your records. If you believe you have the grounds for a legal case, than it's your responsibility to contact an attorney, and he/she will hire an expert witness to review the facts of the case.

Result number: 74

Message Number 260148

Re: AARP Poll finds 86% americans believe ....... View Thread
Posted by john h on 8/28/09 at 09:49

Marie: As a member of AARP for perhaps 20 years I can tell you the organization is very Liberal. Recently 10's of thousands of members have been turning in their cards as the leadership has not been representing our views. Not just on healthcare but on various issues. On the House plan President Obama told a group that the plan had been endorsed by the AARP. That was totally wrong and the next day the President of AARP corrected the President and said they had not endorsed any plan as there is really no plan to endorse. They are one of the most powerful lobby group in the nation with over 40 million members. Older people tend to vote more than others. There is a new organization (The American Seniors Association) that is being formed to compete against AARP. Over 40,000 AARP members have turned in their AARP cards since July 1st. Mine is among them.

http://www.youtube.com/watch?v=JAecYnw4KlA

Result number: 75

Message Number 260131

Jeremy-Orthotic question View Thread
Posted by mrbuddy on 8/27/09 at 09:20

What is your opinion of adding a foam cover to an existing orthotic without removing the old cover. I went in complaining about sore arches and the pod. thought I need more padding. However I think this may be causing me more issues as I now notice pain in balls of my feet in shoes that i could wear fine before.
thanks again

Result number: 76

Message Number 260126

Re: numb toes View Thread
Posted by Dr. DSW on 8/26/09 at 20:31

You should ask your surgeon first, because it will depend on the distribution of the numbness. It can depend on the placement of his incision, since the posterior tibial tendon runs with the tibial nerve into the tarsal tunnel. So any edema or swelling around the tendon can have an impact on the nerve. However, if he kept the incision distal on the foot, the chances of it having an impact on the nerve are significantly less.

Naturally, your spine issues can also be playing a major role in your symptoms, but it would be best to speak with your surgeon to have him evaluate the situation and let him determine whether he thinks it may be related to the surgery or coming from your back, or possibly a combination of both.

Result number: 77

Message Number 260105

Re: Toddler shoes with arch support.... View Thread
Posted by Dr. Wedemeyer on 8/26/09 at 15:34

In a child in-toeing can be a normal variant that resolves over time. The precise cause needs to be addressed and the need for corrective shoes and/or orthoses. I would seek the opinion of a podiatrist or orthopedic foot & ankle specialist that sees a large number of pediatric patients before rushing to judgment. Especially if your child has had any issues with her hips in infancy.

Also bear in mind that simply providing a shoe with a strong medial bias to a high-arched foot can exacerbate the issue that you are concerned about. If she truly need a specific shoe last I would ask for a referral to an orthotist or pedorthist who treats pediatric patients.

Result number: 78

Message Number 260052

Re: To the Doctors and Pedorthists- which shoe brands do you feel offer the best design/support for the money? View Thread
Posted by Dr. DSW on 8/24/09 at 20:22

Doesn't ANYONE appreciate the fact that I keep the pool warm?

On a serious note, I hope that no one gets offended, but I really don't plan on attending the PFOLA convention. Shoes/pedorthics is not my specialty and that's why I refer patients to a Cped when I have a question regarding footwear.

I have very little free time to attend seminars/conventions, etc., therefore when I do, the seminars I attend are usually to keep up to date regarding advances in surgical techniques, new products used in surgery, etc., or new advances in patient care, all of which are the main focus of my clinical/daily practice.

I can not possibly keep up to date on all the new shoes/footwear like Jeremy, and that's why he's an expert and I'm not, and that's why I refer my patients with shoe related issues to a Cped. I can't possibly be an expert on everything......only on MOST everything!!!

So, although I'd like to meet up with everyone, I won't be attending the PFOLA meeting. However, I heard the Miss Hawaiian Tropic meeting is coming up soon.......waddya say??? I'm sure there's something I can find there I can integrate into my office!

Result number: 79

Message Number 260048

Fractured heel spur View Thread
Posted by RCP on 8/24/09 at 19:12

Hi Docs,
A very hard, flat-footed landing on a hard floor (wearing only my socks) resulted in some intense pain on the bottom of my left heel. A trip to my family doc and an x-ray revealed a fairly large spur coming from my left calcaneous bone, which points toward my arch and essentially is parallel to the ground. The x-ray showed that the tip of the spur bascially broke off. Right now I cannot put any weight directly on my foot without experiencing intense pain. My family doc said it should heal in a few weeks if I stay off it as much as possible and ice it frequently. He also recommended buying one or two shoe inserts and cutting 'donut' holes in them to keep the pressure off. However, I find myself wondering two things. First, should I expect a spur (an 'abnormality') to heal properly? Second, given that spurs typically are caused by issues of the plantar fascia, should I worry about other damage (e.g., a tear)?
Thank you!
RCP

Result number: 80

Message Number 260005

Re: Still dealing w/ pain from RSD & PTT View Thread
Posted by JuLeen on 8/23/09 at 01:09

Dr. DSW,
I would never insult my doctor with not trusting him. I have told him many times that I trust him to the extent that I put my life in his hands without any questions and we (my husband and I) completely appreciate everything that he has done for me! He is just as frustrated as I am. He has told me that he feels like he is running out of options. That is the only reason why I was asking.

Please understand that at this point I am just frustrated and I am hoping and praying that we can get the RSD into remission - and quickly!

I have heard of the doctor that you're referring to. I actually got my Pain Management doctor to speak with him about the Ketamine and the Ketamine treatment. I am aware of the Ketamine comas that are not FDA approved in the USA. Although the FDA has approved Ketamine for RDS patients for oral usage, infusion (which my doctor is not familiar with), etc... As you can see we have checked into that.

Plus, in addition to the RSD I continue to deal with PTT issues and a lot of scar tissue that we can not do anything about. Are there any options to deal with scar tissue or to break it up other than surgery. Odviously, that is not an option at this point with RSD in the picture.

Thank you for your input.

I'm hopeful that my foot and ankle will be able to tolerate the Arizona brace that my Orthopedic Doctor is talking about to help support my PTT. Especially since my foot and ankle feel very unstable at this point.

The boot is throwing off my back and it is a big issue with my gait. I need something that will assist with both of these issues and hopefully the brace will do that.

Thank You,

JuLeen

Result number: 81

Message Number 260001

Re: Effect of tort reform on Texas View Thread
Posted by Dr. Ed on 8/22/09 at 20:11

Almost 15,000 doctors have come to Texas since the passage of tort reform. That has made a large impact on services to the poor in underserved/rural areas:
http://www.rickperry.org/issues/health-care?gclid=CIKN-ObLuJwCFQtM2godBRqVmw
Ed

Result number: 82
Searching file 25

Message Number 259965

"Walk like an Egyptian..." View Thread
Posted by Dr. Ed on 8/21/09 at 11:30

admirer:

With credit to the Bangles for their hit song, 'Walk Like an Egyptian' -
http://www.last.fm/music/The+Bangles/_/Walk+Like+an+Egyptian

There is no disease, no pathology, no disability associated with an Egyptian foot type. No need to worry.

An empirical observation was made comparing Greek statues to Egyptian statues years ago. It was noted that the feet of Egyptian statues have the big toe longer than the second and that Greek statues have the second toe longer than the first. That is about all there is to it.

There seem to be a higher incidence of certain biomechanical issues associated with different foot types but no one is treated based solely on the foot type they may have.

Dr. Ed

Result number: 83

Message Number 259891

Re: My 11 year old son's feet have issues- hammertoe, wart? Pediatrist or Ortho? View Thread
Posted by Jeremy L, C Ped on 8/19/09 at 21:06

Your description makes a visit to a medical professional specializing in the foot and ankle (podiatrist or orthopedist) a good idea. Best wishes for him.

As far as 'good, supportive shoes' go, most people have a mistaken idea of what they should be looking for. With elements as you describe in your son, it's almost always critical to have a solid midfoot shank in a shoe. In simpler terms, if you can easily twist the arch area of the soles of his shoes, then they are certainly contributing to his deformity. There are credentialed perdorthists who specialize in pediatrics (an excellent group exists outside Washington, DC) who could particularly be beneficial.

Result number: 84

Message Number 259889

My 11 year old son's feet have issues- hammertoe, wart? Pediatrist or Ortho? View Thread
Posted by Rebecca S. on 8/19/09 at 20:10

Ok, so I seem to be learning more about feet than I cared to this summer!

My 11 year old son, who is almost 5'5' and weighs 155 pounds and wears a men's size 10 shoe (yes, he's huge) showed me his feet yesterday. I am shocked to see that his big toes are turning inward, quite sharply. Right now, they look a lot like the 'after' picture on this page:

http://www.joshuakaye.com/images/BAfeet.JPG

But, I'd say the angle of each big toe is about 10 or so more degrees sharper than the after photo. The toes don't overlap or anything (yet), but this picture was the closest thing I could find in an image search for 'halux hammertoe.'

Obviously, I am concerned and don't want him to get to the 'before' stage. He does have retroverted hips and walks with very little bend in his knees. He has some gross motor impairments and turns both of his feet out when he walks, but his left foot more than his right. His pediatrician has always advised keeping him in good, supportive shoes, which I have always done.

I have had a heck of a summer with my own injury, and haven't been able to be as involved as I usually am w/ his personal hygiene, usually I am checking to make sure he trims his toenails, etc...but I KNOW that I helped him trim them in the middle of June, and his toes were NOT at that angle!

As if I wasn't alarmed enough by how his toes looked, he turns his foot over , and he also has what looks to be like a big plantar wart on his left heel, right in the area where you typically get PF pain on the side of the center of the heel! It is hard to tell for sure, because there is a big callus built up around it. He says this has been there about a month or so. But judging on how big the callus is, I'd say longer.

Where do I start with this? I have an appointment w/ a Pediatric Orhopedist for him in September, because I wanted his gait and hips re-evaluated to see if we could get him walking more naturally. He says he doesn't have any pain in his feet and played baseball all summer without complaining of any pain. The Ortho that he is seeing is the same doctor who took care of my daughter last year when she broke her elbow, and I do trust him and feel he is a caring and knowledgeable doctor. But he's not a foot and ankle specialist, though there are 2 of those in the same practice.

Do I wait and just take him to the Ortho appointment? Should he see a Podiatrist instead? And what about the wart? Is that something a dermatologist handles or what? Maybe I should just take him to his pediatrician? I don't need a referral and since I'm guessing he needs a specialist, I might as well just go on and locate one.

Just looking for a trail to follow so I know who I should start calling tomorrow! Is there anything I can/should do in the meantime?

Result number: 85

Message Number 259869

Apologies. View Thread
Posted by Beau Avery, Pedorthist on 8/19/09 at 13:56

No pun intended: I did not mean to 'step on the toes' of any doctor here. In the interest of helping I mistakenly posted a couple of responses in this forum without realizing that it is restricted for doctors only.Please understand that it was not my intention to, in any way, impress upon the members of this forum that I am a doctor. I am a medical professional, a Pedorthist, interested in the various problems of the feet and gait, and in discussing those issues with the medical community.

Result number: 86

Message Number 259849

Re: Switching from custom orthotics to store-bought? View Thread
Posted by Dr. Ed on 8/18/09 at 21:16

Chris:
There are a number of things to consider. Orthotics only treat one leg of the treatment triad so it may be necessary to better refine the diagnosis and treatment. If orthotics are to be part of the treatment armamentarium then they must target the specific biomechanical issues such as subtalar joint overpronation in the midstance phase of gait and midtarsal joint oversupination in the propulsive phase of gait. Prefabricated orthotics may address the former but almost never the latter biomechanical issue.
Dr. Ed

Result number: 87

Message Number 259847

Re: Making a decision between ESWT, Topaz, or dry needling View Thread
Posted by Dr. Ed on 8/18/09 at 21:03

Mark:

Published results need to be reproduceable across larger numbers of patients and providers before one can come to better conclusions. I think that the downside to dry needling in relatively modest. Nevertheless, we are talking about a sucess rate stated by one practitioner. I have no doubt that he may be a very talented individual.
It is important to know if the issue involve fasciosis or if fasciosis is indeed the primary culprit. If so ESWT and Topaz are targeted for fasciosis.

I have used both ESWT and Topaz. ESWT is a bit hard to come by and coverage issues exist. Dr. Z has a network of practitioners in the Northeast. It is worth giving him a call.

Dr. Ed

Result number: 88

Message Number 259846

Re: Health care, continued View Thread
Posted by Dr. Ed on 8/18/09 at 20:49

Julie:

Good article but consider the specific issues brought up by the author and how simply they could be addressed.
1) A national catastrophic policy for all citizens. This would ensure that no person could be brought to financial ruin by health issues.
2) Delinkage of insurance to the employer. The tax code has favored employer provided health insurance for decades. People should be able to obtain their own policies on the open market. Insurance companies realizing that there is a stop loss provided by the national catastrophic policy would be more willing to write policies for those with chronic conditions.
3) High risk insurance pools. This already exists in many states. Some subsidy may be required to make such policies affordable. Needs testing should be considered.

Of course, I use the word 'simply' somewhat sarcastically. Policies which may seem simple to put in place may be very difficult to establish considering the political landscape in the US.

It is interesting to see people talk about a private market for insurance in the US when about a half a dozen insurance companies or organizations have a near monopoly. The bottom line is that if you want to get health insurance in most states your choices are United Healthcare, Aetna, Blue Cross/Blue Shield, Humana, Cigna and a few smaller players. If you want an individual policy your choices may be limited to Golden Rule (now owned by United), Celtic and Assurant. There are generally some limited offerings in the individual market by the larger players too.

Ed

Result number: 89

Message Number 259766

Re: "Good Feet" Store and Arch Supports View Thread
Posted by Dr. Wedemeyer on 8/16/09 at 18:24

If the only issues are shoes and you have been advised to find more appropriate shoes for your wife by your doctor, I would suggest locating a Certified Pedorthist local to you for fitting:

http://www.abcop.org/Pages/Directory.aspx

Result number: 90

Message Number 259716

Re: Ice making PF pain worse? Anyone else have this? View Thread
Posted by Dr. DSW on 8/15/09 at 06:41

First of all, I take extreme issue with your cryosurgeons comment that he can 'see' nerve entrapment on the ultrasound.

If you are having some of the other symptoms you describe such as the severe cramps, you may need some blood work or tests to rule out other metabolic causes for your pain. Have you ever had a work up for your thyroid or other medical conditions?? I'm not overly concerned if your feet are 'cramping', but if your feet are 'twitching' or having muscle fasciculations, I would be concerned and that would warrant a visit to a neurologist to rule out some serious issues.

Once again, I believe I would hold off on ESWT until you have a much more comprehensive work up than you have so far. I believe that additional tests are in order including diagnostic nerve blocks, blood tests and a possible evaluation by an internist or neurologist.

Result number: 91

Message Number 259699

Re: Finding Truth In Healthcare Reform View Thread
Posted by marie:) on 8/14/09 at 16:48

Hi Wendy,

Some of what you say is true. But in the USA healthcare reform is not about poor people it's about some serious insurance, medical, perscription and prevention issues that affect everyone. It's the average lower to upper middle class American that is most at risk in our country. It's about pre-existing conditions, being dumped by an insurance provider after a dx with serious medical condition, it's about life saving insurance claim denials, defensive medical treatment that runs up billions in unnecessary tests, making money off of it and everyone is just one step away from declaring bankruptcy irregardless of whether or not they have insurance. It's a system that needs changed and I do believe President Obama and Democratic leadership aim to do just that. Phew.

Result number: 92

Message Number 259682

Re: Finding Truth In Healthcare Reform View Thread
Posted by Rick R on 8/13/09 at 17:34

I like the concept of HSA's but in my experience it's been another system where the default behavior is to attempt to duck a contractual obligation. Then if the cutomer complains blackmail them via credit ratings. In manufacturing if we did that we'd bill for a product expect to get paid and never ship then blackmail if they complain. How long would we last? A stupid question on the surface but throw noncompetitive forces in the mix and that's what we have in the medical profession.

Great point, how about we let doctors do doctoring rather than fight the system. Talk about waste!

Ok here's my idea which I guarntee the government formerly of the people by the people will not allow:

You team up with a consortium of doctors covering the 80% of what the data show to be what people need, in the ratio they need. We the users pay in a monthly fee regardless of need or use, as we currently would pay a middleman, the insurance slug. A review board of users and providers arbitrates abuse issues. We users surrender our right to sue. No insurance per sey. Some of the monthly fee goes to a fund for the occasions when we go out of the cooperative. You in?

Rick

Result number: 93

Message Number 259676

Re: Finding Truth In Healthcare Reform View Thread
Posted by john h on 8/13/09 at 14:55

Wendy: The first thing to understand is there is no final plan with all the details for anyone to review. We have a broad outline in the house. If this plan were to be approved then bureaucrats would begin to write the long details of how to make the plan work. That is why it is expected to take at least until 2013 to put the plan into existence if passed. Until we know all the details that have not even been written we lack any specific information from Obama or his staff.

As a Medicare patient I can see any Doctor in the United States who will accept Medicare patients. That is most of them. No matter how good or famous these Doctors are they are still paid what all Doctors are paid by Medicare for a given procedure. I have traveled to Dallas to visit perhaps the best back clinic in the world. The Texas Back Institute. They are often used by the FDA to test new procedures and have often been on the Today Show. I consulted with the founder of the clinic. I did not have to be referred there. I just called up and made an appointment. Having injured my back in an aircraft crash when shot down I have long had a back problem. This was paid for by Medicare. Rich or poor you go on Medicare at age 65. There are two types of Medicare and you can pick one over the other. If you have the money you can go out and buy the most expensive plan available from any company even though you are on Medicare. Some companies pay over $40,000 a year for a plan for certain employees. If you are Bill Gates why would you even want any insurance?

Medicaid is not based on age as is Medicare but is a program for individuals who meet certain low income standards. You may be 22 years old and qualify for Medicaid. It is funded by both the Federal and State governments. You can be an alien and get on this program. The states and Feds are often at odds on this funding. If California is mandated to cover certain legal aliens to cover them under Medicaid then they perhaps have a right to complain as their state drifts towards bankruptcy. I think some of their cuts recently passed may come out of Medicaid.

Concerning high risk patients I heard a discussion that by taking in 45-million new insurance customers the insurance companies would have enough of a new base to cover the cost of those with serious health issues. Since the insurance companies have already basically agreed to this one should think their statisticians would already have concluded that to be the case. Many of the new customer will be young healthy people who will offset those in poor health.

In Canada you have enjoyed your system for many years and apparently are for the most part are happy with it. I suspect if your government proposed to totally change you system to some other you would have some heated town hall meetings. People generally do not like change and particularly change that has not even yet been defined. 78% of Americans are shown to like their insurance so it should come as no surprise that we are having heated debates. The English like small cars and Americans like big cars and pickup trucks. One is not right and the other wrong. We grew as nations in a different manner. Canadians like ice hockey and Americans like American football. Weather made all the difference. We are headed towards a better healthcare system we hope. How we get there will be a problem for all Americans to fight over and ultimately resolve. Our first attempt may fail. It may take more than three years to get there. It may take ten as we are being asked to totally chaned 1/6th of our total economic outut in a matter of a few months.

Medicare is not free. I pay around $94 a month for medicare as does my wife and it goes up each year. I think we have a deductible of $300 that must be met before the Medicare kicks in. We of course have to pay the usual 20% of any cost made by a Doctor or hospital. There are other limits in the system that limit the number of days you can stay in a hospital before you start paying, no chiropractic coverage, no eyeglasses, no dental for the most part and limited mental health care. I still like the program as all of us in this country prefer a Doctor of our choice and for the most part no one wants a bureaucrat making medical decisions on their life base on statistics issued by the government. That is a non starter for most Americans. Covering the uninsured and those with on going diseases like cancer is agreeable and desirable to most Americans. The two big worries are a government take over of healthcare which scares Americans dating back to when our Constitution was first written. Limiting Federal government was a major issue to the colonist. They wanted no part of a big government or a King. That is an underlying issue to this day. The other thing that has Americans scared is our federal deficit of 1.8 trillion dollars to which we are talking about adding another trillion with our new healthcare system. We all know we have only so much money and we cannot continue to just print it. We view the government option as the first step to a government take over of all medical-care. Rightly or wrongly that is the view. You can see in the crowds at the town hall meetings. These people are not shills they are more than just passionate. They are flat out angry no matter if their reasoning is right or wrong. Since Obama and his staff do not have a final plan or details they are left to defend the indefensible of something that does not yet exist. September is going to be more interesting than August once the details get into open debate. The Democrats have the numbers to force through anything they want so most talking head now say the government option now has a 50/50 chance of being part of the bill. I really do not see a difference between a government option and the proposed cooperative that some are proposing. Americans understand cooperatives. We have them everywhere and it is not a scary term like 'government option'.

Obama stated very clearly during questioning after his meeting withy your Prime Minister and the Mexican leader over trade that 'The Canadian system would not work in America'. He did not go into detail about that statement Following that statement then there was an immediate discussion brought up by journalist everywhere about the Canadian system. Her are some of the things presented as factual: I think it was an average of 16 weeks but I have seen blogs that report anywhere from 4 weeks to 6 months. It wan months to see a specialist. It was also reported that there were 36,000 Canadian waiting to get into a hospital. One commentator noted that by having long waiting lines for both GP's and specialist was one way to hold down cost. That seems simple enough to understand. Per capita the U.S. has three time more MRI and Cat Scan machines. It was reported that in England the average to see a 'new' GP was 101 days. Americans have never had to live with such restrictions no matter if the wait is 6 weeks or 6 months. You can see where that would be a very big problem . If we suddenly drop in 40-45 million new patients who now need a GP the system would immediately be over loaded. We do not have enough GP's to meet our current needs. What ever develops it is going to have to happen with careful deliberation. There is no way to suddenly drop a system as large as ours and start over. We have a much larger population than England and Canada which amplifies the problems that will develop. This is where the detail which have not been written comes into play and are so important.

Result number: 94

Message Number 259640

Re: Waiting View Thread
Posted by wendyn on 8/12/09 at 09:25

Oh John- great post, but with so many different thoughts and questions I don't know where to begin!

I know that you and I feel differently when it comes to equality and care for the poor. We're never going to agree and that's okay...my real point was that if you really believe that the poor are poor because they deserve to be, and that they don't deserve the same priveledges as the wealthy - then you will never be okay with health care reform (not matter how it's packaged). It won't matter who proposes it or when they propose it ir how they implement it.

Banking - no Canada and the U.S have very different banking systems. That I know, but I don't know a lot of the details. We do not have the smaller banks that you do and we haven't (as far as I know) seen any bank failures due to this economic crisis. This will be an interesting thing for me to research and learn more about.

When it comes to free trade and American protectionism - I never said I thought Obama was perfect or that everything he might do would be great for Canada. Health care was the interesting subject of the day. We can talk more on trade issues another time.

And, I certainly don't think that big government is the answer to everything. I worked for the municipal government for 17 years, and believe me - I understand problems of waste and inefficiency.

I think you'd be hard pressed to find people from any country with universal health care who thinks they have a perfect system. None of the systems are perfect and they all need work and improvement. That said, I still sleep better at night knowing that a single mom on welfare will receive the same hospital care for her baby as a mom with a rich husband. I know that if I have a family member who has an accident or serious illness, their family is not going through a bankruptcy because of the medical bills.

And I sleep better knowing all that - even if it does mean I have to see my GP before I get a referral to an orthepedic surgeon or if I do have to wait my turn for elective surgery. Seems to me to be a small personal price to pay.

Result number: 95

Message Number 259637

Re: Should I go through with surgery? View Thread
Posted by mh on 8/12/09 at 07:41

I've gone more times than I can count! Basicially, it took about 10 treatments to really get it under control (5 before I felt any difference) but now I go monthly so that my risk of the pain returning is minimized. I also go if I have a flare up. Don't mistake- it hasn't made my feet perfect, but it has made me feel like a normal person. I still have to be careful to take care of myself, but it's become a minor issue in my life (most days are great, some aren't so great), rather than the all consuming pain I'd been feeling before acupuncture. I do feel that acupuncture will be a part of my life for the rest of my life b/c I have begun to use it for other issues. I am a swimmer and had some bursitis in my shoulder and that went away in about 3 treatments. I also have her treat me for stress/anxiety whenever I see her and that seems to keep me focused and able to be more patient w/my children. I lost so much faith in traditional medicine during my deal w/TTS that I often will go right to my acupuncturist for issues rather than my family physician.

No, the needles don't hurt except when she inserts them into the bottom of my feet b/c there are so many nerve endings there. Once the needle is in, I can't feel it at all. The needs elsewhere (legs, shoulder, etc) I don't feel at all.

Result number: 96

Message Number 259636

Finding Truth In Healthcare Reform View Thread
Posted by marie:) on 8/12/09 at 07:32

Bottom line, the far right has organized a disruptive, rude group of people who's soul intent is to prevent any type of healthcare reform bill passed. Kuodos to them but everyone sees it for what it is. There's no sleeping giant here on healthcare reform but there is misinformation fueled by those who feel their way of life, income and business is being threatened. The sleeping giant is a little more about the fact Republicans lost one election after another and no longer are in control. 'Control' can be a source of many emotional problems. Of course insurance companies and medical industry resist reform....if it changed my income I might be too. I'd certainly want to be engaged in the process and don't blame people for being fearful about Medicare issues. Medicare lost alot under Republican leadership. They trusted those leaders and got burned. However, this does not excuse the behavior at these town halls. Being loud or first in line does not make one right it just makes you loud and first in line. And there is no excuse for political pundits who are fueling violence by associating healthcare reform with Hitler. Just none.

I have to admit I very much appreciate John and Wendy's thoughtful discussion on the topic. My postings were simply to allow people to know who is fueling the anger and that anger is fueling violent unreasonable discussions which benefits no one.....especially the Republican Party. It's hurting the party and their efforts. It's time for a reality check. Here is the new website explaining in plain English the facts on the Healthcare Reform. Only you can choose to be part of reality or anger. ;)

http://www.whitehouse.gov/realitycheck/

Result number: 97

Message Number 259583

To Dr Ed & Dr DSW View Thread
Posted by BrianPK on 8/11/09 at 11:18

Thanks,

You both are making me feel a lot better about the surgery, as to your comment about Doctors & Procedures, My orthopedic surgeon will not perform a neuroma removal. He is completely against removing nerves from the body and has in a 25 year career done 3 'revision' surgeries where he had to try & bury the nerve in bone to stop the stump pain.
It is my understanding that professional athletes (basketball & hockey players, golfers) get these removed all the time and so I am looking for a surgeon that does these operations for the local professional sports teams.

As to the sclerosing injections it is my understanding that if the sclerosing agent leaks into the surrounding tissues collateral damage and pain can be present. I am not opposed to trying the alcohol injections but would only have them done if they were ultrasound guided. I have read the technical paper on this procedure.

Before trying the alcohol I would prefer one more shot with Cryo. The cryo ablates the nerve in the same manner as the alcohol but carries none of the toxic risk. Cryo surgery has been used in pain management for back pain for many years. There is some debate however as to the timing of a repeat procedure should pain relief not be gained, some say 3 weeks, some say 10 I would like to know if it still hurts do we try again in 3 weeks or 10. What is the real answer.

Interestingly enough a local podiatrist who is highly regarded told me that both procedures (alcohol & cryo) 'are for lecture circuit doctos & innovators. Here in Milwaukee we are not innovators.'
This podiatrist fells that Dr. Dockery and Fallat are both quacks.

This doctor gave me a cortizone injection that sent me off the roof with pain for 3 months in january. So yes, after just a cortizone injection. I know what greater pain can be and I FEAR it. The cortizone basically disabled me for 6 weeks.

I'm really sick of dealing with this thing however, and am almost ready to have it cut out. It is ruining my life. Many posts both here and on other boards from podiatrists say that they have quit doing nerve removals and just use alcohol or cryo. And thost that use cryo basically say that they quit using the alcohol because of bad reactions.

I know that there is a lot of conflicting information out there and unfortunately Doctors are prevented by HIPPA to even tell you about patients that they have treated. I find it almost ridiculous that you can get a mechanic, plumber, or electrician to give you referrals to jobs done previously, but not medical professionals.

When a customer askes me to resolve an issue I can tell them how I will resolve the problem, how much it will cost and give them a guarantee of success and I deal with very complicated industrial systems. So far the only Doctors that can at least assure me that they will do no further harm are the cryosurgeons.

Result number: 98

Message Number 259581

Re: PF and Exercise and Treadmills View Thread
Posted by Jen R on 8/11/09 at 08:16

Hi Brian,

I am not a doctor but I have suffered for PF for a long time (over 10 years) and have learned quite a bit during my search for pain relief. What I can tell you is that a treadmill is NOT recommended for people with PF because it does not mimic the normal gait of walking. On a treadmill, your foot slides back and as it comes up actually puts more tension on the PF ligament than walking does. So...maybe just stick with walking the dog and other non-impacting exercise. I exercise 3 or 4 times a week and have taken the treadmill totally out of my routine. I've found riding a bike gives me a great workout without pounding my feet. There are also other things like ellipticals, swimming and the cardio machine that you turn pedals with your arms (I forget the name of it). These can all help you burn calories and strengthen your heart and muscles without beating on your feet.
Additionally, good shoes and orthodics may also help keeping in mind that what you may think is a 'good' shoe may actually not be the best shoe for your foot shape and issues. Just because a shoe is expensive or good for someone else doesn't mean that same shoe will be good for you. From my time on this website, I don't hear many of the doctors and experts express many good thoughts on Nike shoes. A certified pedorthist or shoe expert at one of the specialty stores might be able to help you find the shoe and/or orthodic that is best for you.

Good luck,

Jen R

Result number: 99

Message Number 259488

Re: Government Option in Health Care View Thread
Posted by Allie on 8/07/09 at 17:19

Marie, Remember during the civil rights movement there were those who ranted and raved (rightly so). This is the same thing. Obama himself was involved in organizing public protests on many issues. This is America and he had every right to do so, so why are those that are supporters of the health care plan trying to silence any opposition and just making them out to be radicals? This is something so huge that is being proposed so why not address the concerns that you and I will be paying hugely for?

Result number: 100

Message Number 259455

Re: Catholics and Health Care View Thread
Posted by Dr. Ed on 8/06/09 at 18:11

John:
One of the areas addressed by Obamacare is 'end of life' care. Various statistics are used such as 'half of the lifetime healthcare expenditures for a person are spent in his/her last ten days of life.'
This is an issue that needs considerable discussion and development as it is complex and contains moral and ethical issues. It would be a mistake for the Obama Administration to try to attempt to wrap this into a healthcare reform package without an extensive public discussion and a working group that contains a broad spectrum of parties to include the clergy, physicians, attorneys, bioethicists, and a broad cross section of public representation.
Ed

Result number: 101

Message Number 259438

Re: Kidner Procedure Patient View Thread
Posted by KRISTY C on 8/06/09 at 07:10

My 12yr old had the surgery on 6/25/09. First two weeks was a soft cast for post-op swelling. Then she has had two hard cast on at two week intervals. We go in the morning to have her cast taken off and xrays. Hopefully, we will be getting the walking boot and starting PT. She is a dancer and attends the school of the arts with dance as her core. She is very anxious to get back to dance. We had not issues with surgery. I think she may have taken 4 pain pills max.

Result number: 102

Message Number 259437

Re: PF Treatment View Thread
Posted by Dr. DSW on 8/06/09 at 06:37

Excellent question. Although a walking cast/'Cam' walker is an accepted treatment option for plantar fasciitis/fasciosis, sometimes patients describe the problem you have mentioned.

Sometimes, the footbed of the CamWalker is too 'flat' and causes stress on the bottom of the foot due to lack of support. In those cases I try to add some support to the cast or even place an OTC orthotic inside the cast. Additionally, you must make sure the boot is on tight and that your foot isn't 'pistoning' in the boot causing stretching of the tissues.

Result number: 103

Message Number 259416

Catholics and Health Care View Thread
Posted by john h on 8/05/09 at 15:30

There was a good article in the Wall Street Journal today on this subject. There is a very large number of Catholic affiliated hospitals who will obviously weigh in on health care. 52% of Catholics voted for Obama so clearly they are a diverse group regardless of what the Pope says. None of these hospitals will perform abortions but some of them would refer patients to someone who would or in some cases drop their affiliation with the church. Depending on how the health care plan is written it could effect how many Catholics vote based upon religious beliefs. They do believe in abortion if the person has been raped or the mothers life is at risk Catholics also believe very much in care of the poor and those who cannot afford care so they have a dilemma within the group.

The President of Notre Dame said abortion is not health care but ending a life. Some sense to that other than one could argue there is mental health care involved.

They will play an important role in election no matter what any of us believe and they seem as of the moment to be split down the middle. Seems like we as a nation are split down the middle on many important issues. That sort of falls in line with marriage in which about 50% end in divorce. Split down the middle.

Result number: 104

Message Number 259390

Re: Should I go through with surgery? View Thread
Posted by mh on 8/04/09 at 20:59

I did take herbs in the beginning, but don't know what they were.

Right now I live a pretty normal life. I can stand for quite a while with no real issues. I worked in my kitchen for about 2 hours today and felt fine the rest of the day. And if I do have a flare, it's totally managable through rest and an extra acupuncture treatment if it's bad.

Also, just a few things I've learned over the past few years that help me stay well:
1. I only wear Crocs. They are fantastic. I don't know if I would have gotten through the bad times w/out them!
2. I never, ever, ever go barefoot. EVER! Even if I'm getting up w/the kids in the middle of the night, I wear my crocs. Hanging out in the pool (not swimming laps), I wear my Crocs. You get the idea.
3. Stretching helps- alot. I have noticed that if I keep basically the lower part of my body from getting too tight, I feel good. Periformus (sp?) hamstrings and calves seem to be key.

Best of luck!

Result number: 105

Message Number 259336

Community Organizer View Thread
Posted by john h on 8/03/09 at 13:15

President Obama often mentioned his job as a Community Organizer on his resume to become President. When I first heard that term my thought was 'Say What?'. Never heard of one even though I lived on the north side of Chicago and most of my friends parents were blue color union workers. How many of you knew or even now know what a Community Organizer is. In Chicago politics it is often a stepping stone into politics. You can read pages upon pages about what one is and does. The term may have actually originated in Chicago.

1940 to 1960

Saul Alinsky, based in Chicago, is credited with originating the term community organizer during this time period. Alinsky wrote Reveille for Radicals, published in 1946, and Rules for Radicals, published in 1971. With these books, Alinsky was the first person in America to codify key strategies and aims of community organizing. He also founded the first national community organizing training network, the Industrial Areas Foundation, now led by one of his former lieutenants, Edward Chambers.[14]

The following quotations from Alinksy's 1946 'Reveille for Radicals' gives a good sense of his perspective on organizing and of his public style of engagement:

A People’s Organization is a conflict group, [and] this must be openly and fully recognized. Its sole reason in coming into being is to wage war against all evils which cause suffering and unhappiness. A People’s Organization is the banding together of large numbers of men and women to fight for those rights which insure a decent way of life. . . .

A People’s Organization is dedicated to an eternal war. It is a war against poverty, misery, delinquency, disease, injustice, hopelessness, despair, and unhappiness. They are basically the same issues for which nations have gone to war in almost every generation. . . . War is not an intellectual debate, and in the war against social evils there are no rules of fair play. . . .

A People’s Organization lives in a world of hard reality. It lives in the midst of smashing forces, dashing struggles, sweeping cross-currents, ripping passions, conflict, confusion, seeming chaos, the hot and the cold, the squalor and the drama, which people prosaically refer to as life and students describe as “society.[15]

He dedicates the book to lucifer.“Lest we forget at least an over-the-shoulder acknowledgment to the very first radical: from all our legends, mythology, and history (and who is to know where mythology leaves off and history begins — or which is which), the first radical known to man who rebelled against the establishment and did it so effectively that he at least won his own kingdom — Lucifer.'

Result number: 106

Message Number 259287

Re: My story and question- Best over the counter Night Splint for PF? View Thread
Posted by Dr. DSW on 8/01/09 at 10:51

In my opinion, this is horrible. I've been posting on this website for many, many years, and I rarely, yes rarely say negative comments regarding a treating doctor since it's always easy to be a 'backseat' driver and second guess. Additionally, I'm not there to see and examine your foot.

However, 'assuming' your story is accurate, and I have no reason to believe it's not, I am at a loss of words to explain why ANY doctor would continue to inject cortisone into a plantar fascia that is already injured. As you apparently already know, and I have already stated, repeated cortisone injections can not only cause a complete rupture of an already compromised plantar fascia, but can cause atrophy of the surrounding tissues including the plantar fat pad.

Many patients suffer from plantar fasciitis from simple overuse and it develops over time, but yours was from an acute injury. This type of injury isn't treated with additional stretching but MUST be treated like any other acute injury, and that's with rest.

A patient with your described injury in my office would immediately be placed in at LEAST a removable walking cast to allow the plantar fascia to rest and to immobilize the area. You should also be rolling a frozen water bottle under the area 20 min/hour to reduce pain/inflammation if you don't have any medical contra-indications using ice.

The MRI findings with the dark area could have been bleeding from the injury or an accumulation of fluid from the injection that never was absorbed by the body.

However, my strong opinion, based on this doctor's treatment would be to immediately find another doctor. I would like to know why this doctor would question whether or not you have a torn plantar fascia and be so concerned that he wanted to order an MRI, yet at the same time he gave you an injection prior to the MRI.

If I was concerned that a patient may have an injury that warranted an MRI, I certainly would never give an injection until AFTER I obtained the MRI results.

Result number: 107

Message Number 259278

Re: Dellon View Thread
Posted by Mike on 7/31/09 at 23:33

I just want to be clear that though my procedure was not successful, Dr Dellon is a true professional and knows his nerves! And, he's pretty funny too!

I researched and researched and spent alot of time speaking and corresponding with others in similar situations and my conclusion was that he was the best. I could have went to a Dr who was only a couple hours away from home and was trained by Dr Dellon, but I wanted the best - so I flew across the country to have Dr Dellon do the procedure

I ran into some unexpected issues and just wanted to make others aware of those possibilities.

So - just to be clear - Dr Dellon rocks!

Result number: 108

Message Number 259277

Re: Tarsal Tunnel Syndrome View Thread
Posted by Mike on 7/31/09 at 23:19

Im so sorry you are experiencing this pain for so long!
Seems like you are at the point I was several years ago. After 2 years of trying all the different meds and physical/mental therapies and surgeries - none of which worked! I found the solution that worked for me and it was narcotics.

Because of possible side effects and addiction issues, it is for some, the last resort - but if you have a decent Dr and the personal responsability required - it can be handeled effectively and can give you your life back.

I was started on Hydrocodone which worked great but I became concerned with the amount of acetaminophen I was getting in these pills so my Dr switched me to OxyContin - basically the same thing without the acetaminophen. I was on it for about a year but I built up a tolerance fairly quickly so instead of continuous doseage increases, my Dr switched me to Methadone(pills) which actually worked much better because of its long half life.

This medication has litterally given me my life back!!! Instead of lying on the sofa in pain all day, I could do all the things I used to do - without the pain! I could finally sleep at night! Actually, one of the side effects is tiredness which is a bummer but it can be delt with and now I can actually fall asleep at night within a few minutes of lying down.

Dont get me wrong - there are major issues that need to be considered and side effects that need to be delt with, but I seriously beleive that I wouldnt be here today if I would have had to live with that pain for much longer. And I dont mean to make it sound 100% perfect because I do still go thru some pain episodes but nothing close to before!

Also - it doesnt work for everyone. It worked for me and Ive read about several other people with TTS or neuropathy or other nerve pain issues that it has worked well for. But then there are some that cant deal with the side effects and some that it didnt work for at all - But it's sure worth a shot - especially if you have tried everything else!

The main thing is to find a Dr that understands pain and that you can work with to develop a long term relationship to manage your pain.

Good luck - I hope you find something that works for you - and soon!

Result number: 109

Message Number 259260

Re: Forefoot valgus/first ray issues View Thread
Posted by Dr. Wedemeyer on 7/30/09 at 19:17

Denise I deleted my post because although you are using a pseudonym I really should discuss this with you privately at least initially. Should you give your approval I feel and we have some success your case it could be very educational for the readers.

As I said I do not know how much help I can be but I am willing to give it a go. I totally disagree with the casts, design and some of the materials your previous orthoses were made from.

Result number: 110

Message Number 259259

Re: Forefoot valgus/first ray issues View Thread
Posted by denisea on 7/30/09 at 19:06

Hi Dr. Wedemeyer -
Thanks for the response! Yes, you told me to be patient and I have been right? ; ) Glad you took them to the lab, but not so glad my foot is so messed up even the staff is questioning things....Nothing is ever straightforward for me.
I will hold off on shoes for now.
Thank you SOSOSOSOSO much, really. I can't tell you how nice it is to have someone who knows what they are doing take the time to help me. You have great karma coming your way.
Denise

Result number: 111

Message Number 259256

Re: Forefoot valgus/first ray issues View Thread
Posted by Dr. Wedemeyer on 7/30/09 at 18:02

Great timing Denise. I was at my friends lab this morning (an orthotist) and we discussed your case and feet. Based on your casts and my notes he also agrees that Functional Hallux Limitus (FnHL) is the major contributor to your foot issues and Flexor Hallucis dysfunction.

Also looking at the casts even the staff at his lab questioned if the molds were from the same person. More on that when I see or talk to you again.

We came up with an entirely new script for your orthoses than previous versions and should have them shortly. Your previous orthoses were all casted with a high medial arch and forefoot varus as you might recall. We are using a flexible composite material for you with a lower arch, 1st cutouts and a PF/FHL groove etc.

Sorry for the delay, being that you are not local to me I recall asking you to be patient with me and the process. You will have them soon!

In the meantime I wouldn't buy any shoes just yet unless they are very neutral and have no significant heel bias.

Result number: 112

Message Number 259250

Forefoot valgus/first ray issues View Thread
Posted by denisea on 7/30/09 at 10:47

Hey Jeremy,
I saw Dr. Wedemeyer and he thinks my problems stem from forefoot valgus and first ray dysfunction (forget what you call it) and my orthotics will need a first ray cut out. Regardless, while I wait for some new orthotics, what kind of shoes for a normal arch forefoot valgus foot. You gave me suggestions before, but now with this new info you may have some different ideas. Maybe Dr. Wedemeyer could give us more insight into my issue, but he told me you were the go to guy for shoes.
Denise

Result number: 113

Message Number 259231

Re: My new idea View Thread
Posted by john h on 7/29/09 at 11:53

Medicare statistically has to drive a lot of health care cost since the vast majority of the money spent on an individuals health care over a lifetime is spent in the last year of his/her life.

Do we have any moral obligation to keep a person alive who has perhaps a year to live because of some disease. This is not unlike the argument about destroying a fetus? Morality is in the eyes of the beholder. When you are 30 you might say let the geezers die. When you are 75 you are likely to have a change of heart.

This week the numbers released that an obese person cost around $1700 more in health care each year than one who is within the proper weight range. Are there any moral issues here when it comes to insurance and health care. Should you be charged more for your weight problems. Same with smoking and alcohol. As a combat pilot I could not buy any insurance what so ever that would cover me in case of death in combat. All I had for my family was $10,000 in government insurance. The way the system will work under plans coming out of the House is that all high risk people will pay the same as those who are not high risk. Is this right or is this wrong? Is it a moral issue or a money issue?

Healthcare and insurance are so complicated that there is no system that will fit everyones needs or be equitable.

Result number: 114

Message Number 259224

Re: Should I go through with surgery? View Thread
Posted by mh on 7/29/09 at 08:45

As a last effort before surgery, (i tried shots and orthodics to no lasting relief) I got in touch w/an MD licensed in acupuncture and she absolutely changed my life. I started acupuncture in October 2007 and was 99% healed by Christmas of that year. I still go to see her for maintenance and flare ups (a pregnancy resulted in a few steps back). I can now live a pretty normal life with 3 kids under 6, and flares clear up pretty quickly. The only activity I have not yet tackled is running. But I swim, cycle, do yoga, play at the park w/my kids, make dinner, etc. I do have foot pain but it's not the nerve pain as much, now it's normal foot pain of standing all day (nothing like I used to have) that goes away when I rest at the end of the day. I no longer wake in pain as I did when I was in the thick of TTS. And I am no longer depressed because of all the pain. One thing about acupuncture is apparently it has a greater chance of working before surgery b/c scar tissue can screw up the resulting blood flow, so personally, I would advise trying it before surgery rather than after.

Also, I have recently started reading John E Sarno's THE MINDBODY PERSCRIPTION. The awareness that this book has brought to me has made some other health issues and aches and pains minimize.

good luck.

Result number: 115

Message Number 259198

Re: Good shoe to wear indoors? View Thread
Posted by Jen R on 7/28/09 at 08:25

From my experience, I don't think the issue is that those manufacturer don't make decent shoes...but they obviously make some shoes with better quality than others. Most people without foot problems wouldn't spend over $100 for a well made shoe while those of us with foot issues almost have to spend the money for a well made shoe. Look at New Balance...they have shoes in Kohl's for as low as $30. If anyone was to believe that they are using high quality material in this shoe they would be fooling themselves. Additionally, manufacturers use different foot lasts and materials so even within the same manufacturer...your foot shape and issues may make one shoe better for you than another.

The bottom line is that you need to find a quality manufacturer and then try on different styles to see which is most comfortable for you.

Jen R

Result number: 116

Message Number 259172

Re: Heel fat pad (atrophy?) View Thread
Posted by Dr. Ed on 7/27/09 at 13:05

The infracalcaneal fat pad consists of live fatty tissue with contained within fibrous septae. An analogy would be to imagine bubble wrap with the cells being filled by a viscous substance. Often the issue is not so much actual atrophy of the fat pad but displacement of the fat pad. If the septae are fractured or disrupted then the shock absorbing characteristics of the fat pad are lessened. The traditional plastic heel cup works not by providing cushioning but by holding the fat together beneath the heel bone. It is an approximately $3.00 item which is worth trying.

There have been numerous attempts at soft tissue augmentation.... silicone injections in the 1960s, collagen injections in the late 1970s and early 1980s. The silicone injections never garnered FDA approval and there was a problem with shifting. Again, it is not just the cushioning but the act of holding the cushioning in place. Edward Chairman, DPM of Philadelphia, in the late 1980's and early 1990's utilized injection of fat obtained via liposuction. The problem that that fat is pulverized abdominal fat which dies off and does not last.
The fat under the heel bone is living tissue which regenerates itself.

Currently, there is a subset of the podiatry profession utilizing cosmetic dermal fillers to add 'padding' beneath boney areas of the feet. For example: http://www.beverlyhillsfootsurgery.com/fat-pad-augmentation/ Such dermal fillers are designed for parts of the body that are not exposed to the types of pressure and strain placed on the tissues on the bottom of the foot so the longevity of the procedure is not long. Some may consider repeated soft tissue augmentation which need be repeated several times per year if their budget permits and they are sufficiently motivated.

The late Sol Balkin, DPM was the standard bearer and lifelong advocate for use of injectable silicone: http://www.podiatrytoday.com/article/9069 It is my understanding that he obtained the product from Great Britain and used it FDA 'off label' for years.

Dr. Ed

Result number: 117

Message Number 259088

Re: Are there any orthotics that may help with Tarsal Tunnel? View Thread
Posted by Dr. Wedemeyer on 7/24/09 at 15:47

If your issues are due to a biomechanical fault yes, often the appropriate orthoses can help with impingement at the ankle causing TTS.

I would rule out exacerbation of the lumbar complaint as the TTS began following investigation of the lumbar discs. Once ruled out a biomechanical examination can determine the necessity of orthoses versus a primary nerve entrapment at the ankle.

I would recommend Graham Curryer although he is in Ontario, he is an excellent chiropodist with a strong background in biomechanics and orthoses. I am not familiar with the geography of Canada so if he is not local to you perhaps he can recommend a colleague:

http://www.cocoo.on.ca/~s000212.htm

Result number: 118

Message Number 259024

Re: Heel fat pad (atrophy?) View Thread
Posted by Dr. Ed on 7/22/09 at 15:40

Is it certain that all pain emanates from the heel and is not referred pain from the ankle joint; assuming that an osteochondral defect is still present?

I don't have enough information to comment but one way to potentially rule out referred pain from the ankle joint to the heel is to place a small amount of local anesthetic in the ankle joint.

Another thing to look at one the bottom of the heel is thinning of the infracalcaneal fat pad vs. displacement of the fat pad. The traditional heel cups, AKA, M-F heel protectors are thin plastic heel cups designed to 'bunch up' the soft tissues under the calcaneus. The successors to this original design lost site of that and are making heel cups that are truly just cushions.

Dr. Ed

Result number: 119

Message Number 258926

Re: Toe amputation for a horrible corn ?? View Thread
Posted by Dr. DSW on 7/18/09 at 06:46

It depends on the training and specialty of your cardiologist. Ankle/arm pressures or the 'ABI' (index) is not always very reliable. Patients can have a falsely elevated ABI if they have calcifications of the blood vessels. Therefore there are other tests such as skin O2 tension and other specialized tests that are non invasive.

The fact that you have palpable pulses is also a good indicator, but once again does not always predict healing in the toes. Regarding specialists, in today's times, there is sometimes a 'turf' war concerning who does what.

My preference for lower extremity vascular issues is still a vascular surgeon, though interventional cardiologists are now also specializing in that field.

If any procedure involving INCISIONS is performed, I would recommend some form of vascular evaluation.

Result number: 120

Message Number 258850

Bruised ankle--trip to rheumatologist or podiatrist? View Thread
Posted by katidid on 7/14/09 at 21:07

Have a 30 year history of AS which has at various times affected both feet in several locations. Occasional random swelling directly below ankles (inside of foot). Had a mini-flare a couple weeks ago due to temporary stop of meds. In addition to painful feet, the ankle swelled for a few days then turned into a big black/blue spot surrounding ankle to arch. Hasn't been particularly painful and am fairly sure I didn't injure it by twisting or knocking it. I can walk fine but occasionally there's mild throbbing. I know it should be evaluated by dr but looking for advice on which dr to see. Despite the AS related issues, have never had a bruise quite like this and it hasn't gotten better over 2 weeks. Appreciate any thoughts on where to start.

Result number: 121

Message Number 258822

Re: Now we get it! View Thread
Posted by marie:) on 7/13/09 at 11:52

I was talking a little sarcastically in my post. I doubt if either side will ever apologize even when their wrong.

I agree all of it is dumb politicking. I think these fringe political posturing moves just takes precious time away from the real work that needs to be done.

So instead of focusing on the past, Pelosi or Cheney, lets stick with the issues of the day.

Result number: 122

Message Number 258758

WSJ article on internet Doctors View Thread
Posted by scott r on 7/09/09 at 09:57

I thought this article might be of interest. I think treating paying patients over the internet is going to be a quickly growing trend.

=====

Jane Rust woke up early one day last year and discovered that her left eye was red, swollen and itchy. So she logged on to her family doctor’s Web site and typed a message describing her symptoms and asking what to do.

By mid-morning, the 61-year-old homemaker received an online response from her doctor with a diagnosis—conjunctivitis, or pink eye, probably contracted from a child in her Sunday-school class—and a prescription to pick up at the pharmacy. “I didn’t have to disrupt my day,” says Ms. Rust, who lives in Readyville, Tenn. “It’s much more efficient.”

This year, 39% of doctors said they’d communicated with patients online, up from just 16% five years earlier, according to health-information firm Manhattan Research, a unit of Decision Resources Inc. So far, the most common digital doctor services are the simplest ones, like paying bills, sending lab results and scheduling appointments. But patients like Ms. Rust are also using computers to deal with issues that usually require a trip to the doctor’s office.

Though the number of physicians doing formal digital visits is still small, the practice of online care has grown as more health insurers begin paying doctors for treating patients virtually, albeit at a lower fee scale than for traditional in-office appointments. Among companies that now cover digital visits are Aetna Inc. and Cigna Corp., as well as Blue Cross Blue Shield plans in states including Florida, Hawaii and North Carolina. WellPoint Inc. and Humana Inc. are trying it in parts of the country, and may expand their coverage.

“If this service is valued, and there is payment for it, we will see many more primary-care physicians doing it,” says Ted Epperly, a doctor in Boise, Idaho, who is president of the American Academy of Family Physicians. Dr. Epperly offers online visits to his patients, but currently just 3% of the physician group’s members do. That low participation rate, however, doesn’t reflect the widespread use of less-formal digital tools like email to communicate with patients.

Minneapolis-based Fairview Health System, a hospital and clinic operator, started offering digital visits around 18 months ago after it negotiated payments from some insurers with a large presence in the local market. About 85% of the digital visits between Fairview doctors and privately insured patients are now covered.

Doctors who offer digital visits say they generally are most effective for treating mild, simple conditions, often when patients are too busy or too far away to come to the office. Ailments most frequently treated online include sinus problems, cold and flu symptoms, urinary infections, and coughs. Other common conditions are back pain and sleep issues.

Louis Petrillo, 57, a psychologist in Westfield, N.J., says he regularly turns to his family’s doctor, Robert Eidus, for online advice about his frail 90-year-old mother, who finds office visits difficult. His son who is away at college also used an online visit when he had sinus problems. “I can get into his virtual office anytime,” says Dr. Petrillo. He feels the online care works well largely because Dr. Eidus knows his family members’ regular health complaints.

But physicians typically won’t treat certain conditions through online advice, particularly chest pain or other symptoms that may signal an emergency. Some state medical boards have rules that limit the use of digital visits, including requiring that doctors see patients in person before prescribing drugs. Even with minor ailments, many physicians will offer digital advice only to regular patients, for liability reasons and also because they feel that in-person visits are important to discuss broader health issues.

Insurers that cover digital visits often require the use of certain technologies or formats, in part to meet federal privacy requirements but also to ensure that a digital visit is legitimate. Companies say they had initial concerns that doctors might seek to boost their revenue by making excessive use of online communications, or classifying quick emailed messages as reimbursable visits. But so far that hasn’t happened, insurers say. Health plans also generally require that online visits be initiated by patients.

One format, offered by companies including McKesson Corp.’s RelayHealth and Medfusion Inc., requires patients to fill out interactive questionnaires that automatically generate follow-up queries based on the symptoms they initially describe. The answers go to the patient’s doctor, who typically responds within a day. Another type of digital doctor visit is more like secure email, with patients typing up a free-form message, often sent through a special Web site. Physicians often follow up with questions and then a written response within 24 hours. Medem Inc.’s Online Consultations follows this format.

Another option is live online visits, using technology from companies such as American Well Corp. The firm has created an encrypted setup for real-time interaction between doctors and patients, using Web video, live chat or a phone conversation connected through a secure computer system. OptumHealth, a unit of UnitedHealth Group Inc., is rolling out the American Well system nationally.

Daniel Nishikata, 28, of Pearl City, Hawaii, says he likes being able to get real-time care fast and late at night, when he’s often awake because he works the graveyard shift at a pharmacy. One Sunday at 2 a.m., Mr. Nishikata logged on to the American Well system sponsored by his insurer, nonprofit Hawaii Medical Service Association, which provides Blue Cross Blue Shield coverage. The system allows patients to communicate with doctors who are on call. Through the online visit, for which he owed a $10 co-pay, Mr. Nishikata got a renewal of his sleep-drug prescription, which he picked up the following Monday morning.

When an insurer doesn’t pay for online visits, some doctors are asking patients to pay around $20 to $35—far less than an in-person visit. The lower rate reflects the fact that digital visits typically are less demanding and require less of a doctor’s time.

The reduced rate appeals to patients like Shellie Kemp, 30, of Port St. Lucie, Fla. Ms. Kemp lost her banking job last year, and she has no health insurance through her work as a substitute teacher. Her husband has a high-deductible plan. When the couple came down with flu-like symptoms recently, Ms. Kemp filled out online questionnaires for both of them about their symptoms. Their doctor, Lisa Rankin, responded by prescribing antibiotics. The Kemps were charged $30 each. “It gives you a chance to have your doctor treat you, and it’s affordable,” says Ms. Kemp.

Doctors also use digital communication to track patients with chronic conditions like diabetes who can regularly send in their blood-sugar readings. Shawnda Johnson, an Oakland, Calif., pediatrician with the big nonprofit Kaiser Permanente, has used its secure email to monitor a patient she had diagnosed with attention-deficit disorder. Instead of bringing him in to the office, the boy’s parents would regularly send updates about his condition. Dr. Johnson adjusted his medication dose based on the feedback.

Conditions that may be ambiguous don’t lend themselves to online diagnosis. Some doctors say they won’t diagnose complaints such as vertigo and ear aches without an exam. Melissa Gerdes, a family doctor in Whitehouse, Texas, won’t treat abdominal pain in an online visit. “How are you supposed to tell a bladder infection, or appendicitis, or an aneurysm?” she says. “There are too many different potential causes for pain in the belly area.”

Of course, patients can’t always tell what’s urgent. Gynecologist James R. Frede, who practices in Wailuku, Hawaii, grew concerned about six weeks ago when a patient, during a live online conversation with him, described serious abdominal pain that left her curled up in bed. She’d recently learned she was pregnant. Dr. Frede, worried that her symptoms could signal an ectopic, or tubal, pregnancy, urged her to get to an emergency room. Dr. Frede met her there and confirmed that she did have the condition. The woman was treated and recovered.

Result number: 123

Message Number 258751

Re: Open PF Release View Thread
Posted by Dr. Ed on 7/08/09 at 22:30

John:

I would be interested in finding out if there are some published statistics with regards to the success rate of plantar fascial release surgery, including the open procedure, EPF and the MIS approach. The healing time for the procedure can be very long. There are potential complications that are short term but also long term issues such as reduced stability in the midfoot, lateral column pain, painful scar tissue formation. I would have a hard time believing a success rate of more than 50 percent based on my experience. I have not performed a plantar fascial release surgery in almost 5 years.

Plantar fasciitis is not as hard to treat as it seems. See the treatment triad. One important rule...most diseases respond to the common treatments appropriately applied; if the response is not positive, then question the diagnosis or try to refine the diagnosis.
Difficult to treat plantar fasciitis or 'intractable' plantar fasciitis is often actually plantar fasciosis, Baxter's neuritis or fasciitis maintained by an unresolved biomechanical issue such as functional equinus (a tight gastrosoleus achilles complex).

Dr. Ed

Result number: 124

Message Number 258747

Re: 681 View Thread
Posted by Dr. Wedemeyer on 7/08/09 at 20:59

Unfortunately Stacy we can only make limited suggestions as to why in your particular case you are having these problems. The comments that I made previously about studies was to illustrate how studies do not always reflect best practices and clinical decisions and outcomes.

There is some debate in the literature over whether or not AAFD can cause acceleration of existing issues at the knee. In my experience the answer is yes. Flat foot disorder is one issue of the foot that will cause PF and pain at the knee. If the accessory navicular is also symptomatic it can cause PTTD as well, this is well documented. Hormone levels can and do influence tendon integrity, as do certain medications, trauma, weight-gain and a host of other factors.

I would initially look to the design of your orthoses and the modifications used to combat excessive pronation. Reducing the rate of pronation appropriately may ease a lot of your symptoms. If the accessory navicular is a factor it needs to be addressed and reducing pronation moments may help to reduce those symptoms as well. The appropriateness of your footwear is another important factor that cannot be overlooked.

Have you seen a foot and ankle specialist? Who prescribed your orthoses, cast and fit them?

Result number: 125

Message Number 258724

Re: question about heel spur surgery View Thread
Posted by hopalongmomma on 7/08/09 at 17:52

i shall do just that...but i dont see him till july 16th...i have alot of degenerative issues as well i wonder if that contributes to some of this. But thanks for your opinion.

Result number: 126

Message Number 258702

Re: 681 View Thread
Posted by Stacy on 7/07/09 at 20:07

I do not exhibit any significant heel vagus. I am not in the medical profession but am a Speech Pathologist. I stay current in research and conduct and write a fair number of evaluations. I asked the doctor what the 'test' was and what its purpose is. I also do my due diligence by doing the necessary research to be an 'informed consumer.'

I am about ten lbs overweight, my blood pressure is consistently in the LOW average range and my most recent blood work revealed that my blood glucose was normal.

I always had some mild symptoms by the insertion of the accessory navicular; however they have become worse since I hit 50. Could age and hormone changes be a contributing factor? Could my knee issues contribute to the feet issues or vice versa?

Thanks for your response

Result number: 127

Message Number 258695

Re: 681 View Thread
Posted by Dr. Wedemeyer on 7/07/09 at 15:38

If you can stand and support yourself comfortably on your toes you probably do not have PT tendon issues. Adult Acquired Flat Foot (AAFF) disorder can be from a variety of factors. Attenuation of the PT tendon without gross insult can be causative. I would also rule out other factors such as obesity, diabetes and hypertension as they are reported to contribute.

What was the result of the Hubscher Maneuver? Do you exhibit any great degree of heel valgus at this point?

I find it interesting that you know the name of the test. Is your profession in the health field?

Result number: 128

Message Number 258680

Cheilectomy & Osteotomy Recovery and possible future surgery View Thread
Posted by BillBoy on 7/07/09 at 08:48

I am going to post this just to let people know my personal experiences. Everyone needs to realize that everyone's condition is different and different Docs have different preferences and everyone has different recovery times. You need to find a Doc that you are comfortable with who explains things to you sufficiently and to the point that you feel comfortable with you options and eventual decisions. Don't make your decisions by listening to what other patients say to do or not to do.

I am a 27 year old male. I am very athletic and in Military. I was diagnosed with mid to late stage 2 limitus. It was to the point that is was distracting from my everyday life so I decided to do something about it rather than put it off and worsen the condition. My DPM/Surgeon suggested a Cheilectomy with Osteotomy of my right great toe. There are other issues in the same foot such as; extreme flatness, shortened achilles, and bad biomechanics in the ankle joint. Surgery has been mentioned for these issues, but the toe was the first order of business.

I had the procedure done one week ago (June 30, 2009). The first few days, after the local wore off, were not enjoyable at all. But I am now at day 7, post-op, and I couldn't feel better considering. I am non-wieght bearing and on crutches 4/5 weeks. I keep the foot elevated as much as possible. I went into to work for a half-day two days after the surgery and am now back full-time (keep in mind, of course, your occupation; I work in a law office without much physical demand). The foot feels great so far, but I do realize that there probably will not be much pain considering I have not put any weight on the foot for 7 days now. I will admit that, against my Doc's advice, I have been driving very short distances (this is not a choice, I am in the Military), so I guess I have put 'some' pressure on the foot. I have not experienced any pain doing so and if I did I would find a way to stop. I have 8 stiches and they are to be removed next Monday, approximiately 14 days post-op.

I wanted to post this just so people may not be quite as 'scarred' as I seem to read all the time concerning this procedure. If anyone is interested, I will continue to update. I also wanted some possible thoughts on the future surgery that had been mentioned to correct the other problems in the foot, as I realize it is much more complex and recovery time is substantially longer for that procedure. Thanks- B

Result number: 129

Message Number 258679

Cheilectomy & Osteotomy Recovery and possible future surgery View Thread
Posted by BillBoy on 7/07/09 at 08:48

I am going to post this just to let people know my personal experiences. Everyone needs to realize that everyone's condition is different and different Docs have different preferences and everyone has different recovery times. You need to find a Doc that you are comfortable with who explains things to you sufficiently and to the point that you feel comfortable with you options and eventual decisions. Don't make your decisions by listening to what other patients say to do or not to do.

I am a 27 year old male. I am very athletic and in Military. I was diagnosed with mid to late stage 2 limitus. It was to the point that is was distracting from my everyday life so I decided to do something about it rather than put it off and worsen the condition. My DPM/Surgeon suggested a Cheilectomy with Osteotomy of my right great toe. There are other issues in the same foot such as; extreme flatness, shortened achilles, and bad biomechanics in the ankle joint. Surgery has been mentioned for these issues, but the toe was the first order of business.

I had the procedure done one week ago (June 30, 2009). The first few days, after the local wore off, were not enjoyable at all. But I am now at day 7, post-op, and I couldn't feel better considering. I am non-wieght bearing and on crutches 4/5 weeks. I keep the foot elevated as much as possible. I went into to work for a half-day two days after the surgery and am now back full-time (keep in mind, of course, your occupation; I work in a law office without much physical demand). The foot feels great so far, but I do realize that there probably will not be much pain considering I have not put any weight on the foot for 7 days now. I will admit that, against my Doc's advice, I have been driving very short distances (this is not a choice, I am in the Military), so I guess I have put 'some' pressure on the foot. I have not experienced any pain doing so and if I did I would find a way to stop. I have 8 stiches and they are to be removed next Monday, approximiately 14 days post-op.

I wanted to post this just so people may not be quite as 'scarred' as I seem to read all the time concerning this procedure. If anyone is interested, I will continue to update. I also wanted some possible thoughts on the future surgery that had been mentioned to correct the other problems in the foot, as I realize it is much more complex and recovery time is substantially longer for that procedure. Thanks- B

Result number: 130

Message Number 258678

Cheilectomy & Osteotomy Recovery and possible future surgery View Thread
Posted by BillBoy on 7/07/09 at 08:48

I am going to post this just to let people know my personal experiences. Everyone needs to realize that everyone's condition is different and different Docs have different preferences and everyone has different recovery times. You need to find a Doc that you are comfortable with who explains things to you sufficiently and to the point that you feel comfortable with you options and eventual decisions. Don't make your decisions by listening to what other patients say to do or not to do.

I am a 27 year old male. I am very athletic and in Military. I was diagnosed with mid to late stage 2 limitus. It was to the point that is was distracting from my everyday life so I decided to do something about it rather than put it off and worsen the condition. My DPM/Surgeon suggested a Cheilectomy with Osteotomy of my right great toe. There are other issues in the same foot such as; extreme flatness, shortened achilles, and bad biomechanics in the ankle joint. Surgery has been mentioned for these issues, but the toe was the first order of business.

I had the procedure done one week ago (June 30, 2009). The first few days, after the local wore off, were not enjoyable at all. But I am now at day 7, post-op, and I couldn't feel better considering. I am non-wieght bearing and on crutches 4/5 weeks. I keep the foot elevated as much as possible. I went into to work for a half-day two days after the surgery and am now back full-time (keep in mind, of course, your occupation; I work in a law office without much physical demand). The foot feels great so far, but I do realize that there probably will not be much pain considering I have not put any weight on the foot for 7 days now. I will admit that, against my Doc's advice, I have been driving very short distances (this is not a choice, I am in the Military), so I guess I have put 'some' pressure on the foot. I have not experienced any pain doing so and if I did I would find a way to stop. I have 8 stiches and they are to be removed next Monday, approximiately 14 days post-op.

I wanted to post this just so people may not be quite as 'scarred' as I seem to read all the time concerning this procedure. If anyone is interested, I will continue to update. I also wanted some possible thoughts on the future surgery that had been mentioned to correct the other problems in the foot, as I realize it is much more complex and recovery time is substantially longer for that procedure. Thanks- B

Result number: 131

Message Number 258677

Re: Michael Jackson View Thread
Posted by marie:) on 7/07/09 at 08:20

Wendy,

I think it comes down to this, Jackson was a very complex personality with several sides to him. He was an outstanding entertainer, singer, song writer, poet, dancer, choreographer, film maker who innovated much of what goes on in the music industry today . He was in the public eye since he was a child.....for some they appreciated one stage his life in the music industry over the other. He was a generous person who donated his talents and money so that research scientists could continue to be paid to do their job. They don't do it for free, trust me. ;) Without celebrity endorsements most charities would fall short financially. He believed his talent was a gift and that he needed to use it to help others. He was shy and introverted offstage and a socially accessable explosion of energy on stage. He had weaknesses like all people and as a result dealt with prescription drug abuse, self doubt and image issues. The tabloids loved to beat him up, and some bought it as truth and some did not. His intentions were often exploited for money. He kept his children's faces covered while they were out with him........so that when they were out with friends and not in his presence they could be like any other kids. It worked because the paparazzi never knew and they went to the movies, malls and arcades just like anyone else. People took advantage of him and he allowed it by making himself available to them. He was a victim of his own success, a prisoner from childhood into adulthood. He made many choices that where not in his best interest and as a result it cost him dearly. Only he is responsible for those decisions. He was never convicted of child molestation but questions and doubts still remain. People will decide which Jackson they choose to know, appreciate or hate. He was in the limelight for 45 years.....his fans are grieving, his family and children are grieving and out of respect for their loss I think it would be humane not to contribute to the media frenzy both good and bad until after his funeral. Michael is gone, his time here has ended...how we treat those who are grieving and are still here reveals more about our own failings then it does his. It'll all come out with time..........for those who have already made up their mind it won't change anything. For myself, I'm not a fan in the sense that I own any of his music at all. As far as all the crazy media coverage goes........well Jackson always did sell and they know it. I'm not crazy about the media craziness myself. I do understand selling a magazine and using Jackson's image to do so. I did understand his contributions to the music and entertainment industry and respect that and I respect his charitable efforts as I am involved in some of those same charities. I personally don't know him so I won't sit in judgment over his private life, how can I judge someone based on tabloid stories? I just don't have feelings on it at all. I don't read tabloids. Anyone else can make their own decisions on it, I don't expect anything I've written or shared will change anyone's mind. They can decide which side of Michael they liked or didn't like. In the end we are judged by One and that's all that matters. None of us are getting out of here alive.

Yes, he wrote and arranged the music on the majority of his songs and co-wrote many of the others. I think Quincy Jones wrote 'Thriller', Jackson wrote 'Billy Jean' and 'Beat It'. Some others are Another Part of Me, Wanna Be Starting Something, Don't Stop Till You get Enough, Working Day and Night, Bad, The way you make me feel, I just can't stop loving you, Dirty Diana, Smooth Criminal, Leave Me Alone, Heal the World, Black or White, Who Is It, Will You Be There, They Don't Care About Us. Musicians get more royalities when it's their own music, he understood that one.

BTW: Hope you're having a nice vacation.

Result number: 132

Message Number 258670

Re: flexible flat foot and patella femoral syndrome? View Thread
Posted by Dr. Wedemeyer on 7/06/09 at 20:47

I assume you've had PT following the realignment. Was the strength of your vastus medialis oblique (VMO) ever assessed or discussed with you? With high Q angles and especially patella alta, I am less likely to rush to try to achieve control with an in-shoe orthosis alone Stacy.

BTW do you have any ACL or MCl issues as well?

To answer your question, I believe that in many cases of chronic patella alta due to high Q angle forces at the knee that PT AND the appropriate functional orthoses can be of great value and should be reasonably afforded prior to any discussion of surgical correction.

Just how this will affect you long term is debatable but worth discussing with you surgeon.

Result number: 133

Message Number 258664

Re: neuroma View Thread
Posted by Dr. DSW on 7/06/09 at 18:05

I obviously can not help you over the internet. However, I believe you need to get a little more assertive and/or aggressive regarding expressing your concerns with your surgeon.

When an incision extends between the toes, it is not unusual for excess moisture to build up causing some 'maceration' of the tissues. However, this should not cause a continuous solid white liquid come from coming out from the area. Some edema (swelling) is normal post operatively, but if there is constant swelling or if the swelling seems to be getting worse, and there is a constant drainage, it is definitely something that at LEAST needs to be addressed and not constantly brushed aside.

Let your surgeon know that at the present time you are very unhappy AND very concerned about the way your post operative care has been handled and hopefully he will respond accordingly.

If in addition to the swelling and white drainage, there is redness or the foot is warm or if you have a fever, you should speak to him sooner than later.

Result number: 134

Message Number 258628

Re: Treatment for Postier Tibual Tendonitis or what I may have? View Thread
Posted by Caroline on 7/04/09 at 20:35

I just got over posterior tibial tendinitis. My doctor (an ortho who specializes in feet and ankles) gave me accomodator orthotics (they're blue) to wear in my shoes which gave me a lot of arch support, and told me to ice my ankles (I had it in both feet, worse on the right) once a day for 20 minutes. I already take Mobic for arthritic issues elsewhere so that helped calm things down but if I wasn't taking it already, he would've prescribed some kind of anti-inflammatory. I didn't go anywhere without wearing the shoes and the orthotics. I had the accomadator orthotics in my sneaker on top of Sofsole orthotics (worn due to some soft tissue issues in the foot---I had a knee replacement in September so my gait had been screwed up for ages while it tried dealing with a bad knee). I saw him for a follow up after 5 weeks of this treatment and felt much much better. However I do work retail, very part time (about 10 hours a week), but enough to realize that I need to wear the accomadator ones when I do work because they make my feet feel better than when I don't, walking on the hard floor of the store.
I hope this helps you!

Result number: 135

Message Number 258616

Re: Curious about dry needling View Thread
Posted by Dr. Ed on 7/04/09 at 13:42

David:

I have to respectfully disagree about the coverage issue. Remember that the tools used in a procedure do not necessarily change the procedure. We went through this same discussion in the 1980s during the time of laser surgery popularity when providers felt that procedures utilizing a laser should carry higher reimbursement and have different coding. Third parties responded by affirming that the procedure coding stayed the same as the laser was simply a different tool used to do the same procedure.

This analogy is somewhat flawed in that the carbon dioxide laser did not seem to offer any significant advantage in outcomes and was often used as a marketing tool. The coblation equipment does offer an advantage in that tissue is removed with minimal induction of scar tissue which is critical in treatment of plantar fasciosis. Nevertheless, the procedure being performed is a partial fasciectomy, CPT code 28060, nothing more, nothing less. There is no stated requirement for the amount of tissue that need be removed in a partial fasciectomy; that is left to clinical judgement. I use a modification of the Weil technique utilizing a grid 6 by 8 or 48 'holes' or areas of tissue removal on the plantar fascia. I only perform the procedure for recalcitrant cases in which there is documented sonographic evidence of advanced fasciosis. I may modify the technique relative to patient size and the extent of pathologic tissue.

I believe that there are two components to the relief noted by patients. The first component which occurs within 2 to 3 weeks is from the 'debulking' of the fasciosis related to the removal of pathologic tissue. The skin grid heals very rapidly without scarring.
The second component involves the ingrowth of healthy, better vascularized tissue occurring between the 3rd and 6th weeks.

Patients still need to deal with any biomechanical issues. If they needed orthotics before the procedure, they will still need them. Topaz treats only one leg of the treatment triad.

Ed

Result number: 136

Message Number 258615

Re: Curious about dry needling View Thread
Posted by Dr. Ed on 7/04/09 at 13:22

Dr. Z:

The key difference between use of the coblation equipment and other types of equipment is the lack of scar tissue or minimal scar tissue that forms with coblation. I have observed patients post-op clinically and via diagnostic ultrasound and not noting the formation of scar tissue to any significant extent.

I agree that ESWT need become more widespread in its use. I do not believe that it will supplant Topaz. Topaz appears to be providing a higher cure rate and provides relief more rapidly than ESWT based on my experience and my contact with some of the early adopters, McGlamry and Weil. It is invasive so it will not replace ESWT. There will be a role for both.

The amount of undiagnosed and underdiagnoses tendinosis and fasciosis is MASSIVE, in my opinion. I would encourage all to make a case for the proper diagnosis and treatment of those entities rather than worrying about seeming competition between two effective technologies.
A larger concern should be the billions spent on surgery and other treatments (both in direct healthcare costs and loss of work productivity) and not the far too small market share for ESWT and Topaz. We have already seen those in the ESWT industry battle over the efficacy of different protocols and machines which led to a self destructive cycle of third party issues when the logical thing would have been a united front to enlighten all about the nature of fasciosis/tendinosis and how ESWT was one of the few effective modalities out there that could have saved the industry large amounts of unnecessary costs.

Dr. Ed

Result number: 137

Message Number 258614

Re: How Mayo Clinic is giving the BEST care for the least amount of money! View Thread
Posted by Dr. Ed on 7/04/09 at 13:00

Marie:

Judging the effectiveness of healthcare and quality can be tricky. There is a tendency for the large institutional providers of healthcare to make claims to quality based on a number of popular statistical items such as the percentage of individuals getting prenatal visits, immunizations and so on. The problem is that when such criteria are known, the organization will focus on improving those numbers while not necessarily addressing other issues with respect to quality.

We often hear that the US does not compare as favorably as some other countries that have national health plans in the area of infant mortality rates. Consider the following though: http://www.aapsonline.org/newsoftheday/00307

I agree that a team approach to patient care can be a very good way to go. In certain venues, it takes a well organized effort by a medical group to make that happen. Other venues may include communities where the medical community has a good level of cooperation between independent providers.

One area to note with respect to the Mayo Clinic article is the emphasis on the use of EBM or evidence based medicine. EBM, on the surface, sounds like a good thing. It encourages the use of treatments that are backed by sufficient research. But, EBM is a double edged sword. The bottom line is less than about 30% of the medical knowledge base used in treatment is backed by EBM. Proponents of EBM are often third party payors who attempt to use the 'requirements' of EBM to avoid payment for more traditional and inexpensive treatments that have long track records of safety and effectiveness. Additionally, the process of EBM promotion stifles creativity in treatment plans. There is encouragement of uniformity in treatment in the article. That works when the goal is to treat the largest number of patients possible by orienting the treatment at the center of the bell curve. That can yield impressive statistics.

Keep in mind that many posters here have responded poorly to that approach.

Ed

Result number: 138

Message Number 258588

Re: some more details View Thread
Posted by manlyfoot on 7/03/09 at 15:58

i was wondering about the home units, most of which are 1 mhz, which seems appropriate for deep tissues (although i understand that it would be a minimal intensity with home devices). It would seem that 3 mhz is more appropriate for achilles tendonitis, for instance. But the 3 mhz home units are even weaker than the 1 mhz units.

of course this is all moot if you are going to get professional therapy. of course there is no comparison so I wasnt asking about how they compare.

thanks!

MF

Result number: 139

Message Number 258587

Re: some more details View Thread
Posted by Dr. Wedemeyer on 7/03/09 at 15:09

The frequency denotes the depth of penetration into the soft tissues. If that is your concern seek USD from a professional with the training and equipment to offer you real therapeutic benefit, the at home units are very low powered and I would not consider them therapeutic. USD is often a benefit of group health insurance with medical necesssity so it may be covered if you have such benefits available.

Result number: 140

Message Number 258585

Re: can I take a custom foot orthotic to a pedorthist? View Thread
Posted by Dr. Wedemeyer on 7/03/09 at 15:01

Mary your podiatrist is affording many of the standard conservative therapies for PF. If you are not resolving I would discuss this with him first and give him the opportunity to address any issues and concerns that you have.

PF is a multi-factorial complaint and I never rely on one modality to treat it. I would also strongly suggest physical medicine such as ultrasound diathermy or iontophoresis of a steroid gel preparation such as dexamethasone, interferential muscle stimulation, myofascial release and a home stretching regimen for the fascia and lower extremity muscles.

A referral for co-treatment to a PT or DC who performs these services may prove helpful if you are not resolving timely. If he is not open to referring treatment to allied profeesionals and you are not obtaining relief, you can always exercise your right to seek a second opinion.

Result number: 141

Message Number 258574

Re: Can the sciatic nerve cause pain in the heel? View Thread
Posted by hopalongmomma on 7/03/09 at 07:09

great question..i cant wait to read more as i have some major back issues as well

Result number: 142

Message Number 258567

Re: can I take a custom foot orthotic to a pedorthist? View Thread
Posted by Jeremy L, C Ped on 7/02/09 at 21:43

Okay, I 'heard' you. And I'm in on the dialog, now.

As per Dr. Wedemeyer's suspicions, I can say that PAL produces both custom molded orthotics and custom library devices. Based on the insert name provided earlier, I'm going to assume it's the former. There are however issues in the creation of custom functional orthotics with an Xtremityscan device.

The first issue is that the only way to capture a foot image with the Xtremityscan is in a semi-weighted position. The most effective devices made from this casting technique come when the femur, tibia, and foot are set at 90 degree angles. This cannot be accomplished with this machine. In fact, the patient is typically seated with the foot and leg raised, causing an awkwardly loaded plantar contour of the foot. It is also common for the foot to be plantarflexed, again causing an incorrect deformity of the plantar surface. From the resulting digital cast, the lab tech will end up making an arch fill that is insufficient to the patient needs.

The second problem is that the heel sits with the posterior aspect resting against the cup of the scanner. This will universally create an inaccurate shape to the heel, and reduce the depth of the scan itself. In this way, Dr. Wedemeyer is absolutely correct, a full resolution of the heel is impossible to adequately capture with this system.

The reason the Xtremityscan is used so pervasively is because it's mobile, is easy to use and permits greater short term efficiency in the office. The problem is that most offices don't make a thorough search of the various digital scanning systems available, as well as the efficacy of the various labs that create devices from those scans. There are systems that permit greater flexibility in resolution, as well as excellent depth characteristics. It's up to the the decision makers in any office to weed out the lesser quality systems, and maintain high patient success rates.

Result number: 143

Message Number 258535

Re: Significant pain post PF surgery View Thread
Posted by Dr. DSW on 7/01/09 at 16:58

You weren't specific regarding on which type of PF surgery you had performed and on whether or not your doctor released your entire plantar fascia or HOPEFULLY only 1/2 to 2/3 of the fascia. It's generally accepted that the entire width of the fascia should not be released/cut.

Additionally, it can take up to one year to feel complete relief following any plantar fascia release.

To gain your doctor's attention, I would call and speak with his/her office manager and let that person know how displeased you are at the present time. Tell the manager that you would like the doctor to address your concerns or you will seek care elsewhere and will be asking for your complete records.

This may be a wake up call to your doctor, since most docs don't want other doctors taking care of their post op problems due to potential legal issues.

Result number: 144

Message Number 258516

Re: Franken wins!!! View Thread
Posted by john h on 7/01/09 at 12:30

Ugh Ugh Ugh. What surprised me about Franken is that he is a Harvard graduate. So is Bill O'reilly. II did not know that until yesterday. Minnesota has a history of electing strange people. It was not long ago they had as Governor who was a WWW big time wrestler. Franken's background is of course comedy. He should fit nicely into the Senate.

Yesterday, for the first time President Obama had 32% of people surveyed who 'strongly disapproved' of his actions on the economy. He also had 32% who 'strongly approved' of his actions on the economy. This is his worst showing since becoming President and he is trending down. This is in line with past Presidents showings at this point in time. The people not shown are the undecided and are the ones that can turn elections one way or the other. So far we have not seen much improvement in the economy and the unemployed rate continues to rise. Most economist fear the mounting debt we have created since January. The public now see the debt as something to be very concerned about. We are seeing a trend of other nations, including China, moving away from buying our U.S. Treasury Bonds. This is a dangerous trend for our economy and for our future. One man is mainly responsible for the direction the President has chosen to go and that is Secretary Gathner, A lifetime civil servant. President Obama is not an economist or a banker so he has to get his information and direction from the Secretary Gathner on Banks and the economy. Never has one man had so much influence on our entire economy. He is not elected. He was appointed. All we can do is pray that his judgement is correct. We are still very much on the edge of a bottomless pit. Hyper inflation is a possibilty as we continue to print money that we have no way to pay for. Our GNP is in dangerour territory.

The Cap & Trade bill recently passed by the House is very scary to me and I can only hope it is killed or refined in the Senate. It will face some strong opposition from both Democrats and Republicans. 46 Democratic House members voted against it in the House and it barely passed. We have very opposing views on this bill. Republicans call it a job killer and a big tax increase on any thing energy related such as your electric bill. Some Democrats call it a job creator and admit it will increase your electric bill but not nearly as much as Republicans claim.

One thing we all know is that any healthcare bill is going to cost nearly one trillion dollars. We still have no sensible way to pay for it without taxing the people. We are already in debt over our heads and to add another trillion at this time is scary. Obama should have put this off until next year but for what ever reason he is trying to rush through everything. The bill, which was 1100 pages long, and not given to the House members until a few days before the vote. Most had not even read the bill when voted on. There was a 300 page ammendment attached to the bill the day of the vote. How can something so important as this be voted on when it has not even been read or discussed? This is totally unbelievable! At this point I think Obama will sign any bill put in front of him on Healthcare. It is also possible it will not get done this year. The American people are starting to get an understanding of all that is going on and what the consequences might be. Healthcare, the national debt, the economy, North Korea, and Iran are not about Republicans and Democrats. It is about America and all of our futures. Any votes on these issues should come from the heart and not from party politics.

Result number: 145

Message Number 258504

Re: Michael Jackson View Thread
Posted by marie:) on 6/30/09 at 15:25

oh I feel the same. i always wished i could sing. When I was a little girl I used to pray at night that I could sing like Aretha Franklin......but alas in the morning when I looked in the mirror I was still a skinny little white girl who couldn't sing a note.

My only kinship to music was dance. I spent most of my childhood and into my 20's in ballet and modern dance classes. Some productions. I can't say I was especially talented but I loved it and it was great exercise. The dancing probably at least partially led to my tarsal tunnel syndrome and back issues. Now you know where my appreciation of Jackson is.......it's dance and choreography.

Result number: 146

Message Number 258487

Re: Michael Jackson View Thread
Posted by marie:) on 6/30/09 at 08:27

yes, I knew it. Who hasn't heard 'We are the World'? Who doesn't know he had the world's best selling albums.......Thriller, Off the Wall, Bad and Dangerous? Who doesn't know he was an extremely talented choregrapher and dancer? Who doesn't know that he had 19 Grammy Awards? 22 American Music Awards and 12 world Music Awards? Who doesn't know about his humanitarian awards that led him to be honored by 2 United States presidents?

The thing of it is........I know this stuff and I don't own a single record by MJ....I just don't live in a vacuum I guess. I don't defend his behaviors, although he seemed to have many mental health issues, he made a choice to not seek treatment.

Result number: 147

Message Number 258485

Re: Michael Jackson View Thread
Posted by marie:) on 6/30/09 at 08:12

Limbaugh became addicted to pain medication because of a spinal surgery. The initial reasons for the treatment were valid.........but he still became addicted and doctor shopped for prescriptions. This can happen to anyone of us. Limbaugh checked into rehab after he got caught.He tried 2 times before that to kick the habit. He accepted a deal and the charge of prescription fraud was dropped. It requires him to remain in therapy. At one time I too would have agreed that he isn't the head of the party.......until Republican politicians began to grovel for his approval. His fund raising ties are a powerful force for the party. What humanitarian causes has this man contributed to the world?

Now lets see.......Michael Jackson struggled with an addiction to pain medication after he was burned during a Pepsi commercial. He donated all of his financial award, 1.5 million, to the Brotman Medical Center. He checked into rehab some years ago emerging free from his addiction.......but it seems he still had many health issues that may have led back to the use of pain medication and certainly a strong possibility of abuse. Jackson suffered from vitiligo, lupus, and Alpha 1 antitrypsin deficiency. It has been reported he needed a lung transplant from the due to the Alpha 1 antitryspin deficiency. He also had serious back problems which is difficult if your a dancer/choregrapher getting ready to go on tour. He had a broken vertebra and leg he sustained during performances. Let's face it he sells magazines and the odder the story the more sales. The bottom line is we simply just don't know and won't until the final autopsy is complete. Did Michael have deep emotional problems? I would say, yes and how he dealt with them is open for critique.

http://en.wikipedia.org/wiki/Alpha_1-antitrypsin_deficiency

http://www.lupus-erythematosus.com/

http://en.wikipedia.org/wiki/Vitiligo

Result number: 148

Message Number 258479

Re: Michael Jackson View Thread
Posted by JudyS on 6/29/09 at 23:19

I made no asumption that MJ died of a drug overdose. I described his well-publicized lifestyle - which just plain can't be sugar-coated with his talent. He was a very public figure and, as far as I'm concerned, certain responsibilities go along with being a public figure.

I don't think that drug or behavior issues follow party lines. Limbaugh is neither head of the Republican party nor is he President of the United States.
He is an entertainer - that's all. Is he still abusing prescription drugs or is his one time in rehab doing the trick for him? I guess only time will tell.

Result number: 149

Message Number 258476

Re: Michael Jackson View Thread
Posted by marie:) on 6/29/09 at 21:03

At first I thought you were talking about Rush Limbaugh the drug abusing performer and not Michael Jackson the poet, songwriter, dancer, singer, humanitarian and artist. He was deeply troubled and certainly had some issues, I am going to refrain from passing judgments on his personal life until we know more, we're getting a bit ahead of ourselves here. The results of the autopsy aren't even in and peeps are assuming it was a drug overdose. There's just something about Jackson that people seem to assume the worst. he may well have died due to pain medication but we really don't know if it was an addiction or simply his treatment or something else all together. I would never make excuses for anyone who abuses pain drugs........especially Rush Limbaugh, but I waited until the facts came out before I called his butt to the carpet. Will someone please explain to me why the Republican Party allows itself to be led by a drug addicted, cigar smoking performer? I don't get it. ;) He can't even sing.

Result number: 150

Message Number 258432

Re: Michael Jackson View Thread
Posted by marie:) on 6/27/09 at 09:20

It's unfortunate that Farrah's death and contributions have been overshadowed by Michael's surprising demise. She was an extremely talented sculptor and painter with her own history of eccentricities.....recluse, drug use, eating issues and so on but in the end she gave permission to use her pain and suffering so the world might better understand the agony of cancer. Artist's understand the speed and dynamics of visual communication and Farrah gave us that. Even this thread has been over run by Michael's death...which was not my intention. It's just human nature.

Result number: 151

Message Number 258430

Re: Michael Jackson View Thread
Posted by marie:) on 6/27/09 at 07:42

I don't mean that as an insult........I just think when it comes to Michael Jackson and all his complexities people have preformed ideas and judgments and it's up to them to decide whether or not he did good. Michael Jackson did more then donate money to charities he actually did several tours and donated all of his money to charity. A tour is no small undertaking. He used his talent and co-wrote 'We are the World' raising 45 million dollars for Africa. Using one's gift to benefit others in need is a contribution. So if one equates all of that to donating a few dollars to the Salvation Army then it does seem they've made up their mind and there is nothing I can say or share that would enlighten them. Jackson was certainly a complex personality who went twice to Iraq to visit and perform for our troops........but he always kept these things to himself. He didn't want his celebrity to overshadow our troops sacrifice. I think his ex-wife's statement, Lisa Marie Presley, pretty much sums who he was pretty well. I would never defend his prescription drug abuse. I know he had to deal with pain management issues and like many celebrities became addicted. He tried to kick it but it just didn't seem to work. I don't have alot of patience for celebrity abuse of pain management. Every time one of them overdoes their own treatments it sets back the entire goal for treating pain patients.

On Jackson's debts........I know there was lavish spending. It was perhaps just another symptom of his mental health. I mean he seemed to have some serious issues. Not all of that 500 million was spent on toys. Much of it has been spent on staff and security. His assets out weigh the debt. His music rights along with the Beatles music was worth well over a billion dollars.........in death it will probably double. He's never been destitute.

On his talent......I learned to separate my judgment on someone's private life and their artwork a long time ago. We couldn't appreciate much of the artwork in the world if we knew details of their personal lives. Michael Angelo was a recluse who rarely cleaned himself and his home was over run with rats. It has been said he rarely changed his socks and when he did sometimes skin came off with them. He was more then likely gay, yet most of the Catholic churches wealth is guaranteed with the Sistine Chapel. It seems they have separated his work from his personal life as well. daVinci fled Italy to France because he was accused of having a relationship with a very young apprentice.......I believe he was 10 or 11 years old. Yet daVinci is and always will be revered for his genius............most of which never came to fruition during his lifetime. I mean the man invented scissors, bicycle, parachute, under water diving suit, tanks, machine guns and the list goes on and on. His contributions to science are used to this day. They continue to use his anatomical drawings in medical school to this day. he was a painter, sculptor, mathematician, architect, inventor, scientist, engineer and a musician. Even Einstein bowed to his genius.

So yes I can admire his art work and his humanitarian accomplishments but still not condone his behavior. He needed psychological treatment but chose not to pursue it. he could have but chose not to.

Result number: 152

Message Number 258385

Re: Health Care View Thread
Posted by marie:) on 6/25/09 at 19:45

You're right on some of those points. Both sides are unhappy on many issues. I was surprised to hear that the majority of the U.S.A. fully supports government funded health care and reform. The left and right stand firmly behind this.....but lets not all jump to fast here. We won't have the final draft until July. ;)

Result number: 153

Message Number 258353

Re: Health Care View Thread
Posted by Allie on 6/24/09 at 11:20

Before spending money on a health care plan, they need to make the logical cuts (and then look at what we need to do) that we result in massive savings for all of us that pay way too much each money in premiums:
1. Tort reform for doctors so that they don't have to pay 100,000 or more each year in premiums. The cost then gets passed on to the consumer.
2. Tort reform for personal injury (caps on damages)and penalize those filing frivilous lawsuits (very lucrative for lawyers - just judge by all the advertising they buy). The insurance companies then need to raise their rates.
3. Health care services are provided to the poor through our emergency rooms (trust me - not real emergencies) and ambulances. This is a huge waste. I have a friend that goes out on calls where folks cannot speak english. They have their babies in ambulances and call for such things as their 'arm fell asleep'. Yes, there are true emergencies where these folks need a hospital or ambulance, but not for a cold for pete sake.
Also, if folks would loose weight, stop eating so much (sugar) we could save so much money that is spent on weight related issues (diabetes, heart, feet, etc.) that we could insure all of America (according to Michael Milkin). We can't of course make folks loose weight.
I never realized this, but I have heard lately that there is a lot of 'abuse' in that many folks go from doctor to doctor with no real need. That's more cash the insurance companies have to dole out.
Lawyers and those abusing the system could help out so significantly. We are so litigious and before we became a sue happy nation insurance premiums were not sky high. I would love to see what the savings from the above would result in and then look at the next step.

Result number: 154

Message Number 258301

Raynaud's View Thread
Posted by Phoebe N. on 6/22/09 at 13:55

Just wondering, can Raynaud's phenomena cause tingling and numbness that is similar to the sensations of tarsal tunnel? None of the doctors I have seen have been able to address this question for me sufficiently.

I notice that when I am having a Raynaud's flair my tingling and foot pain is worse and even the tinel's sign is worse. When I am calm, relaxed, warm - my feet are significantly less painful. Being on my feet for a while causes a Raynaud's flair too.

What type of doctor would be able to help me with these issues? Maybe I need another type of specialist - I am currently seeing a podiatrist. Any insight would be appreciated.

Thanks.

Result number: 155

Message Number 258287

planter fibromas View Thread
Posted by pockets on 6/21/09 at 22:14

i had and plantar fibromas on the bottom of my foot that was tiny, like the tip of a pen. i went to see a podiatrist to find out what the lump was. The doc comfirmed it to be p.f and urged me to have surgery done to remove it. 1 month after my first visit with the doc he had me in surgery cuting this thing out and cutting my tendon in half witch he left in my foot severed. post sergery i seen this doc several times and i noticed multiple bumps all over the bottom of my foot. the doc injected the bumps with cortozone probably 4 seperate times in 6 months time and insured me this was normal and part of the healing process. so now 2 years later i have probably 8 lumps in my arch witch are huge and hurt like hell and go threw masive swelling issues daily. im now told by a new doc there is no way to treat my foot and basically have to manage the pain and growth of these bumps for the rest of my life. in anyones opinion was med malpractice commited ???????

Result number: 156

Message Number 258282

Re: tarsal tunnel surgery surgeon View Thread
Posted by Dr. DSW on 6/21/09 at 18:57

Neurologists do not perform surgery. You are probably referring to a neurosurgeon. It is not very common for neurosurgeons to perform tarsal tunnel surgery, since the majority of neurosurgeons that I know are busy with spine issues or brain surgery. However, it certainly is reasonable that a neurosurgeon is performing tarsal tunnel surgery since it is a nerve problem. I would want to know if the neurosurgeon specializes in peripheral nerve problems, since there are neurosurgeons with various sub-specialties.

Result number: 157

Message Number 258266

Re: Curious about dry needling View Thread
Posted by Dr. Ed on 6/20/09 at 13:10

Dr. W:

I think the major criterion for use of ESWT, dry needling and/or Topaz is the presence of fasciosis as opposed to fasciitis as the issue addressed is tissue quality. I used to mention the 'treatment triad' on this site reviewing which modalities are targeted at the 3 legs of the triad - inflammation, biomechanics and tissue quality. We have had good treatments for inflammation and biomechanical issues but not tissue quality. It was our hope that if we took care of the first two legs then the third would resolve. That often is the case if the fasciosis is not too advanced. The soft tissue manipulation techniques you mention do address the fasciosis.

When one places a needle in tissue and withdraws the needle, the hole closes. When holes are made by ablation of tissue the result is fenestration with holes that do not immediately close because tissue is actually taken away as opposed to a simple needle puncture. This is analagous to the technique in skin grafting where the graft is fenestrated or perforated which which allow the tissue to be stretched to cover a larger area. (Also the holes allow bleeding not to be trapped beneath the graft). Coblation (cold ablation) refers to instrumentation made by Arthrocare in which a radiofrequency wand produces a plasma field at the tip which removes tissue in a relatively atraumatic fashion. I don't understand the physics behind this but it does work. In the Topaz procedure or coblation, multiple holes are made in the fascia, usually focusing on the area of fasciosis. That area is thick, fibrotic, inelastic and hypovascular. Once the holes are made that area of the fascia is immediately more expansile. The holes then allow ingrowth of normal fascia and vasculature resulting in normalization of the tissue over time. If a laser was used to make the holes or a hyfercator (tissue cautery) one could achieve the immediate fenestration but the trauma of burning the tissue would be likely to foster the ingrowth of scar tissue which would potentially re-create the problem.

As far as use of an appliance, I am not sure how a refrigerator, washing machine or stove would influence plantar fasciitis.

Dr. Ed

Dr. Ed

Result number: 158

Message Number 258247

Re: Curious about dry needling View Thread
Posted by Dr. Wedemeyer on 6/19/09 at 11:46

Dr. DSW I am aware of that case study, perhaps a more thorough study will be performed in the future. Manual techniques such as deep cross-friction and Graston provide a similar effect on the soft-tissues by stimulating the healing cascade in chronic fascial, tendinous, and ligamentous complaints. Less aggressive methods work similarly for acute PF pain and stimulate appropriate healing of the plantar soft-tissues.

I have performed manual soft-tissue release in my office for years without the aid of needles or instruments and my personal success rate is very high.

I feel that any PF complaint should initially be afforded soft-tissue techniques and physical therapy modalities. Orthoses are one part of the equation and my personal opinion is that too many providers rely solely on an appliance to mediate PF when injuries to numerous other body areas are referred to PT for therapy with excellent results.

I am not convinced that dry needling is necessary in any but the most recalcitrant cases of PF at this time though. ESWT is another invasive procedure with a very good track record and I know of several physicians who offer this in their office for chronic soft-tissue complaints.

Result number: 159

Message Number 258246

Re: PF, hamstrings and standing on hard surfaces - ????? View Thread
Posted by Dr. Wedemeyer on 6/19/09 at 11:45

Dr. DSW I am aware of that case study, perhaps a more thorough study will be performed in the future. Manual techniques such as deep cross-friction and Graston provide a similar effect on the soft-tissues by stimulating the healing cascade in chronic fascial, tendinous, and ligamentous complaints. Less aggressive methods work similarly for acute PF pain and stimulate appropriate healing of the plantar soft-tissues.

I have performed manual soft-tissue release in my office for years without the aid of needles or instruments and my personal success rate is very high.

I feel that any PF complaint should initially be afforded soft-tissue techniques and physical therapy modalities. Orthoses are one part of the equation and my personal opinion is that too many providers rely solely on an appliance to mediate PF when injuries to numerous other body areas are referred to PT for therapy with excellent results.

I am not convinced that dry needling is necessary in any but the most recalcitrant cases of PF at this time though. ESWT is another invasive procedure with a very good track record and I know of several physicians who offer this in their office for chronic soft-tissue complaints.

Result number: 160

Message Number 258221

Re: Now What? Long Term Effects of Plantar Fasciitis View Thread
Posted by Mary M. on 6/18/09 at 13:14

Here are my 2 cents as a former right foot PF patient: I also went through getting custom orthotics, stretching, pain killers etc., until I figured out that all that trouble came from my low back.

Here's how: I went to a chiropractor for hip problems. My right hip kept shifting ('popping out' in my terms), which moved it's angle in such a way that it ever so slightly lifted the right leg.

Which meant that the right leg was now considered 'shorter' (an orthopedic doctor had actually prescribed heel lifts to 'even out the lenth' which made the whole thing a lot worse of course, because my leg wasn't actually shorter; it was my out-of-alignment hip pulling it up. According to the orthopedic doctor, he didn't even acknowledge that the hip could move in that way...).

Because it seemed 'shorter', every time I stepped, I put a lot more weight on it. It also messed with with my right knee, which was constantly aching.

As the chiropractor fixed my hip, which was actually due to a disc problem in my low back, magically my knee and my foot also improved. This took several months of weakly treatments - I went to a 'non-cracking' chiropractor, which was a lot easier on my joints. His technique was called BEST technique by the way.

The hip problem had been a chronic thing since a car accident a long time ago. That's probably when the whole low back - hip - knee - foot thing started and it just got worse over the years, because the actual cause of it was never treated.

My whole right side is still vulnerable, probably because the problem went untreated (or treated incorrectly) for so long and I have to be careful with sports. I wear store bought orthotics now (brand is ArchMates - they come in different arch heights and sizes and last for years. They're really great and no, I don't work for them:)) that cost 50 bucks, my knee hasn't felt better in years and my life is going on without me feeling like a patient.

My recommendation to anyone who has foot issues like this one is to find a good and gentle chiropractor to rule out any spine problems first. I've unnecessarily lived with pain for at least 15 years, because I (or the Mds ) never got to the source of the problem first.

Good luck to anyone out there dealing with this - there IS hope and a solution for you! Don't give up!

Result number: 161

Message Number 258220

Re: resection for tarsal coalition View Thread
Posted by Mary M. on 6/18/09 at 12:42

Thanks for the info!

BTW, your site is a great resource for other information about feet as well. I've learned a lot about others going through that surgery and also about treating my own foot issues. I really appreciate you making all this info accessible.

Result number: 162

Message Number 258195

Israel sees deal soon with Obama over settlements View Thread
Posted by marie:) on 6/17/09 at 11:47

More positive news continues. Talks do help.....will it all work? Well we can only hope.

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/16/AR2009061600855.html
'I'm confident that we will be able to reach an agreement in the near future that will enable us to put the settlement issue aside and to move forward to what I regard as far more substantive issues in the peace process,' Michael Oren, Israel's newly appointed ambassador to Washington, told Reuters.

Result number: 163

Message Number 258097

Re: ESWT for insertional achilles tendonosis View Thread
Posted by indyrr1 on 6/12/09 at 09:38

I had ESWT on my right heel (insertional AT) on 3/30 and am now going on 11 weeks post-treatment. I guess I have not been as strict about wearing my orthotics and so this may be causing me some of my issues, but overall my right posterior heel has felt better (especially first morning steps). I've also been cycling instead of running. Last night I ran 2 miles at a relatively slow pace (for me). This morning, my heel is killing me and is very inflammed(hurts to walk and after sitting down for a while and getting up to walk it kills). I know that this process is supposed to take time, but this is very frustrating considering the fact that I spent $1000 out-of-pocket to have this procedure done to avoid surgery. Is there a temporary pain medication or steroid that I can take to allow me to start running (at a much reduced mileage) or do I really need to wait 6 months to see how my heel responds?
Thanks for any help.

Result number: 164

Message Number 258057

Re: Unemployment View Thread
Posted by john h on 6/10/09 at 13:34

The Czar Tim Geithner has approved some of the larger banks to pay back $68 billion dollars of TARP money. Strange you need approval to pay back a loan. Wish my lenders were like that. Now what do you think should happen to that $68 billion payback? I think reasonable people would say use it to pay down the national debt since every household in America owes over $550,000.00 dollars. Makes sense to me. But not so fast John. Uncle Tim is going to put it into a slush fund for future emergencies. I read we now have appointed over 15 CZAR's and are about to appoint a TSAR. Am I in Russia. If I am then Tim Geithner is Ivan The Terrible. It seems that one branch of our government has gone suddenly silent. That would be Congress. They now take their orders from the Commander in Chief. Instead of Uncle Billy we now have Aunt Nancy burning as she goes. Am I the only one that thinks our leadership in Washington has lost their way and does not understand the meaning of debt. Our lenders will soon enough remind them.

Interesting reading:

'Czar Power
Ranjay Gulati, 01.07.09, 04:45 PM EST
The problem with silos in Washington is that issues fall between them.



Czarist solutions to our daunting array of national crises are suddenly everywhere. At current growth rates, we are likely to have a car czar, an energy czar, a financial sector czar and a health sector czar. Who knows how many more will be either named or in place by the time Barack Obama actually takes office?

It seems America is turning into pre-Bolshevik Russia. Can the Cossacks be far behind?
Don't get me wrong. Strong leaders and at least a partially unfettered hand are vital to pulling us out of the many messes we are in. To make any headway against Washington's--and the nation's--entrenched interests, these presidential designees must have the authority to cut through red tape and take quick action when necessary. But if our new czars are as autocratic as their nicknames imply, we could be in for worse, not better, times, even if they are all more like Peter the Great than Ivan the Terrible.

Almost inevitably, these appointments will go to forceful personalities celebrated for their leadership skills. Faced with rescuing entire sectors of our economy, the czars will hire A-list cadres of aides. Directives will follow; power will gravitate to the positions. And if history is any guide, Washington, instead of fostering solutions, will have added yet another tier of self-protective, self-interested silos to its already impressive landscape.

The fact is the dire state of America today is not only the result of faulty leadership but also of systemic organizational failures--specifically, the inability of highly differentiated but non-collaborative government entities to work with each other. Whether in government or business, these silo-type entities provide excellent local accountability and focus, but at a heavy price.

The downside usually comes in the form of structural blind spots of opportunity that are invisible because they lie between silos. Sept. 11 could have been prevented if someone had connected the dots across disparate intelligence branches. A poorly functioning czarist system can also lead to disconnected actions by individual units even when circumstances call for unity.

We saw these patterns during the aftermath of Hurricane Katrina. Rather than consider the suffering people on the ground and pool forces to deliver the relief they so desperately needed, the disparate government agencies involved argued over jurisdictional overlaps and fought to protect, not share, the products and services each was charged with delivering. And we will see the same behavior again if we turn inordinate authority over to men and women more adept at tough talk than coordinated action.

Comment On This Story
Sure, getting the domestic auto industry back on its feet requires some arm-twisting, but it also demands cooperation across multiple agencies--hardly the hallmark of a czarist approach. The Federal Reserve and the Treasury Department, which are dealing with the funding side, will need to work with Environmental Protection Agency, which will nudge manufacturers to produce environmentally efficient cars.'




I

Result number: 165

Message Number 258005

Re: "Good Feet" Store and Arch Supports View Thread
Posted by Rori on 6/07/09 at 12:05

Well, Good Feet saved my life. Now - there are probably better things out there (I've been turned on to posturedyn.com - very different ideas) and recently discovered I have Morton's foot... I originally had custom orthotics, which WRECKED me - gave me plantar fasciatis,put incredible pressure on my hips - it's as though custom stuff just fills in the spaces and doesn't take the rest of your body into account. The Good Feet CURED my heel spur and has served me well (I wear the 'exercisers' mostly - different than the regular standard ones, and I got all 3 levels). I even got them for my 80+ year old mother, and she started walking better right out of the store with them on. It fixed the knee issues for my daughter and husband, too. I love Ina, who actually DOES know about feet and really cares and is always taking classes to learn, in the West L.A. store. Now, it seems the rigid arch supports are pretty much obsolete, and we have to look around more for newer things, but I credit Good Feet with saving me when I was desperate, and now, I'm having trouble because of the heel lift the 'real doctors' gave me...so I'm not so hot to consider a person's official 'degrees' ahead of the results I get.

Result number: 166

Message Number 257996

Re: A Pilots Perspective On Missing Air Bus View Thread
Posted by john h on 6/06/09 at 19:45

On reading further about the Air Bus it seems the aircraft was not only in the clouds at 35000 ft but was in the middle of a thunderstorm. With sophisticated radar on board I cannot imagine how you get in the middle of a thunderstorm at 35000 ft. Most often at that altitude thunderstorms are not lined up but scattered which give you plenty of room to get around them. Investigators are focused on the pitot tube now. This is used to provide airspeed to the pilots and most important. I have been flying along in a fighter and watched the airspeed just drop to zero. Not good but not a big deal if you have experience. You fly on power settings at this point. Depending on your aircraft you will likely know that 75% power will produce a given airspeed at a given altitude. The pilot had over 11 thousand hours and I think several thousand hours in the aircraft so should be well acquainted with airspeeds and power settings. I would sure lean more towards a catastrophic breakup caused by severe turbulence than a frozen up pitot tube. If you have your engine power set at 75-95% you can be rather sure you are moving along rather well unless you airfoils are covered with ice.

The part of the world where this aircraft was flying is not far off the coast of Africa where nearly the weather systems, such as hurricanes, originate that hit the U.S. There are storms that really reach high altitudes in that area. The question that still bothers me is why they could not avoid one if there radar was working. Modern aircraft probably have backup radar. In that area there was no ground radar that could cover them. Could be the radar was knocked out by lightning or turbulence. At this point, nearly everything is guess work so no finger pointing should begin. You can be sure the pilots did everything in their power to save the passengers. Sometimes there is just things that happen that is beyond your power to do anything about. It will likely take a year before the accident board issues their findings. The more of the aircraft they find the more they will know. You can tell by how the metal it torn apart a whole lot of information. You can find traces of fire, bombs, or a hundred other things. It is amazing how liitle it takes to gain so much information.

Once I took off from McConnel AFB in an H43 helicopter. I was at about 300 feet when the engine blew up. I was still over the end of the runway and easily auto-rotated back to the ground with no damage to speak of. The engine of the aircraft was sent back to the factor for examination. What they found was a red rag like an flight engineer carries around to wipe off grease. The engineer when making a preflight inspection dropped this rag into an area where it was sucked into the engine and into the compressor where it caused the compressor to blow up. One of the tiny little compressor blades was caused to break and cause others to break and finally the entire engine compressor gave way with a loud boom and sudden quietness which is never a good sign in a single engine aircraft. Anyway, the engineer was found to be the cause of the accident as he was the only one near the aircraft where the rag would have fallen into the compressor area. As pilots we were always very careful not to be carrying anything like ink pins or any thing that could fall out of your pocket into critical areas of a jet. A large jet can suck up a man in an instant into the compressor if he gets to near it when it is running or on the on the other hand it can fry you if you get to close to the rear. I once stood in front of a B-52 about 40 yards our with a light bulb in my hand. The radar operator turned the radar on and pointed it in my direction. I could get flickers in the bulb. I am sure I could have got it to light up had I got closer but that I think might burn me. Over 21 years of being on the flight line no telling how much radar energy we were exposed to.

Result number: 167

Message Number 257979

Re: considering Tarsel Tunnel Surgery - Scared ??? View Thread
Posted by BEvB on 6/05/09 at 17:54

I had a TTR done on 4-22-09. They found varicose veins in my foot, my ankle and my lower leg causing the trouble. I used a 'Game Ready Cold Compression' machine 30 minutes on and 30 minutes off for the first 3 days, then at least 4-5 times a day after that. I had very little swelling, light bruising, and not bad pain. My doctor was very agressive on the after care -- NO WEIGHT Bearing for 3 weeks, then an aircast for 3 weeks full time. I'm now wieneing myself off the aircast and I've started physical therapy. I have to say I am pleased with the surgery. My foot does not hurt like it use to at all. It has been a good experience for me so far.

I have to do the left foot that has a couple of other issues so the surgery will be more extensive and that is planned for September. I am optimistic it will work as well as the right TTR.

It is scary but most of the stuff I found on the web has been horror stories that I have not experienced at all. They do say that all the swelling and 'twinges' will last about a year cuz you use your feet constantly.

Good Luck and go for it!

Result number: 168

Message Number 257977

I was diagnosed with Fibromyalgia but I think they got it all wrong View Thread
Posted by NW Trillium on 6/05/09 at 17:32

As a child in the late 1950's I had leg braces on both legs for I think it was a year, I am not sure for what. It is my understanding if you didn't walk perfect back then they slapped those things on you. The only reason I knew I had worn them is when I accidently came across a picture of me in a play pen with these big leg braces on. Everyone is dead now no one to ask what the reason for them was. As a young woman I wore high heels to work. Painful but I thought no more painful than for every other woman. In my late 30s I had gained weight and couldn't keep up with everyone and ended up going to see a podiatrist. They made up fiberglass arch supports. I lost weight and found it almost impossible to find shoes that would allow room for orthodics that didn't ruin the shoes and gradully I stopped using them. In my forties I started to have muscle problems all over, in my arms and everywhere. I slowed down and gained weight again over the years. The muscle issues got worse. I tried using the older orthodics but they didn't seem to help. Again they didn't fit into many shoes and ruined them. Also couldn't wear them in sandals around water. I was diagnosed with Fibromyalgia about two years ago in my early 50's. I also had problems sleeping from all the discomfort. The muscles got so tight that my big husband could lean into my muscles with his elbow full bore and I would find relief in that! I recently found sandals that are water resistant and for over pronation. Chaco Z1s I have been wearing them all the time for about a week. I am noticing that my pains all over have changed. They are loosening up and it is a painful process. I am wondering if I had Fibromyalgia at all. I have Kaiser Permanente and they don't cover the costs of having arch supports made. However they are very eager to put me on all sorts of pain killing drugs with all sorts of side affects. Kaiser only provides this group seminar on Fibromyalgia that is totally worthless. They have a doc there passing out a
bibliography of all the books etc you can buy and read about this condition. They have no specialists for you to see only primary care doctors are making these conclusions vs folks with arthritis get specialists. Their answer is pain management (drugs). I seriously wonder if Fibromyalgia is real. About 99.9% of these patients are women. The screening process for this condition is so general. How many older women have aches and tender spots in their knees, shoulders, necks etc. Tons. I am thinking that Fibromyalgia is really a painful reaction to orthopedic issues. It only makes sense if you are walking incorrectly it will affect the whole body in one way for the other. I am thinking that maybe lots of folks are getting misdiagnosed. I think it is cheaper for health care providers to pass out pills rather than send patients to specialists. I also think because it is not life threatening and it is primarily happening to women and women have a tendency like myself to go along with stuff that we are not getting the best care. In the seminar one woman pointed out that all of us were over weight. Some women were on some very serious medications and many on several. They also won't pay for massage and the physical therapy guy said they won't spend time chasing all your aches and pains. But clearly this helps coping with all the pain. I googled but couldn't find anything where anyone was made a connection with this. Are there any studies of children in the 1950 who had these braces how did it affect them in adulthood? Are my problems more than just arch support or is that only part of the equation? Should I be wearing some sort of leg support as well for some sort of orthopedic leg issue? I feel like a guinea pig for leg braces and Kaiser's cost cutting vodo medicine.

Result number: 169

Message Number 257974

Re: Shoe recommendation for ball of foot bursitis?? View Thread
Posted by kmm on 6/05/09 at 15:27

I have forefoot 'issues' related to poor result from bunion surgery. I live in Earth shoes. Be sure you are getting Kalso earth shoes with the negative heel, not the Earth Spirit shoes you can find at Walmart. These shoes have made sooooo much of a difference in my comfort level. My experience is that Earth runs pretty true to size.

Thanks Jeremy for the other brand names. I'll check those out.

Result number: 170

Message Number 257947

Re: 11-year-old with large bony protrusions View Thread
Posted by Dr. DSW on 6/04/09 at 06:27

It is always difficult to make an accurate assessment based on a patient's description over the internet. Obviously, I can not see what you are describing, and often what a patient is describing and what I am 'imagining' are worlds apart.

Therefore, I always recommend that you FIRST visit a local doctor, despite your language difficulty in France and obtain a diagnosis. Then report here with that diagnosis. Once you've pinpointed the problem, I can give you treatment options based on the 'accurate' diagnosis you've obtained, rather than 'guessing'.

From what you've described, it 'sounds' as if you're describing a problem at the area of your son's talo-navicular joint and his feet are 'rolling in' or pronating excessively. This can be caused by an accessory navicular bone, a problem with the posterior tibial tendon, or a pes planus foot type, in addition to other mechanical issues. Sometimes the bony protrusion you describe is referred to as 'talar-navicular bulging'. The treatment depends on the actual diagnosis, and once again, without seeing your son, I would only be guessing.

Therefore, please have your son evaluated, and then return to this site and I'll be happy to explain the diagnosis and/or discuss treatment options.

Result number: 171

Message Number 257923

Re: Killing versus letting die View Thread
Posted by RickR on 6/03/09 at 11:40

As you can see I'm better at finding questions than answers on such matters. It's good that we face the issues at least to have an appreciation for the fact that it is difficult and paople are faced with making decisions of whichat others can sit back and point out the negative consequences.

Rick

Result number: 172

Message Number 257869

Re: Dr DSW View Thread
Posted by Dr. DSW on 6/01/09 at 16:57

Yes, the excessive pronation can be causing your knee and back symptoms, but that's something I can obviously not evaluate.

When the Kidner procedure was originally described, it was meant to also address a 'flat foot' deformity by tightening and re-routing the posterior tibial tendon. But in reality, the Kidner procedure or a modified Kidner procedure which is really performed now-a-days does not REALLY have any significant effect on a flat foot.

In order to really address significant pronation, ancillary procedures must be performed depending on the level of the deformity. Sometimes that involves a 'medial column' procedure, sometimes that includes a rearfoot osteotomy, sometimes that also includes an Achilles tendon lengthening or it can also include a sinus tarsi implant.

Or, an external force such as an orthoses may be beneficial following a modified Kidner. Often, patients can not tolerate an orthoses PRIOR to the surgery due to the irritation from the orthoses rubbing up against the bony prominence. However, once this is surgically addressed/removed, an orthoses can often be very well tolerated post operatively and can often adequately address pronation issues.

If not, a sinus tarsi implant CAN be used at that time, which is a very simply 10-15 minute procedure. But I do NOT think that the use of the sinus tarsi implant as the 'primary' procedure will adequately address your present symptoms.

Result number: 173

Message Number 257865

The Most Powerful Man of 2009 View Thread
Posted by john h on 6/01/09 at 12:16

I propose the man of the year on the cover of Time Magazine be Timmothy Geithner. Probably most people have never heard of this 47 year old. His shadow has covered Secretary of State Clinton. Normally the Secretary of State is the most important cabinet member. He has hands in almost every thing that is going on and his advice to the President carries more weight than anyone else. He is listed as an Independent on his profile. He spent his formative year growing up in foreign nations such as Zimbabwe, India, and Zambia. He is a lifetime Civil Servant. No President could possible have the knowledge to make decisions on these complicated issues and probably no be able to discuss them in detail so a man like Geithner is needed. Where his decisions are the right ones only time will tell and a lot is riding on them.


'Timothy F. Geithner

Born August 18, 1961 (age 47)
Brooklyn, New York, USA
Nationality American
Political party Independent
Spouse Carole M. Sonnenfeld
Children Elise and Benjamin Geithner
Alma mater Johns Hopkins University (M.A.)
Dartmouth College (B.A.)
Occupation Civil Servant
Timothy Franz Geithner (pronounced /ˈɡaɪtnər/; born August 18, 1961), . He was previously the president of the Federal Reserve Bank of New York.

Geithner's position includes a large role in directing the nation's economic response to the financial crisis which began after December 2007. Specific tasks include directing how $350 billion of Wall Street bailout money is allocated. He is currently dealing with multiple high visibility issues, including the survival of the automobile industry, the restructuring of banks, financial institutions and insurance companies, recovery of the mortgage market, demands for protectionism, Obama's new tax proposals, and relations with foreign governments that are dealing with similar crises.'

'Early life and education
Geithner was born in Brooklyn, New York.[2] He spent most of his childhood living outside the United States, including present-day Zimbabwe, Zambia, India, and Thailand where he completed high school at International School Bangkok.[3] He attended Camp Becket-in-the-Berkshires-for-boys, a summer camp located in western Massachusetts. He then attended Dartmouth College, graduating with a B.A. in government and Asian studies in 1983.[4] He earned an M.A. in international economics and East Asian studies from Johns Hopkins University's School of Advanced International Studies in 1985.[4][5] He has studied Chinese[4] and Japanese.[6]'

'Geithner's paternal grandfather, Paul Herman Geithner (1902–1972), emigrated with his parents from Zeulenroda, Germany to Philadelphia, Pennsylvania in 1908.[7] His father, Peter F. Geithner, is the director of the Asia program at the Ford Foundation in New York. During the early 1980s, Peter Geithner oversaw the Ford Foundation's microfinance programs in Indonesia being developed by S. Ann Dunham-Soetoro, President Barack Obama's mother, and they met in person at least once.[8] Timothy Geithner's mother, Deborah Moore Geithner, is a pianist and piano teacher in Larchmont, New York where his parents currently reside. Geithner's maternal grandfather, Charles F. Moore, was an adviser to President Dwight D. Eisenhower and served as Vice President of Public Relations from 1952-1964 for Ford Motor Company.[9]'

Result number: 174

Message Number 257837

Re: itchy left Heel View Thread
Posted by max on 5/31/09 at 01:25

WOW, I'm 25yrs old male, I have my bad habits, but aside from junk food and staying up late, I'm practically healthy without any major health issues. And I too have this itchy left foot. Why just my left foot, I have no idea. It's been this way for about 3 months now. I've tried every itch cream I can get my hands on---and still nothing works! It boggles my mind and I'm desperate to find a reason, if not a cure. Unfortunately all I can offer here is my sympathy. Someone needs to uncover this mystery.

-itchy foot

Result number: 175

Message Number 257834

Re: Injections helpful View Thread
Posted by Dr. DSW on 5/30/09 at 19:42

This is EXACTLY why it is ridiculous to solicit answers from other patients on this site.

You are asking for a patient's SINGLE experience, which is statistically insignificant and has absolutely nothing to do with your situation.

On the other hand, my answer (and the answer of other doctor's on this site) is based on over 23 years of experience, treating thousands of patients with this condition and administering thousands of injections.

Sometimes an injection provides no relief, sometimes an injection provides short term relief and sometimes an injection provides relief that can last for months or years. There is no way to predict that outcome, although if a patient has been suffering from plantar fasciitis for greater than 6 months, the odds are that the injection will be less beneficial. That is because the injection is anti-inflammatory, and after 6 months plantar fasciitis is really now plantar fasciosis and is more of a degenerative condition and less of an inflammatory condition.

Additionally, there are very, very minimal side effects of a 'cortisone' injection (rarely is cortisone actually used, but other safer forms of corticosteroids are used) if the injection is performed properly and prudently.

The most common 'side effect' of a cortisone injection in this area would be hitting the nerve and causing additional irritation which can easily be avoided, or multiple injections causing atrophy of the local tissues, which can also be avoided by limiting the number of injection.

Therefore, I will refer back to my original post that these injections CAN be beneficial, despite 'Rob's' single experience.

I can assure you that my 23 years of experience treating this condition gives me a 'slight' edge regarding statistical significance.

Result number: 176

Message Number 257756

Islam and Abortions View Thread
Posted by john h on 5/26/09 at 23:41

I found this interesting as I had no idea where Islam came down on this issue:

slam & Abortion
Dr. Arafat El Ashi
One of the burning issues these days in Canada and in all Western countries is that of Abortion. In the absence of a specific law on abortion, the provincial governments are, in fact, groping in the dark. One court in Ontario allowed a woman to have abortion. The interesting thing, however, is that on her way out of the court, she announced that she already had abortion but she repented for doing so simply because she returned back to her boy-friend. So she no more supports the pro-abortion campaign in Canada. This statement was hailed by what is called pro-lifers in North America.

Another woman from Quebec, called Chantal D, asked the court there to allow her have abortion of her 21-week pregnancy. The court prevented her from doing so. The woman, however, insisted and defied the court's judgment. She did have an abortion. Not only this but she resorted to the Supreme Court to change that decision. The Supreme Court gave its approval and repealed the prevention decision.

In the light of the above, it may be asked here: What is the attitude of Islam towards the issue of abortion? Is it true that women have full control over their bodies and they can have abortion anytime they wish? Or does Islam agree with those who say: 'No, the fetus is a human being and has full human rights'? It has the right to live and to be protected. So it is a crime to have abortion? How does Islam look at this issue?

Basically, Islam considers life as a sacred gift from God Almighty. No one is allowed to take or stop the life of anyone else except by way of justice or according to the Islamic law. Thus, the Holy Quran says: 'Say: Come, I will rehearse what God has really prohibited you from: Join nothing as equal with Him; be good to your parents, kill not your children on a plea of poverty; We provide sustenance for you and for them; approach not shameful deeds, whether open or secret; take not life, which God has made sacred, except by a way of justice and law (Chapter 6, Verse 151).

In another verse, the Holy Quran says: 'Kill not your children for fear of want; it is We who provide sustenance for them as well as for you; for verily killing them is a great sin.
(Chapter 17, Verse 31).

What should we understand from these two verses? First of all, it is a grave sin to take the life of children for fear of want as was the habit during that period. Neither is it allowed to do so for any other reason unless a great evil is caused by the presence of the fetus that may cause the death of the mother.

But is the fetus a human being? Is it part of the woman's body and she is free to do what she likes with it. This is the logic of modern materialistic way of life. Islam has something else to offer. It is completely different from all other concepts or religions. Here are a few details. As a comprehensive and unique way of life, Islam does not at all agree with those who say that a woman has full control over her body. This does not mean that Islam subjugates woman and puts them under men's control. Islam considers our bodies as a trust, which we have to preserve and maintain. It also confirms that the fetus is the creation of Almighty God. No one, not even the mother, has the right to get rid of it unless its presence threatens the life of the mother. For in that case, Islam allows abortion within those limits only.

As a matter of fact, Islam encourages procreation when necessary. But it leaves the door open for birth control. Thus we are told by some companions of the Prophet, peace be upon him, that they used a method of birth control during the time of revelation. The Prophet knew about it and yet he never asked them to stop using it. We have to confirm here that it is basic in Islam to believe that having children is not decided by parents but is part and parcel of God's will and sole action. All that people can do is to try their human means leaving the decision to God.

The attitude of Islam can be better understood if we elaborate a little bit on the issue of sex. How does Islam look at sex between men and women? Does it allow free sex as long as it is agreed upon by the two adult partners as is the case nowadays with most of the non-Muslims nations so much so that the word 'adultery' has been dropped from their dictionary? Or does Islam consider sex as a filthy sin that does not suit men of God?

Neither of these extremes is accepted in Islam. This last religion of God allows no sex whatsoever before or outside marriage. It, however, honours sex in marriage and raises it to a lofty standard. When a Muslim gets married he secures one half of his faith thanks to this contract. So sex in Islam is not at all a filthy sin as long as it is inside marriage. Not only this but a Muslim is rewarded even when he gratifies this desire. In one tradition the Prophet Muhammad (PBUH) said: 'To cohabit with your wife is charity.' Hearing this the Companion asked: 'O Messenger of Allah. Is it possible that each one of us will be rewarded when he satisfies his sexual desire?' He said: 'Yes indeed.' Therefore, the Messenger of Allah concluded: 'When he satisfies it lawfully he will be rewarded for it.' (Narrated by Muslim).

Thus Islam does not look at sex as an end in itself, but as a means to an end. The end of sex according to Islam is to have children. So, it is not allowed in Islam that a woman can have abortion simply because it is her wish to do so, under the pretext of keeping her beauty and to avoid responsibility. This is considered as selfishness. Should a pregnant woman make abortion without any justified reason such as the expectation of risk on the mother's life, then this act amounts to murder according so Islam.

Islam is the religion of strong family relationships. Once marriage is achieved, the two partners should have no sex with anybody else. Not only this but Islam has imposed a severe penalty on those who commit adultery even before marriage. Thus the society Islam tries to establish is a pure and chaste society where women and men are modest. It is a society that does not raise the madness of sex nor does it exploit women's bodies under the false claim of freedom. It is a pure society that is immune from all evils resulting from sex. It is thus free from AIDS, Herpes, and other evils and epidemics that became rampant in modern free-sex communities.

For humanity to be saved of all the ailments of modern civilization, it has to follow the laws of Islam in sex relationships. We can safely say that Islam's attitude towards sex is the middle and the best attitude. Will people understand this and follow the path of happiness, Islam?

Abortion. In the absence of a specific law on abortion, the provincial governments are, in fact, groping in the dark. One court in Ontario allowed a woman to have abortion. The interesting thing, however, is that on her way out of the court, she announced that she already had abortion but she repented for doing so simply because she returned back to her boy-friend. So she no more supports the pro-abortion campaign in Canada. This statement was hailed by what is called pro-lifers in North America.

Another woman from Quebec, called Chantal Daigle, asked the court there to allow her have abortion of her 21 week pregnancy. The court prevented her from doing so. The woman, however, insisted and defied the court's judgment. She did have abortion. Not only this but she resorted to the Supreme Court to change that decision. The Supreme Court gave its approval and repealed the prevention decision.



with permission from:
Dr. Arafat El Ashi
Director: MUSLIM WORLD LEAGUE
CANADA OFFICE

For More Information Please Contact:
MUSLIM WORLD LEAGUE
191 The West Mall, Suite 1018
Etobicoke, Ontario,
M9C 5K8, CANADA.
Tel: (416)622-2184

Result number: 177

Message Number 257754

An explanation View Thread
Posted by wendyn on 5/26/09 at 22:24

I will try and do a better job of explaining my rant the other day.

People disagree and hold opposing views on abortion because it is an extremely complex and difficult issue. It is possible for folks on either side of the spectrum to have perfectly rational, well-reasoned, and morally justifiable reasons for whatever position that they hold. That is not to say that all people do have perfectly rational, well-reasoned, and morally justifiable reasons for their positions – but it is possible and some do.

On the pro-life side of things – there is a wide spectrum of positions. Some people believe that life begins at the moment of conception and that abortion (even when the mother’s life is endangered) is always morally unacceptable. A few of those people might even go so far as to say that birth control is also unacceptable since it prevents children from being conceived and being born. Those extreme positions would represent the very far right of the spectrum and are usually based on strong religious convictions.

Moving towards the middle, there are a larger number of people who find abortion morally reprehensible under certain circumstances but perhaps not others. They may think that it’s okay if an abortion is performed at less than 3 months gestation, or perhaps less than 6 months gestation, or perhaps only if the mother’s life is in danger. Some might think abortion remains unacceptable when the foetus has a known physical abnormality and some will think that known abnormalities can most certainly justify abortion.

To say one is “pro-life” does not mean that one is usually referring to an all or nothing opinion. Often, there is a whole spectrum of positions.

On the pro-choice side of things – there is also a wide spectrum of views. Some people believe that regardless of the circumstances, abortion is always a woman’s choice and no one should interfere. A few of those people might even go so far as to say that a nine month foetus in the birth canal can still be aborted since it is not yet born. That position would represent the very far left of the spectrum and is usually based on a very strong conviction regarding a woman’s right to non-interference from others.

Moving towards the middle, you find the blending and overlapping of pro-life and pro-choice opinions depending on the circumstances. Some people who are “pro-choice” find abortion morally reprehensible under certain circumstances but not in others. So again, to say that one is “pro-choice” does not always mean that one is referring to an all or nothing opinion.

Regardless of where someone’s opinion lands on the spectrum of far right to far left with abortion, I think the important matter is that it’s a well-reasoned, well-thought out opinion.

Now – to my rant.

Sometimes people who self-identify as “pro-life” espouse reasoning like: “Every life is precious. Every person or potential person has a right to life. Abortion is murder. Abortion is killing babies. A society is judged on how it protects its weakest members.” I don’t take particular exception with people who strongly feel this way (I understand the basis for the statement). My mom is one of the people who hold this opinion.

What I do take strong exception with, is when people claim to have these intense sentiments about a foetus, but then seem to have no interest in a child once it’s born. It’s as if those people perceive that every life is precious from the moment of conception......until birth.

My aunt is one of those people. She believes that abortion is always morally unacceptable and that it should be illegal in all circumstances. She professes to believe that life is precious and that society has an obligation to protect the life of the unborn. She believes that Obama is evil incarnate since he advocates a pro-choice opinion.

At the same time, she holds a number of social views that do not reconcile (from what I can see) with her claim to value life and the protection of the weak. She does not believe in state-supported pre-natal care for the mothers of those foetuses. She does not believe that the foetuses of poor mothers have the right to the same medical care as the foetuses of mothers who have private health insurance. She feels the same way about their future education.

In my opinion, her moral position on this particular subject can only be described as hypocrisy in its purest form.

Her stance provides her with a way of appearing to care about something when really, she does not. Think about it – by saying that all foetuses should be born, it requires no sacrifice on the part of anyone but the child’s mother. My aunt can sit in her kitchen and if abortion became illegal tomorrow then it wouldn’t affect her life one bit. It is very easy for her to claim that something is precious and worth tremendous sacrifice when it will never mean any sacrifice on her part.

But, when it comes to the matter of taking care of future people – the babies that those foetuses become - , when their care would have some effect on her life (through taxes to pay for social support) she washes her hands of any moral obligation.

For a woman who is carrying a child with a known severe physical abnormality – she would say that the woman must have her baby. However, she would not support social programs to provide that child with expensive life-time medical care. For a young pregnant teenager – she would say that the girl must have her baby. However, she would not support pre-natal care for her or funding for education so that she could remain in school and raise her child. The list goes on.

To me, this position exhibits a morally reprehensible stance on abortion. Not because of where her opinion falls on the spectrum of pro-life to pro-choice, but because of the indefensible reasoning behind her position.

I realize that I ranted at you and not my aunt, but knowing what I know about your opinion on social issues – I sensed some similar reasoning (albeit perhaps incorrectly). And I reacted to that.

Now, if you or anyone else can share with me (honestly and rationally) how one can defensibly claim the value of holding human life in such high esteem that it must be protected from the point of conception, but then believe that society is not responsible for the well-being of a child once it is born, I would be truly interested in trying to understand.

At this point in my own reasoning and thoughts I cannot reconcile those two positions in my mind.

I hope that makes sense...

Result number: 178

Message Number 257709

Re: Mion and J41s and Privo View Thread
Posted by Jeremy L, C Ped on 5/24/09 at 15:05

I'm kind of interested in knowing just who these people are. They license their brand name and some of their design features from Chrysler. Before anyone wonders whether we want a failing auto maker constructing our shoes too, I'm not sure they are that intimately involved with design or manufacturing.

Some of their shoes are fine, particularly their casual wedge series. All their styles use a substantially combination shape to their lasts, so they manage well with the fit of younger, American feet. Like most any shoe brand, there are things to watch.

The biggest concern I have is in their sport categories. Rather than building credible sole units, they chose to go the cheap route. This means reinforcing the stock footbed, and placing it into a shoe with virtually no support characteristics. As many have read here before that is a recipe for disaster. This typically doesn't bother younger feet or those without functional issues, but can make at-risk feet worse within a few-to-several weeks of wear.

My personal favorites in this kind of category have been Ahnu and Chaco. I now have reasons to keep a careful eye on the credibility of both brands. Ahnu wants to substantially increase distribution. Not always, but commonly, this often leads to a degradation in product integrity and traditional support mechanisms. Chaco's case is different. They were recently purchased by Merrell. It could be that nothing changes, and they continue making outstanding products. That paradigm has unfortunately not been the hallmark of such brand transactions. I'll personally wait and see. In the meantime, those who can wear Chacos effectively should grab the good ones while they can.

Result number: 179

Message Number 257708

Re: Mion and J41s and Privo View Thread
Posted by cwk on 5/24/09 at 14:15

YIKES! I think I will throw my uglier Keens in the trunk to make sure I am not stranded in pain in case I start to have issues with these cute sandals!

Glad you added your insight! I have wondered why the toe turns up and back but it hasn't bothered me. Of course I have only had these shoes for a month and wear them about once or twice a week. Still I can wear them all day without the foot fatigue I get from real flats.

What do you think about J-41s? I stumbled onto them (no pun intended) in Vermont and have been recommending them to friends and people who stop me on the street to ask where I got them.

Only one store in the Bay Area carries the non-sport J-41 and I have been trying to convince the buyer of one popular boutique in SF to carry them. I know they work for me but am wondering if I should be endorsing them so heartily to others.

Result number: 180

Message Number 257696

Re: Believe it or not - abortion and stem cell View Thread
Posted by wendyn on 5/23/09 at 23:50

Fair enough John - you're right. You haven't publically taken a side on the abortion debate and I shouldn't have indicated you had.

However, as someone who opposes universal health care and who (I believe) opposes public education - I'm not entirely sure why - by referencing these statistics - you're overly concerned about a bunch of children who were never born.

In fact, I would think you might perceive them as a bit of a relief.

Let's just take the emotion out of it for a moment and stick to what you feel is important: the economy and the state of American finances.

If you are concerned about your government's debt and the state of the economy, then you need to reconcile that concern with your concern about babies (and future people) who would likely represent a drain on your limited resources.

The fact is (and we've been down this road before) that the United States has _THE_ highest rate (year after year after year) of teenage/unplanned pregnancy out of all developed countries in the entire world.

That rate is associated with the rate of abortions.

Futhermore, the rate of unplanned pregnancy is directly (and conclusively) linked to a lack of education, lack of health care, and poverty.

If one is not interested in addressing the issues of poor health care, lack of education and poverty, then one should not concern themselves with the rate of abortion.

Period.

It's a harsh but rational analysis. Now, if you can reconcile all of this in your mind some other way - I'd be intrested in hearing it.

There is no right or wrong answer, but if one is going to concern themselves about fetuses that were never born, then one ought to also concern themselves about what type of life those fetuses will eventually have.

If one cannot concern themselves with the future life of a fetus, then one ought not to concern themselves with whether or not they are ever born.

Result number: 181

Message Number 257682

Re: Peroneal Subluxation questions View Thread
Posted by rose8 on 5/23/09 at 08:19

Thank you - I looked into it and my insurance would actually cover treatment by that dr. which would be great. He seems quite well-known, I wonder if it would take a horribly long time to get in to see him. I'm nervous because it seems from what I read that the tendon can rupture if I don't do anything to stop the subluxation - is this what will happen if I let it go?

For a standard surgery without complications, about how long would I be looking for in a cast? a walking boot? etc. I know this has been touched on before but it seems to be a lot of different answers from different people who have had some different issues or additional problems etc.
I guess what I'm wondering is this: What if I had the surgery, all went fairly wel; - what would I be looking at in terms of cast? boot? (and of course I understand you have never seen my ankle or met me and I would never hold you to this answer, I just want an idea of how long I will be out for, as I said, I have never missed more than a couple weeks since I was 13 and even when I have had to take off from running, I have always been able to swim or at least lift weights). So otherwise healthy, mid 20s female, in good shape and former collegiate athelete - can you give me an estimate of what I MIGHT be looking at?

Also - what about the Rochester NY area for foot and ankle specialists? This is where my extended family lives and I am afraid that I would need to go there for assistance while I recover anyway and perhaps if there is someone very good in that area I could have the surgery done there too to make it easier. Does anyone know of a doctor in that area? I really want someone who knows what they are doing, being able to return to activity is SO very important to me. I do realize that I may never be able to compete again but I at least need to be able to walk and swim and I can't have this occur again down the line.

What are the chances that post-surgery, down the line at some point, subluxation will occur again? Does this happen? How common?

What are the chances that my ankle will NEVER be the same? This is what I'm most afraid of. I will do any exercise, physical therapy, treatment, etc. that I need to do afterward to make this ok again. I am so desperate to fix this and to be back to working out but I have seen cases on this message board where the person never recovers fully. This is what I am most terrified of.

Thank you.

Result number: 182

Message Number 257667

ESWT - heal spurs- minimal nerve damage View Thread
Posted by Val on 5/22/09 at 06:22

I have been having issues with heal spurs on and off for almost 18 years and typically orthodics work to relieve pain. Back in 2000, due to back problems and sciatica in my right leg, I have been left with some numbness on the top of my foot towards the right ankle. Then in Aug 2008 I had a blood clot in that leg and that resulted in some numbness in the lateral plantar nerve on the bottom of the same foot.

Recently, I went back to the podiatrist due to pain in the back of my heal towards the right side. X-rays showed 3 bone spurs now, 2 towards the inside of the heal and one on the back. The pain has been ongoing for some time now and I am considering ESWT. I have consulted my neurologist but he was not able to answer my quetion of concern. Maybe you can.... By having the EWST, could that further damange the already troubled nerves in my foot?

Result number: 183

Message Number 257628

Re: Now What? Long Term Effects of Plantar Fasciitis View Thread
Posted by Dr. Wedemeyer on 5/19/09 at 20:01

Do you have a history of low back complaints, neuropathy? The groin pain could be as a result of your hip issues in the absence of the above. It is very difficult to advise you without a very complete history, something available to your treating doctors. Your description falls outside of a common PF complaint and in these instances I would urge you to see the orthopedist and wait for the MRI and his/her examination and opinion.

Result number: 184

Message Number 257517

Pelosi stepped on a land mine View Thread
Posted by john h on 5/15/09 at 13:04

Speaker Polosi has very much to the dismay of other Democrats has stepped on a land mine by calling the CIA liars. In her press conference the other day she looked like a person as guility as sin as she answered hard questions from the press. The press now smells blood and a story. The CIA I would think keeps very good records. She did not attend these briefings by herself. She seems to be digging deeper and deeper while her fellow Democrats would like to move on to other issues. The last thing they want is a full blown investigation. This could very well end her days a majority leader if this thing plays out to a full blown investigation. At one point she said I knew they were talking about water boarding but she did not know they had done it. Then the question should be why would you sit on that knwledge for 4 years and say nothing. Her answer was I knew they would do nothing about it so why bother. That is a simpleton answer if there ever was one. This Democrats would do well to put another person in her position. They have a lot of much more well qualified people than Nancy Polosi. She is an anchor around their necks and is quickly gaining that reputation among the public. Every day I read about her or see her on TV on on the late night talk shows. That can be a sign ob bad things to come when you become the butt of jokes on late night TV.

Result number: 185

Message Number 257396

Re: Dr's-can you help me brain storm a little please? View Thread
Posted by Jillm on 5/10/09 at 11:00

Dr. Ed~ That seems to be my main problem-nothing shows up on x-rays or MRI's. I partially tore my peroneal tendon last May and then strained/sprained both Achilles tendons. The MRI showed a little bit of something on the peroneal and that's what brought them to a Dx of partial tear. Nothing showed up on the achilles. They just burn/ache and feel really tight even though I stretch calves and hamstrings throughout the day.
I'm wearing my orthotics every single day in my Saucony shoes and I can walk 10 minutes MAX! My grocery or mall shopping for me. I can run into the pharmacy for a quick trip, but the heels and achilles start to ache and throb, so I have to leave pretty fast. Are you asking about a hump behind the metatarsals? There is a hump in mine. My pedorthist is pretty perplexed because he says it doesn't look like there's any biomechanical issues. He has made multiple orthotics for me and is known around here for being one of the best. I've been back many times for adjustments and haven't been back in a while, just because nothing is helping. Like I've said, I've had lots of nerve testing and MRI's of the sacrum, lumbar, thoracic, neck and brain to see what the heck might be going on. They all came back normal (lumbar has tiny 2 mm disc issue, but he said that's pretty normal)
When she injected the heels with Cortisone, it really hurt, but I never got the numb feeling like I did in years past when I would get the neuroma areas injected with Cortisone. I had the heels injected twice-same thing-no difference. Took about 8 days for the pain of the injection to go away. Then it was back to the normal pain that I always have. My Rheum. says I have arthritis and that's causing achilles pain, but just not sure I'm willing to accept that and that there's nothing to do about it. I was walking up my yard and not rolling onto the toes enough last May when I first injured my peroneal tendon and achilles. I'm just so frustrated.
Thank you for helping me brain storm. Jill

Result number: 186

Message Number 257355

Re: Obama's Health Care Plan!!!! HURRAY!!!! View Thread
Posted by wendyn on 5/08/09 at 16:27

Well John, I wouldn't stay we've had problems with the 'French speaking province and English Speaking provinces.' It's never really been a language issue. It doesn't bother me at all to press 1 for French or 2 for English.

The main issue here has been that members of Quebec are afraid of losing their language and their culture. They want to be sovreign with their own identity and their own government and they try to do everything possible to preserve their heritage. Sometimes it causes some issues and sometimes they threaten to leave the country. But it's never been about languages per se.

We have French and English on everything we buy and we actually are started to see Spanish pop up on a lot of our products too. No one that I know seems to mind too much.

Result number: 187

Message Number 257347

John Stossel View Thread
Posted by Jenny on 5/08/09 at 10:34

Check out John Stossel's report tonight at 10 on ABC. His specials are always very enlightening. On various issues, he takes things into consideration that many of us haven't thought about.

Result number: 188

Message Number 257313

Re: Seek Sinus Tarsi Implant Recommendation View Thread
Posted by Susan B on 5/06/09 at 17:17

Dr. Wander: I went to Dr. Lombardi today; I'm pretty discouraged... he was totally against the implants (for anyone... said those people should be shot or some such). Said they were only appropriate for children. He later explained (from his point of view) there was just too much weight bearing down on that little screw... that it ultimately would cause arthritis and other issues.

He said films-wise my feet aren't too bad (I do have 'flat feet').... he'd recommend doing nothing. He said if I am in the degree of discomfort I'm claiming he could do a calcaneal osteotomy... but that it may not give me particularly dramatic results (since I'm describing that my whole fasciia hurts).

I understand the implants are controversial but I wasn't expecting him to so thoroughly trash them. Is there anyone else you could recommend (ideally in Manhattan, Dr. Lombardi was in Queens) who does the implants (just to get another opinion), thanks.

Susan

Result number: 189

Message Number 257286

Obama's Health Care Plan!!!! HURRAY!!!! View Thread
Posted by marie:) on 5/04/09 at 19:58

Here's the PLAN:
http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf

http://ohmygov.com/blogs/general_news/archive/2009/05/04/healthcare-under-obama-dispelling-myths-and-setting-precedents.aspx

The Obama-Biden health reform will extend private health coverage to Americans in two ways: the plan will require insurance companies to cover pre-existing conditions and will offer subsidies to those who cannot afford to pay their premiums.

Perhaps the most anticipated and speculated part of Obama's plan is the establishment of a National Health Insurance Exchange that will include both private and public affordable health plans emulated on benefits available to members of Congress. The public health plan included in the Exchange would be a first of it's kind for the country.

For those keen on keeping their current private insurance, Obama has promised to cut premiums by up to $2,500 annually, money that will be saved by investing in prevention, importing generic drugs, and implementing a digital-record health system that will cut administrative costs.

Result number: 190

Message Number 257246

Spector, McCain and Coleman View Thread
Posted by marie:) on 4/30/09 at 17:21

Alright Arlan Spector! McCain showing an effort to listen and change with town hall meetings. Coleman it's over, Pawlenty do your job or forget bid for presidency....we all saw what obstructing the voters did in Ohio. Poor Kenneth Blackwell. It's all about choice.

http://www.foxnews.com/politics/2009/04/28/specter-secures-seat-party-switch/
Now that Sen. Arlen Specter is switching to the Democratic Party, he'll have to screw up pretty bad to lose his bid for a sixth term next year, say political analysts and lawmakers who consider his re-election a foregone conclusion.

http://voices.washingtonpost.com/44/2009/04/30/gops_big_names_try_to_forge_ne.html?wprss=44
a group of party heavyweights including former Florida Gov. Jeb Bush and Sen. John McCain (R-Arizona) are launching a new group that will hold town halls around the country and look to produce GOP ideas on issues like education and health care.

http://www.cbsnews.com/blogs/2009/04/30/politics/politicalhotsheet/entry4980753.shtml
'Most Minnesotans – including Republicans – believe that once the state Supreme Court rules, Governor Pawlenty should do his legal duty and certify Al Franken as our senator,' an announcer says in the spot. 'But the national Republican donors don’t want Minnesota to have our rightful representation in the Senate. The Republican Campaign Chairman, Texas Senator Cornyn, said Norm Coleman’s court challenges could take 'years' to resolve.'

Result number: 191

Message Number 257151

Seek Sinus Tarsi Implant Recommendation View Thread
Posted by Susan B on 4/26/09 at 16:18

I have just stumbled on info on the sinus tarsi implant (the HyProCure one). I have suffered with foot issues all my life, particularly the last 20 years (I'm 56). I am clearly pretty severely pronated, have PF, and also various back and knee issues. Very tight calves which I've had trouble getting stretched out (usually my stretching attempts make it worse), but I keep working on it.

My feet hurt to varying degrees with every step. Everything in my life revolves around my feet. I'd love to find a solution. Yes, I've used orthodics for the last 20+ years (some custom, mostly not); I have boxes and boxes of foot related products (I try practically everything on the market).

I live in New York City and I was surprised to find only one doctor listed on the HyProCure website in the entire state of New York (in Queens, not far away). But it makes me nervous that there was only one choice. Are you willing to recommend someone? Thanks.

Result number: 192

Message Number 257143

Re: Extreme Stabbing Heel Pain - Stand for Hours View Thread
Posted by Dr. DGW on 4/26/09 at 11:32

Unfortunately one of your symptoms 'Even the fibers of my socks feel as though they are digging in and tearing me apart' leads me to believe that there may be a need for you to see a specialist.

What type of physicians have you seen for this condition thus far and what was their impression? It is not credible that prolonged standing alone would cause the issues that you are revealing unless there is either significant trauma, congenital factors, change in body weight or systemic illness at play here.

Also what area do you live in?

Result number: 193

Message Number 257142

Re: Prolotherapy---Does it Work--What is your Opinion? View Thread
Posted by Dr. DGW on 4/26/09 at 11:21

Have you tried the Graston technique? Very similar principle although Graston is a manual 'debridement' of the soft tissues which causes an inflammatory cascade and stimulates healing.

Result number: 194

Message Number 257069

Re: considering achilles tendon surgery View Thread
Posted by ginam on 4/22/09 at 23:24

i had achilles tendonitis - along with pf, hammertoes, a morton's neuroma, displaced peroneal tendons and partially collapsed arches. all of these issues resolved with yoga toes foot stretchers. you can read my story in comment #14 here:
http://well.blogs.nytimes.com/2008/10/13/painful-toes-and-where-they-lead/

i hope you will consider trying these before committing to surgery and big $$$.

best, gina

Result number: 195

Message Number 257068

Re: Waterproof Sandals? View Thread
Posted by ginam on 4/22/09 at 22:50

hi jennifer,

i'm glad to hear that you liked the chacos idea, altho not the flip-flops. it really is a revelation to feel arch support from a shoe, isn't it?! :-) if you try one of the strappy models, i think the toe-loop-less would suit most people better, for comfort and ease of use. (i got the loopy ones only because they were 1/2 off, assuming i could re-sell them for the same price if i didn't like them.) there are a ton of reviews at the site i linked previously, that could help you decide; some people like the security of the toe loop.

are you up for another recommendation? i got rid of my hammer-y toes (and a grab bag of other foot issues) w/ the 'yoga toes' foot stretchers. you can read my story by scrolling down to comment #14 at http://well.blogs.nytimes.com/2008/10/13/painful-toes-and-where-they-lead/. i know one of the medical professionals here has pooh-poohed them, but they have been like a miracle for me.

best, gina

Result number: 196

Message Number 257060

Re: Hyperpronation surgery? View Thread
Posted by Dr. DGW on 4/22/09 at 18:57

Completely agree with Greg here in that surgery should be the last consideration for PF sufferers. Conservative care typically yields excellent results and resolution of acute PF pain. The people who post on this board are the small percentage of patients and people who have not achieved significant resolution and who suffer from chronic, recalcitrant PF (and other foot related issues).

If your doctor is eager to head you straight off to surgery for acute PF pain, get a second opinion. Also because PF is a multifactorial problem, each case can be considerably different and treatment of PF varies greatly amongst different disciplines.

I prefer a combine approach consisting of addressing the biomechanical faults that are causing the PF (PF is almost always an overuse syndrome due to biomechanical faults) in the first place with physical medicine (myofascial release, muscle stimulation, ultrasound, NSAIDS, inserts or custom orthoses and shoe wear assessment and modification) at least initially.

There is always time for those cases that do not respond timely to consider injections, ESWT, Topaz, surgical release etc.

Result number: 197

Message Number 256989

Re: Cucumbers!! View Thread
Posted by Dr. Wedemeyer on 4/19/09 at 21:18

Cucumbers contain very low levels of vitamin C and silica. The former is the primary component of new collagen formation in connective tissue. I advise all patients suffering from tendon and ligamentous insult to increase their uptake of vitamin C and cofactors copper, manganese, selenium and zinc as these help vit. C cross link new collagen. I also believe that MSM is of huge value in these types of injuries as MSM is a sulfurous compound and sulfur is a prerequisite for collagen formation.

Silica while being a minor component of connective tissue has a lot of anecdotal claims for it's efficacy around the internet and yet there are no peer reviewed, published journal articles that validate these claims (vitamin C and the cofactors above are supported in studies and the literature to aid in would and soft-tissue healing). Silica is found in trace amounts in grains, fruits and vegetables and I encourage adequate intake of these foods on a daily basis to begin with. Fruits especially should be varied and eaten 2-3 times per day during healing.

No big mystery here that PF is a type of overuse syndrome of the plantar soft tissues and nutritional support is beneficial and inexpensive. I doubt cucumbers though are a panacea (in fact they are mostly water) and there are many foods we should all eat daily that promote healing and contain the elements being discussed that are more effective in obtaining these essential nutrients.

Result number: 198

Message Number 256958

Re: PRP for severe archilles tendonitis View Thread
Posted by Nacy on 4/18/09 at 07:45

I never had that injection.
Vicodan was the only pain med that helped me.
I had mutiple issues (4) with my tendon, but every doctor concentrated on just one issue, so consider that.
I had to use a cam walker to get relief while waiting for resolution.
I did ice alot.
Lots of websites on achilles can give you info.

Result number: 199

Message Number 256941

Re: In tears, no one seems to be able to help View Thread
Posted by Dr. DGW on 4/16/09 at 23:30

Of course only your doctors would know and I find it difficult to miss PTTD. It may be one of your issues if you cannot raise up on your toes without pain. BTW sciatica is not aggravated by plantarflexing the ankle (pointing down)Did any of your doctors have you perform this test in their office?

Age, body weight and systemic conditions play a role in the development of the condition, but are not always the sole cause because trauma and overuse can induce the tendon to begin to tear.

PTTD is a progressive pronation related problem that stresses the posterior tibial tendon (PT). PF is not typically aggravated by raising onto the toes in the same manner that PT tendinitis is but it can be if there is ankle equinus (toes pointed downward due to a tight or short Achilles tendon).

As PTTD progresses you will see myriad changes in the heel and forefoot; heel valgus (tipped outward, which also is a cause of sinus tarsi insult), dramatic flattening of the medial arch of the foot and eventually abduction of the toes (away from the body) to accomodate the valgus heel and low arch. It is a progressive deformity and can cause many of the symptoms you describe as sequelae. I find it hard to comprehend that any foot/ankle specialist could miss it, so it may be a part of your problems or the primary cause but either way I would ask.

PTTD can be effectively controlled in stages I and II with in shoe orthoses and the appropriate footwear. Beyond that an ankle gauntlet brace or surgery (late stages)to repair the tendon are the recommended treatments.

Result number: 200

Message Number 256937

Re: What's wrong with me? View Thread
Posted by dilynn on 4/16/09 at 21:02

If you tap on the top of my foot around the 2nd metatarsal area it is like a 'zing' very uncomfortable tingling. Does not happen on other foot. Dr. Said 'yeah, that's your nerve' like it was normal. The numbing is around the 3-4 toe. Suspected neuroma.

When I stand on my toes it definitely hurts. I notice when bending my foot up on toes while sitting is very painful. Tightness in low calf is usually present.

I think the EMG/NCV is what the Dr. suggested because he suspects nerve/sciatica issues.

Thank you so much for your post. I am reading it a few times to understand. I have definitely have not been presented with this scenerio. What treatments did the pts. receive and was it helpful?

Thank you, again. :)

Result number: 201

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