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Who has a "dual" or multi-diagnosis in the lower extremities?

Posted by Beverly on 11/26/00 at 22:48 (033587)

I've noticed more and more of us have more things wrong with our feet and lower extremties than PF. I thought it might be interesting to see how many of us are 'dual' or 'multi' diagnosed in lower extremities. For instance, I started out with plain old garden variety PF in my right foot, but over the last nine months it has evolved into a horrible case of PF in both feet, bilateral Post Tibial Tendonitis, and now a bilateral hamstring strain/tear! I'm only 40, and never had a foot problem in my life until this. I feel like all these things are 'feeding' off of each other. And as our 'regulars' know, I don't even work on my feet.

So what about the rest of us?
Beverly

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/26/00 at 23:15 (033589)

i started out with Hallux Limitus which is basically an arthritis in the 2nd joint of the great toe. i personally think this caused me to change my gait when i ran in order to avoid pain when bending the toe. since the toe did not flex much and is attached to fascia things were not normal. some months later the begining of PF.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Julie F on 11/27/00 at 02:27 (033602)

Beverly, are you quite sure that your hamstring strain isn't really a problem emanating from your back? As I remember, you noticed the first one after your experience in the total gym. I remember you saying recently that you'd suspected sciatic nerve involvement but your chiropractor didn't think so. And yet, if it is a hamstring strain, I don't see how it could become bilateral all by itself. Worth checking into the back again?

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Barbara TX on 11/27/00 at 11:48 (033630)

John - I too started out with hallux limitus, pf began acutely a year ago and now achilles tendonitis from stretching. B.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Kay S on 11/27/00 at 11:54 (033632)

I started out with pf in one foot, which quickly progressed to pf in the other one. Next diagnosis was achilles tendinitis. Then tarsal tunnel. Somewhere in there one pod thought my pad was too thin. Now perhaps I have too short tendons from all this protective walking I have been doing over the past 4.5 years. The pt said I have forefoot varus deformity also, but I don't think that is so important at this stage. There must be something else but those are the high spots. Did I win?

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/27/00 at 12:06 (033638)

i had a cheilectomy to repair the hallux limitus on my left toe and it is ok. i still have to deal with the one on my right toe. i definitely think that hallux limitus can lead to PF due to you trying to avoid pain in the toe while walking and the fact the tension on the fascia changes because of lack of upward flexability of the toe.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Barbara TX on 11/27/00 at 14:20 (033649)

I totally agree, John. I think that this is the first thing that a podiatrist should check. I got by two podiatrists who didn't notice this and finally a chiropractor did and stretched it out for me (with active release therapy). The difference in my flexibility is quite noticable. None of the DPM's even TOUCHED my feet, much less checked my flexibility. That is the FIRST thing Dr. Z. did. Viva la difference. B.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Beverly on 11/27/00 at 17:16 (033658)

My big toe gets stiff and I have a small bump that I was told is the beginning of a dorsal bunion, but it came after the PF. I blame it on a bad orthodics/shoe fit, but who knows? This is interesting how many of us have a multi-diagnosis. My personal and completely biased uneducated opinion is that something goes wrong in the foot or ankle and it sets off a domino effect. It does seem like those of us with multi-diagnosises have a harder time getting into recovery.

Kay, you sound like you've been through the wringer. I'm glad you've found this Board. If nothing else, while you are gathering information, having other people to talk to will help your sanity. I know it has helped mine.
Because friends and family try to understand, but it's really hard for them to 'get it.'

Julie, I want the back ruled out, but none of my medical people seem to think that's what it is. I'd love to stick my whole body through an MRI machine. Too bad we can't 'photocopy' ourselves like a piece of paper in a copy machine!

See ya,
Beverly

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Kay S on 11/27/00 at 19:07 (033665)

Beverly---Even though the MRI is a good diagnostic tool, it doesn't automatically give the answer to your foot woes. And as you are seeing from everyone else's case history, multiple problems muddies the waters, so to speak. My MRI was normal and that seemed ridiculous to me. How could it be normal when I have been suffering for so long????? And I know I am not imagining this pain. If I were going to choose to be in pain, I would certainly pick something more acceptable than my feet.
I feel like you gave me a hug, and since this is a baaaaaaaaaaaaad foot day, I needed it! Thanks.I jammed up the garbage disposal this afternoon and my husband ended up having to cut pipes and replace them, so I doubt that I will get much sympathy from him tonight.
Did the doctor say anything about what's next???

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

wendyn on 11/27/00 at 22:35 (033686)

I have been told (at various times)

That I have

Flat feet (true)
PTT (true)
TTS (true)
Bunion (true)
Bunionette (true)
Pronation (true)
Ankolosing Spondylitis (not true)
RSD (not true)
Polyneuropathy (not in the sense they were describing)
Sciatica (true)
Sprain (not true)
PF (true)
Stress fracture (not true)
Lower back problems (true)
Tibial tortion (true)

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

wendyn on 11/27/00 at 22:37 (033689)

Oh - yes - a forefoot varus also.

I think that's it.

Oh - nope

Gastroc equinus contracture which I think is short heel cords - have had achilles tendonitis but not for a while.

There - I think that's it now.

Some dosolateral sublaxation (misalignment of foot joint) and MRI showed a ganglion on my right foot but they don't know if it's a problem or not.

Now I'm done.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/28/00 at 11:54 (033727)

beverly: the small bump if on top of second joint big toe could be the begining of a bunion or the begining of hallux limitus. if the toe starts to turn in it is probably a buninon but it does not and the bump gets bigger and more sore it could be hallux limitus. x-ray can probably define this.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/28/00 at 11:55 (033728)

i think i also told you that you were in the prime of your life.

Re: I finally got talked into the nightsplint.

Beverly on 11/28/00 at 16:35 (033742)

Wendy,

Sounds like you get the prize for most diagnosises and Kay is a close runner up!

I may have something new to add to the list. When I went to get my orthodics fitted today by a combination PT/orthodist, I was told that if ankle positioning/flexing hurts behind my knee, then that can't just be the hamstrings. He said it sounds like I have tight gastrocs too. I said, 'Oh great.' And not being good in anatomy, I'd never even heard of the 'gastrocs' until he showed me where they are.

This guy also thinks I need the nightsplint. Somehow he talked me into what no one else has coaxed me into. He wants me to wear them in an extra gentle style/setting for two weeks before fitting me for the orthodics. He says if that will loosen up my tight heels/ankles, that will give him additional info for making the orthodics. He felt like on a gentle (neutral or even less) setting, it could not hurt my hamstring tear.

I said I'd try them. So, they should be in in a few days. It's padded in lambswool. I just hope it doesn't make the hamstrings hurt more.
Beverly

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Pauline on 11/28/00 at 20:13 (033762)

I remember the guru of Foot and Ankle telling me in 1993 that the Domino effect is exactly what happens in the foot and ankle area. That's why
he was so reluctant to perform surgery unless it was the last resort. His experience is that when you cut in one area you affect another or several others. Since like other surgeries there is the human element to consider you never know what you are going to end up with. Sure after many surgeries a Dr. should have a fairly good idea what the outcome might be but the human body being unpredictable could send you many surprises.

The difference between my two cases has been that the first time it was several weeks before I could get into see the Ortho. By the time I received Physical Therapy several months had gone by and when he finally decided to give me an injection the PF had spread to the other foot.
I also worked at the time and could not spend as much time off my feet.

When my second case popped up I was able to get in to see the Dr. within a week because I was an established patient. He gave me injections in both
feet because I was leaving for Europe which proved to be a poor choice.
The trip, not the injections. I truely think we tend to fear them too much. I got Physical Therapy within 2 weeks and because I had quite my job was able to spend a lot of time on my butt.

My conclusion is early intervention does make a difference especially the Physical Therapy. Being able to sit around is truely the most important key to recovery. Once you can get the pain under control and the inflammation cycle stopped the true healing seems to begin. All of the other things seem to help in their own way. The stretches, the icing,
the night splints etc.etc. This board even plays an important part in the recovery process because it provides ideas, friendship, hope, humor and comfort to all who sign on.

I think the 'dual' or multi problems come about because most of us are not able hang it up for any length of time. We have families, husbands, jobs
that put continue stress on already stressed feet. The problems just multiplies. We hobble to protect one part and injure another. The heel throbs today the arch tomarrow and the ankle the next. The cycle continues until several parts of the foot become inflamed and we are forced to re-evaluate and see this illness in a new light.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Nancy S. on 11/29/00 at 15:15 (033813)

You'd think I'd just found this board. How many days did this get by me.
I won't win any prizes, but since PF in my left foot (first foot problem ever in my life) the following have developed and nearly drove me over an edge:
bilateral achilles tendonitis (bad)
bilateral peroneal tendonitis (bad)
bilateral posterior tibial tendonitis (bad)
bilateral shin splints (hey, not TOO bad)
depression, anxiety, generally nuts (bad)

I agree with many things Pauline wrote. I also am convinced that weird PF walking leads to a variety of nasty conditions, and this makes perfect sense to me. Now.

Oh, I forgot one more diagnosis. It's a self-diagnosis, but I learned it from heelspurs.com over time:

bilateral foot and mental bad-pod treatment (extra bad)

Learned the hard way: immediate location of a good and interested doctor and immediate active treatment, along with faithful rest, are a must. And I'm beginning to think that if you have any structural problems (like flat feet) or gait problems (like hyperpronation), investing in the best custom orthotics by a superb professional is an important path to try.

Nancy

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/26/00 at 23:15 (033589)

i started out with Hallux Limitus which is basically an arthritis in the 2nd joint of the great toe. i personally think this caused me to change my gait when i ran in order to avoid pain when bending the toe. since the toe did not flex much and is attached to fascia things were not normal. some months later the begining of PF.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Julie F on 11/27/00 at 02:27 (033602)

Beverly, are you quite sure that your hamstring strain isn't really a problem emanating from your back? As I remember, you noticed the first one after your experience in the total gym. I remember you saying recently that you'd suspected sciatic nerve involvement but your chiropractor didn't think so. And yet, if it is a hamstring strain, I don't see how it could become bilateral all by itself. Worth checking into the back again?

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Barbara TX on 11/27/00 at 11:48 (033630)

John - I too started out with hallux limitus, pf began acutely a year ago and now achilles tendonitis from stretching. B.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Kay S on 11/27/00 at 11:54 (033632)

I started out with pf in one foot, which quickly progressed to pf in the other one. Next diagnosis was achilles tendinitis. Then tarsal tunnel. Somewhere in there one pod thought my pad was too thin. Now perhaps I have too short tendons from all this protective walking I have been doing over the past 4.5 years. The pt said I have forefoot varus deformity also, but I don't think that is so important at this stage. There must be something else but those are the high spots. Did I win?

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/27/00 at 12:06 (033638)

i had a cheilectomy to repair the hallux limitus on my left toe and it is ok. i still have to deal with the one on my right toe. i definitely think that hallux limitus can lead to PF due to you trying to avoid pain in the toe while walking and the fact the tension on the fascia changes because of lack of upward flexability of the toe.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Barbara TX on 11/27/00 at 14:20 (033649)

I totally agree, John. I think that this is the first thing that a podiatrist should check. I got by two podiatrists who didn't notice this and finally a chiropractor did and stretched it out for me (with active release therapy). The difference in my flexibility is quite noticable. None of the DPM's even TOUCHED my feet, much less checked my flexibility. That is the FIRST thing Dr. Z. did. Viva la difference. B.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Beverly on 11/27/00 at 17:16 (033658)

My big toe gets stiff and I have a small bump that I was told is the beginning of a dorsal bunion, but it came after the PF. I blame it on a bad orthodics/shoe fit, but who knows? This is interesting how many of us have a multi-diagnosis. My personal and completely biased uneducated opinion is that something goes wrong in the foot or ankle and it sets off a domino effect. It does seem like those of us with multi-diagnosises have a harder time getting into recovery.

Kay, you sound like you've been through the wringer. I'm glad you've found this Board. If nothing else, while you are gathering information, having other people to talk to will help your sanity. I know it has helped mine.
Because friends and family try to understand, but it's really hard for them to 'get it.'

Julie, I want the back ruled out, but none of my medical people seem to think that's what it is. I'd love to stick my whole body through an MRI machine. Too bad we can't 'photocopy' ourselves like a piece of paper in a copy machine!

See ya,
Beverly

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Kay S on 11/27/00 at 19:07 (033665)

Beverly---Even though the MRI is a good diagnostic tool, it doesn't automatically give the answer to your foot woes. And as you are seeing from everyone else's case history, multiple problems muddies the waters, so to speak. My MRI was normal and that seemed ridiculous to me. How could it be normal when I have been suffering for so long????? And I know I am not imagining this pain. If I were going to choose to be in pain, I would certainly pick something more acceptable than my feet.
I feel like you gave me a hug, and since this is a baaaaaaaaaaaaad foot day, I needed it! Thanks.I jammed up the garbage disposal this afternoon and my husband ended up having to cut pipes and replace them, so I doubt that I will get much sympathy from him tonight.
Did the doctor say anything about what's next???

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

wendyn on 11/27/00 at 22:35 (033686)

I have been told (at various times)

That I have

Flat feet (true)
PTT (true)
TTS (true)
Bunion (true)
Bunionette (true)
Pronation (true)
Ankolosing Spondylitis (not true)
RSD (not true)
Polyneuropathy (not in the sense they were describing)
Sciatica (true)
Sprain (not true)
PF (true)
Stress fracture (not true)
Lower back problems (true)
Tibial tortion (true)

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

wendyn on 11/27/00 at 22:37 (033689)

Oh - yes - a forefoot varus also.

I think that's it.

Oh - nope

Gastroc equinus contracture which I think is short heel cords - have had achilles tendonitis but not for a while.

There - I think that's it now.

Some dosolateral sublaxation (misalignment of foot joint) and MRI showed a ganglion on my right foot but they don't know if it's a problem or not.

Now I'm done.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/28/00 at 11:54 (033727)

beverly: the small bump if on top of second joint big toe could be the begining of a bunion or the begining of hallux limitus. if the toe starts to turn in it is probably a buninon but it does not and the bump gets bigger and more sore it could be hallux limitus. x-ray can probably define this.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

john h on 11/28/00 at 11:55 (033728)

i think i also told you that you were in the prime of your life.

Re: I finally got talked into the nightsplint.

Beverly on 11/28/00 at 16:35 (033742)

Wendy,

Sounds like you get the prize for most diagnosises and Kay is a close runner up!

I may have something new to add to the list. When I went to get my orthodics fitted today by a combination PT/orthodist, I was told that if ankle positioning/flexing hurts behind my knee, then that can't just be the hamstrings. He said it sounds like I have tight gastrocs too. I said, 'Oh great.' And not being good in anatomy, I'd never even heard of the 'gastrocs' until he showed me where they are.

This guy also thinks I need the nightsplint. Somehow he talked me into what no one else has coaxed me into. He wants me to wear them in an extra gentle style/setting for two weeks before fitting me for the orthodics. He says if that will loosen up my tight heels/ankles, that will give him additional info for making the orthodics. He felt like on a gentle (neutral or even less) setting, it could not hurt my hamstring tear.

I said I'd try them. So, they should be in in a few days. It's padded in lambswool. I just hope it doesn't make the hamstrings hurt more.
Beverly

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Pauline on 11/28/00 at 20:13 (033762)

I remember the guru of Foot and Ankle telling me in 1993 that the Domino effect is exactly what happens in the foot and ankle area. That's why
he was so reluctant to perform surgery unless it was the last resort. His experience is that when you cut in one area you affect another or several others. Since like other surgeries there is the human element to consider you never know what you are going to end up with. Sure after many surgeries a Dr. should have a fairly good idea what the outcome might be but the human body being unpredictable could send you many surprises.

The difference between my two cases has been that the first time it was several weeks before I could get into see the Ortho. By the time I received Physical Therapy several months had gone by and when he finally decided to give me an injection the PF had spread to the other foot.
I also worked at the time and could not spend as much time off my feet.

When my second case popped up I was able to get in to see the Dr. within a week because I was an established patient. He gave me injections in both
feet because I was leaving for Europe which proved to be a poor choice.
The trip, not the injections. I truely think we tend to fear them too much. I got Physical Therapy within 2 weeks and because I had quite my job was able to spend a lot of time on my butt.

My conclusion is early intervention does make a difference especially the Physical Therapy. Being able to sit around is truely the most important key to recovery. Once you can get the pain under control and the inflammation cycle stopped the true healing seems to begin. All of the other things seem to help in their own way. The stretches, the icing,
the night splints etc.etc. This board even plays an important part in the recovery process because it provides ideas, friendship, hope, humor and comfort to all who sign on.

I think the 'dual' or multi problems come about because most of us are not able hang it up for any length of time. We have families, husbands, jobs
that put continue stress on already stressed feet. The problems just multiplies. We hobble to protect one part and injure another. The heel throbs today the arch tomarrow and the ankle the next. The cycle continues until several parts of the foot become inflamed and we are forced to re-evaluate and see this illness in a new light.

Re: Who has a "dual" or multi-diagnosis in the lower extremities?

Nancy S. on 11/29/00 at 15:15 (033813)

You'd think I'd just found this board. How many days did this get by me.
I won't win any prizes, but since PF in my left foot (first foot problem ever in my life) the following have developed and nearly drove me over an edge:
bilateral achilles tendonitis (bad)
bilateral peroneal tendonitis (bad)
bilateral posterior tibial tendonitis (bad)
bilateral shin splints (hey, not TOO bad)
depression, anxiety, generally nuts (bad)

I agree with many things Pauline wrote. I also am convinced that weird PF walking leads to a variety of nasty conditions, and this makes perfect sense to me. Now.

Oh, I forgot one more diagnosis. It's a self-diagnosis, but I learned it from heelspurs.com over time:

bilateral foot and mental bad-pod treatment (extra bad)

Learned the hard way: immediate location of a good and interested doctor and immediate active treatment, along with faithful rest, are a must. And I'm beginning to think that if you have any structural problems (like flat feet) or gait problems (like hyperpronation), investing in the best custom orthotics by a superb professional is an important path to try.

Nancy