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What is the problem?

Posted by Steve H. on 3/11/01 at 12:43 (041044)

Hi,

I know that you cannot give me any definite answers being email...however, I would greatly welcome your opinions. I also have posted a message on one of the other message boards, too (I think under foot surgery).

I have had all the treatments possible for plantar fascitis and TTS...inserts, taping, shots (2), exercises, walking casts, and surgery...both endoscopic PF release and the TTS surgery. It seemed to help a bit... less pain when walking, but now I think things are back worse than before and now my other foot is starting to have the fascitis pain.

The pain seems to be worse when driving...lots of burning pain in the heel, arch, and sometimes in ankle and leg.

I have had walkiing casts before. Some with the heel on it. I have been told that this can damage the nerves in the foot. I am questioning whether this may be part of the problem.

I also am questioning if I have a fracture somewhere, a nerve problem, or something else.

What do you think is happening and what is my best course of action?? My own gut-level sense is that I need to be off my foot for several weeks and in a hard cast so that everything can be kept in place and rested. I also think some good rehab therapy would be helpful afterward so I don't just make matters worse. At this point, I will try anything....more surgery...months of casts if necessary....I would just like to be relatively free of this and KNOW EXACTLY what is happening. My hunch is that I have more than plantar fascitis and TTS, but maybe not....

In any case, thanks for 'listening' and I'd welcome any thoughts you have on the issue.

Steve

PS. I live in Central Texas and am 1.5 hours from Dallas and Austin, and 3 hours from Houston. Do you know of any good DPMs/MDs who are experts in this? Might you be in Texas?

Re: What is the problem?

Dr. Zuckerman on 3/11/01 at 14:08 (041057)

Hi,

You have been thru alot and I am sorry if I repeat anything that you have already done. If I have just let me know. I am brain storming as I write this very difficult situation you are in.

How is your lower back. Has any spinal stenosis or dis sydrome be investigated.

If appears that the other foot is due to compensation from the very painful foot. Rest is very good at this point. The concern I have with a hard cast before the lower back and lower extremity examination is if you do have motor and or sensory problems in the back, the cast could make this worse.

So what can you do.? First an exmamination of the lower extremity if normal then cast rest physical therapy is a very good avenue to take.

What do you think increases the problem. Have you noticed any weakness in your foot, legs. Is the pain confined to the foot. Tell me about other joint, including hands and cervical neck.

What was told to you about the reason for getting the problem in the first place. How is your weight, do you run,

Try to give me alittle more information. Make a daily if possible how this started all of your treatment. The plantar fascia data survey is a very good method for your to make a diary. Think about what started this if you can.

Re: What is the problem?

Beverly on 3/11/01 at 14:09 (041058)

Steve,

I am not a medical person... just another patient. I couldn't help but notice your post about problems with driving. Last summer when I was at my worst, driving was sheer misery. I went out my way to drive as little as possible. Is there anyway your wife or other family member could do most of the driving for a few weeks? I did not let myself drive for two solid weeks... not even to the grocery store. This was hard to do because I live alone, but with the help of friends, my church, and taxis, I pulled it off.
It gave my feet a break and I think helped. (I have PF, PTT, and back then a torn hamstring.)

I have noticed that the shoes I wear makes a difference when driving. I try to wear my most supportive shoes when driving. For me, that's Birks.
One thing that helped me was to put my truck in park at red lights. It gave me a tiny break. I have auto transmission. I think manual would be sheer torture.
Take care,
Beverly

Re: What is the problem?

Steve H. on 3/11/01 at 14:40 (041062)

Hi again,

Thanks for your fast reply. Here's a few things you asked about.

1. I am 34 years-old, 5'8' and about 175. I've always had about an extra 10 lbs. around the waist.

2. About 2-3x per year, I get what I think is sciatica. The pain is worst in my hips, often both sides. It lasts a few days and goes away. I do not know what the precipitants are. It does not seem to co-occur with heel pain, at least what I am aware of. As far as other orthopedic problems, I have had problems with my neck on the right side (same side as the foot problem). I have seen a chiropractor about 1 1/2 yrs. ago, and this has helped. I had the foot and heel problems long before the neck problem, however, I am pretty good at managing the problem now, and don't have too many difficulties, although about 1 1/2 weeks ago I had it really bad...like when I first went to the chiropractor. I iced it and it is much better now.

Also, about 2-3 months ago, I noticed in my LEFT hip a sharp pain when I get up. I sit back down and try it again, and it is much better. I have not noticed a problem like this before, though.

Also within the past month, I noticed that on the lateral side of my right foot (the problematic one), there was a lot of pain when I touched and pressed the side where the tarsal bones met up. It is a little better now, but I thought it was strange that I was having that kind of pain.

3. I do not run or exercise regularly. As far as what exacerbates it, I think that driving does it. I do drive once a week 200 miles round trip, besides everyday driving. I am not aware of injuring the foot at any time, although I had a vague recollection about 4-5 monthts before I first saw a physician of stepping on something while in my stocking feet. I cannot remember what it was, but I do know it hurt like heck for a little while.

4. The pain is in my arch, heel, and may radiate into the tarsal region (although not into my toes). I notice that my ankle hurts when it is really bad and sometimes I feel it in my leg (around the tibia, which makes me think it is something neurological). Even once in a while I feel some burning behind my knee... my Achilles does not cause me obvious problems, although I have thought about Achilles problems, given the knee pain...this is very infrequent, however, so I don't know if I can make much of it. I did notice about 4 days ago while returning home on one of those 200 mile trips that my foot, ankle and behind the knee hurt like heck. When I stopped driving and rested a while, the pain decreased a lot.

Do you think that MRI and/or a nerve conduction test is in order? The podiatrist who did the surgery mentioned doing a nerve conduction test, but said that the results would not change my discomfort level and that surgery was probably in order. So, I never had it done. Also, do you think that I might have a hidden fracture somewhere?

One final thing....since my left PF is getting worse, what should I do, esp. if I end up getting casted/crutches for my right foot/ankle??

Thanks again for your help.

Steve

Re: What is the problem?

Steve on 3/11/01 at 14:42 (041063)

Hi,

Thanks for your input. I think I am going to have to drive less...when I have been casted before, the cast makes driving much less painful.

I wear Birks a lot, but cannot to work. I've noticed that even with Birks or other shoes with great arch support that if I am on my feet too long, I hurt like heck. Even in Birks, the pain can be worse when I've been standing too long.

Steve

Re: What is the problem?

diane on 3/12/01 at 06:35 (041129)

where in texas are you at. i am in longview east texas. i am 145 miles east of dallas.

Re: What is the problem?

Dr. Zuckerman on 3/11/01 at 14:08 (041057)

Hi,

You have been thru alot and I am sorry if I repeat anything that you have already done. If I have just let me know. I am brain storming as I write this very difficult situation you are in.

How is your lower back. Has any spinal stenosis or dis sydrome be investigated.

If appears that the other foot is due to compensation from the very painful foot. Rest is very good at this point. The concern I have with a hard cast before the lower back and lower extremity examination is if you do have motor and or sensory problems in the back, the cast could make this worse.

So what can you do.? First an exmamination of the lower extremity if normal then cast rest physical therapy is a very good avenue to take.

What do you think increases the problem. Have you noticed any weakness in your foot, legs. Is the pain confined to the foot. Tell me about other joint, including hands and cervical neck.

What was told to you about the reason for getting the problem in the first place. How is your weight, do you run,

Try to give me alittle more information. Make a daily if possible how this started all of your treatment. The plantar fascia data survey is a very good method for your to make a diary. Think about what started this if you can.

Re: What is the problem?

Beverly on 3/11/01 at 14:09 (041058)

Steve,

I am not a medical person... just another patient. I couldn't help but notice your post about problems with driving. Last summer when I was at my worst, driving was sheer misery. I went out my way to drive as little as possible. Is there anyway your wife or other family member could do most of the driving for a few weeks? I did not let myself drive for two solid weeks... not even to the grocery store. This was hard to do because I live alone, but with the help of friends, my church, and taxis, I pulled it off.
It gave my feet a break and I think helped. (I have PF, PTT, and back then a torn hamstring.)

I have noticed that the shoes I wear makes a difference when driving. I try to wear my most supportive shoes when driving. For me, that's Birks.
One thing that helped me was to put my truck in park at red lights. It gave me a tiny break. I have auto transmission. I think manual would be sheer torture.
Take care,
Beverly

Re: What is the problem?

Steve H. on 3/11/01 at 14:40 (041062)

Hi again,

Thanks for your fast reply. Here's a few things you asked about.

1. I am 34 years-old, 5'8' and about 175. I've always had about an extra 10 lbs. around the waist.

2. About 2-3x per year, I get what I think is sciatica. The pain is worst in my hips, often both sides. It lasts a few days and goes away. I do not know what the precipitants are. It does not seem to co-occur with heel pain, at least what I am aware of. As far as other orthopedic problems, I have had problems with my neck on the right side (same side as the foot problem). I have seen a chiropractor about 1 1/2 yrs. ago, and this has helped. I had the foot and heel problems long before the neck problem, however, I am pretty good at managing the problem now, and don't have too many difficulties, although about 1 1/2 weeks ago I had it really bad...like when I first went to the chiropractor. I iced it and it is much better now.

Also, about 2-3 months ago, I noticed in my LEFT hip a sharp pain when I get up. I sit back down and try it again, and it is much better. I have not noticed a problem like this before, though.

Also within the past month, I noticed that on the lateral side of my right foot (the problematic one), there was a lot of pain when I touched and pressed the side where the tarsal bones met up. It is a little better now, but I thought it was strange that I was having that kind of pain.

3. I do not run or exercise regularly. As far as what exacerbates it, I think that driving does it. I do drive once a week 200 miles round trip, besides everyday driving. I am not aware of injuring the foot at any time, although I had a vague recollection about 4-5 monthts before I first saw a physician of stepping on something while in my stocking feet. I cannot remember what it was, but I do know it hurt like heck for a little while.

4. The pain is in my arch, heel, and may radiate into the tarsal region (although not into my toes). I notice that my ankle hurts when it is really bad and sometimes I feel it in my leg (around the tibia, which makes me think it is something neurological). Even once in a while I feel some burning behind my knee... my Achilles does not cause me obvious problems, although I have thought about Achilles problems, given the knee pain...this is very infrequent, however, so I don't know if I can make much of it. I did notice about 4 days ago while returning home on one of those 200 mile trips that my foot, ankle and behind the knee hurt like heck. When I stopped driving and rested a while, the pain decreased a lot.

Do you think that MRI and/or a nerve conduction test is in order? The podiatrist who did the surgery mentioned doing a nerve conduction test, but said that the results would not change my discomfort level and that surgery was probably in order. So, I never had it done. Also, do you think that I might have a hidden fracture somewhere?

One final thing....since my left PF is getting worse, what should I do, esp. if I end up getting casted/crutches for my right foot/ankle??

Thanks again for your help.

Steve

Re: What is the problem?

Steve on 3/11/01 at 14:42 (041063)

Hi,

Thanks for your input. I think I am going to have to drive less...when I have been casted before, the cast makes driving much less painful.

I wear Birks a lot, but cannot to work. I've noticed that even with Birks or other shoes with great arch support that if I am on my feet too long, I hurt like heck. Even in Birks, the pain can be worse when I've been standing too long.

Steve

Re: What is the problem?

diane on 3/12/01 at 06:35 (041129)

where in texas are you at. i am in longview east texas. i am 145 miles east of dallas.