Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Recently diagnosed with Plantar Fasciitis

Posted by Soccermom on 7/20/01 at 12:17 (053828)

I went to my regular doctor complaining of heel pain. They treated me for 2 wks then ref'd me to a Podiatrist
He is taping one foot, both are in pain. Also, have been given 2 cortisone shots in left foot over a 4 week period.

I am off work for a few weeks as I stand in my job and the pain is so severe by the end of the day.

I have been in pain for approx 3 months. So far, nothing is making it better except staying off both feet.
I am seriously considering surgery as this is not a normal life for me....I usally am an active person!

My pain is in both heels and radiates to my toes.By day's end, I have pain and sensation like I walked bare foot over
hot coals. Any help for suggestions would be appreciated. Thanks!

Re: Recently diagnosed with Plantar Fasciitis

BrianG on 7/20/01 at 17:00 (053841)

Hi Soccermom,

Sorry to hear about the foot pain. Personally I think it's way too early for surgery. Your job is most likely keeping you from feeling better. It's important to give your feet a rest. If you continue your present lifestyle, your going to be in for a long run of pain. Get off your feet, they need some rest. Ice works well. Stretching and taping also help. No more barefoot, even in the tub. Time to get some good shoes, New Balance have some good models. There is so much more, including ESWT treatment. Take some time to read Scott's heel pain book. We're here for questions, let em' rip! Good luck

BCG

PS Cortisone shots are not a cure all, I wouldn't have any more for awhile, time to try some other things. I also like how you said this is not like your normal life, your an active person. Join the group, we ALL feel that way, unfortunatly :*(

Re: Recently diagnosed with Plantar Fasciitis

soccermom on 7/20/01 at 20:57 (053860)

Brian,
Thanks for your response, but why with this type of pain do folks want to wait forever to have surgery?
I don't understand...anything else on your body with this type of pain, you wouldn't wait months.
Is this a difficult surgery with alot of complications? Maybe I just don't understand. All I know
is after standing for more than 30 minutes or less, I am miserable. I need to stand at my job or change to
another one that I don't want to do. I can't go to an amusement park or zoo because of the pain.

How long do I tolerate this before I would consider surgery? Thanks for your input or anyone else that responds.

Re: Recently diagnosed with Plantar Fasciitis

Dr. Marlene Reid on 7/20/01 at hrmin (053863)

Yes, this type of surgery has a lot of complications and the sucess rate is not that great. There are a lot of different conservative treatments and 85% of patients do well with them. But for the rest of you (you heelspur.com'ers) there are only so many non surgical options left.

One promising treatment is ESWT and there is a lot of info on it at this site. Feel free to call my office for more info (630) 852-8650. I didn't see your initial post fully, but you should see a foot and ankle specialist (podiatrist or foot and ankle fellow ortho) to see what treatment options would be best for you.

Re: Recently diagnosed with Plantar Fasciitis

Tammie on 7/20/01 at 21:43 (053864)

Dear soccermom,
I read your post and I feel your pain, more then your foot pain I feel the questions and wondering the decision making and the overwelming feelings! Welcome to foot pain! Sorry but unfortuantly it is true this is one area that seems to take time and that is the big word TIME , I just wanted to say I had the surgery the pf release, I had it done april 17, itis now july 20, and I still am at home and I still have pain I cant tell you weather it is pain from the initial problem, or if it is pain from healing ,I am not the dr. but I can tell you this, it has taken much longer to heal then they told me , after every visit it was be patient it takes time to heal, ok well he said I would be back to my work in 4 to 8 weeks, then it changed to 12 then , well now I have no clue as I see him again in Aug,And I still am having some troubles! I am a nurses aide, I love my job really, I worked with pain for months walking on my toes, unable to get up when I sat down, they used to say come sit down for a break, I was the one who said no I would rather work thru it, (if I sat I could not get up without crying) I could not get out of my car when I would drive home, I could not go to the bathroom in the morning or at night without pain and tears, I understand your despair, I really do! I am telling you this so that u might think really hard, and to realize what ever you choose it will take time, and surgery there is no going back, please try anything that you can before the surgery and really try hard to rest,it may make the difference in healing! If you do decide surgery, be well informed and realize we all heal at different rates, and do expect it to take time,Ask all questions you can think of and get a second dr. thought, but whatever you decide please remember this is a wonderful site, we are all here to help in any way we can! Have you read the heel pain book above? It is very helpful, have you tried taping? Ice? different shoes? There are so many things, to try they have ESWT have you read about this? Just be informed so you can make the best choice for you and your feet! There are many good people here to help and give you info! There are some wonderful DR.s also that you may post a question and they try to give advice, be patient ,this is a time consuming thing! Welcome and I am sorry that you have so much pain! Please take care and read and read more! Please let us know how you are, and remember, this board is here for you! Hugs to u and best wishes for a quick recovery!

Re: Recently diagnosed with Plantar Fasciitis

wendyn on 7/20/01 at 23:39 (053873)

soccermom - as dr reid said - it's not that simple.

If it was as simple as just having a minor procedure and then hitting the trails - believe me...there would be no bulletin board for PF sufferers.

Re: Recently diagnosed with Plantar Fasciitis

Julie on 7/21/01 at 01:18 (053884)

I second all the others have said. Surgery really is the last resort, only to be considered after all conservative treatments have failed, and even then there is ESWT to be looked into first. All surgery carries risks; foot surgery is particularly tricky because if you are left with unresolvable complications they can affect the rest of your life. No foot doctor would perform surgery until all conservative treatments have been tried unsuccessfully. This takes time.

Rest, and patience, are the key.

Get off your feet and give them a rest. Can you switch to sitting down duties at work? If not, get more time off.

It isn't a matter of 'tolerating' the pain, but of identifying and addressing the cause of it. Educate yourself here, by reading the message boards from which you can learn lots about others' experience, and by studying the heel pain book. It will inform you about PF and the treatments that are options for you, and will help you to involve yourself actively in healing yourself.

There are no 'quick fixes' for heel pain.

Re: Recently diagnosed with Plantar Fasciitis

Donna M on 7/22/01 at 22:15 (053988)

Everyone is telling you right, Soccermom! Like Wendy said, if it was as simple as surgery there would be no heelspurs.com site.
I found this site a few months ago and have had PF and a heelspur for a year now. I have had just about everyhing done but ESWT and surgery. I would love to have ESWT, but I am far from anyone that does it. As far as surgery is concerned, just read some of the horror stories and that is why so many of us still just suffer!!
I am sure some surgeries are quite successful, but we don't get to hear about those very often.
Like everyone has told you, read the PF Book, it has 'lots of good info', and make sure you ice your foot and learn to tape it! Have you tried Birkenstocks? They are the reason I can get around as well as I do! I think the majority of folks here depend on Birks.
We all know the pain you are suffering with and our hearts go out to you. Glad you found this site, there are some really caring and helpful people here!
I hope you can get some relief and your PF is short lived!
Donna

Re: Recently diagnosed with Plantar Fasciitis

Dan L on 7/26/01 at hrmin (054401)

Just hang in there! I've had this in both feet for approx 5 years now. I wish in my early stages (those first few months) I had taken seriously the need for proper stretching and physical therapy. PLEASE don't go the surgery route this soon. Ortotics help many but not all. PROPER stretching is so important. It will take a while but I think you have a diagnosis early enough to allow you to recover fully. Don't give up!!!!!
Oh....if you ever DO seriously consider surgery, go to a qualified Orthopaedic Surgeon. I have (had) a good Podiatrist but I wish he had not been the one that cut on both my feet. Best wishes.

Re: Recently diagnosed with Plantar Fasciitis

Ed Davis, DPM on 7/30/01 at hrmin (054861)

Dan:
Sorry to hear you had a poor result with foot surgery. Podiatrists, statistically do the vast majority of foot surgery for non-acute trauma in the US. Most orthopedic surgeons have limited training in foot surgery except for 'foot and ankle orthopods.' I have had to re-do a lot of failed foot surgery from orthopedic surgeons but very few from podiatrists over my 19 year career.

Ultimately, it is the skills of the individual surgeon that really counts as opposed to the degree.
Ed

Re: Re:Thank u for saying this as so many think pods are a bad choice and it is a hard decision to make sometimes!

Tammie on 7/30/01 at 22:06 (054877)

I think the dr. is only as good as there training and there head allows them to be! Good and bad and doesnt matter what there title is . So many have shamed me for seeing a pod not to mention letting him do a surgery on me, but he was the only one who knew and understood and was set up to treat thease things,I seen a ortho guy he didnt like me lol said I had no spur gaveme celebrex and sent me home with no return appointment! LOL and mind u he was a foot and ankle guy! Now the pod yes I had a longgggg wait but they new how to xray and were seet up with railings even so when u can t stand on foot and balance well u can hold it (yeah) He had all things for feet, and his xrays showed a spur and he explained that was my least troubles! That was not the problem! So Thank u Dr. for saying something good for the pods!

Re: PF Pain Questions for the Doctors

john h on 8/05/01 at 10:25 (055532)

this is just a passing thought. after someone has experienced PF for 5 or 6 years are we not more likely to describe our pain level in lower terms than when we first experienced the pain. what i perceived as a pain level of 4 or 5 some years ago i might perceive as a 2-3 now. your early pain perception is colored my lack of knowledged and your emotions. with knowledge and support your perception of pain may decrease. i think i am better than 4 or 5 years ago but this may just be perception which is my reality? this sounds more like a question for a shrink now that i read it!

Re: PF Pain Questions for the Doctors

wendyn on 8/05/01 at 11:09 (055533)

John - I think you are right...once pain becomes 'normal' - it's only the increases from 'normal' that really get your attention. I think with long term exposure to any type of pain, the threshold raises so it requires more to be considered pain.

I know that with my lower back, I wasn't even really aware of how much discomfort it caused until PT started helping it...then I noticed 'wow I can sure move better'!

Re: PF Pain Questions for the Doctors

Dr. Zuckerman on 8/05/01 at 12:10 (055535)

I tend to think that either it is gone or still there. The ability to control pain is a very a part of this equation. I understand what you are saying. Most patients only come to the doctor when the pain is in the acute phase or when it has increased or when they stop being able to do certain things.

Interesting view is how the ESWT orthowave people studies view pain. They view the ability to do increase activity just as important if not more important then the ability to have decrease pain. What I mean by this that the patients that still had pain were able to increase their activity levels more but still had pain

Dam pain is a very complex subject!!!

Re: PF Pain Questions for the Doctors

Julie on 8/05/01 at 12:57 (055540)

People differ in their capacity to handle pain. There is a good deal of evidence to show that if one can accept pain, one suffers less than if one is continually engaged in a battle with it. According to Dr Michael Lerner, founder of the Commonweal Cancer Support Program in California, there is a distinction to be made between pain and suffering: he says that 'pain is the physiological phenomenon; suffering is the human experience of pain'. Acceptance, which is of course a mental attitude, can be encouraged by relaxation, which will usually alter the experience and lessen the suffering.

Relief Without Drugs, by Ainslie Mears, is a good source of information on this - and any of Stephen Levine's books.

Re: PF Pain Questions for the Doctors

wendyn on 8/05/01 at 13:59 (055549)

I've always like the quote
'Pain is inevitable (sp?), suffering is optional.'

Re: PF Pain Questions for the Doctors

Glenn X on 8/05/01 at hrmin (055551)

John, Wendy, and Others:
I've been pondering the issue of pain too, ever since I landed on heelspurs a couple of months ago. I read people describing their pain on a scale of 0 to 10, and while I understand that higher numbers are more painful, I'm not really sure what people are saying. Is this pain at the moment? or maybe averaged out over the day or week? Is it brief and jabbing, or extended and constant? Is it with or without pain medications? Is it physical or psychological, or both? Clearly a lot of dimensions to consider.

When I attempt to characterize my pain I try and reflect back on the entire day and derive a'24-hour average.' Yet as John and Wendy suggest, over time we (I) adapt to higher than 'normal' thresholds, and what was a 5 three months ago, may be a 3 today -- yet really is the same intensity. I'm also guilty of putting as positive a spin as I can muster on these chronic circumstances and intensely dislike describing my pain in my daily PF log as worse this day than the previous day. I'd rather stick with denial ... until it screams at me.

One other factor that gives me difficulty is the scale itself. I think I understand level TEN to be 'can't-stand-it' pain, and level ZERO to be complete absence of pain. But I'm fuzzy on the in-between numbers. Six is greater that three, but is it twice as painful? Perhaps there's a pain scale somewhere on this site, but a search on pain yields too many hits. I tried a cursory web search and found several scales, but none that seemed quite fitting. The one I like best is the pediatric smiley-frowny-face scale for kids, but that doesn't express my own experience adequately.

I realized yesterday that the way I'd been characterizing my own pain the past year or so was inadequate. I've been tracking it daily using words like sore, edgy, sharp, stabbing, scratchy, stinging, deep, tender, and so forth --- not numbers, and not really helpful in the long term. So I took a stab at characterizing a scale for myself last night. (It's an early draft and needs much work).

0-None
1-
2-Noticeable but not limiting
3-
4-Discomfort
5-
6-Bearable/Limiting
7-
8-Limits all but essential tasks
9-
10-Laid up

As I review this today I realize this has more to do with life activities than with physical torment, but for now it seems to allow me a back door into my pain experience. Too much squeezed into the upper end too. And 'discomfort' isn't quite the right word at 4. WIP

What's also assumed here is a hoped-for absence of aggravation to the condition. So if I'm at an 8 right now, what I'm saying is that I hurt a lot and am managing my pain at that level such that I won't further damage my injury. Is PF and associated foot / ankle / leg pains different this way in terms of manageability?

One last thought. Perhaps we need 4 or 5 parallel scales to fully describe pain? For foot and ankle sufferers something like.

Pain at rest --- 1.
Pain accomplishing basic life needs --- 5
Pain full weight bearing (standing and walking) --- 10
Pain doing all normal pre-onset activities --- 10
Pain psychological --- 2

Other points of definition might be important to paint a full pain picture.
Using medications to alleviate the pain? If so, pain with, pain without.
Using any get-around devices (canes, crutches, etc.) to manage the above? Pain with / without?
Taping?
Finally, I think checking ONE word that best describes the nature of the physical pain might be helpful (a.k.a. sharp, stabbing, scratchy, stinging, etc.). Mine is stinging. Perhaps too, one word to describe any pain of the spirit (a.k.a., upbeat, optimistic, depressed, frustrated, sad, anxious, angry, and so forth). I'm a bit somber today.

I wonder if shaping a worksheet is worth pursuing? Something to post here on heelspurs (or not to overly-volunteer Scott's time) something we could e-mail to each other. Users could log into the worksheet, check some boxes, and get a 'weighted average' pain/life-experience level. i.e., How truly painful is your situation? People could track this weekly or monthly to monitor progress (or not) and it might be useful in our dialogues. I'm going to take a cut at one for myself.

As I read this through it seems rather busy, but I'm a strong believer in care-fully defining circumstances and measuring progress against criteria that are meaningful to changing those circumstances.

I'd be interested in what doctors and others on the site have to say about even basic methods of evaluating pain to some sort of uniform scale.

Re: Thanks for the quote, Wendy

Julie on 8/06/01 at 05:00 (055603)

I wasn't familiar with it, and I like it and believe there is truth in it. It suggests that our attitude towards pain, and our response to it, determine to a great extent the degree of our suffering. As in most things, we have a choice.

Re: Thanks for the quote, Wendy

nancy s. on 8/06/01 at 06:28 (055604)

sometimes i get a lot out of intellectually good-sounding quotes like this one.
and sometimes i think suffering is more optional for some people than for others, depending on what pain they're in, what else they're dealing with in their life, and what stage they're at in coming to grips. i try to be careful not to 'blame the victim,' and sometimes these quotes teeter on that edge. on an especially hard day, i can read a quote like this and feel like a complete failure for being unable to see the light that day and unsuccessful at transferring an intellectual no-suffering idea/choice into an emotional no-suffering experience.
wish that dealing with suffering of any type were as simple as this sounds. i'd never have a bad day in my life.

Re: Nancy

Julie on 8/06/01 at 06:49 (055605)

Nancy, check your e-mail.

Love to you, Julie

Re: Thanks for the quote, Wendy

wendyn on 8/06/01 at 10:57 (055633)

When my friend was dying I did a lot of research on death and dying (sounds awful now but we were going through it with him step by step). I think I may have found it in something related to Tibeten or Budhist book of dying or something? Does that sound right?

Re: Thanks for the quote, Wendy

wendyn on 8/06/01 at 10:59 (055634)

I know what you mean Nancy - I sometimes feel exactly the same way. But the 'Pain is inevitable' part is true - there will be pain, more pain for some than others - that's an unfortunate fact of life. The suffering is optional part for me is day to day. Some days I suffer - some days I don't.

Re: Recently diagnosed with Plantar Fasciitis

BrianG on 7/20/01 at 17:00 (053841)

Hi Soccermom,

Sorry to hear about the foot pain. Personally I think it's way too early for surgery. Your job is most likely keeping you from feeling better. It's important to give your feet a rest. If you continue your present lifestyle, your going to be in for a long run of pain. Get off your feet, they need some rest. Ice works well. Stretching and taping also help. No more barefoot, even in the tub. Time to get some good shoes, New Balance have some good models. There is so much more, including ESWT treatment. Take some time to read Scott's heel pain book. We're here for questions, let em' rip! Good luck

BCG

PS Cortisone shots are not a cure all, I wouldn't have any more for awhile, time to try some other things. I also like how you said this is not like your normal life, your an active person. Join the group, we ALL feel that way, unfortunatly :*(

Re: Recently diagnosed with Plantar Fasciitis

soccermom on 7/20/01 at 20:57 (053860)

Brian,
Thanks for your response, but why with this type of pain do folks want to wait forever to have surgery?
I don't understand...anything else on your body with this type of pain, you wouldn't wait months.
Is this a difficult surgery with alot of complications? Maybe I just don't understand. All I know
is after standing for more than 30 minutes or less, I am miserable. I need to stand at my job or change to
another one that I don't want to do. I can't go to an amusement park or zoo because of the pain.

How long do I tolerate this before I would consider surgery? Thanks for your input or anyone else that responds.

Re: Recently diagnosed with Plantar Fasciitis

Dr. Marlene Reid on 7/20/01 at hrmin (053863)

Yes, this type of surgery has a lot of complications and the sucess rate is not that great. There are a lot of different conservative treatments and 85% of patients do well with them. But for the rest of you (you heelspur.com'ers) there are only so many non surgical options left.

One promising treatment is ESWT and there is a lot of info on it at this site. Feel free to call my office for more info (630) 852-8650. I didn't see your initial post fully, but you should see a foot and ankle specialist (podiatrist or foot and ankle fellow ortho) to see what treatment options would be best for you.

Re: Recently diagnosed with Plantar Fasciitis

Tammie on 7/20/01 at 21:43 (053864)

Dear soccermom,
I read your post and I feel your pain, more then your foot pain I feel the questions and wondering the decision making and the overwelming feelings! Welcome to foot pain! Sorry but unfortuantly it is true this is one area that seems to take time and that is the big word TIME , I just wanted to say I had the surgery the pf release, I had it done april 17, itis now july 20, and I still am at home and I still have pain I cant tell you weather it is pain from the initial problem, or if it is pain from healing ,I am not the dr. but I can tell you this, it has taken much longer to heal then they told me , after every visit it was be patient it takes time to heal, ok well he said I would be back to my work in 4 to 8 weeks, then it changed to 12 then , well now I have no clue as I see him again in Aug,And I still am having some troubles! I am a nurses aide, I love my job really, I worked with pain for months walking on my toes, unable to get up when I sat down, they used to say come sit down for a break, I was the one who said no I would rather work thru it, (if I sat I could not get up without crying) I could not get out of my car when I would drive home, I could not go to the bathroom in the morning or at night without pain and tears, I understand your despair, I really do! I am telling you this so that u might think really hard, and to realize what ever you choose it will take time, and surgery there is no going back, please try anything that you can before the surgery and really try hard to rest,it may make the difference in healing! If you do decide surgery, be well informed and realize we all heal at different rates, and do expect it to take time,Ask all questions you can think of and get a second dr. thought, but whatever you decide please remember this is a wonderful site, we are all here to help in any way we can! Have you read the heel pain book above? It is very helpful, have you tried taping? Ice? different shoes? There are so many things, to try they have ESWT have you read about this? Just be informed so you can make the best choice for you and your feet! There are many good people here to help and give you info! There are some wonderful DR.s also that you may post a question and they try to give advice, be patient ,this is a time consuming thing! Welcome and I am sorry that you have so much pain! Please take care and read and read more! Please let us know how you are, and remember, this board is here for you! Hugs to u and best wishes for a quick recovery!

Re: Recently diagnosed with Plantar Fasciitis

wendyn on 7/20/01 at 23:39 (053873)

soccermom - as dr reid said - it's not that simple.

If it was as simple as just having a minor procedure and then hitting the trails - believe me...there would be no bulletin board for PF sufferers.

Re: Recently diagnosed with Plantar Fasciitis

Julie on 7/21/01 at 01:18 (053884)

I second all the others have said. Surgery really is the last resort, only to be considered after all conservative treatments have failed, and even then there is ESWT to be looked into first. All surgery carries risks; foot surgery is particularly tricky because if you are left with unresolvable complications they can affect the rest of your life. No foot doctor would perform surgery until all conservative treatments have been tried unsuccessfully. This takes time.

Rest, and patience, are the key.

Get off your feet and give them a rest. Can you switch to sitting down duties at work? If not, get more time off.

It isn't a matter of 'tolerating' the pain, but of identifying and addressing the cause of it. Educate yourself here, by reading the message boards from which you can learn lots about others' experience, and by studying the heel pain book. It will inform you about PF and the treatments that are options for you, and will help you to involve yourself actively in healing yourself.

There are no 'quick fixes' for heel pain.

Re: Recently diagnosed with Plantar Fasciitis

Donna M on 7/22/01 at 22:15 (053988)

Everyone is telling you right, Soccermom! Like Wendy said, if it was as simple as surgery there would be no heelspurs.com site.
I found this site a few months ago and have had PF and a heelspur for a year now. I have had just about everyhing done but ESWT and surgery. I would love to have ESWT, but I am far from anyone that does it. As far as surgery is concerned, just read some of the horror stories and that is why so many of us still just suffer!!
I am sure some surgeries are quite successful, but we don't get to hear about those very often.
Like everyone has told you, read the PF Book, it has 'lots of good info', and make sure you ice your foot and learn to tape it! Have you tried Birkenstocks? They are the reason I can get around as well as I do! I think the majority of folks here depend on Birks.
We all know the pain you are suffering with and our hearts go out to you. Glad you found this site, there are some really caring and helpful people here!
I hope you can get some relief and your PF is short lived!
Donna

Re: Recently diagnosed with Plantar Fasciitis

Dan L on 7/26/01 at hrmin (054401)

Just hang in there! I've had this in both feet for approx 5 years now. I wish in my early stages (those first few months) I had taken seriously the need for proper stretching and physical therapy. PLEASE don't go the surgery route this soon. Ortotics help many but not all. PROPER stretching is so important. It will take a while but I think you have a diagnosis early enough to allow you to recover fully. Don't give up!!!!!
Oh....if you ever DO seriously consider surgery, go to a qualified Orthopaedic Surgeon. I have (had) a good Podiatrist but I wish he had not been the one that cut on both my feet. Best wishes.

Re: Recently diagnosed with Plantar Fasciitis

Ed Davis, DPM on 7/30/01 at hrmin (054861)

Dan:
Sorry to hear you had a poor result with foot surgery. Podiatrists, statistically do the vast majority of foot surgery for non-acute trauma in the US. Most orthopedic surgeons have limited training in foot surgery except for 'foot and ankle orthopods.' I have had to re-do a lot of failed foot surgery from orthopedic surgeons but very few from podiatrists over my 19 year career.

Ultimately, it is the skills of the individual surgeon that really counts as opposed to the degree.
Ed

Re: Re:Thank u for saying this as so many think pods are a bad choice and it is a hard decision to make sometimes!

Tammie on 7/30/01 at 22:06 (054877)

I think the dr. is only as good as there training and there head allows them to be! Good and bad and doesnt matter what there title is . So many have shamed me for seeing a pod not to mention letting him do a surgery on me, but he was the only one who knew and understood and was set up to treat thease things,I seen a ortho guy he didnt like me lol said I had no spur gaveme celebrex and sent me home with no return appointment! LOL and mind u he was a foot and ankle guy! Now the pod yes I had a longgggg wait but they new how to xray and were seet up with railings even so when u can t stand on foot and balance well u can hold it (yeah) He had all things for feet, and his xrays showed a spur and he explained that was my least troubles! That was not the problem! So Thank u Dr. for saying something good for the pods!

Re: PF Pain Questions for the Doctors

john h on 8/05/01 at 10:25 (055532)

this is just a passing thought. after someone has experienced PF for 5 or 6 years are we not more likely to describe our pain level in lower terms than when we first experienced the pain. what i perceived as a pain level of 4 or 5 some years ago i might perceive as a 2-3 now. your early pain perception is colored my lack of knowledged and your emotions. with knowledge and support your perception of pain may decrease. i think i am better than 4 or 5 years ago but this may just be perception which is my reality? this sounds more like a question for a shrink now that i read it!

Re: PF Pain Questions for the Doctors

wendyn on 8/05/01 at 11:09 (055533)

John - I think you are right...once pain becomes 'normal' - it's only the increases from 'normal' that really get your attention. I think with long term exposure to any type of pain, the threshold raises so it requires more to be considered pain.

I know that with my lower back, I wasn't even really aware of how much discomfort it caused until PT started helping it...then I noticed 'wow I can sure move better'!

Re: PF Pain Questions for the Doctors

Dr. Zuckerman on 8/05/01 at 12:10 (055535)

I tend to think that either it is gone or still there. The ability to control pain is a very a part of this equation. I understand what you are saying. Most patients only come to the doctor when the pain is in the acute phase or when it has increased or when they stop being able to do certain things.

Interesting view is how the ESWT orthowave people studies view pain. They view the ability to do increase activity just as important if not more important then the ability to have decrease pain. What I mean by this that the patients that still had pain were able to increase their activity levels more but still had pain

Dam pain is a very complex subject!!!

Re: PF Pain Questions for the Doctors

Julie on 8/05/01 at 12:57 (055540)

People differ in their capacity to handle pain. There is a good deal of evidence to show that if one can accept pain, one suffers less than if one is continually engaged in a battle with it. According to Dr Michael Lerner, founder of the Commonweal Cancer Support Program in California, there is a distinction to be made between pain and suffering: he says that 'pain is the physiological phenomenon; suffering is the human experience of pain'. Acceptance, which is of course a mental attitude, can be encouraged by relaxation, which will usually alter the experience and lessen the suffering.

Relief Without Drugs, by Ainslie Mears, is a good source of information on this - and any of Stephen Levine's books.

Re: PF Pain Questions for the Doctors

wendyn on 8/05/01 at 13:59 (055549)

I've always like the quote
'Pain is inevitable (sp?), suffering is optional.'

Re: PF Pain Questions for the Doctors

Glenn X on 8/05/01 at hrmin (055551)

John, Wendy, and Others:
I've been pondering the issue of pain too, ever since I landed on heelspurs a couple of months ago. I read people describing their pain on a scale of 0 to 10, and while I understand that higher numbers are more painful, I'm not really sure what people are saying. Is this pain at the moment? or maybe averaged out over the day or week? Is it brief and jabbing, or extended and constant? Is it with or without pain medications? Is it physical or psychological, or both? Clearly a lot of dimensions to consider.

When I attempt to characterize my pain I try and reflect back on the entire day and derive a'24-hour average.' Yet as John and Wendy suggest, over time we (I) adapt to higher than 'normal' thresholds, and what was a 5 three months ago, may be a 3 today -- yet really is the same intensity. I'm also guilty of putting as positive a spin as I can muster on these chronic circumstances and intensely dislike describing my pain in my daily PF log as worse this day than the previous day. I'd rather stick with denial ... until it screams at me.

One other factor that gives me difficulty is the scale itself. I think I understand level TEN to be 'can't-stand-it' pain, and level ZERO to be complete absence of pain. But I'm fuzzy on the in-between numbers. Six is greater that three, but is it twice as painful? Perhaps there's a pain scale somewhere on this site, but a search on pain yields too many hits. I tried a cursory web search and found several scales, but none that seemed quite fitting. The one I like best is the pediatric smiley-frowny-face scale for kids, but that doesn't express my own experience adequately.

I realized yesterday that the way I'd been characterizing my own pain the past year or so was inadequate. I've been tracking it daily using words like sore, edgy, sharp, stabbing, scratchy, stinging, deep, tender, and so forth --- not numbers, and not really helpful in the long term. So I took a stab at characterizing a scale for myself last night. (It's an early draft and needs much work).

0-None
1-
2-Noticeable but not limiting
3-
4-Discomfort
5-
6-Bearable/Limiting
7-
8-Limits all but essential tasks
9-
10-Laid up

As I review this today I realize this has more to do with life activities than with physical torment, but for now it seems to allow me a back door into my pain experience. Too much squeezed into the upper end too. And 'discomfort' isn't quite the right word at 4. WIP

What's also assumed here is a hoped-for absence of aggravation to the condition. So if I'm at an 8 right now, what I'm saying is that I hurt a lot and am managing my pain at that level such that I won't further damage my injury. Is PF and associated foot / ankle / leg pains different this way in terms of manageability?

One last thought. Perhaps we need 4 or 5 parallel scales to fully describe pain? For foot and ankle sufferers something like.

Pain at rest --- 1.
Pain accomplishing basic life needs --- 5
Pain full weight bearing (standing and walking) --- 10
Pain doing all normal pre-onset activities --- 10
Pain psychological --- 2

Other points of definition might be important to paint a full pain picture.
Using medications to alleviate the pain? If so, pain with, pain without.
Using any get-around devices (canes, crutches, etc.) to manage the above? Pain with / without?
Taping?
Finally, I think checking ONE word that best describes the nature of the physical pain might be helpful (a.k.a. sharp, stabbing, scratchy, stinging, etc.). Mine is stinging. Perhaps too, one word to describe any pain of the spirit (a.k.a., upbeat, optimistic, depressed, frustrated, sad, anxious, angry, and so forth). I'm a bit somber today.

I wonder if shaping a worksheet is worth pursuing? Something to post here on heelspurs (or not to overly-volunteer Scott's time) something we could e-mail to each other. Users could log into the worksheet, check some boxes, and get a 'weighted average' pain/life-experience level. i.e., How truly painful is your situation? People could track this weekly or monthly to monitor progress (or not) and it might be useful in our dialogues. I'm going to take a cut at one for myself.

As I read this through it seems rather busy, but I'm a strong believer in care-fully defining circumstances and measuring progress against criteria that are meaningful to changing those circumstances.

I'd be interested in what doctors and others on the site have to say about even basic methods of evaluating pain to some sort of uniform scale.

Re: Thanks for the quote, Wendy

Julie on 8/06/01 at 05:00 (055603)

I wasn't familiar with it, and I like it and believe there is truth in it. It suggests that our attitude towards pain, and our response to it, determine to a great extent the degree of our suffering. As in most things, we have a choice.

Re: Thanks for the quote, Wendy

nancy s. on 8/06/01 at 06:28 (055604)

sometimes i get a lot out of intellectually good-sounding quotes like this one.
and sometimes i think suffering is more optional for some people than for others, depending on what pain they're in, what else they're dealing with in their life, and what stage they're at in coming to grips. i try to be careful not to 'blame the victim,' and sometimes these quotes teeter on that edge. on an especially hard day, i can read a quote like this and feel like a complete failure for being unable to see the light that day and unsuccessful at transferring an intellectual no-suffering idea/choice into an emotional no-suffering experience.
wish that dealing with suffering of any type were as simple as this sounds. i'd never have a bad day in my life.

Re: Nancy

Julie on 8/06/01 at 06:49 (055605)

Nancy, check your e-mail.

Love to you, Julie

Re: Thanks for the quote, Wendy

wendyn on 8/06/01 at 10:57 (055633)

When my friend was dying I did a lot of research on death and dying (sounds awful now but we were going through it with him step by step). I think I may have found it in something related to Tibeten or Budhist book of dying or something? Does that sound right?

Re: Thanks for the quote, Wendy

wendyn on 8/06/01 at 10:59 (055634)

I know what you mean Nancy - I sometimes feel exactly the same way. But the 'Pain is inevitable' part is true - there will be pain, more pain for some than others - that's an unfortunate fact of life. The suffering is optional part for me is day to day. Some days I suffer - some days I don't.