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More in detailed explanation for Elliott...and anyone else

Posted by Carmen H on 8/07/01 at 18:45 (055829)

Hi Elliott~More specific details on my feet..I'll try. When I say my feet burn they burn on the lateral side close to the heel and on the bottoms close to the center of my foot NOT the Achilles area. It also burns at times right at the VERY center of the bottom my foot. I do have sciatica and Piriformus problems in BOTH sides.... and yes my lower back hurts but not my neck. I don't know if this is helpful at all in explaining it better but honestly the pain changes every day sometimes every couple of hours. Like right now the left foot hardly hurts but the right...I am ready to cut off and send you for careful scrutiny. ha ha
Wouldn't that be nice....just send our feet away to get fixed...give them back when they are 100% again. And I don't mind if you ask I have high arches...The Saucony's are 'grids' and the insert is Dr. Scholls Athletic Sport shock absorbers recommended by the person who made my orthotics.
I would like to get my back and hips looked at but Chiropractic care is not possible for me right now. Who else would I see that insurance would cover? Are there any Orthotics you recommend for my Saucony's until I can getmy Orthotics fixed so they don't kill me?
THANKS Elliot.

Re: we're zoning in

elliott on 8/08/01 at 12:45 (055929)

Lateral side close to heel is definitely not TTS, just no question about that in my mind; none of the various nerve branches involved in TTS is located there. Not sure about middle of foot at bottom. The lateral plantar nerve does run along there, but if you had localized entrapment there (as opposed to the standard TTS at the ankle, where symptoms move around more), the pain would probably be more steady. Can you define center more exactly? Any tingling in your two smallest toes?

Given your more global problems, how it keeps changing locations and is in both feet, my best guess is still it's coming from higher up. Can you tell where the source is? I have sciatica as well (right-sided only due to bulging disc) and get knots in various locations andthat is what yours may be, but unlike you, the pain in the foot from the sciatica is not yet unbearable (although I've known some who've reached that point), and much lower on the totem pole compared with my post-surgical problems in that foot. Try to concentrate on all symptoms at once and see if you can sense where the source of pain is. For example, does sciatic pain higher up coincide with the foot pain? When is the pain worse (standing, walking, lying, sitting? no rhyme or reason?)

Saucony Grid is not enough info; they're all Grid now. I need the name of the shoe. Also, do you have a wide, medium or narrow forefoot? Hard, soft, or rigid orthotics? (As if by your answering all these questions I'll be able to help :-)) What do you mean until they get fixed?

Regarding doctors, I don't mean a chiro, although some have success with the relief they can provide. For starters, if you didn't have a back xray and an MRI of your spine (lumbar and possibly higher), get it. Your primary should know what to write down or you need a new primary. Sounds like you should also get an EMG/NCV (muscle and nerve conduction test), and be sure to tell the tester of your symptoms and so to check for abnormalities in the back and possibly even neck. Your primary should be able to refer you for all of these, or send you to someone who will. Depending on the results, you may need to go to a neurosurgeon--you may end up there first, and then that doc will send you for all those tests, the results of which he absolutely needs to see for a diagnosis, as well as ideas on what to do next (PT or...gulp!). Ot it may be another type of doc (e.g. one dealing in deformation of the spine).

Re: More info Elliott...

Carmen on 8/08/01 at 15:30 (055951)

Okay...the Center meaning about 3' from the back of my heel. I am agreeing with you that the pain is from higher up and it's all related. My lower back hurts a LOT and combined with; one short leg, tilted pelvis, pronation, piriformus syndrome and sciatica I have a feeling it may be more like a Sacroiliac Joint Dysfunction or nerve problem in my back. I have had two MRI's but not since he Piri. form surgery in December 2000. they were normal...but the last xray I had of the pelvis showed mild scoliosis. He said nothing to worry about but....maybe it's all related?
The pain in my rear is right at the bone I sit on and it's BAD when I am sitting for long.....This pain sends more pain down my legs. when I stand the pain is worse in my feet but I can still feel the pain dully in my rear. Make sense yet? I am not a doctor so it's hard to be TOO specific. But I do feel pain in my glutes, legs and into my feet at times. Not necessarily sitting or standing...just both and often. I looked up neurology today but got lost on the technical jargon. I feel lost right now...I appreciate all of your input and definitely am going to take notes on all of this to the doc tomorrow (the GP wanting to cover the Scoliosis diagnoses) and see what we come up with. I think my walk is really hurting everything on my body....
Keep writing if you have time...it really helps.

Re: not much more to add

elliott on 8/08/01 at 16:53 (055957)

I'm certainly no expert on specific back-related problems, but I think the key thing learned in this discussion is that you don't want a peripheral release of nerves in your feet since the source is higher up. Hopefully the docs will figure it out, preferably before it causes you major damage to your lower extremities due to altered gait. Are you doing a lot of stretches and balance things? That might help for starters. Ever try yoga? Even the beginning poses (e.g. standing on one foot at a time and its variations), and of course headstands :-)), might really help with the imbalance, which may be the root cause. Maybe Julie our resident yoga expert can provide further advice. (Did you ever say what your physical fitness level is?) Worth trying before they start cutting up back and butt.

3'? Do I take it your foot is exactly 6'? :-)

Hey, what's with the orthotics (I bet you thought I'd forget to ask)? And I'm still waiting for the name of the Grid. You're not holding out on me, are ya? :-)

Re: More in detailed explanation for Elliott...and anyone else

wendyn on 8/08/01 at 21:54 (055990)

Carmen - I haven't had a lot of time to post lately - but I wanted to let you know that you and I share a lot of similar symptoms. I've had sciatica, I have problems with SI joints, same burning in feet, lower back pain etc. For me it is all related - and they've never been positive which makes the other worse - or both! My walk affects my back and my hips, and I think the way I am made has affected my walk. Do you walk like a duck too?

When my TTS was very bad, I also had a lot of pain in my baby toes, outer ankles, and the bump on the outside bottom of my knee. I understand that this has something to do with the peroneal nerve (Elliot bail me out here?).

Thankfully - that pain is gone, in fact when I think about it - a lot of the pain that I used to have is gone...but it took a long time.

Once you get a dignosis and are on a good treatment plan, you may want to consider acupuncture as a supplement for pain/inflammation control - I have to attribute a lot of my recovery to it. Even though I am still somewhat skeptical...I can't understand HOW it works, I did not BELIEVE it would work - however the fact remains that it seems to HAVE helped a lot!

I have not been much this year - I will try to make the time to go for a bit in the fall.

Re: Carmen

Julie on 8/09/01 at hrmin (056002)

Carmen

You've given us a great deal more information recently on the full extent of your difficulties, on the strength of which I feel that you should be having a full medical workup, including an evaluation of your spine and all the tests that are necessary to arrive at an identification of the source of your foot problems. Sciatia, scoliosis, leg length difference, tilted pelvis, piriformis syndrome, possible SI dysfunction - these are conditions you've had for a long time, so it's more likely that the source is in your spine than in your feet, which have started giving you pain more recently. In this chicken-and-egg situation, my guess is that the spine is chicken.

You yourself suspect, and I suspect you're right, that more is going on than the pain in your feet, and I think you need more than a podiatrist. (And more than a chiropractor: I wouldn't suggest any treatment of your spine until the necessary work has been done to establish the source.) Perhaps the podiatrist you see tomorrow, or one of the doctors here, can advise you how to proceed. I'm not saying that in the meantime nothing should be done to treat your feet, particularly if the pain can be relieved and with it some of the stress you're under, but if the source is higher up, it will need to be dealt with or the foot problem will continue to be a problem.

As to exercise, I feel that you should do nothing now. Nothing. Certainly not yoga, and perhaps not even the foot exercises I gave you. I know you found them helpful, but even the simple ankle bending and rotations could have irritated the nerves in your feet if you overdid them. The golden rule is, if it hurts, stop - but very active people don't always heed pain messages.

Standing postures of any kind, particularly the one-legged balances, would not help you and would probably hurt you. If you were a prospective student, I probably wouldn't teach you, but would advise you to get the medical help you need for your multiple spinal problems. Physical yoga might not be suitable for you at all, and even if it was, it would be better for you to attend a remedial, therapeutic class for people with back problems, rather than a general class. So I'm certainly not going to advise you on yoga practice on the internet, where I cannot see you.

Relaxation, and breathing exercises would help to calm you and restore your balance, and I truly believe that this is what you need right now: to back off all physical exercise, all 'doing' that at this point may exacerbate your pain, and chill out. I know it's not easy, particularly when one feels desperate, but if you want to try, please e-mail me and I'll send you a copy of my tape (it's called 'Breathe and Relax: A Way to Healing').

Take care, Carmen.

Julie

Re: we're zoning in

elliott on 8/08/01 at 12:45 (055929)

Lateral side close to heel is definitely not TTS, just no question about that in my mind; none of the various nerve branches involved in TTS is located there. Not sure about middle of foot at bottom. The lateral plantar nerve does run along there, but if you had localized entrapment there (as opposed to the standard TTS at the ankle, where symptoms move around more), the pain would probably be more steady. Can you define center more exactly? Any tingling in your two smallest toes?

Given your more global problems, how it keeps changing locations and is in both feet, my best guess is still it's coming from higher up. Can you tell where the source is? I have sciatica as well (right-sided only due to bulging disc) and get knots in various locations andthat is what yours may be, but unlike you, the pain in the foot from the sciatica is not yet unbearable (although I've known some who've reached that point), and much lower on the totem pole compared with my post-surgical problems in that foot. Try to concentrate on all symptoms at once and see if you can sense where the source of pain is. For example, does sciatic pain higher up coincide with the foot pain? When is the pain worse (standing, walking, lying, sitting? no rhyme or reason?)

Saucony Grid is not enough info; they're all Grid now. I need the name of the shoe. Also, do you have a wide, medium or narrow forefoot? Hard, soft, or rigid orthotics? (As if by your answering all these questions I'll be able to help :-)) What do you mean until they get fixed?

Regarding doctors, I don't mean a chiro, although some have success with the relief they can provide. For starters, if you didn't have a back xray and an MRI of your spine (lumbar and possibly higher), get it. Your primary should know what to write down or you need a new primary. Sounds like you should also get an EMG/NCV (muscle and nerve conduction test), and be sure to tell the tester of your symptoms and so to check for abnormalities in the back and possibly even neck. Your primary should be able to refer you for all of these, or send you to someone who will. Depending on the results, you may need to go to a neurosurgeon--you may end up there first, and then that doc will send you for all those tests, the results of which he absolutely needs to see for a diagnosis, as well as ideas on what to do next (PT or...gulp!). Ot it may be another type of doc (e.g. one dealing in deformation of the spine).

Re: More info Elliott...

Carmen on 8/08/01 at 15:30 (055951)

Okay...the Center meaning about 3' from the back of my heel. I am agreeing with you that the pain is from higher up and it's all related. My lower back hurts a LOT and combined with; one short leg, tilted pelvis, pronation, piriformus syndrome and sciatica I have a feeling it may be more like a Sacroiliac Joint Dysfunction or nerve problem in my back. I have had two MRI's but not since he Piri. form surgery in December 2000. they were normal...but the last xray I had of the pelvis showed mild scoliosis. He said nothing to worry about but....maybe it's all related?
The pain in my rear is right at the bone I sit on and it's BAD when I am sitting for long.....This pain sends more pain down my legs. when I stand the pain is worse in my feet but I can still feel the pain dully in my rear. Make sense yet? I am not a doctor so it's hard to be TOO specific. But I do feel pain in my glutes, legs and into my feet at times. Not necessarily sitting or standing...just both and often. I looked up neurology today but got lost on the technical jargon. I feel lost right now...I appreciate all of your input and definitely am going to take notes on all of this to the doc tomorrow (the GP wanting to cover the Scoliosis diagnoses) and see what we come up with. I think my walk is really hurting everything on my body....
Keep writing if you have time...it really helps.

Re: not much more to add

elliott on 8/08/01 at 16:53 (055957)

I'm certainly no expert on specific back-related problems, but I think the key thing learned in this discussion is that you don't want a peripheral release of nerves in your feet since the source is higher up. Hopefully the docs will figure it out, preferably before it causes you major damage to your lower extremities due to altered gait. Are you doing a lot of stretches and balance things? That might help for starters. Ever try yoga? Even the beginning poses (e.g. standing on one foot at a time and its variations), and of course headstands :-)), might really help with the imbalance, which may be the root cause. Maybe Julie our resident yoga expert can provide further advice. (Did you ever say what your physical fitness level is?) Worth trying before they start cutting up back and butt.

3'? Do I take it your foot is exactly 6'? :-)

Hey, what's with the orthotics (I bet you thought I'd forget to ask)? And I'm still waiting for the name of the Grid. You're not holding out on me, are ya? :-)

Re: More in detailed explanation for Elliott...and anyone else

wendyn on 8/08/01 at 21:54 (055990)

Carmen - I haven't had a lot of time to post lately - but I wanted to let you know that you and I share a lot of similar symptoms. I've had sciatica, I have problems with SI joints, same burning in feet, lower back pain etc. For me it is all related - and they've never been positive which makes the other worse - or both! My walk affects my back and my hips, and I think the way I am made has affected my walk. Do you walk like a duck too?

When my TTS was very bad, I also had a lot of pain in my baby toes, outer ankles, and the bump on the outside bottom of my knee. I understand that this has something to do with the peroneal nerve (Elliot bail me out here?).

Thankfully - that pain is gone, in fact when I think about it - a lot of the pain that I used to have is gone...but it took a long time.

Once you get a dignosis and are on a good treatment plan, you may want to consider acupuncture as a supplement for pain/inflammation control - I have to attribute a lot of my recovery to it. Even though I am still somewhat skeptical...I can't understand HOW it works, I did not BELIEVE it would work - however the fact remains that it seems to HAVE helped a lot!

I have not been much this year - I will try to make the time to go for a bit in the fall.

Re: Carmen

Julie on 8/09/01 at hrmin (056002)

Carmen

You've given us a great deal more information recently on the full extent of your difficulties, on the strength of which I feel that you should be having a full medical workup, including an evaluation of your spine and all the tests that are necessary to arrive at an identification of the source of your foot problems. Sciatia, scoliosis, leg length difference, tilted pelvis, piriformis syndrome, possible SI dysfunction - these are conditions you've had for a long time, so it's more likely that the source is in your spine than in your feet, which have started giving you pain more recently. In this chicken-and-egg situation, my guess is that the spine is chicken.

You yourself suspect, and I suspect you're right, that more is going on than the pain in your feet, and I think you need more than a podiatrist. (And more than a chiropractor: I wouldn't suggest any treatment of your spine until the necessary work has been done to establish the source.) Perhaps the podiatrist you see tomorrow, or one of the doctors here, can advise you how to proceed. I'm not saying that in the meantime nothing should be done to treat your feet, particularly if the pain can be relieved and with it some of the stress you're under, but if the source is higher up, it will need to be dealt with or the foot problem will continue to be a problem.

As to exercise, I feel that you should do nothing now. Nothing. Certainly not yoga, and perhaps not even the foot exercises I gave you. I know you found them helpful, but even the simple ankle bending and rotations could have irritated the nerves in your feet if you overdid them. The golden rule is, if it hurts, stop - but very active people don't always heed pain messages.

Standing postures of any kind, particularly the one-legged balances, would not help you and would probably hurt you. If you were a prospective student, I probably wouldn't teach you, but would advise you to get the medical help you need for your multiple spinal problems. Physical yoga might not be suitable for you at all, and even if it was, it would be better for you to attend a remedial, therapeutic class for people with back problems, rather than a general class. So I'm certainly not going to advise you on yoga practice on the internet, where I cannot see you.

Relaxation, and breathing exercises would help to calm you and restore your balance, and I truly believe that this is what you need right now: to back off all physical exercise, all 'doing' that at this point may exacerbate your pain, and chill out. I know it's not easy, particularly when one feels desperate, but if you want to try, please e-mail me and I'll send you a copy of my tape (it's called 'Breathe and Relax: A Way to Healing').

Take care, Carmen.

Julie