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Going to the Podiatrist

Posted by M. Wilson on 8/08/01 at hrmin (055932)

The last few summers I noticed heel pain during my vacation time off work - when I'd be wearing sandals. My sister had PF so I figured that's what it was & switched to wearing better shoes. Last year I noticed arch pain only when working out - Pod recommended orthotics which I've worn since last summer - no problem.
In March, I stepped hard on my right foot at work & knew right away that I did something. I made sure to wear my good walking shoes & orthotics, but it didn't go away. Improved a lot over Easter weekend (4 days off work) so I figured it must have been the running shoes I was wearing w/ my orthotics. So, I switched to wearing just those, only those. Made walking easier until I got transferred to a new building where there is no decent parking. Had to walk 1/2 mile in from my car & back out. Couldn't walk by end of 1st day. Went to my doctor, got Vioxx & a handicap parking pass for 3 months.
Vioxx helped but as soon as I was out, I was back to square one. Discovered this web site. Started icing daily & doing some mild stretches. Bought a pair of Birks on June 30 and have worn them non-stop since then. Even walked thru the Smithsonian wearing the Birks. Still, the pain is there every morning, every time I get up from my desk.
I'm now still wearing the birks from Bed AM to Bed PM. I ice it AM & PM. I rub aspircreme AM & PM. I stopped my walking exercises. I stretch. I have a bike on order for alternative exercise. This AM I wake up & I noticed mild heel pain in MY OTHER FOOT! I'm in a panic! How could I get this in my other foot when I've been doing all this to improve my first foot?
I have an appointment w/ a POD tonight. I really do not want cortizone shots - I'm terrified of them. What should my next step be? Should I get a night splint now? Should I request physical therapy? Any specific questions I should ask him?

Re: Going to the Podiatrist

Ed Davis, DPM on 8/08/01 at hrmin (055974)

night splints may help if your plantar fascia and achilles is tight--discuss that with your podiatrist. Possibly an adjustment or upgrade to your orthotics. Dolgit cream which is the Ibuprofen Cream mentioned on this site works better than aspercream. The shoes you wear can influence the effect of your orthotics by about 25% up or down. If you can wear running shoes most of the time consider the Brooks Beast (for men), Brooks Ariel (for women), New Balance 1121 or ASICS Gel MC+ V
Ed

Re: Going to the Podiatrist

BrianG on 8/09/01 at 07:43 (056012)

Not a Dr, but.....
Why didn't you continue with the Vioxx? I'm under the impression it can be taken long term.

BCG

Re: Going to the Podiatrist

M. Wilson on 8/09/01 at 16:32 (056068)

Well, I went to the POD last night. I really liked him. Re: why didn't I stay on the Vioxx - my primary care doc gave me a month's worth & told me to report back in a month. After the month, I went thru a very hectic month at work (3 transfers in 1 month) & then away on vacation. So when I got back & contacted her again, she just gave me the referral to the POD.
I showed the POD info from this web site & told him everything I've been doing. He told me he first wants to start from the beginning by putting me back on Vioxx, since it did help, and pairing it w/ physical therapy 3x/week. Plus he wants me to do 5 minutes of heat followed by 5 minutes of ice, then some stretching to stretch the fascia (pulling toes back type of stretch). Plus stretching in the AM before getting up, which I was already doing.
He's had a lot of success w/ the shockwave therapy, but it's not covered by insurance. He also told me that he has a high success rate for surgery but that there's no need for us to consider that or cortizone at this early stage yet. My foot is better than it was in March/April, but I'm very worried about re-injury. Oh - he says my Birkenstocks are fine, but since they are the only thing I'm wearing he'd like to see me try to wear my ecco's with my orthotics again while we do this therapy. See if I can start wearing shoes w/ my orthotics again.
So far, I feel like he knows what he's doing. He seems to love his work.

Re: Going to the Podiatrist

m. wilson on 8/09/01 at 16:34 (056069)

I forgot to mention - the POD said he does not have a lot of success w/ his patients with night splints. He said he might consider casting my foot for a short time rather than the night splint, but that's also down the road in the treatment course. Start w/ the therapy, hot/cold/stretch, and Vioxx for now...

Re: Going to the Podiatrist

Ed Davis, DPM on 8/09/01 at hrmin (056106)

Sounds like you have a good plan going.
I wonder how tight your achilles is though. Straighten and stiffen your knee, holding your foot at 90 degrees to your leg. Then try to bring your foot back on your leg (toes toward your face). Your foot needs to go back an additional 15 degrees from perpendicular. If it does not, you need to improve that range of motion. You may want to show your podiatrist the N'Ice and Stretch nightsplint on this site. A lot of nightsplints are made of hard plastic, are uncomfortable so patients do not stick with them. The N'Ice and Stretch is probably most comfortable one on the market so he may have more success with this one.
Ed

Re: Going to the Podiatrist

M. Wilson on 8/10/01 at 14:23 (056199)

I have been doing achilles stretches on my own, and I do yoga, so I don't think it's overly tight. It's not as loose as last year when I was working out more regularly, but I do the FootFlex pretty regularly. I don't know if it's 15 degrees, but my foot does come back some, even with my knees straight.

I have the info about the N'Ice & Stretch printed to show him if I need to go to that next step. Thanks Ed!

Re: Going to the Podiatrist

M. Wilson on 8/10/01 at 14:23 (056201)

I have been doing achilles stretches on my own, and I do yoga, so I don't think it's overly tight. It's not as loose as last year when I was working out more regularly, but I do the FootFlex pretty regularly. I don't know if it's 15 degrees, but my foot does come back some, even with my knees straight.

I have the info about the N'Ice & Stretch printed to show him if I need to go to that next step. Thanks Ed!

Re: Going to the Podiatrist

Ed Davis, DPM on 8/08/01 at hrmin (055974)

night splints may help if your plantar fascia and achilles is tight--discuss that with your podiatrist. Possibly an adjustment or upgrade to your orthotics. Dolgit cream which is the Ibuprofen Cream mentioned on this site works better than aspercream. The shoes you wear can influence the effect of your orthotics by about 25% up or down. If you can wear running shoes most of the time consider the Brooks Beast (for men), Brooks Ariel (for women), New Balance 1121 or ASICS Gel MC+ V
Ed

Re: Going to the Podiatrist

BrianG on 8/09/01 at 07:43 (056012)

Not a Dr, but.....
Why didn't you continue with the Vioxx? I'm under the impression it can be taken long term.

BCG

Re: Going to the Podiatrist

M. Wilson on 8/09/01 at 16:32 (056068)

Well, I went to the POD last night. I really liked him. Re: why didn't I stay on the Vioxx - my primary care doc gave me a month's worth & told me to report back in a month. After the month, I went thru a very hectic month at work (3 transfers in 1 month) & then away on vacation. So when I got back & contacted her again, she just gave me the referral to the POD.
I showed the POD info from this web site & told him everything I've been doing. He told me he first wants to start from the beginning by putting me back on Vioxx, since it did help, and pairing it w/ physical therapy 3x/week. Plus he wants me to do 5 minutes of heat followed by 5 minutes of ice, then some stretching to stretch the fascia (pulling toes back type of stretch). Plus stretching in the AM before getting up, which I was already doing.
He's had a lot of success w/ the shockwave therapy, but it's not covered by insurance. He also told me that he has a high success rate for surgery but that there's no need for us to consider that or cortizone at this early stage yet. My foot is better than it was in March/April, but I'm very worried about re-injury. Oh - he says my Birkenstocks are fine, but since they are the only thing I'm wearing he'd like to see me try to wear my ecco's with my orthotics again while we do this therapy. See if I can start wearing shoes w/ my orthotics again.
So far, I feel like he knows what he's doing. He seems to love his work.

Re: Going to the Podiatrist

m. wilson on 8/09/01 at 16:34 (056069)

I forgot to mention - the POD said he does not have a lot of success w/ his patients with night splints. He said he might consider casting my foot for a short time rather than the night splint, but that's also down the road in the treatment course. Start w/ the therapy, hot/cold/stretch, and Vioxx for now...

Re: Going to the Podiatrist

Ed Davis, DPM on 8/09/01 at hrmin (056106)

Sounds like you have a good plan going.
I wonder how tight your achilles is though. Straighten and stiffen your knee, holding your foot at 90 degrees to your leg. Then try to bring your foot back on your leg (toes toward your face). Your foot needs to go back an additional 15 degrees from perpendicular. If it does not, you need to improve that range of motion. You may want to show your podiatrist the N'Ice and Stretch nightsplint on this site. A lot of nightsplints are made of hard plastic, are uncomfortable so patients do not stick with them. The N'Ice and Stretch is probably most comfortable one on the market so he may have more success with this one.
Ed

Re: Going to the Podiatrist

M. Wilson on 8/10/01 at 14:23 (056199)

I have been doing achilles stretches on my own, and I do yoga, so I don't think it's overly tight. It's not as loose as last year when I was working out more regularly, but I do the FootFlex pretty regularly. I don't know if it's 15 degrees, but my foot does come back some, even with my knees straight.

I have the info about the N'Ice & Stretch printed to show him if I need to go to that next step. Thanks Ed!

Re: Going to the Podiatrist

M. Wilson on 8/10/01 at 14:23 (056201)

I have been doing achilles stretches on my own, and I do yoga, so I don't think it's overly tight. It's not as loose as last year when I was working out more regularly, but I do the FootFlex pretty regularly. I don't know if it's 15 degrees, but my foot does come back some, even with my knees straight.

I have the info about the N'Ice & Stretch printed to show him if I need to go to that next step. Thanks Ed!