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Your opinion needed on a comprehensive treatment plan

Posted by Carmel M on 8/13/01 at hrmin (056663)

I've been putting off posting my question because I'm convinced the answer will be 'No'.

My question is have I had a comprehensive treatment plan?

I've seen two pods (the second one only because we moved and the PF was not better.) The first Pod taped my foot, said rest, ice, compression and elevation, come back if it still hurts. Next visit more tape and third visit I was casted for custom orthotics. Had no problems with orthotics, so I didn't see him again, and then we moved. I had many months with almost zero pain (although I ended up having PT for a knee problem). So time goes on and the pain is slowly creeping back in.

Second pod seemed perplexed by recalcitrant pain, gave me a handout on treatment options for PF and suggested cortisone shot, which I opted for. At the second visit he asked if the cortisone helped, I said yes, so I opted for another shot. Then I discovered this site and learned about stretching and the importance of ice and rest. So I followed the advice of other posters from this site. The third visit to the Pod resulted in a lengthy conversation about things that haven't been done ie: another x-ray, look at differences in leg length, gait analysis, MRI and PT. The visit resulted in another cortisone shot and his promise to order an MRI if I wanted it and to prescribe PT if the pain comes back.

I've had PF for two years and just want to help myself get better. Is there anything you would recommend or something I (or the Pod) overlooked? Somebody on this site recommended I see an orthopedic surgeon to address the leg length difference and all the problems associated with my previous spinal cord injury (1978).

Thank you for your time.

Carmel

Re: Thought on stretching.

Glenn X on 8/14/01 at hrmin (056693)

Carmel: Sounds a little familiar to my earlier PF days. You mention stretching, but have you had your flexibility measured to determine if that may be a problem? In my earlier more naive days with this, as weeks went by and I seemed to stay the same or worsen slightly, I favored my foot more. I was only doing moderate stretching and exercise of my foot and calves and I am certain it was not sufficient to maintain a needed level of flexibility --- which had the inevitable consequence of relentlessly placing more stress on my PF.

Anymore I am a firm believer in people with PF, not only stretching, but regularly measuring their degree of flexibility (angle of dorsiflexion).

Re: Your opinion needed on a comprehensive treatment plan

Ed Davis, DPM on 8/14/01 at hrmin (056696)

Carmel:
It sounded like the second podiatrist studied your biomechanics but it is not clear that the biomechanics were applied to your treatment. One important measurement, mentioned by Glenn, is ankle dorsiflexion. What amount of dorsiflexion do you have? If not enough, it must be acted upon before much success can occur with other treatments.

The fact that you had a period of relief with the first set of orthotics is encouraging---were they adjusted, modified?
Ed

Re: Your opinion needed on a comprehensive treatment plan

Carmel M on 8/14/01 at 11:08 (056707)

Dr. Ed,
I'm not sure what you mean by 'the second podiatrist studied your biomechanics'? In what way did he do so?

I don't know what amount of ankle dorsiflexion I have and to my knowledge I've never been tested for that. Although when my podiatrist examines my foot he does a lot of bending the foot at the ankle (towards my head), so maybe that is the 'test', and if so he never said how much dorsiflexion I have or don't have.

The current set of custom orthotics are my one and only set and no, they have never been adjusted. I heard they can last for years, so I'm assuming they are still providing the support needed.

Is PT the next step, or is it even needed?

Thanks again for your help.
Carmel

Re: Your opinion needed on a comprehensive treatment plan

Ed Davis, DPM on 8/14/01 at hrmin (056711)

You stated that he watched your gait, measured you for limb length differences. Those are components of a biomechanical exam.

Your orthotics may not be 'broken' but your need for support may have changed and the orthotics adjusted accordingly. They may not be okay if you currently have pain.

Physical therapy can be very helpful. I think you need to know for sure if a tight gastrosoleus achilles complex (limited ankle dorsiflexion) is a factor--ask your podiatrist on your next visit. If dorsiflexion is limited then the physical therapy treatment plan should include modalities to increase that range of motion.
Ed

Re: Your opinion needed on a comprehensive treatment plan

Carmel on 8/14/01 at 13:30 (056724)

You must have mis-read a section on my first post. I have NOT had a gait analysis nor a discussion or exam about the leg length difference.

Re: Your opinion needed on a comprehensive treatment plan

Ed Davis, DPM on 8/15/01 at hrmin (056781)

You listed those items in the 4th paragraph of the inital post. Did you mean that you talked to the 2nd pod about those items but they were not done?

Heading to APMA convention in Chicago -- will pick up on conversation Sunday night.
Ed

Re: Your opinion needed on a comprehensive treatment plan

Carmel M on 8/15/01 at 14:09 (056804)

I did talk to the second Podiatrist about gait analysis (he said 'not necessary') and mentioned the leg length difference to which he had no suggestions or comments. So the answer is no, I have never had a gait anaylsis nor a thorough exam concerning the leg length difference.

Have fun at the conference and I look forward to seeing your response when you get back.

Thanks,
Carmel

Re: Thought on stretching.

Glenn X on 8/14/01 at hrmin (056693)

Carmel: Sounds a little familiar to my earlier PF days. You mention stretching, but have you had your flexibility measured to determine if that may be a problem? In my earlier more naive days with this, as weeks went by and I seemed to stay the same or worsen slightly, I favored my foot more. I was only doing moderate stretching and exercise of my foot and calves and I am certain it was not sufficient to maintain a needed level of flexibility --- which had the inevitable consequence of relentlessly placing more stress on my PF.

Anymore I am a firm believer in people with PF, not only stretching, but regularly measuring their degree of flexibility (angle of dorsiflexion).

Re: Your opinion needed on a comprehensive treatment plan

Ed Davis, DPM on 8/14/01 at hrmin (056696)

Carmel:
It sounded like the second podiatrist studied your biomechanics but it is not clear that the biomechanics were applied to your treatment. One important measurement, mentioned by Glenn, is ankle dorsiflexion. What amount of dorsiflexion do you have? If not enough, it must be acted upon before much success can occur with other treatments.

The fact that you had a period of relief with the first set of orthotics is encouraging---were they adjusted, modified?
Ed

Re: Your opinion needed on a comprehensive treatment plan

Carmel M on 8/14/01 at 11:08 (056707)

Dr. Ed,
I'm not sure what you mean by 'the second podiatrist studied your biomechanics'? In what way did he do so?

I don't know what amount of ankle dorsiflexion I have and to my knowledge I've never been tested for that. Although when my podiatrist examines my foot he does a lot of bending the foot at the ankle (towards my head), so maybe that is the 'test', and if so he never said how much dorsiflexion I have or don't have.

The current set of custom orthotics are my one and only set and no, they have never been adjusted. I heard they can last for years, so I'm assuming they are still providing the support needed.

Is PT the next step, or is it even needed?

Thanks again for your help.
Carmel

Re: Your opinion needed on a comprehensive treatment plan

Ed Davis, DPM on 8/14/01 at hrmin (056711)

You stated that he watched your gait, measured you for limb length differences. Those are components of a biomechanical exam.

Your orthotics may not be 'broken' but your need for support may have changed and the orthotics adjusted accordingly. They may not be okay if you currently have pain.

Physical therapy can be very helpful. I think you need to know for sure if a tight gastrosoleus achilles complex (limited ankle dorsiflexion) is a factor--ask your podiatrist on your next visit. If dorsiflexion is limited then the physical therapy treatment plan should include modalities to increase that range of motion.
Ed

Re: Your opinion needed on a comprehensive treatment plan

Carmel on 8/14/01 at 13:30 (056724)

You must have mis-read a section on my first post. I have NOT had a gait analysis nor a discussion or exam about the leg length difference.

Re: Your opinion needed on a comprehensive treatment plan

Ed Davis, DPM on 8/15/01 at hrmin (056781)

You listed those items in the 4th paragraph of the inital post. Did you mean that you talked to the 2nd pod about those items but they were not done?

Heading to APMA convention in Chicago -- will pick up on conversation Sunday night.
Ed

Re: Your opinion needed on a comprehensive treatment plan

Carmel M on 8/15/01 at 14:09 (056804)

I did talk to the second Podiatrist about gait analysis (he said 'not necessary') and mentioned the leg length difference to which he had no suggestions or comments. So the answer is no, I have never had a gait anaylsis nor a thorough exam concerning the leg length difference.

Have fun at the conference and I look forward to seeing your response when you get back.

Thanks,
Carmel