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

Surgery question Doctors and Julie

Posted by Carmen H on 9/01/01 at 09:47 (058696)

I went to the doc for my second round of shots yesterday...okay I ended up getting one foot done the pain was tooooo BAD. Marcaine sucks.
Anyway...the question. My doc mentioned surgery three times (I said I am not interested in that option...I have only seen him twice and haven't even begun to try EVERYthing) but he said it's the simplest procedure...'You have the Plantar Fasciotomy release (sp?) and it's done endoscopically. Two days (3 maximum) you are walking again and a mere 6-8 weeks later you should return to normal exercise you were doing before the PF happened.' I asked about the scar tissue and how sometimes people have PF worse when they are done with the surgery then before they have it.
He said ' Not likely to happne Mrs. Hunter'.
Okay....what is he talking about? I KNOW surgery is a LAST DITCH effort to treat this PF but he talks about it as though it's a simple pill you take and VOILA! You're healed for good. I don't fall for such things...I am a researching kinda gal and would leave him before I would let that be my last opinion. I hadn't even tried the night splint or PT yet!
I asked him about taping as well and he said the method Scott has and everyone here has used is not easy to do on your own and get the proper technique right.???? He is an older pod who has obviously been doing this for a looooooong time.....but he sits down with me and listens and discusses my concerns and that's more then anyone has done so far. Just curious about his methods..Please advise.

Re: Surgery question Doctors and Julie

Julie on 9/01/01 at 10:10 (058699)

Carmen

This is really a question for the doctors, but as I seem to be on line simultaneously with you I'll give you my opinion, which is that you haven't yet succeeded in finding a doctor who is prepared to work with you on a truly comprehensive healing programme, and I feel that this is what you need.

I also feel as you do that surgery is the last resort, after all else has been tried and has failed. You are nowhere near that point. I don't think many podiatrists would recommend surgery or even consider it before you had been systematically treated conservatively for at least six months. And I don't know why your doctor talks of it as though it is a simple, risk-free procedure.

The next option, before surgery, is ESWT, if you are a candidate for it.

You've been around here long enough to have read of other people's experiences of surgery. When did you last hear anyone say they were walking in three days and back to normal activities in 6-8 weeks? Perhaps it's only the unlucky ones who tell their stories, and you could be lucky. But then again...

I have heard Dr Z say many times that he does not think highly of EPF (Endoscopic Plantar Fasciotomy) and prefers the Minimal Incision technique.

Add all this to the known and frequently experienced complications of the fascia release, as described by Dr Z, Dr Davis and others - i.e. that it can put an additional load on other structures and can lead to other problems - and I really think you are looking at some more research. When you first asked for recommendations, Dr Z and others said 'Peachtree Podiatry', but you couldn't contact them. They can't have disappeared from the face of the earth, so why not have another look around for them - or for the individual doctors who were named at the time.

So, having sounded off, probably putting both feet deep in it, I re-read your post and see that you like your present doctor and that he listens to you. So maybe he is someone you can work with - those two things are certainly a good basis for it. But I still feel you are absolutely right not to want to think about surgery at this stage. Perhaps you'll decide for it in future, but that's way down the line.

Taping is not at all difficult. The simple technique that I and others have used is perfectly easy to do on your own. You may need to experiment a bit to get the tension right. There have been many posts on it, including interminably repetitious ones from me. Do a search. Try it and see if it helps you.

I hope this is helpful.

All the best

Julie

Re: Surgery question Doctors and Julie

Glenn X on 9/01/01 at 14:01 (058716)

Carmen: Good description of the Marcaine treatment.

Has anyone measured the dorsiflexion angle of your ankle? You OK there? If not, increased flexibility is certainly a wise, conservative path to consider. And the night splint and PT can be helpful with this.

As an aside, my wrists began to bother me a month ago. I did a cursory search on the net for a doc to check it out. (Didn't want to be casual about it like I was with PF in the early going). Found a reference to an orthopedic surgeon, who also happened to be the team physician for the Portland Trailblazers. Seemed a solid enough referral.

Saw him two weeks ago. He came in, saw the crutches and asked what they were about. I mentioned PF, told him I was (finally) being treated by someone I had great confidence in (Ed Davis). Nonetheless, he spent 20 minutes talking about sports figures he'd treated for the same condition, mentioned surgeries he'd done, and suggested that he knew his stuff re 'cutting.' I nodded politely, not the least interested in his surgical solution. He then got up to leave. I said, 'wait a minute. How about my wrists?' He turned around, asked me to bend them this way and that and said, 'they'll improve when you get rid of the crutches.' End of visit.

I'd guess he's 'older,' but not senile, and we had a pleasant enough conversation about PF. But do you think for a minute I'd get in the same room with him where knives were handy? No way!

Not because of his age, not because he didn't even understand why I was there in the first place, and not because he did such a pitiful job evaluating my wrists. I wouldn't let him cut on me because he didn't even discuss conservative regimens, much less dive into them with eagerness, because I know based on my own research that I have NO WAY exhausted the wealth of non-bloody treatments available, and because I'm just three years into this, and surgery isn't even in my field of vision.

(It helps too to have Ed Davis on my side).

You seem to appreciate this guy some. You also sound anxious to get better. In such a frame of mind, someone speaking with confidence who sits down with you and listens and discusses your concerns can be compelling. But from my limited experience, both shots and surgical discussions seem to have come awful early in your treatment by this guy. I have not heard either 'S' word from Davis.

You're a superlative researcher. You can find better.

Re: Surgery question Doctors and Julie

Pauline on 9/01/01 at 14:40 (058718)

Carmen,
Above all please remember that no one can force you to have any surgery
you do not want. They can talk till they are tired of listening to themselves, but if you do not make the decision to have the surgery it's not going to happen. As the others have written, I too agree that if you want to try all the other conservative treatments first before jumping into surgery you should do so.

Surgery always sounds easy when it's someone else that's getting it done. What doctor would not be up beat about his technique and his results? It always sounds so easy and fast and positive. Unfortunately not all cases come out that way. Surgery carries no guarantee that your pain will be eliminated or that it will not compromise other parts of your foot causing you more pain or pain in a different location. When you have surgery it's part of the risk you take.

Some posters on this site have taken that risk and have had wonderful results, others have taken the same risk and are still unable to walk pain free and have had to contend with complications such as infections along the way.

The road back from P.F. is a long one and each of us tries various treatments that we feel comfortable with to become pain free again. what ever choices you make, you should feel comfortable with so you have no regrets. Eventually surgery may be one of them. Do your research, read the postings on the surgery board from people who have had the surgery, try all the conservative things, give youself time to heal and then decide if surgery is a choice you want for yourself.

The intricate workings of the human foot is truely a marvel. Like your eyes you only get two of them. Take care of them well. Good luck with the decisions you have to make.

Re: ALL....

Carmen H on 9/02/01 at 09:01 (058767)

Thanks for all your input. I logged on just to check responses today....I appreciate it. But rest assured...Carmen won't have surgery. I have been that route when the chance of complete recovery were slim (Piriformus Syndrome) and I now have a 7' (YES...that's 7 INCHES) scar on my left side. For nothing. Stil living with PS and PF and waking up with reasons to smile each day so I won't fall for that S word for sure. I DO like the doc 'okay'....for now he'll work to monitor my progress but as soon as I get the PT underway for the Piriformus I will see how my PF reacts to treatment and go from there. I am starting the stretching and PT next to see how that works. If I start to have relief I will cease the shots and find a doctor on this side of town that will work more with the PT and less with the shots nad surgery aspect of it.
Peachtree Pod has yet to resurface...the directory gives the only number available and it says 'It's been disconnected'. I have no idea why this is.
I truly hope that I am on the right track thinking that once the Piriformus is stretched and the calves are stretched and the fascia is loosened (my flexiblity will be better) that the PF will calm down a bit.
I know EWST is expensive and my insurance won't cover it so that's another option I can't look at for now. We bought a house (YEA!!!) and will be moving in a month and a half and life is about to get even busier.
You guys are great....thansk for your words of experiemce and wisdom. Glenn you sound like me.....reading your post reminded me of the way I think sometimes. I certainly hope your wrists ease up a bit. Have you tried strengthening? Like with stress balls or chinese synosis balls....?
I have started that b/c like you I don't want to end up with Carpal Tunnel and be too far into it to help myself right away. So strengthening is the key for me.
Anyway.....Thanks again everyone.

Re: Loosening Up

Glenn X on 9/02/01 at 12:06 (058791)

Carmen: You sound great and well in charge of your own care.

I've been doing a concentrated stretching regimen for several weeks now and am making good progress with flexibility. Couple of thoughts may be worth sharing.

I don't want to sound like a broke poster, but measuring ankle dorsiflexion is a smart of any stretching therapy. For me, getting a start angle and working forward from that to an angle the doctor thinks I need, helps me maintain a good balance between agressiveness and fascia rest. I get measured every couple of weeks. One degree per week may be realistic in the early going of a stretching regimen. Once things get loosened up, progress may slow to maybe half a degree weekly (or even a quarter) as tendons and other stiffer tissues come more into play. At least that's my experience -- everyone's different.

I wrote a short bit about my stretching routines a week or so ago and attributed my flexibility progress from night splints at 15 or 20 percent of overall flex-value. Increasingly I'm thinking the splints play a more important role than I realized. It's just a much slower, more sustained role.

I find my feet are regularly sore from the focused stretching I do. I don't believe I'm re-injuring my fascia. My 'hot' spot is less and less aggravated. But I find it difficult to tension the full range of calves, achilles, heel, fascia, and toes without exciting the nerve endings on the bottom of my feet. In fact, for me, simply sitting and stretching my hamstrings adds sensitivity to my foot bottoms. Seems strange. But then, foot bone connected to the ankle bone, etc, etc, may be truer for ALL tissues than I ever appreciated.

Re: Finding a Doctor

Glenn X on 9/02/01 at 12:28 (058793)

Thanks for your thoughts on my wrists. I saw a great doctor for this a week or so after I was disappointed by my first foray. This guy, Dr. Peter Nathan in Portland, quickly put me on a therapeutic (and simple) track.

After a thorough and concientious exam, he felt (as did the PT who works in the same office with him -- and who also examined me) that my need was more forearm flexibiltity, period. Gave me two simple exercises to do four times daily, and now, four days later they are much improved. Just to be sure he asked me to call him in a week and talk to him directly ('save the cost of an office visit, ' he said, 'but I want to hear how you're doing').

Anymore I feel like an expert at evaluating the quality of care I get. This was first rate, and it was nice to be able to be genuinely complementary to Nathan and his team.

For others looking for a good doctor ... in this instance I found Nathan by first asking our company's benefits manager if she was aware of anyone who seemed particularly skilled in this area. She wasn't, but she contacted our third-party work comp administrator. A claims manager there said, 'if she needed to see someone for carpal tunnel or any other wrist problems, she'd see Dr. Peter Nathan.'

When I called their office and asked, 'is this the Doctor Nathan that treats wrists?' The receptionist replied, 'he sure is, and he's the best!' That made for the second trustworthy recommendation I got for this guy. (Trustworthy because she said it with enthusiasm).

Medical claims adjustors MAY be another good referral source.

Re: Surgery question Doctors and Julie

Ed Davis, DPM on 9/02/01 at 13:31 (058801)

Carmen:

Your treatment description is sounding a bit dissapointing. I am understanding from many of the posts that patients are really having a hard time finding doctors who effectively treat tough cases of plantar fasciitis. It has come as a surprise to me as I assumed that I and my colleagues were deriving treatment plans from the same or similar knowledge base.

The need to change doctors can both be a hassle and expensive to the patient. I certainly prefer to see a good doctor-patient relationship established. Arm yourself with as much information from this site as you can before your next appointment. Consider calling the doctors office ahead of time, informing his staff that you will need a bit of extra time with the doctor (they amy have to change your appointment time to accomodate this request). Present the information to him in a positive manner. If you feel that he has accepted your information, discussed it in a productive manner and is willing to act on it, consider sticking with him. If not, it may be time to move on. We can look at where you live and try to come up with some names.
Ed

Re: Finding a Doctor

JudyS on 9/02/01 at 13:54 (058806)

Glenn - I feel badly because I apparently missed the first posts regarding your wrists and wasn't aware that you are having problems......I have been as well and wonder if you wouldn't mind sharing those exercise techniques you mentioned. Thanks. Glad it's better for you.
judith.schmidt@gcccd.net

Re: To Glen Loosening Up

Pauline on 9/02/01 at 17:05 (058833)

Glen,
Can you give me any idea (numbers) for the ankle flexibility we should have? Where did you start and what is your number now. I don't know how to tell how far forward my ankles should be able to flex. I assume there is some limitation, but I'd really like to know what is considered loose.
Thanks

Re: Wrist exercises

Glenn X on 9/02/01 at 20:26 (058864)

Judy: Please don't feel bad. I only mentioned it briefly, once I believe, and then more as a curiosity. Wrists started getting sore when I started an ambitious stretching program. I wondered if tensioning soft tissues in my legs and feet could heighten the sensitivity of other similar soft tissues in the body.

Having learned from my laize faire attitude about PF, I jumped on the wrist soreness two weeks after onset. Caught it early.

I have no nerve degradation. Muscle tone in arms is good. Soreness is mostly in my forearms, some in my wrists. It's aggravated by steady typing more than anything. Essential need is inceased flexibility in forearm (fingering) muscles and tendons.

My treatment consists of 1) Holding my arm out straight from my body, palm up, grasping my fingers with my other hand, and bending them downwards into a comfortable tensioning of my forearm for 15 seconds. Repeat four times daily. 2) Hold arm down at side, palm facing forward. Reach arm back and up, keeping it stiff, while at the same time bending my wrist and moving the back of my hand and fingers toward the ceiling. I don't hold this movement. Just reach back as far as I comfortably can and then let my arm come back to my side. Four times.

My sense is that this regimen is fairly particular to my inflexible forearms, and not for everyone.

I also have some ergonomic changes I need to make to my workstations, both at home and at work.

I am not yet 100 percent, but am clearly on track.

Have you been looked at by a doctor? Depending on where one's at, they ask about symptoms, duration, aggravations, etc., and do things like bend and twist and thump your arm, and prick each of your fingers with a two-pronged thingy to make sure you can feel both prongs. There's also a more advanced nerve induction test that I wasn't in need of.

Not to sound alarming, but this is one of those things like PF where if intervention is delayed, the road to recovery is more arduous. But if caught and treated early can quickly and relatively simply be resolved.

Carpal tunnel also seems more studied and understood than PF.

All the best, and don't hesitate if you think I can add anything more.

Re: To Glen Loosening Up

Glenn X on 9/02/01 at 20:54 (058865)

Pauline: This is one of those things a doctor or physical therapist should measure and advise about.

We're talking about the angle formed by your foot and lower leg when you 'dorsiflex' your ankle (move your foot and toes in the direction of your face as far as you can).

If you look at things from the side when doing this, you'll see something like a 90 degree right angle. IDEALLY your foot will be even more flexible so that the angle is less than 90 degrees. Your foot can dorsiflex more.

I'm told an angle of 80 degrees is good and 75 degrees is better.

A couple of years ago a DPM attributed my PF to stretching and cautioned me against doing ANY. I didn't, and gradually over time, because I was pretty immobile, my angle, my inflexibility increased to 105 degrees. (I couldn't even bend my foot toward my shin to get a right angle).

This past February I realized the mistaken direction I was taking and began a flexibility routine. Five weeks ago I connected up with Ed Davis and his PT and accelerated my progress. I'm now at 85 degrees and still working at it. My goal is 75, a milestone likely to be several weeks out.

Ankle flexibility is a fundamental element of PF. If you ain't got it -- getting it (carefully) will probably be helpful. I wish there were an easy way to measure it at home.

Be nice to hear from more experienced folks about this.

Re: Wrist exercises

JudyS on 9/02/01 at 21:09 (058867)

Glenn, thank you so much for this information! Like you, my forearm and wrist pain developed a few weeks ago as a result of too many hours on the keyboard Instant Messaging with my favorite folks!
I did see a doctor after about two weeks who gave me splints and anti-inflammatorys.....the usual drill. He said nothing about exercises. I was in Tucson for a week during which I had no computer so no pain. My workstation has been ergonomically upgraded.......but as soon as I returned home and started typing, (just gotta talk with special folks!), the soreness was right back. So now, like TexBev, I'll have to be ever-conscious of limiting my keyboard time. Bummer.....they really are special folks!
Thanks again.......now, perhaps you could explain the 'mission creep' thing to us ill-informed civilians? :)

Re: ED

Carmen H on 9/03/01 at 08:36 (058892)

Ed
Disappointing is an understatement and 12 weeks later I STILL don't have a doctor I feel comfortable with. I think part of my frustration is just THAT. That I don't have ANYone I trust to go to with this!!!! I have documented my progress and the things I have been doing since this started in a typewritten and dated journal, brought in a couple artticles and threads from this site, and asked a myriad of questions BEFORE I went. I actually got the doc to talk to me before I made an appt. Now I am at the disappointment stage and he is saying surgery more time then I think is right at this stage.
If you can help me find a doctor in this area I would REALLY appreciate it. I have done the search on the rate your doctor part of this board.....My doctor was on there but I have to say he's about a 6 or maybea 5. I have had no relief or answers yet. I need to find someone closer. I can't continue to take time off work every friday (one hour to travel 1 hour in office and literally 2 hours just to get home. Atlanta traffic is BAD and his office is way far away from me. Help?
Thanks Dr. Ed...so much.

Re: GLENN....?'s

Carmen H on 9/03/01 at 09:54 (058906)

I read your post and am wondering what 'hot spot' you mean? Where is yours? I have weird sensations in my feet now that are very similar to how they felt when I first got PF. I was better for awhile (no REAL pain when walking....could go all day witout too much discomfort) and now I have started stretching a little more to get some flexiblity in my hamstrings and calves (the tightness was killing me and the POD I was seeing said it was okay to stretch those muscles) and now my feet tingle and burn a lot more then they used to. I go for PT tomorrow and want to know what to 'expect' in the way of stretching the PF and ankle dorsiflexion. You said your feet are regularly sore from the stretching the fascia. I have to ask What does your fascia look like when you flex and gently pull your big toe and second toe? My fascias on both feet are so unbelievably tight that it looks like there is something under the skin. HARD as a rock. Is this normal for PF? The doctor says it is....but I am beginning to wonder. I value your input Glenn...how long have you had PF? Is it JUST pf or is something else involved with yours?
Thanks in advance!

Re: Mission Creep

Glenn X on 9/03/01 at 21:00 (058959)

Judy: Mission creep is when your job is to drain the swamp, but before you can pull the plug, you find yourself up to your armpits in alligators. And then a pleasure boat rams a nearby dock flinging three non-swimmers into the water, lightning strikes, the trees catch fire . . . followed by a mosquito attack, and you know they're carrying west nile. So what was my mission again?

Every once in a while PF is a little like that.

Re: Mission Creep

wendyn on 9/03/01 at 22:49 (058969)

We call it 'scope creep'. Actually had a case of it my house. My dishwasher leaked. So I had to buy a new one (the old one was toast). The leak wrecked my linoleum. So I need a new lino. Decided if we were going to do that - might as well do the whole main floor - rip out the carpet too - redo the whole floor. Then - seeing as how the floor would be ripped out - this is a good time to paint. Then - my fridge started leaking - got the fridge fixed too - couldn't have a fridge leaking on a new floor (actually thought for a bit that we needed a new fridge). This has been one expensive broken dishwasher!!!!!

Re: Mission Creep

JudyS on 9/03/01 at 22:53 (058972)

I guess we don't call it Mission Creep around here......we call it Murphy's Law!

Re: Mission Creep

Julie on 9/04/01 at 01:56 (058979)

...and we call it Sod's Law.

Re: Wrist exercises

Julie on 9/04/01 at 02:05 (058980)

Glenn, I've been trying out your wrist exercise: they feel good, and I think they'd be useful for anyone who - like Judy, like me, like lots of us here - spends too much time at the keyboard. The first one particularly, the dorsiflexion one, stretches out the muscles and tendons that too-long-at-the-keyboard tend to tighten. Thanks for posting them.

Re: Mission Creep

Glenn X on 9/04/01 at 20:38 (059038)

Wendy: Classic, hilarious -- LOL. I like that term 'scope creep.'

Re: Wrist exercises

Glenn X on 9/04/01 at 20:45 (059041)

Julie: I like 'em too. Still tension up with too much keyboarding, but then I've only been at 'em a week. And I haveb't got the workstation changes yet.

I particularly liked the focused direction. Probably all sorts of exercises possible with wrists. I even asked about others, and about strengthening. But the doctor and PT were clear, 'for what you need, just do these.'

Re: Wrist exercises

Julie on 9/05/01 at 02:33 (059068)

I've just done them, after an hour at the keyboard. It feels good. I also like the way they 'stop' you and give you a minute's quiet. I wish I'd known them when I wrote 'Office Yoga'.

Thanks for them!

Re: ED

Ed Davis, DPM on 9/05/01 at 18:32 (059151)

John Ruch, DPM
Ed

Re: Surgery question Doctors and Julie

Julie on 9/01/01 at 10:10 (058699)

Carmen

This is really a question for the doctors, but as I seem to be on line simultaneously with you I'll give you my opinion, which is that you haven't yet succeeded in finding a doctor who is prepared to work with you on a truly comprehensive healing programme, and I feel that this is what you need.

I also feel as you do that surgery is the last resort, after all else has been tried and has failed. You are nowhere near that point. I don't think many podiatrists would recommend surgery or even consider it before you had been systematically treated conservatively for at least six months. And I don't know why your doctor talks of it as though it is a simple, risk-free procedure.

The next option, before surgery, is ESWT, if you are a candidate for it.

You've been around here long enough to have read of other people's experiences of surgery. When did you last hear anyone say they were walking in three days and back to normal activities in 6-8 weeks? Perhaps it's only the unlucky ones who tell their stories, and you could be lucky. But then again...

I have heard Dr Z say many times that he does not think highly of EPF (Endoscopic Plantar Fasciotomy) and prefers the Minimal Incision technique.

Add all this to the known and frequently experienced complications of the fascia release, as described by Dr Z, Dr Davis and others - i.e. that it can put an additional load on other structures and can lead to other problems - and I really think you are looking at some more research. When you first asked for recommendations, Dr Z and others said 'Peachtree Podiatry', but you couldn't contact them. They can't have disappeared from the face of the earth, so why not have another look around for them - or for the individual doctors who were named at the time.

So, having sounded off, probably putting both feet deep in it, I re-read your post and see that you like your present doctor and that he listens to you. So maybe he is someone you can work with - those two things are certainly a good basis for it. But I still feel you are absolutely right not to want to think about surgery at this stage. Perhaps you'll decide for it in future, but that's way down the line.

Taping is not at all difficult. The simple technique that I and others have used is perfectly easy to do on your own. You may need to experiment a bit to get the tension right. There have been many posts on it, including interminably repetitious ones from me. Do a search. Try it and see if it helps you.

I hope this is helpful.

All the best

Julie

Re: Surgery question Doctors and Julie

Glenn X on 9/01/01 at 14:01 (058716)

Carmen: Good description of the Marcaine treatment.

Has anyone measured the dorsiflexion angle of your ankle? You OK there? If not, increased flexibility is certainly a wise, conservative path to consider. And the night splint and PT can be helpful with this.

As an aside, my wrists began to bother me a month ago. I did a cursory search on the net for a doc to check it out. (Didn't want to be casual about it like I was with PF in the early going). Found a reference to an orthopedic surgeon, who also happened to be the team physician for the Portland Trailblazers. Seemed a solid enough referral.

Saw him two weeks ago. He came in, saw the crutches and asked what they were about. I mentioned PF, told him I was (finally) being treated by someone I had great confidence in (Ed Davis). Nonetheless, he spent 20 minutes talking about sports figures he'd treated for the same condition, mentioned surgeries he'd done, and suggested that he knew his stuff re 'cutting.' I nodded politely, not the least interested in his surgical solution. He then got up to leave. I said, 'wait a minute. How about my wrists?' He turned around, asked me to bend them this way and that and said, 'they'll improve when you get rid of the crutches.' End of visit.

I'd guess he's 'older,' but not senile, and we had a pleasant enough conversation about PF. But do you think for a minute I'd get in the same room with him where knives were handy? No way!

Not because of his age, not because he didn't even understand why I was there in the first place, and not because he did such a pitiful job evaluating my wrists. I wouldn't let him cut on me because he didn't even discuss conservative regimens, much less dive into them with eagerness, because I know based on my own research that I have NO WAY exhausted the wealth of non-bloody treatments available, and because I'm just three years into this, and surgery isn't even in my field of vision.

(It helps too to have Ed Davis on my side).

You seem to appreciate this guy some. You also sound anxious to get better. In such a frame of mind, someone speaking with confidence who sits down with you and listens and discusses your concerns can be compelling. But from my limited experience, both shots and surgical discussions seem to have come awful early in your treatment by this guy. I have not heard either 'S' word from Davis.

You're a superlative researcher. You can find better.

Re: Surgery question Doctors and Julie

Pauline on 9/01/01 at 14:40 (058718)

Carmen,
Above all please remember that no one can force you to have any surgery
you do not want. They can talk till they are tired of listening to themselves, but if you do not make the decision to have the surgery it's not going to happen. As the others have written, I too agree that if you want to try all the other conservative treatments first before jumping into surgery you should do so.

Surgery always sounds easy when it's someone else that's getting it done. What doctor would not be up beat about his technique and his results? It always sounds so easy and fast and positive. Unfortunately not all cases come out that way. Surgery carries no guarantee that your pain will be eliminated or that it will not compromise other parts of your foot causing you more pain or pain in a different location. When you have surgery it's part of the risk you take.

Some posters on this site have taken that risk and have had wonderful results, others have taken the same risk and are still unable to walk pain free and have had to contend with complications such as infections along the way.

The road back from P.F. is a long one and each of us tries various treatments that we feel comfortable with to become pain free again. what ever choices you make, you should feel comfortable with so you have no regrets. Eventually surgery may be one of them. Do your research, read the postings on the surgery board from people who have had the surgery, try all the conservative things, give youself time to heal and then decide if surgery is a choice you want for yourself.

The intricate workings of the human foot is truely a marvel. Like your eyes you only get two of them. Take care of them well. Good luck with the decisions you have to make.

Re: ALL....

Carmen H on 9/02/01 at 09:01 (058767)

Thanks for all your input. I logged on just to check responses today....I appreciate it. But rest assured...Carmen won't have surgery. I have been that route when the chance of complete recovery were slim (Piriformus Syndrome) and I now have a 7' (YES...that's 7 INCHES) scar on my left side. For nothing. Stil living with PS and PF and waking up with reasons to smile each day so I won't fall for that S word for sure. I DO like the doc 'okay'....for now he'll work to monitor my progress but as soon as I get the PT underway for the Piriformus I will see how my PF reacts to treatment and go from there. I am starting the stretching and PT next to see how that works. If I start to have relief I will cease the shots and find a doctor on this side of town that will work more with the PT and less with the shots nad surgery aspect of it.
Peachtree Pod has yet to resurface...the directory gives the only number available and it says 'It's been disconnected'. I have no idea why this is.
I truly hope that I am on the right track thinking that once the Piriformus is stretched and the calves are stretched and the fascia is loosened (my flexiblity will be better) that the PF will calm down a bit.
I know EWST is expensive and my insurance won't cover it so that's another option I can't look at for now. We bought a house (YEA!!!) and will be moving in a month and a half and life is about to get even busier.
You guys are great....thansk for your words of experiemce and wisdom. Glenn you sound like me.....reading your post reminded me of the way I think sometimes. I certainly hope your wrists ease up a bit. Have you tried strengthening? Like with stress balls or chinese synosis balls....?
I have started that b/c like you I don't want to end up with Carpal Tunnel and be too far into it to help myself right away. So strengthening is the key for me.
Anyway.....Thanks again everyone.

Re: Loosening Up

Glenn X on 9/02/01 at 12:06 (058791)

Carmen: You sound great and well in charge of your own care.

I've been doing a concentrated stretching regimen for several weeks now and am making good progress with flexibility. Couple of thoughts may be worth sharing.

I don't want to sound like a broke poster, but measuring ankle dorsiflexion is a smart of any stretching therapy. For me, getting a start angle and working forward from that to an angle the doctor thinks I need, helps me maintain a good balance between agressiveness and fascia rest. I get measured every couple of weeks. One degree per week may be realistic in the early going of a stretching regimen. Once things get loosened up, progress may slow to maybe half a degree weekly (or even a quarter) as tendons and other stiffer tissues come more into play. At least that's my experience -- everyone's different.

I wrote a short bit about my stretching routines a week or so ago and attributed my flexibility progress from night splints at 15 or 20 percent of overall flex-value. Increasingly I'm thinking the splints play a more important role than I realized. It's just a much slower, more sustained role.

I find my feet are regularly sore from the focused stretching I do. I don't believe I'm re-injuring my fascia. My 'hot' spot is less and less aggravated. But I find it difficult to tension the full range of calves, achilles, heel, fascia, and toes without exciting the nerve endings on the bottom of my feet. In fact, for me, simply sitting and stretching my hamstrings adds sensitivity to my foot bottoms. Seems strange. But then, foot bone connected to the ankle bone, etc, etc, may be truer for ALL tissues than I ever appreciated.

Re: Finding a Doctor

Glenn X on 9/02/01 at 12:28 (058793)

Thanks for your thoughts on my wrists. I saw a great doctor for this a week or so after I was disappointed by my first foray. This guy, Dr. Peter Nathan in Portland, quickly put me on a therapeutic (and simple) track.

After a thorough and concientious exam, he felt (as did the PT who works in the same office with him -- and who also examined me) that my need was more forearm flexibiltity, period. Gave me two simple exercises to do four times daily, and now, four days later they are much improved. Just to be sure he asked me to call him in a week and talk to him directly ('save the cost of an office visit, ' he said, 'but I want to hear how you're doing').

Anymore I feel like an expert at evaluating the quality of care I get. This was first rate, and it was nice to be able to be genuinely complementary to Nathan and his team.

For others looking for a good doctor ... in this instance I found Nathan by first asking our company's benefits manager if she was aware of anyone who seemed particularly skilled in this area. She wasn't, but she contacted our third-party work comp administrator. A claims manager there said, 'if she needed to see someone for carpal tunnel or any other wrist problems, she'd see Dr. Peter Nathan.'

When I called their office and asked, 'is this the Doctor Nathan that treats wrists?' The receptionist replied, 'he sure is, and he's the best!' That made for the second trustworthy recommendation I got for this guy. (Trustworthy because she said it with enthusiasm).

Medical claims adjustors MAY be another good referral source.

Re: Surgery question Doctors and Julie

Ed Davis, DPM on 9/02/01 at 13:31 (058801)

Carmen:

Your treatment description is sounding a bit dissapointing. I am understanding from many of the posts that patients are really having a hard time finding doctors who effectively treat tough cases of plantar fasciitis. It has come as a surprise to me as I assumed that I and my colleagues were deriving treatment plans from the same or similar knowledge base.

The need to change doctors can both be a hassle and expensive to the patient. I certainly prefer to see a good doctor-patient relationship established. Arm yourself with as much information from this site as you can before your next appointment. Consider calling the doctors office ahead of time, informing his staff that you will need a bit of extra time with the doctor (they amy have to change your appointment time to accomodate this request). Present the information to him in a positive manner. If you feel that he has accepted your information, discussed it in a productive manner and is willing to act on it, consider sticking with him. If not, it may be time to move on. We can look at where you live and try to come up with some names.
Ed

Re: Finding a Doctor

JudyS on 9/02/01 at 13:54 (058806)

Glenn - I feel badly because I apparently missed the first posts regarding your wrists and wasn't aware that you are having problems......I have been as well and wonder if you wouldn't mind sharing those exercise techniques you mentioned. Thanks. Glad it's better for you.
judith.schmidt@gcccd.net

Re: To Glen Loosening Up

Pauline on 9/02/01 at 17:05 (058833)

Glen,
Can you give me any idea (numbers) for the ankle flexibility we should have? Where did you start and what is your number now. I don't know how to tell how far forward my ankles should be able to flex. I assume there is some limitation, but I'd really like to know what is considered loose.
Thanks

Re: Wrist exercises

Glenn X on 9/02/01 at 20:26 (058864)

Judy: Please don't feel bad. I only mentioned it briefly, once I believe, and then more as a curiosity. Wrists started getting sore when I started an ambitious stretching program. I wondered if tensioning soft tissues in my legs and feet could heighten the sensitivity of other similar soft tissues in the body.

Having learned from my laize faire attitude about PF, I jumped on the wrist soreness two weeks after onset. Caught it early.

I have no nerve degradation. Muscle tone in arms is good. Soreness is mostly in my forearms, some in my wrists. It's aggravated by steady typing more than anything. Essential need is inceased flexibility in forearm (fingering) muscles and tendons.

My treatment consists of 1) Holding my arm out straight from my body, palm up, grasping my fingers with my other hand, and bending them downwards into a comfortable tensioning of my forearm for 15 seconds. Repeat four times daily. 2) Hold arm down at side, palm facing forward. Reach arm back and up, keeping it stiff, while at the same time bending my wrist and moving the back of my hand and fingers toward the ceiling. I don't hold this movement. Just reach back as far as I comfortably can and then let my arm come back to my side. Four times.

My sense is that this regimen is fairly particular to my inflexible forearms, and not for everyone.

I also have some ergonomic changes I need to make to my workstations, both at home and at work.

I am not yet 100 percent, but am clearly on track.

Have you been looked at by a doctor? Depending on where one's at, they ask about symptoms, duration, aggravations, etc., and do things like bend and twist and thump your arm, and prick each of your fingers with a two-pronged thingy to make sure you can feel both prongs. There's also a more advanced nerve induction test that I wasn't in need of.

Not to sound alarming, but this is one of those things like PF where if intervention is delayed, the road to recovery is more arduous. But if caught and treated early can quickly and relatively simply be resolved.

Carpal tunnel also seems more studied and understood than PF.

All the best, and don't hesitate if you think I can add anything more.

Re: To Glen Loosening Up

Glenn X on 9/02/01 at 20:54 (058865)

Pauline: This is one of those things a doctor or physical therapist should measure and advise about.

We're talking about the angle formed by your foot and lower leg when you 'dorsiflex' your ankle (move your foot and toes in the direction of your face as far as you can).

If you look at things from the side when doing this, you'll see something like a 90 degree right angle. IDEALLY your foot will be even more flexible so that the angle is less than 90 degrees. Your foot can dorsiflex more.

I'm told an angle of 80 degrees is good and 75 degrees is better.

A couple of years ago a DPM attributed my PF to stretching and cautioned me against doing ANY. I didn't, and gradually over time, because I was pretty immobile, my angle, my inflexibility increased to 105 degrees. (I couldn't even bend my foot toward my shin to get a right angle).

This past February I realized the mistaken direction I was taking and began a flexibility routine. Five weeks ago I connected up with Ed Davis and his PT and accelerated my progress. I'm now at 85 degrees and still working at it. My goal is 75, a milestone likely to be several weeks out.

Ankle flexibility is a fundamental element of PF. If you ain't got it -- getting it (carefully) will probably be helpful. I wish there were an easy way to measure it at home.

Be nice to hear from more experienced folks about this.

Re: Wrist exercises

JudyS on 9/02/01 at 21:09 (058867)

Glenn, thank you so much for this information! Like you, my forearm and wrist pain developed a few weeks ago as a result of too many hours on the keyboard Instant Messaging with my favorite folks!
I did see a doctor after about two weeks who gave me splints and anti-inflammatorys.....the usual drill. He said nothing about exercises. I was in Tucson for a week during which I had no computer so no pain. My workstation has been ergonomically upgraded.......but as soon as I returned home and started typing, (just gotta talk with special folks!), the soreness was right back. So now, like TexBev, I'll have to be ever-conscious of limiting my keyboard time. Bummer.....they really are special folks!
Thanks again.......now, perhaps you could explain the 'mission creep' thing to us ill-informed civilians? :)

Re: ED

Carmen H on 9/03/01 at 08:36 (058892)

Ed
Disappointing is an understatement and 12 weeks later I STILL don't have a doctor I feel comfortable with. I think part of my frustration is just THAT. That I don't have ANYone I trust to go to with this!!!! I have documented my progress and the things I have been doing since this started in a typewritten and dated journal, brought in a couple artticles and threads from this site, and asked a myriad of questions BEFORE I went. I actually got the doc to talk to me before I made an appt. Now I am at the disappointment stage and he is saying surgery more time then I think is right at this stage.
If you can help me find a doctor in this area I would REALLY appreciate it. I have done the search on the rate your doctor part of this board.....My doctor was on there but I have to say he's about a 6 or maybea 5. I have had no relief or answers yet. I need to find someone closer. I can't continue to take time off work every friday (one hour to travel 1 hour in office and literally 2 hours just to get home. Atlanta traffic is BAD and his office is way far away from me. Help?
Thanks Dr. Ed...so much.

Re: GLENN....?'s

Carmen H on 9/03/01 at 09:54 (058906)

I read your post and am wondering what 'hot spot' you mean? Where is yours? I have weird sensations in my feet now that are very similar to how they felt when I first got PF. I was better for awhile (no REAL pain when walking....could go all day witout too much discomfort) and now I have started stretching a little more to get some flexiblity in my hamstrings and calves (the tightness was killing me and the POD I was seeing said it was okay to stretch those muscles) and now my feet tingle and burn a lot more then they used to. I go for PT tomorrow and want to know what to 'expect' in the way of stretching the PF and ankle dorsiflexion. You said your feet are regularly sore from the stretching the fascia. I have to ask What does your fascia look like when you flex and gently pull your big toe and second toe? My fascias on both feet are so unbelievably tight that it looks like there is something under the skin. HARD as a rock. Is this normal for PF? The doctor says it is....but I am beginning to wonder. I value your input Glenn...how long have you had PF? Is it JUST pf or is something else involved with yours?
Thanks in advance!

Re: Mission Creep

Glenn X on 9/03/01 at 21:00 (058959)

Judy: Mission creep is when your job is to drain the swamp, but before you can pull the plug, you find yourself up to your armpits in alligators. And then a pleasure boat rams a nearby dock flinging three non-swimmers into the water, lightning strikes, the trees catch fire . . . followed by a mosquito attack, and you know they're carrying west nile. So what was my mission again?

Every once in a while PF is a little like that.

Re: Mission Creep

wendyn on 9/03/01 at 22:49 (058969)

We call it 'scope creep'. Actually had a case of it my house. My dishwasher leaked. So I had to buy a new one (the old one was toast). The leak wrecked my linoleum. So I need a new lino. Decided if we were going to do that - might as well do the whole main floor - rip out the carpet too - redo the whole floor. Then - seeing as how the floor would be ripped out - this is a good time to paint. Then - my fridge started leaking - got the fridge fixed too - couldn't have a fridge leaking on a new floor (actually thought for a bit that we needed a new fridge). This has been one expensive broken dishwasher!!!!!

Re: Mission Creep

JudyS on 9/03/01 at 22:53 (058972)

I guess we don't call it Mission Creep around here......we call it Murphy's Law!

Re: Mission Creep

Julie on 9/04/01 at 01:56 (058979)

...and we call it Sod's Law.

Re: Wrist exercises

Julie on 9/04/01 at 02:05 (058980)

Glenn, I've been trying out your wrist exercise: they feel good, and I think they'd be useful for anyone who - like Judy, like me, like lots of us here - spends too much time at the keyboard. The first one particularly, the dorsiflexion one, stretches out the muscles and tendons that too-long-at-the-keyboard tend to tighten. Thanks for posting them.

Re: Mission Creep

Glenn X on 9/04/01 at 20:38 (059038)

Wendy: Classic, hilarious -- LOL. I like that term 'scope creep.'

Re: Wrist exercises

Glenn X on 9/04/01 at 20:45 (059041)

Julie: I like 'em too. Still tension up with too much keyboarding, but then I've only been at 'em a week. And I haveb't got the workstation changes yet.

I particularly liked the focused direction. Probably all sorts of exercises possible with wrists. I even asked about others, and about strengthening. But the doctor and PT were clear, 'for what you need, just do these.'

Re: Wrist exercises

Julie on 9/05/01 at 02:33 (059068)

I've just done them, after an hour at the keyboard. It feels good. I also like the way they 'stop' you and give you a minute's quiet. I wish I'd known them when I wrote 'Office Yoga'.

Thanks for them!

Re: ED

Ed Davis, DPM on 9/05/01 at 18:32 (059151)

John Ruch, DPM
Ed