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Baxter Report

Posted by BrianJ on 2/05/02 at 09:43 (072624)

I went to see Dr. Don Baxter yesterday. He's the Houston doctor who has treated notable athletes such as Carl Lewis, Mary Decker Slaney, Leroy Burrell, Picabo Street, Mark McGwire, etc.

Dr. Baxter noted my bilateral long-term pain (4 years), LACK of traditional PF symptoms such as first-step pain, and previous failure to respond to ESWT. He then prodded an area more medial than the PF insertion point and elicited considerable pain from me, even though my standing pain seems to be more central at the front of the heel. From these facts (and the fact that my X-rays and MRIs were unremarkable), Dr. Baxter surmised that my pain was probably related to compression of the first branch of the lateral plantar nerve. When this nerve is irritated, it can spread pain across the front of the heel, and the pain can migrate up the fascia toward the ball of the foot.

Dr. Baxter said he could perform decompression surgery, where he goes in, locates the nerve, and makes sure that nothing is pressing against it. He thought the chance of improvement was high (80%), but I am hesitant to have any surgery that could make things worse. However, if I do have surgery in the future, I would have great confidence in Dr. Baxter.

I'm interested in any comments and thoughts, especially from our resident expert, Dr. Z.

Thank you.

Re: Baxter Report

john h on 2/05/02 at 10:08 (072627)

you have just seen Dr. Baxter who is surely one of the best there is and who has probably performed thousands of surgeries. if you are going to have this type of surgery i would look no further. i had a tarsal tunnel release and it neither helped or made it worse. when the doctor did mine, however, he was more or less exploring and did not have something specific in mind. no pain involved with the surgery. crutches for two weeks with a small cast and then stitches out at 10 days, crutches gone in two weeks, and back and walking with no limp at 14 days.

Re: Baxter Report

JudyS on 2/05/02 at 10:13 (072629)

Brian, John h - isn't the 'compressed nerve' theory the one that Dr. Baxter has perfected and pretty much applies to Plantar pain in general?

Re: Baxter Report

John h on 2/05/02 at 15:15 (072653)

Judy: my understanding is that Dr. Baxter believes most cases of PF and the pain it produces is from an inflamed fascia pressing on the Baxter Nerve. He developed a procedre for Plantar Fasciaitis (Baxter Procedure) which removes a half moon portion of fascia (1/2' across') located directly over the fascia. It in effect releases a very small amount of the fascia perhaps 15% and removes the portion that is directly over the nerve. This is not a Tarsal Tunnel Release. He has other procedures for relieving compressed nerves. The beauty of his PF procedure is that so little of the fascia is released you are unlikely to have any foot stabilization problems in the future. Not all doctors agree with his thinking but many do. Only a small incision is used and it is probably a 25 minute procedure. I

Re: Baxter Report

Dr. Zuckerman on 2/05/02 at 17:56 (072680)

You have had almost every type of treatment short of foot surgery. Correct.? Is he going to cut the nerve only. What is going to happen to the plantar facia.?

Re: Baxter Report

BG CPed on 2/05/02 at 18:20 (072684)

If they are going to open it to look around and see if there is actually some sort of compression is there any type of test to make sure before you do the exploratory surg? I have always wondered why I almost never get a pt in with a dx of tarsal tunnel but I read about this dx being made often. I have only had about 3 cases of it in last 2 years and they were all failed surg and all pt claimed they were worse off and wouldnt do it again.

I realize this is not the same procedure but I have often wondered if tarsal tunnel is an over made dx and that there are too many cases where it is operated on with poor results. Perhaps some of the Docs can comment on this?

Re: Baxter Report

John h on 2/05/02 at 18:31 (072690)

BG: i had my emg test for carpel tunnel with a doctor that does nothing else but do that test and he is an orthopedic surgeon. both he and my surgeon said there is no gold standard for tts and that ultimately the only way you really know is if you get in there and look. the doctor was very frank and said it would be a shot in the dark even though i tested positive for tts on the electrical studies. he simply said to me if I wanted the surgery he would do it when he performed the cheilectomy on my great toe. i still had not made up my mind when they came to roll me into surgery. i saw the doc and said go for it. i have at least eliminated the possibility of tts being the problem. I am no worse about 4 years later. this is just a real personal decision that each of us have to make on our own.

Re: Baxter Report

BG CPed on 2/05/02 at 18:44 (072694)

Thats what I mean John, if you are getting sp already it is not as bad. I just have seen too many that have had it done or been dx with it and not had good results with the treatment they received either way. I wish one of the docs or somebody could explain the pathomechanics of this.

I am always curious about nerve issues in the foot. I see many that have been told they have a mortons neuroma also. They get several injections and or surg. They were never told about footwear etc,ot they just had a crappy met pad stuck into a shoe that is too tight and porr to begij with. Many times it is actually metatarsalgia or synovitis. It just seems that nerve related foot issues are very over used. I realize nerves are not as simple as a fx bone etc but it seems that they are found to be the problem in too many cases

Re: Baxter Report

BrianJ on 2/05/02 at 19:41 (072710)

Gentlemen -- Your candid comments are greatly appreciated. Yes, Dr. Z, I have had EVERY conservative treatment, as well as ESWT (OssaTron) twice bilaterally and endoscopic fasciotomy on my left foot once -- all without any notable change in the pain level. If Dr. Baxter does the decompression surgery, it is my understanding he would NOT cut the fascia.

I wish there were a test that could confirm nerve compression BEFORE surgery (my EMG was negative, for what that's worth). Is there any medication -- Neurontin, for example -- that might tell us if the pain is neurogenic? I share BG's concern that nerve entrapment is sometimes a 'trash can' diagnosis when the patient does not respond to ordinary treatment.

As always, I welcome your thoughts.

Re: Baxter Report

BG CPed on 2/05/02 at 19:48 (072712)

You are symptomatic bi laterally? Have you had any decrease in symptoms with any device? What is the posture of your foot and what type of shoes and or orthotics have helped or hindered your healing

Re: Baxter Report

BrianJ on 2/05/02 at 20:08 (072719)

BG: I'm a former recreational runner, five-ten, 150 lbs., high arches, and my shoes wear at the balls of the feet and the lateral back corners (I usually wear New Balance 878's). I have almost no first-step pain; rather, it's standing in one place and heel strike when walking that hurt. I also often have pain when resting, especially after being on my feet.

Treatment modalities which partially relieve my symptoms are rest, custom orthotics, taping, hot water, and icing.

Treatments that haven't worked for me are stretching, cortisone shots, OTC orthotics, massage, acupuncture, NSAIDs, endoscopic PF release and ESWT.

Hope this helps your thought process. Thank you.

Re: Baxter Report

paula on 2/05/02 at 20:10 (072720)

i anm not a doctor, just a fellow sufferer but has anyone tested you for posterior tibial tendon dysfunction? i have read that some feel that more pf is caused by this then most folks realize. i have it and it took forever to get a diagnosis. just thought it would be a good idea if everything was ruled out before surgery

Re: Baxter Report

Dr. Zuckerman on 2/05/02 at 20:13 (072721)

How about numbing that nerve branch and seeing if your get relief. IF relief go for it if none well that is telling you don't go for it or the chance are low for results. There is an article on this problem in podiatry today. Go either to this search engine or to the podiatry today web site and read the article. Very good information for this nerve entrapement

Re: Baxter Report

BrianJ on 2/05/02 at 20:18 (072722)

Paula -- Thanks for your message. No one has checked me for PTT dysfunction. What are the symptoms and what is the treatment? I totally agree that anything that can be ruled out SHOULD be ruled out before surgery.

Re: Baxter Report

BrianJ on 2/05/02 at 20:20 (072723)

Great information, Dr. Z! Thank you.

Re: actually, TTS is considered underdiagnosed

elliott on 2/05/02 at 21:23 (072729)

All the literature says that, and to back that up, we still see many here posting that their docs (primaries) know little about it. Of course, as it gets more well known, it might go the other way (overdiagnosis), especially given the difficulty in confirming it (nerve conduction test is just not foolproof, and it usually doesn't directly show up on an MRI either). OTOH, there is continuing debate as to whether the Baxter nerve phenomenon is overdiagnosed.

--

Re: Baxter Report

BG CPed on 2/05/02 at 21:38 (072731)

Did your fo have a neutral lift under heel? not a varus post but neutral and about 5 mm thick? Did the arch of the orthotic contact tight to the arch of your foot? what type of forefoot post did it have? if you have a true cavus foot you probably have a plantarflexed 1st met head, if the device is 3/4 shell and stops behind the met heads they missed a bif factor when they made them

Re: Baxter Report

BG CPed on 2/05/02 at 21:40 (072733)

VERY good idea Dr Z

Re: Baxter Report

BrianJ on 2/06/02 at 08:55 (072768)

BG: I do not know whether I have a true cavus foot --I only know that my arches are higher than most people I've met. The device I currently use is a 3/4 semi-rigid shell. If you will give me your email address, I would like to discuss this more. I am open to buying a new pair of orthotics, and I gather I would benefit from your help.

Thank you.

Re: Baxter Report

john h on 2/06/02 at 09:30 (072771)

Brain from my personal exprience and what I have read I just do not think there is a Gold Standard test for an entrapped nerve. My doctor who did the surgery said as much. I am sure there are cases where a nerve is indeed the culprit for the pain you experience but I do not think anyone knows for sure in 99% of the cases. Good luck. My personal thinking and the way I reached my decision will I accept the pain I am in for the rest of my life and pass on a procedure that might help? What are the chances of making it worse? If it does not work at least I have eliminated a possibility that I do not need to address anymore. Has my doctor done this many times and have confidence in what he is doing? Now go make your decision Brian.

Re: Baxter Report

paula on 2/06/02 at 17:25 (072826)

well it depends who you ask as far as symptoms and diagnosis . one of the docs here can probabley answer better than i. but as i understand it. some signs might be, if i remember correctly.flat feet, many toe sign (toes stick out to the outside when standing and looking from the back) , difficulty raising on toes, inside ankle pain just under ankle and in arch of foot, plantar fasciitis, tendonitis, outside ankle and foot pain if the foot is in a really advanced stage . i don't think a person needs all of these to have it, but i got em. oh and the foot elongating and i think widening over time, shin splints. well i am not a doc and could have these wrong. but i have all of the above and severe pttd. so i thought i'd toss them all in here.

Re: Baxter Report

BG CPed on 2/06/02 at 21:35 (072860)

Can you email me pics of your foot wt bearing from front and back. Also a pic of your orthotic from front back and side view sitting on a flat table. It is not perfect way but may be able to see enough to get an idea. Let me know, you can call me 9 to 5 est 248 371 3800

Re: In the interest of more information...

Suzanne D on 2/07/02 at 17:30 (072953)

Hi, Brian! I shared an article with you a few weeks ago, and now I have a VERY comprehensive (many pages) article on Plantar Heel Pain. It is challenging for me as compared to that last article; if it were considered middle school level in understanding, this would be college + level! :-) But I am reading it with great interest and trying to comprehend all I can to help me or anyone else. I well remember my mama's old adage that 'a little knowledge is dangerous' and realize humbly that I fit well into that category and will keep that in mind...

However; in this article is a section called 'Entrapment of the First Branch of the Lateral Plantar Nerve'. There are 3 and 1/2 pages on this topic, including drawings and an explanation of the surgical technique. I would be happy to copy these pages and mail them to you. If you are interested, please e-mail me at the address below and send your mailing address to me. I may not still have it from the last article I sent.

I am glad you have seen a dr. with whom you have great respect and confidence, and I wish you the best! After 4 years and all the treatments you have tried, I certainly hope you can find relief.

(email removed)

Re: Baxter Report

Dr. Marlene Reid on 2/07/02 at 23:33 (072986)

I have been away for a few days and find it interesting to see everyone's comments to this. Dr. Z had a great idea to try to confirm the diagnosis. I would be a little cautions, given that this is Dr. Baxter's 'thing' and I would be afraid that most of his patinets with heel pain might fall into this category (which is not to say that you don't have this diagnosis, it just makes me wonder).

Re: could you try and summarize that section for us? (nm)

elliott on 2/08/02 at 06:49 (073001)

.

Re: could you try and summarize that section for us? (nm)

Suzanne D on 2/08/02 at 15:28 (073071)

The article claims that nerve entrapment is one of the most commonly overlooked causes of heel pain, possibly accounting for 20% of chronic foot pain. It states that athletes such as sprinters, ballet dancers, or skaters who spend a great deal of time on their toes are prone to this problem.

It says that the diagnosis of nerve entrapment is made on clinical grounds and that electromyography and nerve conduction studies aren't consistent in diagnosing nerve entrapment. Early morning pain is not common with it, and there is maximal tenderness over the course of the nerve on the plantar medial aspect.

'Most patients' are cured with conservative care similar to that for PF: rest, activity, modication, NSAIDs, ice, massage, stretching, and cortisone injections. Shock absorbant heel inserts help decrease inflammation, and arch support can decrease compression.

With persistent disabling symptoms of more than 6 months, surgery (an open procedure) should be considered. An 85% success rate for the surgery was claimed with the recovery time to normal activity being 3 months.

Re: could you try and summarize that section for us? (nm)

BrianJ on 2/08/02 at 21:01 (073105)

Suzanne provides an excellent summary of the topic. In researching the whole 'nerve entrapment' issue, I found two things particularly interesting. First, the nerve we're talking about runs just forward of the plantar fascia's site of origin. Second, that same nerve provides sensation to the calcaneal periosteum (membrane covering the heel bone). Thus, it's not hard to understand why irritation of this nerve might cause heel pain and be confused with plantar fasciitis -- especially because you can have both conditions at the same time.

All of the articles on this subject acknowledge that plantar faciitis is still the most common cause of heel pain. However, when the pain defies conservative treatment for a long time and there is little or no 'first step' pain, the nerve entrapment issue should be considered.

Re: I should have done a better job of proofreading this!

Suzanne D on 2/09/02 at 08:59 (073127)

I should have stated 'activity modification' in what I wrote...I was hurrying and had both my daughters talking to me at the same time while I was trying to write this before we left the house...:-)

I hope it still made sense!

Re: Baxter Report

Abra L. on 2/11/02 at 14:51 (073361)

Please help: I have been under a doctors care for a year now for PF. I spent the summer in a cast and can honestly say I have not seen much improvement over the course of my treatment. I ice, stretch, rest, and wear a night splint faithfully. I have gotten very depressed over the last few weeks because nothing seems to relieve the pain. I work in tennis shoes every day and can not stand to wear anything else. I can't stand to go bare footed long enough to even take a shower. The doctor said that if I didn't get better by May then we would fix it. Which I assume means surgery. I really don't care to do the surgery but I am really at my wits end over this. I have read many of the posted messages about PF and it frightens me to no end. I welcome any advice. Please don't say visit another doctor. This is my third doctor I have seen.

Re: Baxter Report

John h on 2/11/02 at 17:22 (073371)

Abra: consider looking into ESWT prior to foot surgery. We have several good doctors on this board who do this non invasive procedure which has produced some very good results. I can remember Dr. Zuckerman's home page so start by looking there at http://www.thefootspecialist.com

you can call and he will give you some good info. you can also access http://www.healthtronics.com that will tell you about the procedure. by all means consider this before surgery. our other good doctors on the board may also have a home page which they should post up so all will know how to contact them.

where are you located Abra?

Re: Baxter Report

Julie on 2/12/02 at 03:08 (073401)

Abra, ok, I won't say 'see another doctor'. But may I ask some questions:

What stretching are you doing?
What tennis shoes are you wearing?
What is your job?
Do you have to be on your feet a lot?

If the answer to Q1 is 'wall stretches' or other weight-bearing exercise, it's possible that this is obstructing the healing process.

If the answer to Q4 is 'yes', there may be ways in which you can modify your duties to allow you to get off your feet more - but we'd need to know more about what you do in order to advise. At the very least, you need to be sure that your tennis shoes are good quality, with good arch support and plenty of cushioning, that they are the right size, and that you replace them often.

Taping the foot/feet (instructions in the heel pain book, which you should read for information and ideas) can be a great help. It 'rests' the foot by supplying the support for the arch that the injured plantar fascia can't give.

And yes, get in touch with Dr Zuckerman and find out about ESWT - certainly this non-invasive treatment, which has proved successful for large numbers of sufferers, should be investigated and try before you even breathe the words surgery.

Re: Baxter Report

john h on 2/05/02 at 10:08 (072627)

you have just seen Dr. Baxter who is surely one of the best there is and who has probably performed thousands of surgeries. if you are going to have this type of surgery i would look no further. i had a tarsal tunnel release and it neither helped or made it worse. when the doctor did mine, however, he was more or less exploring and did not have something specific in mind. no pain involved with the surgery. crutches for two weeks with a small cast and then stitches out at 10 days, crutches gone in two weeks, and back and walking with no limp at 14 days.

Re: Baxter Report

JudyS on 2/05/02 at 10:13 (072629)

Brian, John h - isn't the 'compressed nerve' theory the one that Dr. Baxter has perfected and pretty much applies to Plantar pain in general?

Re: Baxter Report

John h on 2/05/02 at 15:15 (072653)

Judy: my understanding is that Dr. Baxter believes most cases of PF and the pain it produces is from an inflamed fascia pressing on the Baxter Nerve. He developed a procedre for Plantar Fasciaitis (Baxter Procedure) which removes a half moon portion of fascia (1/2' across') located directly over the fascia. It in effect releases a very small amount of the fascia perhaps 15% and removes the portion that is directly over the nerve. This is not a Tarsal Tunnel Release. He has other procedures for relieving compressed nerves. The beauty of his PF procedure is that so little of the fascia is released you are unlikely to have any foot stabilization problems in the future. Not all doctors agree with his thinking but many do. Only a small incision is used and it is probably a 25 minute procedure. I

Re: Baxter Report

Dr. Zuckerman on 2/05/02 at 17:56 (072680)

You have had almost every type of treatment short of foot surgery. Correct.? Is he going to cut the nerve only. What is going to happen to the plantar facia.?

Re: Baxter Report

BG CPed on 2/05/02 at 18:20 (072684)

If they are going to open it to look around and see if there is actually some sort of compression is there any type of test to make sure before you do the exploratory surg? I have always wondered why I almost never get a pt in with a dx of tarsal tunnel but I read about this dx being made often. I have only had about 3 cases of it in last 2 years and they were all failed surg and all pt claimed they were worse off and wouldnt do it again.

I realize this is not the same procedure but I have often wondered if tarsal tunnel is an over made dx and that there are too many cases where it is operated on with poor results. Perhaps some of the Docs can comment on this?

Re: Baxter Report

John h on 2/05/02 at 18:31 (072690)

BG: i had my emg test for carpel tunnel with a doctor that does nothing else but do that test and he is an orthopedic surgeon. both he and my surgeon said there is no gold standard for tts and that ultimately the only way you really know is if you get in there and look. the doctor was very frank and said it would be a shot in the dark even though i tested positive for tts on the electrical studies. he simply said to me if I wanted the surgery he would do it when he performed the cheilectomy on my great toe. i still had not made up my mind when they came to roll me into surgery. i saw the doc and said go for it. i have at least eliminated the possibility of tts being the problem. I am no worse about 4 years later. this is just a real personal decision that each of us have to make on our own.

Re: Baxter Report

BG CPed on 2/05/02 at 18:44 (072694)

Thats what I mean John, if you are getting sp already it is not as bad. I just have seen too many that have had it done or been dx with it and not had good results with the treatment they received either way. I wish one of the docs or somebody could explain the pathomechanics of this.

I am always curious about nerve issues in the foot. I see many that have been told they have a mortons neuroma also. They get several injections and or surg. They were never told about footwear etc,ot they just had a crappy met pad stuck into a shoe that is too tight and porr to begij with. Many times it is actually metatarsalgia or synovitis. It just seems that nerve related foot issues are very over used. I realize nerves are not as simple as a fx bone etc but it seems that they are found to be the problem in too many cases

Re: Baxter Report

BrianJ on 2/05/02 at 19:41 (072710)

Gentlemen -- Your candid comments are greatly appreciated. Yes, Dr. Z, I have had EVERY conservative treatment, as well as ESWT (OssaTron) twice bilaterally and endoscopic fasciotomy on my left foot once -- all without any notable change in the pain level. If Dr. Baxter does the decompression surgery, it is my understanding he would NOT cut the fascia.

I wish there were a test that could confirm nerve compression BEFORE surgery (my EMG was negative, for what that's worth). Is there any medication -- Neurontin, for example -- that might tell us if the pain is neurogenic? I share BG's concern that nerve entrapment is sometimes a 'trash can' diagnosis when the patient does not respond to ordinary treatment.

As always, I welcome your thoughts.

Re: Baxter Report

BG CPed on 2/05/02 at 19:48 (072712)

You are symptomatic bi laterally? Have you had any decrease in symptoms with any device? What is the posture of your foot and what type of shoes and or orthotics have helped or hindered your healing

Re: Baxter Report

BrianJ on 2/05/02 at 20:08 (072719)

BG: I'm a former recreational runner, five-ten, 150 lbs., high arches, and my shoes wear at the balls of the feet and the lateral back corners (I usually wear New Balance 878's). I have almost no first-step pain; rather, it's standing in one place and heel strike when walking that hurt. I also often have pain when resting, especially after being on my feet.

Treatment modalities which partially relieve my symptoms are rest, custom orthotics, taping, hot water, and icing.

Treatments that haven't worked for me are stretching, cortisone shots, OTC orthotics, massage, acupuncture, NSAIDs, endoscopic PF release and ESWT.

Hope this helps your thought process. Thank you.

Re: Baxter Report

paula on 2/05/02 at 20:10 (072720)

i anm not a doctor, just a fellow sufferer but has anyone tested you for posterior tibial tendon dysfunction? i have read that some feel that more pf is caused by this then most folks realize. i have it and it took forever to get a diagnosis. just thought it would be a good idea if everything was ruled out before surgery

Re: Baxter Report

Dr. Zuckerman on 2/05/02 at 20:13 (072721)

How about numbing that nerve branch and seeing if your get relief. IF relief go for it if none well that is telling you don't go for it or the chance are low for results. There is an article on this problem in podiatry today. Go either to this search engine or to the podiatry today web site and read the article. Very good information for this nerve entrapement

Re: Baxter Report

BrianJ on 2/05/02 at 20:18 (072722)

Paula -- Thanks for your message. No one has checked me for PTT dysfunction. What are the symptoms and what is the treatment? I totally agree that anything that can be ruled out SHOULD be ruled out before surgery.

Re: Baxter Report

BrianJ on 2/05/02 at 20:20 (072723)

Great information, Dr. Z! Thank you.

Re: actually, TTS is considered underdiagnosed

elliott on 2/05/02 at 21:23 (072729)

All the literature says that, and to back that up, we still see many here posting that their docs (primaries) know little about it. Of course, as it gets more well known, it might go the other way (overdiagnosis), especially given the difficulty in confirming it (nerve conduction test is just not foolproof, and it usually doesn't directly show up on an MRI either). OTOH, there is continuing debate as to whether the Baxter nerve phenomenon is overdiagnosed.

--

Re: Baxter Report

BG CPed on 2/05/02 at 21:38 (072731)

Did your fo have a neutral lift under heel? not a varus post but neutral and about 5 mm thick? Did the arch of the orthotic contact tight to the arch of your foot? what type of forefoot post did it have? if you have a true cavus foot you probably have a plantarflexed 1st met head, if the device is 3/4 shell and stops behind the met heads they missed a bif factor when they made them

Re: Baxter Report

BG CPed on 2/05/02 at 21:40 (072733)

VERY good idea Dr Z

Re: Baxter Report

BrianJ on 2/06/02 at 08:55 (072768)

BG: I do not know whether I have a true cavus foot --I only know that my arches are higher than most people I've met. The device I currently use is a 3/4 semi-rigid shell. If you will give me your email address, I would like to discuss this more. I am open to buying a new pair of orthotics, and I gather I would benefit from your help.

Thank you.

Re: Baxter Report

john h on 2/06/02 at 09:30 (072771)

Brain from my personal exprience and what I have read I just do not think there is a Gold Standard test for an entrapped nerve. My doctor who did the surgery said as much. I am sure there are cases where a nerve is indeed the culprit for the pain you experience but I do not think anyone knows for sure in 99% of the cases. Good luck. My personal thinking and the way I reached my decision will I accept the pain I am in for the rest of my life and pass on a procedure that might help? What are the chances of making it worse? If it does not work at least I have eliminated a possibility that I do not need to address anymore. Has my doctor done this many times and have confidence in what he is doing? Now go make your decision Brian.

Re: Baxter Report

paula on 2/06/02 at 17:25 (072826)

well it depends who you ask as far as symptoms and diagnosis . one of the docs here can probabley answer better than i. but as i understand it. some signs might be, if i remember correctly.flat feet, many toe sign (toes stick out to the outside when standing and looking from the back) , difficulty raising on toes, inside ankle pain just under ankle and in arch of foot, plantar fasciitis, tendonitis, outside ankle and foot pain if the foot is in a really advanced stage . i don't think a person needs all of these to have it, but i got em. oh and the foot elongating and i think widening over time, shin splints. well i am not a doc and could have these wrong. but i have all of the above and severe pttd. so i thought i'd toss them all in here.

Re: Baxter Report

BG CPed on 2/06/02 at 21:35 (072860)

Can you email me pics of your foot wt bearing from front and back. Also a pic of your orthotic from front back and side view sitting on a flat table. It is not perfect way but may be able to see enough to get an idea. Let me know, you can call me 9 to 5 est 248 371 3800

Re: In the interest of more information...

Suzanne D on 2/07/02 at 17:30 (072953)

Hi, Brian! I shared an article with you a few weeks ago, and now I have a VERY comprehensive (many pages) article on Plantar Heel Pain. It is challenging for me as compared to that last article; if it were considered middle school level in understanding, this would be college + level! :-) But I am reading it with great interest and trying to comprehend all I can to help me or anyone else. I well remember my mama's old adage that 'a little knowledge is dangerous' and realize humbly that I fit well into that category and will keep that in mind...

However; in this article is a section called 'Entrapment of the First Branch of the Lateral Plantar Nerve'. There are 3 and 1/2 pages on this topic, including drawings and an explanation of the surgical technique. I would be happy to copy these pages and mail them to you. If you are interested, please e-mail me at the address below and send your mailing address to me. I may not still have it from the last article I sent.

I am glad you have seen a dr. with whom you have great respect and confidence, and I wish you the best! After 4 years and all the treatments you have tried, I certainly hope you can find relief.

(email removed)

Re: Baxter Report

Dr. Marlene Reid on 2/07/02 at 23:33 (072986)

I have been away for a few days and find it interesting to see everyone's comments to this. Dr. Z had a great idea to try to confirm the diagnosis. I would be a little cautions, given that this is Dr. Baxter's 'thing' and I would be afraid that most of his patinets with heel pain might fall into this category (which is not to say that you don't have this diagnosis, it just makes me wonder).

Re: could you try and summarize that section for us? (nm)

elliott on 2/08/02 at 06:49 (073001)

.

Re: could you try and summarize that section for us? (nm)

Suzanne D on 2/08/02 at 15:28 (073071)

The article claims that nerve entrapment is one of the most commonly overlooked causes of heel pain, possibly accounting for 20% of chronic foot pain. It states that athletes such as sprinters, ballet dancers, or skaters who spend a great deal of time on their toes are prone to this problem.

It says that the diagnosis of nerve entrapment is made on clinical grounds and that electromyography and nerve conduction studies aren't consistent in diagnosing nerve entrapment. Early morning pain is not common with it, and there is maximal tenderness over the course of the nerve on the plantar medial aspect.

'Most patients' are cured with conservative care similar to that for PF: rest, activity, modication, NSAIDs, ice, massage, stretching, and cortisone injections. Shock absorbant heel inserts help decrease inflammation, and arch support can decrease compression.

With persistent disabling symptoms of more than 6 months, surgery (an open procedure) should be considered. An 85% success rate for the surgery was claimed with the recovery time to normal activity being 3 months.

Re: could you try and summarize that section for us? (nm)

BrianJ on 2/08/02 at 21:01 (073105)

Suzanne provides an excellent summary of the topic. In researching the whole 'nerve entrapment' issue, I found two things particularly interesting. First, the nerve we're talking about runs just forward of the plantar fascia's site of origin. Second, that same nerve provides sensation to the calcaneal periosteum (membrane covering the heel bone). Thus, it's not hard to understand why irritation of this nerve might cause heel pain and be confused with plantar fasciitis -- especially because you can have both conditions at the same time.

All of the articles on this subject acknowledge that plantar faciitis is still the most common cause of heel pain. However, when the pain defies conservative treatment for a long time and there is little or no 'first step' pain, the nerve entrapment issue should be considered.

Re: I should have done a better job of proofreading this!

Suzanne D on 2/09/02 at 08:59 (073127)

I should have stated 'activity modification' in what I wrote...I was hurrying and had both my daughters talking to me at the same time while I was trying to write this before we left the house...:-)

I hope it still made sense!

Re: Baxter Report

Abra L. on 2/11/02 at 14:51 (073361)

Please help: I have been under a doctors care for a year now for PF. I spent the summer in a cast and can honestly say I have not seen much improvement over the course of my treatment. I ice, stretch, rest, and wear a night splint faithfully. I have gotten very depressed over the last few weeks because nothing seems to relieve the pain. I work in tennis shoes every day and can not stand to wear anything else. I can't stand to go bare footed long enough to even take a shower. The doctor said that if I didn't get better by May then we would fix it. Which I assume means surgery. I really don't care to do the surgery but I am really at my wits end over this. I have read many of the posted messages about PF and it frightens me to no end. I welcome any advice. Please don't say visit another doctor. This is my third doctor I have seen.

Re: Baxter Report

John h on 2/11/02 at 17:22 (073371)

Abra: consider looking into ESWT prior to foot surgery. We have several good doctors on this board who do this non invasive procedure which has produced some very good results. I can remember Dr. Zuckerman's home page so start by looking there at http://www.thefootspecialist.com

you can call and he will give you some good info. you can also access http://www.healthtronics.com that will tell you about the procedure. by all means consider this before surgery. our other good doctors on the board may also have a home page which they should post up so all will know how to contact them.

where are you located Abra?

Re: Baxter Report

Julie on 2/12/02 at 03:08 (073401)

Abra, ok, I won't say 'see another doctor'. But may I ask some questions:

What stretching are you doing?
What tennis shoes are you wearing?
What is your job?
Do you have to be on your feet a lot?

If the answer to Q1 is 'wall stretches' or other weight-bearing exercise, it's possible that this is obstructing the healing process.

If the answer to Q4 is 'yes', there may be ways in which you can modify your duties to allow you to get off your feet more - but we'd need to know more about what you do in order to advise. At the very least, you need to be sure that your tennis shoes are good quality, with good arch support and plenty of cushioning, that they are the right size, and that you replace them often.

Taping the foot/feet (instructions in the heel pain book, which you should read for information and ideas) can be a great help. It 'rests' the foot by supplying the support for the arch that the injured plantar fascia can't give.

And yes, get in touch with Dr Zuckerman and find out about ESWT - certainly this non-invasive treatment, which has proved successful for large numbers of sufferers, should be investigated and try before you even breathe the words surgery.