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Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Posted by CatherineL on 2/12/02 at 08:19 (073412)

Hi all,

It's been a long haul with the rheumetologist treating me with long-term antibitoics. As per some info I found on it, I'm feeling much worse right now and expect to feel much better in 3 weeks. We'll see?!?

But other than that, my only options left are ESWT, another cortisone shot, Prolotherapy/trigger point injections, and walking boot.

ESWT is expensive and VERY far away; cortisone only helped for a couple of weeks and hurt like h*ll; prolotheraphy or trigger point injections are available nearby but hate the idea of the needling my feet!; walking boot i unsure if it works...

The laser therapy has helped, but if I stop going, I'm back to square-one...

any ideas, experiences...

Thanx
Catherine

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Carmen H on 2/12/02 at 08:37 (073413)

What are you currently doing for treatment? Such as Orthotics? Stretching? How many cortisone shots have you had?

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

CatherineL on 2/12/02 at 15:09 (073472)

Hi All,

Carmen,

The athletic therapist told me yesterday, that I've done almost everything and this may be it for me... I may never get better! That was hard to hear! I guess that's why I'm posting and asking what else there is! I gave in last month and applied for a temp handicap parking permit, but I'm not ready to give-up!

What I've tried:
better shoes (Etonics, Footsaver, footbed sandles), custom orthotics, naproxen, Vioxx, taping, Phisiotherapy - 3 phisiotherapists, massage therapy, Less time on my feet, anelgesic cream, night splint (4 months and counting), 2 drs (my dr. and sport & injury dr.), Ice when sore, Heat, Stretching, NEVER go barefoot, Laser therapy, cortisone, ART, Chiro

What helps the most:
LASER, Vioxx, Taping, orthotics

I've tried these things in many combinations for almost 2 years! ugh! The cortisone was one injection in each foot, and it helped for a couple of weeks and then I was back to the same pain. It was the most painful thing I've ever gone through, so, unless they can assure me it's well worth it, I won't be doing that again?!?

One other thing that may help, is our little city is finally building an indoor pool, and I plan to join and try the walking-around-the-pool thing. I've also been told I may have early signs of arthritis and that I have the signs or fibro, so the pool thing would help on all fronts. Now it will be just a matter of making the committment and the time!

What is everyones experiences with: accupuncture? prolotherapy? trigger point injections? eswt? walking boot? don't know what else to do, I keep getting told to try 'this' for 3 months and come back, then try 'that' for 3 months... etc... It's been almost 2 years of it and I'm feeling a bit frustrated!

Thanx
Catherine

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Carmen H on 2/12/02 at 21:08 (073538)

I know you are frustrated. FIRST thing I can think of is the shoes you're wearing...have you ever tried New Balance? Birkenstocks? Danskos?
any of those?
What types of orthotics have you tried? More than one? what types of stretching have you been doing?
I wouldn't give up yet...there are avenues you haven't explored and doctors you haven't seen. Maybe you just haven't seen the right one yet, worn the right shoes with the right orthotics yet, etc etc.
2 years is a loooong time to suffer I agree....but never give up.
I think you need to make the committment to the pool. Not only would this be helpful for fibro (if you are definitely diagnosed with that) it would help to exercise raise those endorphin levels and seratonin levels and get some positivity in your life. Have you tried St. Johns Wort or any type of prescribed anti depressants to help with the outlook on this? Sometimes that is more damaging than we realize...that the stress due to these conditions is making things worse.
So time for you to take a deep breath...relax and find another doctor for another opinion. I have been to 4 and still looking...so don't give up.
I belive accupuncture is good for managing pain...but not a cure for PF. I have heard some talk of prolotherapy on this site but haven't looked into it for myself so I don't know much. Do a search on the message boards and put in the word prolotherapy. Peoples posts will pop up for you to get some ideas.
ESWT? POST TO DR. Z on the foot doctors board. He is a great doctor and a wonderful concerned man. He will help you find out if you are a candidate for ESWT he will be the one to tell you how to go about it. You will probably need to be seen to see if you can get it done.
Where do you live? Northeast? Northwest? West Coast?
A walking boot may be an option for you as well....The most important thing to do is find a doctor that will EXHAUST all conservative efforts to help you and won't fill your mind with megative thoughts.
I would not go back to the Athletic therapist....not for that kind of negativity. If you do go back tell them you know you will get better and won't think otherwise. Have you gotten iontophereis (sp?)? Massage? If PF is ALL you have than you can't ever think you won't ever get better. It is possible. A guy posted the other day that has gotten better after THREE years!
Get blood work for arthritis, get a definite diagnosis of Fibro and get a plan with a doctor you trust. This is my advice..I am no doctor just someone who won't take NO for an answer and doesn't believe anyone should be told to 'live with it'.
You're going to find the right combination...hang in there.

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Crystal S on 2/13/02 at 00:02 (073564)

Hi Catherine,
Boy do I sure understand how you feel.I had PF release surgery and heel spur removal and I am worse now than I was.I am seriously considering applying for dissability but hate the feeling of 'well I might as well give up'.I absolutely despise the cortisone injections and will NOT ever have another one.It was horrible.I had them before surgery and again after surgery in the foot that had surgery.That was really bad because it is so sore and painful anyway.My question for you is where do I go to apply for a temporary handicap permit? I did not know that I could even apply for that but I have to admit that sometimes I have parked there illegally. :-)
It is just to hard to make those long walks across a parking lot.Thanks for the advice and good luck with your continued recovery.It is nice to know we are not alone in our pain.

Blessings,
Crystal

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Necee on 2/13/02 at 00:27 (073566)

Hi Catherine,
I would stick with what ever was helping you, however small. Don't allow yourself to get in the mindset that you'll never get better. I believe that you will, it just takes time. I was seeing a Pod who only wanted to discuss surgery, well for me that wasn't an option, I've heard too many horror stories about foot surgery and simply decided that wasn't for me. I saw two Ortho Surgeons and they both advised against surgery. They said if I rested my foot, practiced daily stretching exercises and wore good shoes then with time it will get better. I've had this pain for about a year now, and I can say that I'm a little better. I bought Birkenstock shoes, and always wear them, I believe those shoes have been the deciding factor in my improvement.
With PF comes inflammation and with inflammation comes pain, so by easing the inflammation, which will take time in most cases, you will get better.
Hang in there and stay with us here on this website, there are some wonderful people who will be more than happy to answer any questions you might have.
Happy Trails....
Necee

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

CatherineL on 2/13/02 at 09:05 (073589)

Thanx for all the posts...

2 diff types of orthotics, the ones I'm using are great... but I've had to put one of those gel grid heel pieces ontop to cushion.

To make matters worse... I have small feet, with very high arches, and underpronate... or so I'm told. So... I have a hard time finding a size 5 1/2 shoe that has a high-arch footbed or a removable one that will allow for my very high-arched ones... so the shoe front is a bit limited. The array of footwear here is very limited... The array of footwear in the city is still pretty limited and ordering shoes over the internet with such strange fussy feet is difficult... and if it's US, the exchange rate and shipping etc, makes them a few hundred a pair. I've tried what I could: ecco, deerstags, good-fake birks, footsaver, etonic stable pro, etc. The birk-type sandles, the footsaver maryjanes and the etonic runners are the only ones I can wear.

Good catch on the deppressant front. St. John's wort is too hard on my stomach. I went off zoloft last fall and my dr. is looking at another low-dose one, probably elavil, which should help with sleep, fibro, mild-depression. The stress may not be helping, but since going off the zoloft, things with my feet have been pretty-much unchanged.

I'm also going to my new general prac, who I haven't discussed the PF with much, to see if she has any ideas. For ESWT, and posting to Dr. Z, I have, but I'm in Canada 'eh', so, he gave me the info for a provider about 20hrs away and I have contacted them, but have been unable to get much info from them, in the way or cost, # of treatments etc. And the other nearest provider is about 16 hr drive. We're going that way this summer on holiday, so, I'm keeping that as a possible option.

The dr. I've been seeing hasn't given up on me though and has doen the x-ray, the wslking gait assesment, the blood-tests, forwarded me to the ortho surgeon and rhuemetologist, but it's taking so long with the try this for 3 months, try that for 3 months... and he is running out of options for me.

What is iontrphereis?

Crystal,

Sorry to say, but your situtation is the one I want to avoid at all cost - surgery! I hope it gets better for you...

The handicap permit would definately be a good idea for you ... I searched on the web for it to find where to apply. After my dr. signed the application, I mailed it in and it took about 10 days for approval. I've only used it once, cuz most times I can find a parking spot within a half-dozen spots from the door.

STRETCHING - I dont' tend to do much as it hurts with the smallest stretch and agrivates it to no end. A couple times of mild stretching can make it almost unbearable to walk for a few days... so even though my calves are Sooooo tight, I tend not to stretch them much. I do mild, non weight bearing streching only. Any ideas/thought on this.

Also, although the birk-type sandles feel great, I live in snowy, wintery Canada, so sandles year-round is not an alternative.

Thanx all
Catherine

Re: Temporary handicap permit

Carole C in NOLA on 2/13/02 at 11:55 (073613)

I've had handicap parking permits in both Texas and Louisiana. In my case, they were permanent ones but it's the same form. Your doctor has to sign a form from your state's Motor Vehicles Department. I'd suggest calling your doctor's office to find out if they already have the form, and to get your doctor to sign it. If he doesn't have the form, you'll have to go get it and take it to him.

Once you have the signed form in hand, then you may have to go stand in line at the Motor Vehicles office to get your permit. You might want to call the Motor Vehicles office and find out if you can just mail it in, and get your handicap hangtag by mail, instead of all the standing in line.

Carole C

Re: Birkenstock for winter

Carole C in NOLA on 2/13/02 at 11:58 (073614)

How about Birkenstock clogs? They are available with the same built in orthotic footbed. The 'Boston' seems to be the most popular style of Birkenstock clogs.

Carole C

Re: Birkenstock for winter

CatherineL on 2/13/02 at 13:45 (073623)

thanx carole

3 feet of snow is a bit cold on the feet in any footwear except boots. This year has been less snow so I've been able to avoid boots so far, and I'll check into the clogs for indoors and for the spring/fall.
thanx
Catherine

Re: Birkenstock for winter

Carole C in NOLA on 2/13/02 at 16:45 (073630)

Birkenstock makes boots too, but I don't know anything about them because I live in New Orleans. I didn't think about 3 feet of snow! That must be like a different world from southern Louisiana. :)

Carole C

Re: Birkenstock for winter

CatherineL on 2/14/02 at 08:45 (073680)

HI Carole,

Same world, just a BIT! colder, lots of sunshine, no flowers for 5 months:(, and the only greenery is evergreen trees and... of course with white fluffy stuff all around ;-)

At work, we often get visitors from all over... someone form Puerto Rico was amazed that our bare stick-trees, actually got leaf buds and grew new leaves every spring, she just couldn't fathom that, they just look so dead to her!

We still go about our day like everyone else in the world - either by pretending its not -20, or grumbling about it!

(and no... no polar bears or igloos)

I checked the birk page and ordered a clearance pair of clogs and they had them in MY size. They are suitable for work and outside - . (if I'm not tromping throught 3+ feet of snow). Hope to get them by spring.

thanx
Catherine

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Carmen H on 2/12/02 at 08:37 (073413)

What are you currently doing for treatment? Such as Orthotics? Stretching? How many cortisone shots have you had?

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

CatherineL on 2/12/02 at 15:09 (073472)

Hi All,

Carmen,

The athletic therapist told me yesterday, that I've done almost everything and this may be it for me... I may never get better! That was hard to hear! I guess that's why I'm posting and asking what else there is! I gave in last month and applied for a temp handicap parking permit, but I'm not ready to give-up!

What I've tried:
better shoes (Etonics, Footsaver, footbed sandles), custom orthotics, naproxen, Vioxx, taping, Phisiotherapy - 3 phisiotherapists, massage therapy, Less time on my feet, anelgesic cream, night splint (4 months and counting), 2 drs (my dr. and sport & injury dr.), Ice when sore, Heat, Stretching, NEVER go barefoot, Laser therapy, cortisone, ART, Chiro

What helps the most:
LASER, Vioxx, Taping, orthotics

I've tried these things in many combinations for almost 2 years! ugh! The cortisone was one injection in each foot, and it helped for a couple of weeks and then I was back to the same pain. It was the most painful thing I've ever gone through, so, unless they can assure me it's well worth it, I won't be doing that again?!?

One other thing that may help, is our little city is finally building an indoor pool, and I plan to join and try the walking-around-the-pool thing. I've also been told I may have early signs of arthritis and that I have the signs or fibro, so the pool thing would help on all fronts. Now it will be just a matter of making the committment and the time!

What is everyones experiences with: accupuncture? prolotherapy? trigger point injections? eswt? walking boot? don't know what else to do, I keep getting told to try 'this' for 3 months and come back, then try 'that' for 3 months... etc... It's been almost 2 years of it and I'm feeling a bit frustrated!

Thanx
Catherine

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Carmen H on 2/12/02 at 21:08 (073538)

I know you are frustrated. FIRST thing I can think of is the shoes you're wearing...have you ever tried New Balance? Birkenstocks? Danskos?
any of those?
What types of orthotics have you tried? More than one? what types of stretching have you been doing?
I wouldn't give up yet...there are avenues you haven't explored and doctors you haven't seen. Maybe you just haven't seen the right one yet, worn the right shoes with the right orthotics yet, etc etc.
2 years is a loooong time to suffer I agree....but never give up.
I think you need to make the committment to the pool. Not only would this be helpful for fibro (if you are definitely diagnosed with that) it would help to exercise raise those endorphin levels and seratonin levels and get some positivity in your life. Have you tried St. Johns Wort or any type of prescribed anti depressants to help with the outlook on this? Sometimes that is more damaging than we realize...that the stress due to these conditions is making things worse.
So time for you to take a deep breath...relax and find another doctor for another opinion. I have been to 4 and still looking...so don't give up.
I belive accupuncture is good for managing pain...but not a cure for PF. I have heard some talk of prolotherapy on this site but haven't looked into it for myself so I don't know much. Do a search on the message boards and put in the word prolotherapy. Peoples posts will pop up for you to get some ideas.
ESWT? POST TO DR. Z on the foot doctors board. He is a great doctor and a wonderful concerned man. He will help you find out if you are a candidate for ESWT he will be the one to tell you how to go about it. You will probably need to be seen to see if you can get it done.
Where do you live? Northeast? Northwest? West Coast?
A walking boot may be an option for you as well....The most important thing to do is find a doctor that will EXHAUST all conservative efforts to help you and won't fill your mind with megative thoughts.
I would not go back to the Athletic therapist....not for that kind of negativity. If you do go back tell them you know you will get better and won't think otherwise. Have you gotten iontophereis (sp?)? Massage? If PF is ALL you have than you can't ever think you won't ever get better. It is possible. A guy posted the other day that has gotten better after THREE years!
Get blood work for arthritis, get a definite diagnosis of Fibro and get a plan with a doctor you trust. This is my advice..I am no doctor just someone who won't take NO for an answer and doesn't believe anyone should be told to 'live with it'.
You're going to find the right combination...hang in there.

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Crystal S on 2/13/02 at 00:02 (073564)

Hi Catherine,
Boy do I sure understand how you feel.I had PF release surgery and heel spur removal and I am worse now than I was.I am seriously considering applying for dissability but hate the feeling of 'well I might as well give up'.I absolutely despise the cortisone injections and will NOT ever have another one.It was horrible.I had them before surgery and again after surgery in the foot that had surgery.That was really bad because it is so sore and painful anyway.My question for you is where do I go to apply for a temporary handicap permit? I did not know that I could even apply for that but I have to admit that sometimes I have parked there illegally. :-)
It is just to hard to make those long walks across a parking lot.Thanks for the advice and good luck with your continued recovery.It is nice to know we are not alone in our pain.

Blessings,
Crystal

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

Necee on 2/13/02 at 00:27 (073566)

Hi Catherine,
I would stick with what ever was helping you, however small. Don't allow yourself to get in the mindset that you'll never get better. I believe that you will, it just takes time. I was seeing a Pod who only wanted to discuss surgery, well for me that wasn't an option, I've heard too many horror stories about foot surgery and simply decided that wasn't for me. I saw two Ortho Surgeons and they both advised against surgery. They said if I rested my foot, practiced daily stretching exercises and wore good shoes then with time it will get better. I've had this pain for about a year now, and I can say that I'm a little better. I bought Birkenstock shoes, and always wear them, I believe those shoes have been the deciding factor in my improvement.
With PF comes inflammation and with inflammation comes pain, so by easing the inflammation, which will take time in most cases, you will get better.
Hang in there and stay with us here on this website, there are some wonderful people who will be more than happy to answer any questions you might have.
Happy Trails....
Necee

Re: Not many treatment options left - input on ESWT, Laser, walking boot, cortisone?

CatherineL on 2/13/02 at 09:05 (073589)

Thanx for all the posts...

2 diff types of orthotics, the ones I'm using are great... but I've had to put one of those gel grid heel pieces ontop to cushion.

To make matters worse... I have small feet, with very high arches, and underpronate... or so I'm told. So... I have a hard time finding a size 5 1/2 shoe that has a high-arch footbed or a removable one that will allow for my very high-arched ones... so the shoe front is a bit limited. The array of footwear here is very limited... The array of footwear in the city is still pretty limited and ordering shoes over the internet with such strange fussy feet is difficult... and if it's US, the exchange rate and shipping etc, makes them a few hundred a pair. I've tried what I could: ecco, deerstags, good-fake birks, footsaver, etonic stable pro, etc. The birk-type sandles, the footsaver maryjanes and the etonic runners are the only ones I can wear.

Good catch on the deppressant front. St. John's wort is too hard on my stomach. I went off zoloft last fall and my dr. is looking at another low-dose one, probably elavil, which should help with sleep, fibro, mild-depression. The stress may not be helping, but since going off the zoloft, things with my feet have been pretty-much unchanged.

I'm also going to my new general prac, who I haven't discussed the PF with much, to see if she has any ideas. For ESWT, and posting to Dr. Z, I have, but I'm in Canada 'eh', so, he gave me the info for a provider about 20hrs away and I have contacted them, but have been unable to get much info from them, in the way or cost, # of treatments etc. And the other nearest provider is about 16 hr drive. We're going that way this summer on holiday, so, I'm keeping that as a possible option.

The dr. I've been seeing hasn't given up on me though and has doen the x-ray, the wslking gait assesment, the blood-tests, forwarded me to the ortho surgeon and rhuemetologist, but it's taking so long with the try this for 3 months, try that for 3 months... and he is running out of options for me.

What is iontrphereis?

Crystal,

Sorry to say, but your situtation is the one I want to avoid at all cost - surgery! I hope it gets better for you...

The handicap permit would definately be a good idea for you ... I searched on the web for it to find where to apply. After my dr. signed the application, I mailed it in and it took about 10 days for approval. I've only used it once, cuz most times I can find a parking spot within a half-dozen spots from the door.

STRETCHING - I dont' tend to do much as it hurts with the smallest stretch and agrivates it to no end. A couple times of mild stretching can make it almost unbearable to walk for a few days... so even though my calves are Sooooo tight, I tend not to stretch them much. I do mild, non weight bearing streching only. Any ideas/thought on this.

Also, although the birk-type sandles feel great, I live in snowy, wintery Canada, so sandles year-round is not an alternative.

Thanx all
Catherine

Re: Temporary handicap permit

Carole C in NOLA on 2/13/02 at 11:55 (073613)

I've had handicap parking permits in both Texas and Louisiana. In my case, they were permanent ones but it's the same form. Your doctor has to sign a form from your state's Motor Vehicles Department. I'd suggest calling your doctor's office to find out if they already have the form, and to get your doctor to sign it. If he doesn't have the form, you'll have to go get it and take it to him.

Once you have the signed form in hand, then you may have to go stand in line at the Motor Vehicles office to get your permit. You might want to call the Motor Vehicles office and find out if you can just mail it in, and get your handicap hangtag by mail, instead of all the standing in line.

Carole C

Re: Birkenstock for winter

Carole C in NOLA on 2/13/02 at 11:58 (073614)

How about Birkenstock clogs? They are available with the same built in orthotic footbed. The 'Boston' seems to be the most popular style of Birkenstock clogs.

Carole C

Re: Birkenstock for winter

CatherineL on 2/13/02 at 13:45 (073623)

thanx carole

3 feet of snow is a bit cold on the feet in any footwear except boots. This year has been less snow so I've been able to avoid boots so far, and I'll check into the clogs for indoors and for the spring/fall.
thanx
Catherine

Re: Birkenstock for winter

Carole C in NOLA on 2/13/02 at 16:45 (073630)

Birkenstock makes boots too, but I don't know anything about them because I live in New Orleans. I didn't think about 3 feet of snow! That must be like a different world from southern Louisiana. :)

Carole C

Re: Birkenstock for winter

CatherineL on 2/14/02 at 08:45 (073680)

HI Carole,

Same world, just a BIT! colder, lots of sunshine, no flowers for 5 months:(, and the only greenery is evergreen trees and... of course with white fluffy stuff all around ;-)

At work, we often get visitors from all over... someone form Puerto Rico was amazed that our bare stick-trees, actually got leaf buds and grew new leaves every spring, she just couldn't fathom that, they just look so dead to her!

We still go about our day like everyone else in the world - either by pretending its not -20, or grumbling about it!

(and no... no polar bears or igloos)

I checked the birk page and ordered a clearance pair of clogs and they had them in MY size. They are suitable for work and outside - . (if I'm not tromping throught 3+ feet of snow). Hope to get them by spring.

thanx
Catherine