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intractable pain

Posted by Jane T on 7/16/02 at 19:26 (089807)

I am a 45 year old female emergency medicine physician. My feet have been worse for 2 years, I think secondary to pregnancy changes (I have a 3.5 year old child). My right foot has been debilitating for 4 months and the doctors are recommending a minimal medial band surgery incision. I am currently stretching, resting, using a boot, night boot, ice constantly, taping, orthotics, NSAIDs in high quantities. Two steroid injections did nothing. I also started Yoga. Accupunture, chiropractic adjustment and ultrasound did not help. I am looking into massage, rolfing, physical therapy. Kaiser can do the surgery in 3 months, which is a long delay.
Most of my pain and tenderness is medial band, r foot, but both feet hurt. The right is musch worse and tighter. Twenty years ago the left foot

Re: intractable pain

Dr. John Cozzarelli on 7/18/02 at 05:49 (089936)

Hi Doc:

Why would you have an invassive procedure if ESWT can be performed. It is non-invassive and the FDA has reported success rates of 92%. I would also use a night splint to passively stretch the plantar fascia.

Dr. John Cozzarelli

Re: intractable pain

Dr. David S. Wander on 7/18/02 at 07:55 (089946)

I agree with Dr. Cozzarelli 100%. With ESWT available, I would certainly try this treatment prior to considering a partial fasciotomy. Naturally, surgery carries some potential risks, and may prevent you from performing your duties as an ER physician since you may have difficulty standing for prolonged periods following the surgery. Look into ESWT, I think you'll be happy with the information you receive and the reported success rates.

Re: about that 92% figure

elliott on 7/18/02 at 11:31 (089962)

I'm not knocking trying ESWT before surgery by any means, but I do wonder about that 92% figure. If it were true, only a fraction need remain on heelspurs. There have been several on this board that tried it with little or no improvement at all, making that figure less believable (unless you want to claim that people end up here precisely because they're the worst of the worst, or perhaps that there really are 300,000 silent readers here, and aside from a garrulous few, most post only after a failed ESWT :-)).

Sure, there's a lot of factors involved (which machine, who applies it, how many applications, whether one had pre-ESWT surgery, etc.). But it might be a good idea to look real closely at the study claiming 92% success: in particular, how long the patients had PF pre-ESWT, what other treatments tried first, surgery pre-ESWT or not and what kind, how success is defined, etc. 92%? Sorry, I just don't believe it.

---

Re: intractable pain

Jane T on 7/18/02 at 14:44 (089989)

Thank you for your comments. I am researching going to Toronto, Canada for the shock wave therapy. Dr Gordon (orthopedics) says that he and his associate have been doing the procedure for 5 years and are very experienced., He expressed concern regarding the experience of people that may do it in California, and he says that it makes a huge difference. He is quoting 70% success rate for the foot that has never seen surgery. He says that it is up to the patient in terms of which procedure is done: low intensity, Simmons machine for 3 treatments, 3 days which does not require anesthesia---or high intensity OSSatron one time which does require anesthesia. The cost is less than US: $1000/foot for low intensity and $1200/foot for high intensity. Here in Northern California (Bay Area) several podiatrist are using the high intensity Ossatron. It is very expensive, however--$2500 for the machine, plus podiatry fee, room fee and anesthesia. One place had quoted $4000 but I am not sure if that is one foot or both.
Any opinion on type of machine or any of the above? Thank you
Jane Thrush
PS: Bayshore clinic , Dr Gordon is the name of the place in Toronto

Re: intractable pain

Jane T on 7/18/02 at 14:50 (089990)

Thank you for your comments. I am looking into the Bayshore CLinic in Toronto, Canada. Dr Gordon says that he and his associate have been doing this for 5 years and that experience counts. He questioned the limited experience of the doctors in our SF Bay Area. He has trained them, and a machine comes up once/month from Southern Ca. for them to use--the Ossatron, one time, high intensity, about $4000, but I think this is for one foot and not two.
Canada gives you two choices--Simmons low intensity with 3 treatments over 3 days or Ossatron one treatment, the latter requiring anesthesia. He quotes 70% success on the non operated foot and says that either method is fine--a 2% difference between the two. The low intensity is $1000/foot and the high intensity $1200/foot.
Comments? Experience?
Thank you
Jane Thrush

Re: about that 92% figure

Jane T on 7/18/02 at 14:54 (089993)

Thanks for your comments. The Canadian (Bayshore Clinic) gives a success rate of 70% for the foot that has never had surgery.
They offer two machines and say that it does not matter which one: high intensity, Ossatron, one time requiring anesthesia, and low intensity Simmons--3 treatments over 3 days, no anesthesia needed. One is $1000/foot and the high intensity is $1200/foot.
Dr Gordon (Canada) says that they are much more experienced at doing the procedure and he would question the experience of the SF Bay Area Docs. They have a machine that comes up once/month for Southern Ca. and he says that he has trained the people. The cost here was $4000--but now I'm not sure if that is total or per foot.
Comment?
Also, I got three replys but I was not sure how to respond to them in one message, so I sent a message to each one. Do you know how to do this? Thank you.
Jane Thrush

Re: about that 92% figure

Ed Davis, DPM on 7/19/02 at 15:09 (090137)

Elliott:

92% does sound high. Patient selection would significantly affect the figures. ESWT is indicated for 'intractable' plantar fasciitis, that is PF in which all the other reasonable non-surgical modalities have been used. The treatment 'pipeline' for ESWT is narrow now but if it goes the way of other treatments, usage will increase and I would expect some overusage to occur eventually. The success rates would drastically drop if that happens.

Remember what I termed the 'treatment triad' for PF : treat the biomechanics, inflammatory process and tissue quality. ESWT is the only modality targeted toward the third -- tissue quality. If the pipeline opens wide and we start jumping to ESWT without regards to biomechanics then we will probably start to see more failures occurring.
Ed

Re: about that 92% figure

Ed Davis, DPM on 7/19/02 at 21:23 (090176)

Consider the Siemens Soncour located in Vancouver, BC. Two treatments can be done in succession followed by the third a couple of weeks out.
Ed

Re: about that 92% here it is

DR Zuckerman on 7/20/02 at 18:45 (090235)

What the 92% refers to is that the average pain reduction on a VAS of 1-10 is 0.6 after a ONE year follow up. They average pre ESWT patient had a VAS score of 7.7 . That turns out to be a reduction in pain of 92%. Even the ossatron scores after one year will close ot 90%. IF there is any thing that these scores shows is that the pain reduction continues after 12 weeks of treatment from ESWT and that if you are improving after 12 weeks just let the body continue to heal.

Re: about that 92% here it is

Jane T on 7/24/02 at 17:15 (090520)

Thank you for clarifcation. A couple more questions. There are two choices of machines if I go to Toronto,Canada at the Bayshore Clinic. Low intensity Simmons for 3 days : consecutive or every other day; high intensity Ossatron one time only.
Do you have an opinion or statistics on which is better?
Also, how much time should I take off afterward? Some people say none, but as an ED physician I either to 4-5 hours at a time, or 8-9 hours with a lot of standing and walking on concrete.
I am also considering casting, but my concern about casting is driving and the inability to ice.

Re: about that 92% figure

Jane T on 7/24/02 at 17:18 (090522)

Thank you for your comment. The Bayshore clinic told me three treatments every other day or consecutive days.
Any opinion on the Siemons and this schedule versus the Ossatron one time?

Re: intractable pain

Nigel B on 7/31/02 at 15:58 (091176)

Jane,

I am also a doctor (GP in UK)-I have had pf for 2 years but I must say that rest from cycling and hiking has really helped-Birkenstocks take some getting used to but I know a lot of housephysicians who wear them on the wards-the arch pain settled first for me and I now have only sl discomfort in the heels-I would avoid surgery -I really think PF is like tennis elbow-One comforting thought-if I see a patient with PF in the past records eg 1996-they don't come limping in today-ie it usually goes away!also 'clinical evidence' from the BMJ looked at all treatments and concluded it usually (>95%) goes away anyway after 48 months whatever you do.

Re: intractable pain

Julie on 7/31/02 at 17:22 (091190)

Nigel

I'm not a doctor, but I've had both Tennis Elbow and PF, and though I that they're essentially similar types of repetitive motion injury, there's one huge difference. We don't have to walk on our elbows.

TE will usually go away by itself if not treated; but I seriously doubt whether PF does, and there are lots of people here whose PF has become chronic (thank goodness I'm not among them) to prove it.

Re: intractable pain

RACHAEL T. on 7/31/02 at 21:59 (091220)

Are you saying that PF is 'self-limiting' & 48 months is the usual time span that it 'runs itself out??' Pls. advise.

Thanks!

Re: intractable pain

Nigel B on 8/01/02 at 16:07 (091299)

It all depends what people mean by treatment-I have had many different opinions regarding orthotics, stretching , ICE etc-some people say injecn helps but for a short time only (just like tennis elbow)-some say surgery helps-others say its horrendous-what I DO KNOW is that REST has helped me most-less walking less hard cycling-(not using screw drivers or heavy shearing helps tennis elbow)-My quote of 48 months comes from 'BMJ Clinical Evidence'june 2001-pages 823-831-they look at hundereds of studies and have concluded that :

Symptoms respond spontaneously in most people allocated placebo

No evidence of long term benefit from steroid injections

Conflicting evidence about the use of orthotics

Limited evidence of ESWT

NO randomised controlled trials of surgery

No significant benefit from laser/ultrasound or night splints

A telephone survey of people treated conservatively showed that out of 100 people 82 had complete resolution of symptoms and 15 had no limitation of work or activity after an average of 47 months-NOW conservative treatment can mean anything not surgical-Scotts surveys seem to support this-lets look at the evidence (I trust the BMJ )-heel pain usually eventually settles without dramatic intervention-I only say this because it is easy to become depressed when looking at the postings but most people have had it less than 3 yrs.

Re: intractable pain

Julie on 8/01/02 at 17:11 (091309)

Nigel

The orthopaedic consultant who examined my husband's lower back around the time I was dealing with PF two years ago thought somewhat as you do, and pronounced authoritatively (as consultants sometimes tend to do) 'Plantar fasciitis is like tennis elbow. It lasts 18 months, goes away by itself, and comes back again. Then it goes away forever.'

I didn't buy into that, and I doubt that most podiatrists would. There are just too many variables, in patients, doctors, and treatments. My own case was relatively mild as it turned out, though at its worst it was very painful. It resolved fully in five months, with accurate diagnosis and with what I and my pod considered an appropriate treatment plan, which included taping, icing, custom orthotics, stretching (as regards which we parted company on what was appropriate) and rest. I've been ok ever since: no setbacks even when walking barefoot on the beach, or hiking in the hills in Crete. I'm hoping the ortho's prediction about its inevitable return is as wrong as his '18 months' was.

The BMJ 'average' of 47 months is pretty horrifying, actually. If you allow for the many straightforward cases which do resolve in a matter of weeks or months, that leaves God knows how many people suffering for longer, perhaps much longer, than four years. A long time to be in pain. I trust the BMJ too - but that's an awful situation and nothing to be sanguine about.

Wouldn't you agree? I would hope that most patients with PF, who present to a competent foot doctor without delay (I mean without walking and running through the pain for any length of time) and who are active in their treatment, would be back to normal, more or less, in much less than 47 months.

I agree with you about rest, which was certainly a most important aspect of my own healing plan.

And now I'll throw a spanner in the works and tell you that my tennis elbow, 20 years ago, went away with one cortisone injection, returned two years later, and went away (forever, I trust) with another.

Anyway, I certainly hope that your feet improve before 47 months have elapsed.

Re: intractable pain

jane t on 8/01/02 at 17:59 (091321)

I have had PF in both feet off and on for 20 years. The right foot is now creating disability. I am glad to hear that yours is gone, but I would avoid things that could make it return--especially walking barefoot on the beach,etc.
Jane T

Re: intractable pain

Julie on 8/02/02 at 01:38 (091361)

Hello Jane

Of course you're right. 'Walking barefoot on the beach' is a rare, special treat for me (on one particular beach in South India where I have - on two occasions in the past two years - been simply unable to resist). I mentioned it only to indicate that it is now possible for me to do it - as it is to do many things I couldn't do during my PF.

Otherwise, I never go barefoot. I'm not generally a risk-taker with my feet, and am always to be found in my Birkenstocks (my feet slip into them the moment they're out of bed in the morning) or my North Face trainers. I even, still, teach (yoga) in my Birks (highly unorthodox, but my students understand).

I absolutely agree with you that one should avoid doing things that might cause a recurrence of PF. I know it can come back. My instincts tell me (though even the doctors here have sometimes said otherwise and that a total cure is possible) that whatever were the underlying reasons for my PF (the only one I'm completely sure of is overpronation) they haven't gone away even though the symptoms thankfully have. So I'm never without my Birks or my orthotics - in other words, I do my best to continue to deal with the underlying causes. Apart, that is, for being unable to resist the wonderful freedom of walking barefoot on that beach, twice in an 18 month period. (Both times with tape.)

I'm so sorry you've been suffering for so long. In your case, doesn't it have something to do with having to be on your feet a grgeat deal? Is there any way you could change that? (probably not, I guess, or you would have). I know you've tried almost everything, and of course I don't know your circumstances, but mightn't it be worth borrowing the money for ESWT (or travelling to somewhere where it's cheaper than $4000 - Canada, or even Germany, for instance?)

I do hope you can lick it eventually.

All the best, Julie

Re: intractable pain

Andrue on 8/02/02 at 03:44 (091365)

PMFJI,

As a GP in the UK I'd have thought you had enough problems without PF - you have my sympathy. I suppose also you will be one of the GPs who can offer their patient a full understanding of the problem :)

Nice to know that PF doesn't last forever anyway..

Re: intractable pain

Nigel B on 8/02/02 at 05:55 (091370)

thanks-it has helped me understand all types of chronic pain and the social aspects involved

Re: intractable pain

Nigel B on 8/02/02 at 06:08 (091371)

Julie

Thanks for your message-the BMJ article actually cheered me up after 2 yrs and it was looking like forever-I feel that people should use what helps them at the time-Birks taping etc but keep optimistic about a PROBABLE CURE whilst all of these treatments are helping with the pain-I feel people (like me) get very low when no treatment seems to be helping cure it-I stopped looking for a single answer but rested it and taped etc which all helped-knowing that the majority of people are better given time.

Anyway I'm glad yours was a short (although it probably seemed a long ) problem-I think we should all consider ourselves as having 'glass feet' which need to be looked after for life (I,m planning to live until 108!)

Nigel

Re: intractable pain

jane t on 8/02/02 at 13:09 (091426)

Tape is good: I'd just hate to see yours come back. I am going to Canada today for the eswt: low intensity.
I am going to permanently cut down on my shifts (when I can get back at all) and do some psychiatry. If that doesn't work, I am going to change full time into psychiatry. Luckily, I have another field. Yes, it has everything to do with bad feet, high arches, overpronation, and my job.

Re: intractable pain

Julie on 8/02/02 at 16:23 (091450)

Jane

I wish you all the best for your ESWT, and hope that between it and your change of job emphasis, you'll soon feel a real difference.

Re: intractable pain

Nigel B on 8/04/02 at 03:51 (091520)

Rachael

Sorry I didnt reply direct-if you see the other thread messages then yes there is good evidence that PF usually settles after 48 months -if we look after it (I spoke to a rheumatologist also who feels we will always be prone to it -like having a bad back really so we will always have to be careful)

Re: intractable pain

Dr. John Cozzarelli on 7/18/02 at 05:49 (089936)

Hi Doc:

Why would you have an invassive procedure if ESWT can be performed. It is non-invassive and the FDA has reported success rates of 92%. I would also use a night splint to passively stretch the plantar fascia.

Dr. John Cozzarelli

Re: intractable pain

Dr. David S. Wander on 7/18/02 at 07:55 (089946)

I agree with Dr. Cozzarelli 100%. With ESWT available, I would certainly try this treatment prior to considering a partial fasciotomy. Naturally, surgery carries some potential risks, and may prevent you from performing your duties as an ER physician since you may have difficulty standing for prolonged periods following the surgery. Look into ESWT, I think you'll be happy with the information you receive and the reported success rates.

Re: about that 92% figure

elliott on 7/18/02 at 11:31 (089962)

I'm not knocking trying ESWT before surgery by any means, but I do wonder about that 92% figure. If it were true, only a fraction need remain on heelspurs. There have been several on this board that tried it with little or no improvement at all, making that figure less believable (unless you want to claim that people end up here precisely because they're the worst of the worst, or perhaps that there really are 300,000 silent readers here, and aside from a garrulous few, most post only after a failed ESWT :-)).

Sure, there's a lot of factors involved (which machine, who applies it, how many applications, whether one had pre-ESWT surgery, etc.). But it might be a good idea to look real closely at the study claiming 92% success: in particular, how long the patients had PF pre-ESWT, what other treatments tried first, surgery pre-ESWT or not and what kind, how success is defined, etc. 92%? Sorry, I just don't believe it.

---

Re: intractable pain

Jane T on 7/18/02 at 14:44 (089989)

Thank you for your comments. I am researching going to Toronto, Canada for the shock wave therapy. Dr Gordon (orthopedics) says that he and his associate have been doing the procedure for 5 years and are very experienced., He expressed concern regarding the experience of people that may do it in California, and he says that it makes a huge difference. He is quoting 70% success rate for the foot that has never seen surgery. He says that it is up to the patient in terms of which procedure is done: low intensity, Simmons machine for 3 treatments, 3 days which does not require anesthesia---or high intensity OSSatron one time which does require anesthesia. The cost is less than US: $1000/foot for low intensity and $1200/foot for high intensity. Here in Northern California (Bay Area) several podiatrist are using the high intensity Ossatron. It is very expensive, however--$2500 for the machine, plus podiatry fee, room fee and anesthesia. One place had quoted $4000 but I am not sure if that is one foot or both.
Any opinion on type of machine or any of the above? Thank you
Jane Thrush
PS: Bayshore clinic , Dr Gordon is the name of the place in Toronto

Re: intractable pain

Jane T on 7/18/02 at 14:50 (089990)

Thank you for your comments. I am looking into the Bayshore CLinic in Toronto, Canada. Dr Gordon says that he and his associate have been doing this for 5 years and that experience counts. He questioned the limited experience of the doctors in our SF Bay Area. He has trained them, and a machine comes up once/month from Southern Ca. for them to use--the Ossatron, one time, high intensity, about $4000, but I think this is for one foot and not two.
Canada gives you two choices--Simmons low intensity with 3 treatments over 3 days or Ossatron one treatment, the latter requiring anesthesia. He quotes 70% success on the non operated foot and says that either method is fine--a 2% difference between the two. The low intensity is $1000/foot and the high intensity $1200/foot.
Comments? Experience?
Thank you
Jane Thrush

Re: about that 92% figure

Jane T on 7/18/02 at 14:54 (089993)

Thanks for your comments. The Canadian (Bayshore Clinic) gives a success rate of 70% for the foot that has never had surgery.
They offer two machines and say that it does not matter which one: high intensity, Ossatron, one time requiring anesthesia, and low intensity Simmons--3 treatments over 3 days, no anesthesia needed. One is $1000/foot and the high intensity is $1200/foot.
Dr Gordon (Canada) says that they are much more experienced at doing the procedure and he would question the experience of the SF Bay Area Docs. They have a machine that comes up once/month for Southern Ca. and he says that he has trained the people. The cost here was $4000--but now I'm not sure if that is total or per foot.
Comment?
Also, I got three replys but I was not sure how to respond to them in one message, so I sent a message to each one. Do you know how to do this? Thank you.
Jane Thrush

Re: about that 92% figure

Ed Davis, DPM on 7/19/02 at 15:09 (090137)

Elliott:

92% does sound high. Patient selection would significantly affect the figures. ESWT is indicated for 'intractable' plantar fasciitis, that is PF in which all the other reasonable non-surgical modalities have been used. The treatment 'pipeline' for ESWT is narrow now but if it goes the way of other treatments, usage will increase and I would expect some overusage to occur eventually. The success rates would drastically drop if that happens.

Remember what I termed the 'treatment triad' for PF : treat the biomechanics, inflammatory process and tissue quality. ESWT is the only modality targeted toward the third -- tissue quality. If the pipeline opens wide and we start jumping to ESWT without regards to biomechanics then we will probably start to see more failures occurring.
Ed

Re: about that 92% figure

Ed Davis, DPM on 7/19/02 at 21:23 (090176)

Consider the Siemens Soncour located in Vancouver, BC. Two treatments can be done in succession followed by the third a couple of weeks out.
Ed

Re: about that 92% here it is

DR Zuckerman on 7/20/02 at 18:45 (090235)

What the 92% refers to is that the average pain reduction on a VAS of 1-10 is 0.6 after a ONE year follow up. They average pre ESWT patient had a VAS score of 7.7 . That turns out to be a reduction in pain of 92%. Even the ossatron scores after one year will close ot 90%. IF there is any thing that these scores shows is that the pain reduction continues after 12 weeks of treatment from ESWT and that if you are improving after 12 weeks just let the body continue to heal.

Re: about that 92% here it is

Jane T on 7/24/02 at 17:15 (090520)

Thank you for clarifcation. A couple more questions. There are two choices of machines if I go to Toronto,Canada at the Bayshore Clinic. Low intensity Simmons for 3 days : consecutive or every other day; high intensity Ossatron one time only.
Do you have an opinion or statistics on which is better?
Also, how much time should I take off afterward? Some people say none, but as an ED physician I either to 4-5 hours at a time, or 8-9 hours with a lot of standing and walking on concrete.
I am also considering casting, but my concern about casting is driving and the inability to ice.

Re: about that 92% figure

Jane T on 7/24/02 at 17:18 (090522)

Thank you for your comment. The Bayshore clinic told me three treatments every other day or consecutive days.
Any opinion on the Siemons and this schedule versus the Ossatron one time?

Re: intractable pain

Nigel B on 7/31/02 at 15:58 (091176)

Jane,

I am also a doctor (GP in UK)-I have had pf for 2 years but I must say that rest from cycling and hiking has really helped-Birkenstocks take some getting used to but I know a lot of housephysicians who wear them on the wards-the arch pain settled first for me and I now have only sl discomfort in the heels-I would avoid surgery -I really think PF is like tennis elbow-One comforting thought-if I see a patient with PF in the past records eg 1996-they don't come limping in today-ie it usually goes away!also 'clinical evidence' from the BMJ looked at all treatments and concluded it usually (>95%) goes away anyway after 48 months whatever you do.

Re: intractable pain

Julie on 7/31/02 at 17:22 (091190)

Nigel

I'm not a doctor, but I've had both Tennis Elbow and PF, and though I that they're essentially similar types of repetitive motion injury, there's one huge difference. We don't have to walk on our elbows.

TE will usually go away by itself if not treated; but I seriously doubt whether PF does, and there are lots of people here whose PF has become chronic (thank goodness I'm not among them) to prove it.

Re: intractable pain

RACHAEL T. on 7/31/02 at 21:59 (091220)

Are you saying that PF is 'self-limiting' & 48 months is the usual time span that it 'runs itself out??' Pls. advise.

Thanks!

Re: intractable pain

Nigel B on 8/01/02 at 16:07 (091299)

It all depends what people mean by treatment-I have had many different opinions regarding orthotics, stretching , ICE etc-some people say injecn helps but for a short time only (just like tennis elbow)-some say surgery helps-others say its horrendous-what I DO KNOW is that REST has helped me most-less walking less hard cycling-(not using screw drivers or heavy shearing helps tennis elbow)-My quote of 48 months comes from 'BMJ Clinical Evidence'june 2001-pages 823-831-they look at hundereds of studies and have concluded that :

Symptoms respond spontaneously in most people allocated placebo

No evidence of long term benefit from steroid injections

Conflicting evidence about the use of orthotics

Limited evidence of ESWT

NO randomised controlled trials of surgery

No significant benefit from laser/ultrasound or night splints

A telephone survey of people treated conservatively showed that out of 100 people 82 had complete resolution of symptoms and 15 had no limitation of work or activity after an average of 47 months-NOW conservative treatment can mean anything not surgical-Scotts surveys seem to support this-lets look at the evidence (I trust the BMJ )-heel pain usually eventually settles without dramatic intervention-I only say this because it is easy to become depressed when looking at the postings but most people have had it less than 3 yrs.

Re: intractable pain

Julie on 8/01/02 at 17:11 (091309)

Nigel

The orthopaedic consultant who examined my husband's lower back around the time I was dealing with PF two years ago thought somewhat as you do, and pronounced authoritatively (as consultants sometimes tend to do) 'Plantar fasciitis is like tennis elbow. It lasts 18 months, goes away by itself, and comes back again. Then it goes away forever.'

I didn't buy into that, and I doubt that most podiatrists would. There are just too many variables, in patients, doctors, and treatments. My own case was relatively mild as it turned out, though at its worst it was very painful. It resolved fully in five months, with accurate diagnosis and with what I and my pod considered an appropriate treatment plan, which included taping, icing, custom orthotics, stretching (as regards which we parted company on what was appropriate) and rest. I've been ok ever since: no setbacks even when walking barefoot on the beach, or hiking in the hills in Crete. I'm hoping the ortho's prediction about its inevitable return is as wrong as his '18 months' was.

The BMJ 'average' of 47 months is pretty horrifying, actually. If you allow for the many straightforward cases which do resolve in a matter of weeks or months, that leaves God knows how many people suffering for longer, perhaps much longer, than four years. A long time to be in pain. I trust the BMJ too - but that's an awful situation and nothing to be sanguine about.

Wouldn't you agree? I would hope that most patients with PF, who present to a competent foot doctor without delay (I mean without walking and running through the pain for any length of time) and who are active in their treatment, would be back to normal, more or less, in much less than 47 months.

I agree with you about rest, which was certainly a most important aspect of my own healing plan.

And now I'll throw a spanner in the works and tell you that my tennis elbow, 20 years ago, went away with one cortisone injection, returned two years later, and went away (forever, I trust) with another.

Anyway, I certainly hope that your feet improve before 47 months have elapsed.

Re: intractable pain

jane t on 8/01/02 at 17:59 (091321)

I have had PF in both feet off and on for 20 years. The right foot is now creating disability. I am glad to hear that yours is gone, but I would avoid things that could make it return--especially walking barefoot on the beach,etc.
Jane T

Re: intractable pain

Julie on 8/02/02 at 01:38 (091361)

Hello Jane

Of course you're right. 'Walking barefoot on the beach' is a rare, special treat for me (on one particular beach in South India where I have - on two occasions in the past two years - been simply unable to resist). I mentioned it only to indicate that it is now possible for me to do it - as it is to do many things I couldn't do during my PF.

Otherwise, I never go barefoot. I'm not generally a risk-taker with my feet, and am always to be found in my Birkenstocks (my feet slip into them the moment they're out of bed in the morning) or my North Face trainers. I even, still, teach (yoga) in my Birks (highly unorthodox, but my students understand).

I absolutely agree with you that one should avoid doing things that might cause a recurrence of PF. I know it can come back. My instincts tell me (though even the doctors here have sometimes said otherwise and that a total cure is possible) that whatever were the underlying reasons for my PF (the only one I'm completely sure of is overpronation) they haven't gone away even though the symptoms thankfully have. So I'm never without my Birks or my orthotics - in other words, I do my best to continue to deal with the underlying causes. Apart, that is, for being unable to resist the wonderful freedom of walking barefoot on that beach, twice in an 18 month period. (Both times with tape.)

I'm so sorry you've been suffering for so long. In your case, doesn't it have something to do with having to be on your feet a grgeat deal? Is there any way you could change that? (probably not, I guess, or you would have). I know you've tried almost everything, and of course I don't know your circumstances, but mightn't it be worth borrowing the money for ESWT (or travelling to somewhere where it's cheaper than $4000 - Canada, or even Germany, for instance?)

I do hope you can lick it eventually.

All the best, Julie

Re: intractable pain

Andrue on 8/02/02 at 03:44 (091365)

PMFJI,

As a GP in the UK I'd have thought you had enough problems without PF - you have my sympathy. I suppose also you will be one of the GPs who can offer their patient a full understanding of the problem :)

Nice to know that PF doesn't last forever anyway..

Re: intractable pain

Nigel B on 8/02/02 at 05:55 (091370)

thanks-it has helped me understand all types of chronic pain and the social aspects involved

Re: intractable pain

Nigel B on 8/02/02 at 06:08 (091371)

Julie

Thanks for your message-the BMJ article actually cheered me up after 2 yrs and it was looking like forever-I feel that people should use what helps them at the time-Birks taping etc but keep optimistic about a PROBABLE CURE whilst all of these treatments are helping with the pain-I feel people (like me) get very low when no treatment seems to be helping cure it-I stopped looking for a single answer but rested it and taped etc which all helped-knowing that the majority of people are better given time.

Anyway I'm glad yours was a short (although it probably seemed a long ) problem-I think we should all consider ourselves as having 'glass feet' which need to be looked after for life (I,m planning to live until 108!)

Nigel

Re: intractable pain

jane t on 8/02/02 at 13:09 (091426)

Tape is good: I'd just hate to see yours come back. I am going to Canada today for the eswt: low intensity.
I am going to permanently cut down on my shifts (when I can get back at all) and do some psychiatry. If that doesn't work, I am going to change full time into psychiatry. Luckily, I have another field. Yes, it has everything to do with bad feet, high arches, overpronation, and my job.

Re: intractable pain

Julie on 8/02/02 at 16:23 (091450)

Jane

I wish you all the best for your ESWT, and hope that between it and your change of job emphasis, you'll soon feel a real difference.

Re: intractable pain

Nigel B on 8/04/02 at 03:51 (091520)

Rachael

Sorry I didnt reply direct-if you see the other thread messages then yes there is good evidence that PF usually settles after 48 months -if we look after it (I spoke to a rheumatologist also who feels we will always be prone to it -like having a bad back really so we will always have to be careful)