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Anxiety - the cause of PF???

Posted by ScottW on 8/14/02 at 13:39 (092472)

I went to see a rheumatologist today at the Cleveland Clinic and he tried to tell me that it is anxiety that is causing my problem with my feet and that it is not PF at all. I personally think he is a quack! I will admit I don't have the classic PF (see my story below), but what he is saying sounds a bit ridiculous! I typed out my story and handed it to him. I included it below. I was just wanting to know if anyone else has ever heard of this diagnosis for foot discomfort before?

my story (that I gave to the rheumatologist):

My PF began 18 months ago after playing basketball all winter. I am a 31 year old civil engineer with a desk job. I have been to 2 podiatrists, 2 physical therapists, 1 orthopedic, 1 sports med doctor, and an Endocrinologist. I have had many sets of blood work done, a glucose tolerance test (to test for diabetes-it was normal), a bone scan, and x-rays (no spurs). All were normal except the sed rate was high on one blood test early on but I'm not sure if any doctor has tested it since that time. I have tried many conservative treatments including 2 pair of expensive prescription orthotics, many OTC inserts, Vioxx, Jade Balm cream, stretching, and a night splint with no relief. The entire bottom of my feet ache and get really sore after standing for about 5 minutes. Walking is much easier on them but I still need to sit after about 10 minutes or so. Concrete floors are awful, while soft plush carpet or grass are the best. It feels as if my nerves on the bottom of my feet are super sensitive to anything --- like a severe dull ache (i,e, not sharp pain). In fact, I can't even rest them on the floor while sitting sometimes due to their sensitivity. I often take my shoes off and prop them up on a stool while working so that nothing is touching the bottom of my feet. I have no 'classic' morning pain. They don't hurt when pressed on either. I have tried taping but it doesn't seem to help much either. Ice numbs my feet and removes the intense aching and soreness temporarily (I ice at least 2 times a day on most days). My whole lower half of my body (legs, knees and hips) are now aching some after I stand or walk for awhile. I was just seen by the 2nd podiatrist recently (June 2002). He said my feet look fine 'structurally' and that there is nothing more he can do. He said it doesn't sound like plantar fasciitis (PF) to him because there is no morning pain, and because the dull ache is over entire bottom of both feet instead of just the heal, and they don't hurt to press on. He suggested going to see a neurologist and/or a rheumatologist. He thought it might be a nerve problem possibly even related to my back. I also recently spoke to a Dr. Zuckerman (another Podiatrist) from N.J. on the phone about ESWT (elctro-shock wave therapy - a new treatment for PF that has had good success) and he told me that I wasn't a candidate for ESWT because my pain wasn't specifically in one place.

Scott Warner

Re: Anxiety - the cause of PF???

Scott R on 8/14/02 at 13:59 (092475)

most definitely you need to see a neurologist.

Re: Anxiety - the cause of PF???

BrianJ on 8/14/02 at 14:02 (092478)

Scott --

As you know, my problem is very similar to yours (bilateral heel pain secondary to repeated athletic participation on a hard surface). The small difference is that most of the time, it's just my heels that hurt. Only when I drive (using pedals) or otherwise stress my feet do the ENTIRE bottoms of the feet AND my ankles hurt.

I can promise you that the problem is not just in our heads, but I think it is quite possible that stress is or was a factor. When I hurt my feet five years ago, I was also going through a great deal of job-related stress. It's no secret that stress can have physical manifestations -- and that healing is better in a positive, non-stressful environment.

Be that as it may, the real question is what do we do now? I agree that ruling out spinal stenosis and looking at other nerve and rheumatic issues are good ideas. We must keep trying, and frequently failing, in order to finally understand why our feet hurt and how we can make them feel better.

Re: Anxiety - the cause of PF???

D.Thomas on 8/14/02 at 19:04 (092496)

Scott,

Welcome to our party :) My PF pain is mainly in the arches, but after standing about 5 to 10 min the pain comes the the inflammation that develops and is the whole bottom of my feet until I ice again. I do not have the classic morning pain, my feet are stiff in the morning but not painful on the first step. I cannot have my shoes on more than 30 min before I need to elevate my feet in some fashion to keep the inflamation down. I cannot wear socks becuase of the sensitivity. I have to have the air condition in my car blow on them to keep them cool and the inflamation down whenever I'm driving. I have my legs up all day at work (thank god I have a desk job).

I am not a doctor but what you posted sounds like PF to me. Just because you don't have morning pain or the pain isn't in the heel doesn't mean you don't have PF. It means you found a doctor who doesn't know squat about PF.

Sometimes it can take a few times before you find a good doc. I actually had one POD who told me that my problem was that I was thinking about the pain to much and I need to stop thinking about the pain. Hang in there, and look around and ask people, you'll find a good one. Sometimes they are hard to find but if you keep looking you will find one. It took me about 8 or 9.

Re: Anxiety - the cause of PF???

anon on 8/14/02 at 19:31 (092497)

Ditto D thomas Scott....Pf takes on many forms. This is one of them.

Re: Anxiety - the cause of PF???

Shaira on 8/14/02 at 22:59 (092512)

You've definitely got it. I don't think a lot of doctors really *know* about this disease, you know?

Pain like your having is definitely PF.

Re: Anxiety - the cause of PF???

BrianJ on 8/14/02 at 23:10 (092516)

Scott --

While I respect the other posters who have responded to your message, I would urge you NOT to blindly accept the idea that your problem is just PF. Yes, PF is the most common cause of heel pain, and yes, PF takes many forms. However, you should rule out the other things we discussed, as well as considering whether you may have entrapment of the first branch of the lateral plantar nerve. Don Baxter and others have written numerous articles about this nerve entrapment, and the March 2002 edition of Foot and Ankle International suggests that this entrapment is much more common than previously thought.

Re: Anxiety - the cause of PF???

Julie on 8/15/02 at 02:50 (092524)

I agree with Scott R. Do see a neurologist. And don't assume it is PF. If it is a nerve-related condition, treating yourself for PF may be losing valuable time: these things get worse.

The pains in your legs, knees and hips could be knock-on effects of the changes you've made in your way of walking to accommodate your foot pain, or they could be nerve-related (coming from your spine). Either way, the sooner you get to the bottom of it, the better.

Pay no attention to the rheumatologist's remark. He probably knows his rheumatology, and probably isn't a quack - you just weren't in his field of vision and knew he couldn't help you from his own particular specialism. Some consultants are like this. I had a discussion with an orthopaedic consultant once (in a social, not a medical context) who flatly declared that there is no such thing as RSI (repetitive strain injury) and that it was all 'emotional'. Go figure.

Re: amen to Brian

Scott R on 8/15/02 at 06:55 (092529)

Yes, as we told Scott W back in June, he needs to see a neurologist. I didn't read anyhting in his post that makes me think he has PF.

Re: amen to Brian

ScottW on 8/15/02 at 07:53 (092537)

I plan to see a neurologist soon. What if they say it is 'not a nerve problem', which at this point I am expecting? Does that mean I am left with some weird form of PF as my diagnosis or are there other options?

Re: Anxiety - the cause of PF???

BrianJ on 8/15/02 at 09:01 (092542)

Scott --

The neurologist will examine your feet (high-arched feet are more prone to neuropathy). He/she will also do sensation tests using a toothpick to lightly prick your feet and a reflex test with a small rubber hammer as well. Finally, the neurologist may do a nerve conduction velocity (NCV)test, which measures the speed with which nerve impulses travel from one part of your foot to another.

NCV tests will often pick up problems like tarsel tunnel syndrome, but will almost never pick up entrapment of the first branch of the lateral plantar nerve. Thus, a negative NCV test does not prove the absence of a nerve problem.

Re: Scott - why not cross that bridge when you come to it?

Julie on 8/15/02 at 09:24 (092544)

**

Re: Don't worry if neurological

Sandy H. on 8/15/02 at 09:52 (092549)

If it is neurological. ie related to your spine then you can do a lot of work on the muscles that support your spine to help the condition improve. I'm getting better (slowly) by core stability and physio to get my hip in a neutral position. If you find that the pain gets worse when you are stressed well that is quite normal as back pain always gets worse when you are stressed. That is because your muscles tense up ready for 'fight or flight' and then you don't work it out, tense muscles become sore muscles, soreness leads to tension and on and on. The trick is to recognise the signs and do something to shake out the tension. RSI is related to anxiety and stress, at least it certainly was when I had it in my hands from typing and my feet certainly hurt after I missed a boat from work today but as soon as I said 'never mind' the pain got less. The pain isn't in your mind, it is real. But anxiety makes it worse. No doubt.

Re: amen to Brian

D.Thomas on 8/15/02 at 10:15 (092554)

Scott W.,

I wish to apologize. I am not a doctor and wouldn't want to bias your thinking. I hope you find a good dotor that can help you find out what is causing your issues. Good Luck :)

Re: amen to Brian

ScottW on 8/15/02 at 11:34 (092558)

No need to apologize. Any information helps. I know you are not a doctor, but I'm finally to realizing that doctors do not have all the answers either.

I would like to know more about how you got your PF? How old are you? What doctors have you been to, tests done, etc... We sound like pretty similar cases. In fact I'm sitting at my desk right now with my feet elevated on a stool. Let me know a little more of your story if you have the time. Thanks!

Re: amen to Brian

D.Thomas on 8/15/02 at 19:39 (092614)

I'm 36 years old. I first developed PF 8 years ago while hanging out in music clubs that had solid concrete floors. I went to a Pod and he prescribed orthotics and gave me two cortisone shots and sent me to PT. My feet settled down and I didnt feel that much pain for 3 years. After the 3rd year, the pain came back and I went to see an Ortho, he sent me to a Cped to redo my orthotics. My feet settled down again but I couldn't stay on them as long as in the past before they started to throb. So I basically changed my life and didn't overdo it on my feet.

A year and half ago they really started to get upset. They started up again becuase I started walking at night with my wife. I went to 3 different Pods to find out for once and all what was wrong with them. Well, stupid me let this one Pod talk me into a new set of orthotics. They were 3/4 rigid hard. I have high arches and they pushed all they way up into them. I complained to the Pod that the pain was really getting bad and that I could barely walk at all anymore. He is the one that told me I needed to stop thinking about the pain. I was actually going through some pretty hard times and I had some anxiety during this time. He knew about that and I think he thought I was making up the pain.

Anyway, I went to 3 other Pods and 2 Orthos but finally found one that someone I knew recommended who had PF. We tried stretching, Vioxx, tape, PT, ART Release, etc. And nothing really helped. He then decided that he wanted to do a fasica release.

Well, by this time I decided to visit Dr. Manoli who posts here every once in a while becasue he seemed to understand and have good experience with the cavus (high arch) foot. Bascically he told me that he was very against the plantar fascia cutting because of the detrimental effect on the long and short plantar ligaments, where the strain increases 60-70%. He stated an article is coming out in foot and ankle international any month now and he stated my cavus feet with the plantarflexed 1st rays makes my heel cords act like they are tighter, as the plantar plane is angled downward. He wants to lengthen my gastroc. He also thinks I have plantar fibromastosis.

My pain is in the medial band of the fascia on both feet. It is in the arches. I have not had one day in a year and a half where I have not felt pain. I have not dropped below a pain level of 6. The inflammmation is a complete bummer, it makes the whole bottom of my feet throb and hurt. I have had some of the Pods say I have a trapped nerve. I had a nerve test (EMG or whatever it is called) and it came up positive, but some of the Pods don't believe in the test and didn't trust it. It all depends which doctor you talk to about it. My feet actually had a vibration feeling for about four months. That's why some of them thought I had a trapped nerve or that I was starting to develop TTS.

Depending how much I am on my feet, depends how much I have to ice. I usually ice 3 times a day, sometimes 5 or 6 times a day. I can not wear socks because my feet are too sensitive. And I always have my air condition on them in the car without my shoes on. I haven't taken a shower in a year becuase I can't stand on them long enough, I can only take baths. I sleep with my feet on pillows so they are above my heart at night. Believe it or not, I have actually learned to live with the pain so it doesn't drive me crazy as much as it did.

I don't know if any of this helps, but I hope you find a CURE! That's what we are all looking for.

Re: amen to Brian

Tammie on 8/15/02 at 19:50 (092617)

D Thomas , it sounds as tho you pretty well checked things out so what is the plan for you now if I might ask? I came in this thread late but reading this made me stop and want to say I hear you and I hear your pain . I also hear that you are still into this looking with all that have had terrible pain and have foot troubles that dont seem to match the pain or the pain levels they have for us.

About the sensitivity with socks , have you been to see a pain management ? have they looked into something called RSD? There have been some very good threads hear where a few that have this RSD talked about it. You should look for it as maybe it may click with u? The sensitivity seems a big part of this RSD that is what I have been told over and over till I know it in my sleep! Just a thought . My best hopes for you finding the rainbows end!

Re: Anxiety - the cause of PF???

Tammie on 8/15/02 at 20:17 (092618)

Cleveland Clinic ? Interesting, Can I ask the name of this Rheum/DOC?
My husband has one from there and just curious if it might be him?
Small world if you close to go there. It is about a hour or so away. They rave about there Doctors, But there are people not GOD as some like to blindly believe. In any case I am sorry no answers there, I have been thinking also to maybe see one and just be sure there is nothing there. I a checking into a good neuro also . Did you find one yet? Take care and Sorry the clinic didint have a miracle !

I wonder how much restraint you had to keep from bopping him when he said anxiety ? never heard that directly / when there is pain of course ther is a bit of it,the pain causes that not visa versa? I would have guessed he would tell a woman something such as this but interesting that you sat there and heard this with out walking out or bopping him lol. YOU are Great!! Keep looking that pot of gold has to be here somewhere!!! If I find it first I will share it with all of you here my good fortune!

Re: should also mention the fact is that i am verry unlucky lol (nm)

Tammie on 8/15/02 at 20:19 (092619)

ha ha no luck keep searching

Re: Anxiety - the cause of PF???

ScottW on 8/16/02 at 06:45 (092649)

Dr. Bernard Singsen was his name. He probably had a minor in psychology! Don't get me wrong though, he was a very nice guy. He was just a bit on the arrogant side to be able to say what he said without truly understanding what I have been going through. But to be honest, that is how I might have been if I were in his shoes (i.e. my feet didn't hurt). My feet look normal on the outside, I look healthy, yet I can barely walk or stand for 10 minutes. If I didn't have it myself, I would probably think it was all in the head if someone told me they had 'bad' feet! I think Julie hit the nail on the head with her post, this Dr. just didn't have an answer for me based on his training and he probably thought he would try to 'help' me anyway he could!

Re: Anxiety - the cause of PF???

Leon S. on 8/19/02 at 15:07 (092920)

I read with interest the diagnosis of anxiety causing the pain. I am a recent (2 mos) sufferer of what I now know is PF. I have been a casual runner and walker for about 25 yrs and only in June did I start to develop all the symptoms in my left foot. I went on vacation for 3 weeks in July and for some reason the pain seemed to disappear to the point that I was able to resume my regular (and sometimes accelerated) running habits without any residual pain afterwards. The first day back to work (I normally walk approx. 1 1/4 miles each way to keep up my exercise routine) I could barely walk and was in alot of pain by the time I got to the office. Strange as it seems, it appears to me that the relaxation of being on vacation might have had something to do with the pain clearing up and the stress of returning to work might have brought it back. Two days ago I started taking ibuprophen and that helped alot.

Re: Anxiety - the cause of PF???

scott r on 8/19/02 at 16:14 (092926)

Breaking your routine can have more of an effect than stress. Stress can cause inflammation and many other things, but I think it's over a much longer period of time. The difference in what shoes you wear on vacation verses work, the amount of walking or the type of floors, and probably other things. But if it is anxiety, I can recommend nothing stronger than 3 or 4 grams of vitamin C 4 times a day for a month, and a B-50 complex each day.

Anybody going to Destin for labor day?

Re: Anxiety - the cause of PF???

Carole C in NOLA on 8/19/02 at 17:59 (092932)

Nope, instead of Destin I'll be moving into my new house over Labor Day weekend. Have fun!

Carole C

Re: Baths and Showers and getting clean! :)

Carole C in NOLA on 8/19/02 at 18:35 (092934)

D. Thomas, I am so saddened to hear about what an awful time you have had with PF despite all you have done. Like Tammie says it sounds like you have been doing the right things.

In the interest of 'covering all bases', which you have pretty much done already, here's one small thing that I noticed which might help, possibly. Well, it all depends on how you get in and out of your bathtub....

If you do it in the normal way, then you are taking a step into the tub barefoot and then sitting down, and then you are standing up barefoot and stepping out of the tub. Standing up barefoot on porcelain can be SO hard on the plantar fascia. I don't know about other people, but I feel certain that I could not have healed much at all if I did that. I would have been re-injuring my feet every day, slightly.

I tried taking baths without stepping into or out of the tub, but couldn't figure out how. If you have then you probably don't need my suggestions, but I'll go ahead and suggest anyway. If the following doesn't help you, maybe it will help someone else. Here goes:

I'd suggest taking showers. Buy a good, stable shower stool at a medical supply store and adjust it to the right height for you. Also, buy some shower shoes that work for you. (I wasn't able to find shower shoes with sufficient arch support fast enough, so I use some Nike waterproof sandals with inch thick plastic soles that provide a lot of cushioning.)

When taking a shower, put the shower shoes on to step into the shower and then sit on the shower stool. (If you decide to get a stool but not to get shower shoes, then sit on the stool before slipping your feet out of your regular shoes.)

The reason to sit during most of your shower even if you have shower shoes is that most shower shoes don't provide the amount of support provided by regular shoes.

The reason to have the shower shoes is that you don't take even one step barefoot, and also they allow you to stand briefly in the shower if you wish. Thirdly, perhaps you have noticed that when seated, sometimes the weight of your legs can put pressure on your feet. Having shower shoes protects your feet from that weight while they are on porcelain or tile that makes them so vulnerable to re-injury.

I know this sounds a little obsessive, but I found that my shower stool made a HUGE difference in my recovery. Total cost for me was $50 for the shower stool (it's worth it to get a good one, though), and $20 for my Nike sandals. Like all PF stuff, that's a lot, but if it works it's cheaper than some procedures.

I hope this helps. It helps to have a shower massager on the long flexible handle, to aim at different parts of you while you sit, but that probably isn't absolutely necessary.

Carole C

Re: Anxiety - the cause of PF???

john h on 8/20/02 at 08:26 (092972)

Scott: I will be in Destin the for a week begining 15 September. I stay at the Destin Gulfgate which is about 1/2mile west of the Back Porch.

Re: destin Aug 31 to Sept 2

scott r on 8/20/02 at 09:48 (092983)

John, well that's no good, you gotta show up 2 weeks earlier. I figured I could go to san fran some other time.

Re: Anxiety - the cause of PF???

Scott R on 8/14/02 at 13:59 (092475)

most definitely you need to see a neurologist.

Re: Anxiety - the cause of PF???

BrianJ on 8/14/02 at 14:02 (092478)

Scott --

As you know, my problem is very similar to yours (bilateral heel pain secondary to repeated athletic participation on a hard surface). The small difference is that most of the time, it's just my heels that hurt. Only when I drive (using pedals) or otherwise stress my feet do the ENTIRE bottoms of the feet AND my ankles hurt.

I can promise you that the problem is not just in our heads, but I think it is quite possible that stress is or was a factor. When I hurt my feet five years ago, I was also going through a great deal of job-related stress. It's no secret that stress can have physical manifestations -- and that healing is better in a positive, non-stressful environment.

Be that as it may, the real question is what do we do now? I agree that ruling out spinal stenosis and looking at other nerve and rheumatic issues are good ideas. We must keep trying, and frequently failing, in order to finally understand why our feet hurt and how we can make them feel better.

Re: Anxiety - the cause of PF???

D.Thomas on 8/14/02 at 19:04 (092496)

Scott,

Welcome to our party :) My PF pain is mainly in the arches, but after standing about 5 to 10 min the pain comes the the inflammation that develops and is the whole bottom of my feet until I ice again. I do not have the classic morning pain, my feet are stiff in the morning but not painful on the first step. I cannot have my shoes on more than 30 min before I need to elevate my feet in some fashion to keep the inflamation down. I cannot wear socks becuase of the sensitivity. I have to have the air condition in my car blow on them to keep them cool and the inflamation down whenever I'm driving. I have my legs up all day at work (thank god I have a desk job).

I am not a doctor but what you posted sounds like PF to me. Just because you don't have morning pain or the pain isn't in the heel doesn't mean you don't have PF. It means you found a doctor who doesn't know squat about PF.

Sometimes it can take a few times before you find a good doc. I actually had one POD who told me that my problem was that I was thinking about the pain to much and I need to stop thinking about the pain. Hang in there, and look around and ask people, you'll find a good one. Sometimes they are hard to find but if you keep looking you will find one. It took me about 8 or 9.

Re: Anxiety - the cause of PF???

anon on 8/14/02 at 19:31 (092497)

Ditto D thomas Scott....Pf takes on many forms. This is one of them.

Re: Anxiety - the cause of PF???

Shaira on 8/14/02 at 22:59 (092512)

You've definitely got it. I don't think a lot of doctors really *know* about this disease, you know?

Pain like your having is definitely PF.

Re: Anxiety - the cause of PF???

BrianJ on 8/14/02 at 23:10 (092516)

Scott --

While I respect the other posters who have responded to your message, I would urge you NOT to blindly accept the idea that your problem is just PF. Yes, PF is the most common cause of heel pain, and yes, PF takes many forms. However, you should rule out the other things we discussed, as well as considering whether you may have entrapment of the first branch of the lateral plantar nerve. Don Baxter and others have written numerous articles about this nerve entrapment, and the March 2002 edition of Foot and Ankle International suggests that this entrapment is much more common than previously thought.

Re: Anxiety - the cause of PF???

Julie on 8/15/02 at 02:50 (092524)

I agree with Scott R. Do see a neurologist. And don't assume it is PF. If it is a nerve-related condition, treating yourself for PF may be losing valuable time: these things get worse.

The pains in your legs, knees and hips could be knock-on effects of the changes you've made in your way of walking to accommodate your foot pain, or they could be nerve-related (coming from your spine). Either way, the sooner you get to the bottom of it, the better.

Pay no attention to the rheumatologist's remark. He probably knows his rheumatology, and probably isn't a quack - you just weren't in his field of vision and knew he couldn't help you from his own particular specialism. Some consultants are like this. I had a discussion with an orthopaedic consultant once (in a social, not a medical context) who flatly declared that there is no such thing as RSI (repetitive strain injury) and that it was all 'emotional'. Go figure.

Re: amen to Brian

Scott R on 8/15/02 at 06:55 (092529)

Yes, as we told Scott W back in June, he needs to see a neurologist. I didn't read anyhting in his post that makes me think he has PF.

Re: amen to Brian

ScottW on 8/15/02 at 07:53 (092537)

I plan to see a neurologist soon. What if they say it is 'not a nerve problem', which at this point I am expecting? Does that mean I am left with some weird form of PF as my diagnosis or are there other options?

Re: Anxiety - the cause of PF???

BrianJ on 8/15/02 at 09:01 (092542)

Scott --

The neurologist will examine your feet (high-arched feet are more prone to neuropathy). He/she will also do sensation tests using a toothpick to lightly prick your feet and a reflex test with a small rubber hammer as well. Finally, the neurologist may do a nerve conduction velocity (NCV)test, which measures the speed with which nerve impulses travel from one part of your foot to another.

NCV tests will often pick up problems like tarsel tunnel syndrome, but will almost never pick up entrapment of the first branch of the lateral plantar nerve. Thus, a negative NCV test does not prove the absence of a nerve problem.

Re: Scott - why not cross that bridge when you come to it?

Julie on 8/15/02 at 09:24 (092544)

**

Re: Don't worry if neurological

Sandy H. on 8/15/02 at 09:52 (092549)

If it is neurological. ie related to your spine then you can do a lot of work on the muscles that support your spine to help the condition improve. I'm getting better (slowly) by core stability and physio to get my hip in a neutral position. If you find that the pain gets worse when you are stressed well that is quite normal as back pain always gets worse when you are stressed. That is because your muscles tense up ready for 'fight or flight' and then you don't work it out, tense muscles become sore muscles, soreness leads to tension and on and on. The trick is to recognise the signs and do something to shake out the tension. RSI is related to anxiety and stress, at least it certainly was when I had it in my hands from typing and my feet certainly hurt after I missed a boat from work today but as soon as I said 'never mind' the pain got less. The pain isn't in your mind, it is real. But anxiety makes it worse. No doubt.

Re: amen to Brian

D.Thomas on 8/15/02 at 10:15 (092554)

Scott W.,

I wish to apologize. I am not a doctor and wouldn't want to bias your thinking. I hope you find a good dotor that can help you find out what is causing your issues. Good Luck :)

Re: amen to Brian

ScottW on 8/15/02 at 11:34 (092558)

No need to apologize. Any information helps. I know you are not a doctor, but I'm finally to realizing that doctors do not have all the answers either.

I would like to know more about how you got your PF? How old are you? What doctors have you been to, tests done, etc... We sound like pretty similar cases. In fact I'm sitting at my desk right now with my feet elevated on a stool. Let me know a little more of your story if you have the time. Thanks!

Re: amen to Brian

D.Thomas on 8/15/02 at 19:39 (092614)

I'm 36 years old. I first developed PF 8 years ago while hanging out in music clubs that had solid concrete floors. I went to a Pod and he prescribed orthotics and gave me two cortisone shots and sent me to PT. My feet settled down and I didnt feel that much pain for 3 years. After the 3rd year, the pain came back and I went to see an Ortho, he sent me to a Cped to redo my orthotics. My feet settled down again but I couldn't stay on them as long as in the past before they started to throb. So I basically changed my life and didn't overdo it on my feet.

A year and half ago they really started to get upset. They started up again becuase I started walking at night with my wife. I went to 3 different Pods to find out for once and all what was wrong with them. Well, stupid me let this one Pod talk me into a new set of orthotics. They were 3/4 rigid hard. I have high arches and they pushed all they way up into them. I complained to the Pod that the pain was really getting bad and that I could barely walk at all anymore. He is the one that told me I needed to stop thinking about the pain. I was actually going through some pretty hard times and I had some anxiety during this time. He knew about that and I think he thought I was making up the pain.

Anyway, I went to 3 other Pods and 2 Orthos but finally found one that someone I knew recommended who had PF. We tried stretching, Vioxx, tape, PT, ART Release, etc. And nothing really helped. He then decided that he wanted to do a fasica release.

Well, by this time I decided to visit Dr. Manoli who posts here every once in a while becasue he seemed to understand and have good experience with the cavus (high arch) foot. Bascically he told me that he was very against the plantar fascia cutting because of the detrimental effect on the long and short plantar ligaments, where the strain increases 60-70%. He stated an article is coming out in foot and ankle international any month now and he stated my cavus feet with the plantarflexed 1st rays makes my heel cords act like they are tighter, as the plantar plane is angled downward. He wants to lengthen my gastroc. He also thinks I have plantar fibromastosis.

My pain is in the medial band of the fascia on both feet. It is in the arches. I have not had one day in a year and a half where I have not felt pain. I have not dropped below a pain level of 6. The inflammmation is a complete bummer, it makes the whole bottom of my feet throb and hurt. I have had some of the Pods say I have a trapped nerve. I had a nerve test (EMG or whatever it is called) and it came up positive, but some of the Pods don't believe in the test and didn't trust it. It all depends which doctor you talk to about it. My feet actually had a vibration feeling for about four months. That's why some of them thought I had a trapped nerve or that I was starting to develop TTS.

Depending how much I am on my feet, depends how much I have to ice. I usually ice 3 times a day, sometimes 5 or 6 times a day. I can not wear socks because my feet are too sensitive. And I always have my air condition on them in the car without my shoes on. I haven't taken a shower in a year becuase I can't stand on them long enough, I can only take baths. I sleep with my feet on pillows so they are above my heart at night. Believe it or not, I have actually learned to live with the pain so it doesn't drive me crazy as much as it did.

I don't know if any of this helps, but I hope you find a CURE! That's what we are all looking for.

Re: amen to Brian

Tammie on 8/15/02 at 19:50 (092617)

D Thomas , it sounds as tho you pretty well checked things out so what is the plan for you now if I might ask? I came in this thread late but reading this made me stop and want to say I hear you and I hear your pain . I also hear that you are still into this looking with all that have had terrible pain and have foot troubles that dont seem to match the pain or the pain levels they have for us.

About the sensitivity with socks , have you been to see a pain management ? have they looked into something called RSD? There have been some very good threads hear where a few that have this RSD talked about it. You should look for it as maybe it may click with u? The sensitivity seems a big part of this RSD that is what I have been told over and over till I know it in my sleep! Just a thought . My best hopes for you finding the rainbows end!

Re: Anxiety - the cause of PF???

Tammie on 8/15/02 at 20:17 (092618)

Cleveland Clinic ? Interesting, Can I ask the name of this Rheum/DOC?
My husband has one from there and just curious if it might be him?
Small world if you close to go there. It is about a hour or so away. They rave about there Doctors, But there are people not GOD as some like to blindly believe. In any case I am sorry no answers there, I have been thinking also to maybe see one and just be sure there is nothing there. I a checking into a good neuro also . Did you find one yet? Take care and Sorry the clinic didint have a miracle !

I wonder how much restraint you had to keep from bopping him when he said anxiety ? never heard that directly / when there is pain of course ther is a bit of it,the pain causes that not visa versa? I would have guessed he would tell a woman something such as this but interesting that you sat there and heard this with out walking out or bopping him lol. YOU are Great!! Keep looking that pot of gold has to be here somewhere!!! If I find it first I will share it with all of you here my good fortune!

Re: should also mention the fact is that i am verry unlucky lol (nm)

Tammie on 8/15/02 at 20:19 (092619)

ha ha no luck keep searching

Re: Anxiety - the cause of PF???

ScottW on 8/16/02 at 06:45 (092649)

Dr. Bernard Singsen was his name. He probably had a minor in psychology! Don't get me wrong though, he was a very nice guy. He was just a bit on the arrogant side to be able to say what he said without truly understanding what I have been going through. But to be honest, that is how I might have been if I were in his shoes (i.e. my feet didn't hurt). My feet look normal on the outside, I look healthy, yet I can barely walk or stand for 10 minutes. If I didn't have it myself, I would probably think it was all in the head if someone told me they had 'bad' feet! I think Julie hit the nail on the head with her post, this Dr. just didn't have an answer for me based on his training and he probably thought he would try to 'help' me anyway he could!

Re: Anxiety - the cause of PF???

Leon S. on 8/19/02 at 15:07 (092920)

I read with interest the diagnosis of anxiety causing the pain. I am a recent (2 mos) sufferer of what I now know is PF. I have been a casual runner and walker for about 25 yrs and only in June did I start to develop all the symptoms in my left foot. I went on vacation for 3 weeks in July and for some reason the pain seemed to disappear to the point that I was able to resume my regular (and sometimes accelerated) running habits without any residual pain afterwards. The first day back to work (I normally walk approx. 1 1/4 miles each way to keep up my exercise routine) I could barely walk and was in alot of pain by the time I got to the office. Strange as it seems, it appears to me that the relaxation of being on vacation might have had something to do with the pain clearing up and the stress of returning to work might have brought it back. Two days ago I started taking ibuprophen and that helped alot.

Re: Anxiety - the cause of PF???

scott r on 8/19/02 at 16:14 (092926)

Breaking your routine can have more of an effect than stress. Stress can cause inflammation and many other things, but I think it's over a much longer period of time. The difference in what shoes you wear on vacation verses work, the amount of walking or the type of floors, and probably other things. But if it is anxiety, I can recommend nothing stronger than 3 or 4 grams of vitamin C 4 times a day for a month, and a B-50 complex each day.

Anybody going to Destin for labor day?

Re: Anxiety - the cause of PF???

Carole C in NOLA on 8/19/02 at 17:59 (092932)

Nope, instead of Destin I'll be moving into my new house over Labor Day weekend. Have fun!

Carole C

Re: Baths and Showers and getting clean! :)

Carole C in NOLA on 8/19/02 at 18:35 (092934)

D. Thomas, I am so saddened to hear about what an awful time you have had with PF despite all you have done. Like Tammie says it sounds like you have been doing the right things.

In the interest of 'covering all bases', which you have pretty much done already, here's one small thing that I noticed which might help, possibly. Well, it all depends on how you get in and out of your bathtub....

If you do it in the normal way, then you are taking a step into the tub barefoot and then sitting down, and then you are standing up barefoot and stepping out of the tub. Standing up barefoot on porcelain can be SO hard on the plantar fascia. I don't know about other people, but I feel certain that I could not have healed much at all if I did that. I would have been re-injuring my feet every day, slightly.

I tried taking baths without stepping into or out of the tub, but couldn't figure out how. If you have then you probably don't need my suggestions, but I'll go ahead and suggest anyway. If the following doesn't help you, maybe it will help someone else. Here goes:

I'd suggest taking showers. Buy a good, stable shower stool at a medical supply store and adjust it to the right height for you. Also, buy some shower shoes that work for you. (I wasn't able to find shower shoes with sufficient arch support fast enough, so I use some Nike waterproof sandals with inch thick plastic soles that provide a lot of cushioning.)

When taking a shower, put the shower shoes on to step into the shower and then sit on the shower stool. (If you decide to get a stool but not to get shower shoes, then sit on the stool before slipping your feet out of your regular shoes.)

The reason to sit during most of your shower even if you have shower shoes is that most shower shoes don't provide the amount of support provided by regular shoes.

The reason to have the shower shoes is that you don't take even one step barefoot, and also they allow you to stand briefly in the shower if you wish. Thirdly, perhaps you have noticed that when seated, sometimes the weight of your legs can put pressure on your feet. Having shower shoes protects your feet from that weight while they are on porcelain or tile that makes them so vulnerable to re-injury.

I know this sounds a little obsessive, but I found that my shower stool made a HUGE difference in my recovery. Total cost for me was $50 for the shower stool (it's worth it to get a good one, though), and $20 for my Nike sandals. Like all PF stuff, that's a lot, but if it works it's cheaper than some procedures.

I hope this helps. It helps to have a shower massager on the long flexible handle, to aim at different parts of you while you sit, but that probably isn't absolutely necessary.

Carole C

Re: Anxiety - the cause of PF???

john h on 8/20/02 at 08:26 (092972)

Scott: I will be in Destin the for a week begining 15 September. I stay at the Destin Gulfgate which is about 1/2mile west of the Back Porch.

Re: destin Aug 31 to Sept 2

scott r on 8/20/02 at 09:48 (092983)

John, well that's no good, you gotta show up 2 weeks earlier. I figured I could go to san fran some other time.