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Baxter, Schon or Hamilton

Posted by DJ on 8/15/02 at 20:52 (092624)

I have a very tough decision to make and would appreciate any input or opinions I can get. I recently returned from Houston to see Dr. Don Baxter who quickly diagnosed me with 'joggers foot' (medial nerve entrapment at knot of Henry) Although he was very confident that this is what I had and told me there was a 90% chance that I would be better after surgery, I was reluctant, mostly because of how quickly he came to that conclusion without completely reviewing my injury history.
I then called Dr. William Hamilton, the well-known doctor who had referred me to Baxter. Dr. Hamilton was not surprised at Baxter's diagnosis. In fact, Hamilton had mentioned the possibility of Jogger's foot or other nerve problem before referring me to Baxter. Hamilton thought I should see Dr. Tom Novella and try orthotics before having surgery. I don't think he realized that I have tried three pairs of orthotics and they make my foot hurt worse.

Yesterday, I went to see Dr. Lew Schon, another very well known doctor who did his fellowship under Baxter. Dr. Schon was familiar with jogger's foot, has written about it, but did not think I had it and did not think I should proceed with surgery. He instead recommended I try ESWT. Needless to say this left me very confused. ESWT costs 750 per treatment in Baltimore with a minimum of 3 treatments, especially since I've never heard of anyone being successfully treated for midfoot pain with ESWT. Without Insurance coverage, ESWT is really not an option at this point. With that in mind, my options seem to be:

1) Proceed with surgery: Baxter has successfully treated many athletes. From what I've heard and read, the procedure does not seem to be very risky, although there is always that chance of negative results. In addition, Baxter has worked with many more runners than Schon, and may be more familiar with the symptoms.
2) Get another opinion from a doctor who is familiar with medial nerve entrapment.
3) Wait for ESWT to be more affordable or for insurance to cover a portion of the cost.
I'd appreciate any opinions I can get from the board. I am very eager to be able to live a normal live without pain and was ready to schedule the surgery before visiting Schon. I now have a lot to think about.

Re: Baxter, Schon or Hamilton

Dr. Zuckerman on 8/15/02 at 20:59 (092625)

Hi

Its tough to make a decision with so many different opinions from well know doctors.

Here are some questions that I have that may or may not help you

1. Any pain in the morning when you first get up. This is called heel spur syndrome.
2. Did you have foot examined after prolonged walking or actively or at the end of the day
3. Could place a very long acting local anesthetic in the areas of the nerve called Dr. Baxter's nerve. This is also called the first branch of teh lateral plantar nerve.
4. Could have nerve testing that Dr. Dellon talks about called QST

Ok here is another way to look at this. So long as there is no cutting of the fascia and there is a suspension of a neuroma of this nerve then the surgery should work or at the very least not make your foot worse.

The recommendation of ESWT instead of nerve surgery is very contradictin unless Dr. Schon doesn't know that ESWT wont work on nerve problems.

Tell me more about your foot and maybe I can give you additional advice

Re: To Doctor Zuckerman

Pete R on 8/16/02 at 04:54 (092644)

I was interested in your comment in 2. above.

Is it best to get your foot examined after some lengthy walking i.e maybe when your then in pain / sore so the Pod can see you at your worst ?

Re: To Doctor Zuckerman

Dr. Zuckerman on 8/16/02 at 08:38 (092657)

YES

Re: Baxter, Schon or Hamilton

DJ on 8/16/02 at 08:39 (092658)

Thanks for your comments Doctor.
1) I've never had the classic first step in morning pain. My pain is more midfoot and hurts more toward the end of the day and standing. The pain is toward the inside of the foot

2) I saw Hamilton and Baxter after going for a long walk prior to my appointment in an attempt to get the foot as imflamed as possible so that I could better communicate to them where the pain was.

3) My pain is about a couple inches forward of the Baxter's nerve area. I have had some nerve blocks done to the Knot of Henry area by Schon and Hamilton. Hamilton felt that he could have missed the nerve. Baxter said that it is very easy to miss this nerve and even then it is 'iffy'

4) I had an EMG nerve study done by a Neurologist that came up Negative. Baxter and Hamilton were not surprised at all by these results. He said that the EMG test is static while my pain is more dynamic. The Pain is very intermittent. Although the pain is definitely worse when I'm standing for awhile, there doesn't really seem to be much of a pattern.

Dr. Schon doesn't believe that it is a nerve problem that I have, he thought it might be some strange muscle problem, although I ended up worse if anything after spending one month on crutches. Thanks.

Re: Baxter, Schon or Hamilton

Dr. David S. Wander on 8/17/02 at 07:15 (092718)

Have any of these doctors commented on your posterior tibial tendon? This tendon is one of the tendons in the tarsal tunnel and travels from the medial ankle (inside)to the area of the navicular. It sounds like this may be your area of discomfort, though I obviously haven't examined your foot. Does it hurt to stand on your toes? Have you had an MRI to rule out soft tissue pathology other than nerve? If the doctors have not mentioned the posterior tibial tendon, maybe you should inquire. Good luck.

Re: Baxter, Schon or Hamilton

Dr. Zuckerman on 8/18/02 at 08:13 (092821)

Good point Dr. Wander. So how are doing today. Are you going to be at the pool today.??

Re: Re:Tell me more about being worse after on Crutches

Dr. Zuckerman on 8/18/02 at 08:14 (092822)

I would like to hear more about exactly what you mean by worse after being on crutches for one month

Re: Baxter, Schon or Hamilton

D.J on 8/19/02 at 22:13 (092948)

This has been looked into. My symptoms and the area of my pain were very puzzling to every doctor except for Dr. Baxter. My MRI turned out normal as well. Thanks for your help.

Re: Re:Tell me more about being worse after on Crutches

D.J on 8/19/02 at 22:16 (092949)

My pain actually seemed to be worse after being on crutches for a month. Even when I was on crutches, I could feel pain in my foot ocasionally while sitting.

Re: Baxter, Schon or Hamilton

Dr. Zuckerman on 8/15/02 at 20:59 (092625)

Hi

Its tough to make a decision with so many different opinions from well know doctors.

Here are some questions that I have that may or may not help you

1. Any pain in the morning when you first get up. This is called heel spur syndrome.
2. Did you have foot examined after prolonged walking or actively or at the end of the day
3. Could place a very long acting local anesthetic in the areas of the nerve called Dr. Baxter's nerve. This is also called the first branch of teh lateral plantar nerve.
4. Could have nerve testing that Dr. Dellon talks about called QST

Ok here is another way to look at this. So long as there is no cutting of the fascia and there is a suspension of a neuroma of this nerve then the surgery should work or at the very least not make your foot worse.

The recommendation of ESWT instead of nerve surgery is very contradictin unless Dr. Schon doesn't know that ESWT wont work on nerve problems.

Tell me more about your foot and maybe I can give you additional advice

Re: To Doctor Zuckerman

Pete R on 8/16/02 at 04:54 (092644)

I was interested in your comment in 2. above.

Is it best to get your foot examined after some lengthy walking i.e maybe when your then in pain / sore so the Pod can see you at your worst ?

Re: To Doctor Zuckerman

Dr. Zuckerman on 8/16/02 at 08:38 (092657)

YES

Re: Baxter, Schon or Hamilton

DJ on 8/16/02 at 08:39 (092658)

Thanks for your comments Doctor.
1) I've never had the classic first step in morning pain. My pain is more midfoot and hurts more toward the end of the day and standing. The pain is toward the inside of the foot

2) I saw Hamilton and Baxter after going for a long walk prior to my appointment in an attempt to get the foot as imflamed as possible so that I could better communicate to them where the pain was.

3) My pain is about a couple inches forward of the Baxter's nerve area. I have had some nerve blocks done to the Knot of Henry area by Schon and Hamilton. Hamilton felt that he could have missed the nerve. Baxter said that it is very easy to miss this nerve and even then it is 'iffy'

4) I had an EMG nerve study done by a Neurologist that came up Negative. Baxter and Hamilton were not surprised at all by these results. He said that the EMG test is static while my pain is more dynamic. The Pain is very intermittent. Although the pain is definitely worse when I'm standing for awhile, there doesn't really seem to be much of a pattern.

Dr. Schon doesn't believe that it is a nerve problem that I have, he thought it might be some strange muscle problem, although I ended up worse if anything after spending one month on crutches. Thanks.

Re: Baxter, Schon or Hamilton

Dr. David S. Wander on 8/17/02 at 07:15 (092718)

Have any of these doctors commented on your posterior tibial tendon? This tendon is one of the tendons in the tarsal tunnel and travels from the medial ankle (inside)to the area of the navicular. It sounds like this may be your area of discomfort, though I obviously haven't examined your foot. Does it hurt to stand on your toes? Have you had an MRI to rule out soft tissue pathology other than nerve? If the doctors have not mentioned the posterior tibial tendon, maybe you should inquire. Good luck.

Re: Baxter, Schon or Hamilton

Dr. Zuckerman on 8/18/02 at 08:13 (092821)

Good point Dr. Wander. So how are doing today. Are you going to be at the pool today.??

Re: Re:Tell me more about being worse after on Crutches

Dr. Zuckerman on 8/18/02 at 08:14 (092822)

I would like to hear more about exactly what you mean by worse after being on crutches for one month

Re: Baxter, Schon or Hamilton

D.J on 8/19/02 at 22:13 (092948)

This has been looked into. My symptoms and the area of my pain were very puzzling to every doctor except for Dr. Baxter. My MRI turned out normal as well. Thanks for your help.

Re: Re:Tell me more about being worse after on Crutches

D.J on 8/19/02 at 22:16 (092949)

My pain actually seemed to be worse after being on crutches for a month. Even when I was on crutches, I could feel pain in my foot ocasionally while sitting.