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PF without spur, negative MRI

Posted by RalphP on 8/27/02 at 20:14 (093742)

A question for the foot docs. I've had a diagnosis of PF for 3 1/2 years now. I'm scheduled for ESWT treatment in September. Because of the planned ESWT, and in order to confirm once and for all that there was nothing going on besides PF, my pod ordered x-rays (the first on my feet in a year or two) and an MRI (the first I'd had). The x-ray showed no heel spur, and the MRI was negative -- no evidence of inflammation of the plantar fascia, or of any other abnormality in my feet. My pod was a bit nonplussed by these results, and now seems to be starting to wonder if I even have PF. He says it's very unusual to have PF for 3 1/2 years without developing a heel spur, and also a little surprising not to have anything show up on an MRI after so long. Would you start to wonder about a PF diagnosis (and ESWT treatment) in the face of these results?

Background: the pain is at the insertion point, front inside heel. Bilateral, much worse on the left foot. Pain worst in morning, late in the day, and after too much walking or standing. I've had most if not all conservative treatments. I haven't had a nerve conduction test, but my pod says no overt evidence of nerve entrapment. I have fibromyalgia, which could be a factor -- but the heel problem seems to behave exactly like straightforward PF.

Re: PF without spur, negative MRI

Dr. Zuckerman on 8/27/02 at 20:21 (093743)

Here is what I would do to confirm plantar fasciitis. I do an diagnostic ultrasound to measure the plantar fascia to see if it is thickened. Even if it is I wouldn't do ESWT on someone with Pf due to the low chance of a permanent resolution of pain. I just haven't had great long term sucess with a patient that has fibro and pf. Sorry just my experience. It is my opinion that Fibromalgia. Who and where is the ESWT being done.?

Re: PF without spur, negative MRI

RalphP on 8/28/02 at 19:46 (093826)

Thanks for the reply. The ESWT treatment is scheduled at Bayshore. I figured low-energy was probably best given my FM. The view of Bayshore's doctor, relayed to me (and I don't think this was Sunny of this board) was that while I obviously shouldn't expect ESWT to do anything for my FM, my FM wasn't a contraindication for treatment of the PF. That seems to be my pod's opinion as well, although he's never claimed to be all that familiar with ESWT.

That you haven't had much success with ESWT on people with FM is important information to me, given the huge amount of experience you've had and your successful track record. Could you tell me more? Roughly how many people with FM have you treated? What tends to happen with them? Is it no response, temporary response followed by relapse, or, God forbid, increased pain following the procedure?

My attitude heretofore has been not to expect the same probability of lasting success as the average PF sufferer, but nothing to lose. But perhaps I should reconsider.

Re: PF without spur, negative MRI

Dr. Zuckerman on 8/27/02 at 20:21 (093743)

Here is what I would do to confirm plantar fasciitis. I do an diagnostic ultrasound to measure the plantar fascia to see if it is thickened. Even if it is I wouldn't do ESWT on someone with Pf due to the low chance of a permanent resolution of pain. I just haven't had great long term sucess with a patient that has fibro and pf. Sorry just my experience. It is my opinion that Fibromalgia. Who and where is the ESWT being done.?

Re: PF without spur, negative MRI

RalphP on 8/28/02 at 19:46 (093826)

Thanks for the reply. The ESWT treatment is scheduled at Bayshore. I figured low-energy was probably best given my FM. The view of Bayshore's doctor, relayed to me (and I don't think this was Sunny of this board) was that while I obviously shouldn't expect ESWT to do anything for my FM, my FM wasn't a contraindication for treatment of the PF. That seems to be my pod's opinion as well, although he's never claimed to be all that familiar with ESWT.

That you haven't had much success with ESWT on people with FM is important information to me, given the huge amount of experience you've had and your successful track record. Could you tell me more? Roughly how many people with FM have you treated? What tends to happen with them? Is it no response, temporary response followed by relapse, or, God forbid, increased pain following the procedure?

My attitude heretofore has been not to expect the same probability of lasting success as the average PF sufferer, but nothing to lose. But perhaps I should reconsider.