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plantar fibroma (?) podiatrist vs orthopedist

Posted by irene w on 11/07/02 at 09:51 (099557)

I would like to know if I should be referred (HMO) to an orthopedist specializing in foot and ankle rather than a podiatrist. I have a tumor on the upper part of my left foot arch growing and radiating itch, burn and pain. If it has to be cut should I not prefer to have it done by an orthopedist since I cannot check the background and experience of podiatrists? I look forward to your response. Thank you.

Re: plantar fibroma (?) podiatrist vs orthopedist

Dave R on 11/07/02 at 10:53 (099563)

Irene,

I too have a plantar fibroma. Based on my unique experience I would first explore ALL other more conservative methods to treat the fibroma (see below).
If next year I do decide to have the surgery I will most likely go to an Ortho that has performed this surgery at least 5 times....if I can find one....and then ask him to define the proceedures and risks for the surgery (Steindler plantar fascial stripping)

Whether you use a Pod or an Ortho.....check for references....ask for them. And most importantly research your options thoroughly.

So far I've seen 3 Pods...their recommendations ranged from surgery immediately....to orthotics.

see this website below for the surgery details.............
http://www.podiatrynetwork.com/document_disorders.cfm?id=263

Two months ago I was scheduled to have surgery to remove a plantar fibroma from my right heel/arch. My pod performed an ultrasound were is was discovered that I had a wide thickening of the plantar fascia near the heel....his conclusion a large plantar fibroma...his suggestion..surgery.

The week before surgery I did alot of research and sought as much on-line advice as I could get. This led me to have questions that I needed to ask my Pod. I can definitely say that I did not receive all the important facts about the surgery....actually I was told the I would not miss the plantar fascia that was to be removed. I stopped in my Pods office and let the staff know that I had a couple important questions to ask my Pod about the upcoming surgery....and asked if he could call me either that day, evening, or sometime the following day. The staff person rudely told me that the Pod has other patients...and if I wanted to ask the Dr any questions I would have to schedule ANOTHER 'surgery counseltation' appointment later in the week. I left the office and cancelled the surgery. Also that same day I went to another Pod for a second opinion.

The second opinion also suggested surgery based on his firm belief in general that a tumor is a tumor and should be removed. However, he also suggested an MRI. I went back to my original Pod who then scheduled me for an MRI. Here's what the MRI revealed...........................

'39 yr old male has pain in the medial arch near heel' '

1. Large focal thickening of the central band of the plantar facia is noted at the plantar aspect of the medial arch with diffuse increased signal noted within its substance, approximately 8 cm distal to its calcaneal original. The MRI findings are consistant with a very chronic interfacial tear or developing plantar fibroma/interfacial fibrosis. Proximal and distal to this area the 3 bands appear normal in their signal intensity and morphology. It must be noted that there is no interfacila tear found. The plantar fat pad appears normal in its thickness and signal intensity

2. Mild tenosynovitis of the flexor hallucis longus tendon. Due to a mild amount of high T2 signal fluid is noted around the tendon from its myotendinous origin to the knot of Henry. High signal fluid causing distention of the tendon sheath is consistant with tenosynovitis. (all other observances of the right ankle and forefoot are normal) '

Basically what this MRI proves is that have plantar fasiitis at the insertion of the heel bone....may or may not be a fibroma/tear. And remember...I was on my way to a fairly painful and debilitating surgery...that is often not a success in the long run.

With the MRI results I went back to the Pod...he then suggested that we will persue wearing the punched-out orthotics. Based on my reseach I suggested...a below the knee cast to protect the foot and brace it to prevent rupture of the tendon....he agreed.

So I wore a removable walking cast during all day long for 3 weeks. In the morning and evening I apply cold and hot packs...to reduce the minor swelling and hopefully trigger some healing.

I've been wearing my newly adjusted 'punched out' orthotics since 10/31 and the heel/arch area is considerably less irritated. After 1 to 2 months of wearing the orthotics if there is no still problems I will reconsider the surgery.

That's where I am with this now....hope my little adventure is of help to you.

Re: plantar fibroma (?) podiatrist vs orthopedist

chuck on 11/07/02 at 15:44 (099590)

If you're dealing with HMO's, depending on the policy you have they won't pay for podiatry....although I've had HMO's pay for procedures they supposedly weren't supposed to cover so......

The way it was explained to me was this: orthopedists cover everything to the ankle, then anything below that is considered podiatry, but who knows? Again, it depends on the HMO contract you have and your faith in your Primary Care Physician.

Good luck and keep us posted as to your outcome

Re: plantar fibroma (?) podiatrist vs orthopedist

Dr. John Cozzarelli on 11/07/02 at 19:47 (099600)

Hi Irene:

Both doctors should have experience removing these. I would go with the doctor you feel most comofrtable with. A doctor patient relationship is an individual thing. In my practice I have probably operated on about 50 in the last 15 years.

Dr. John Cozzarelli

Re: plantar fibroma (?) podiatrist vs orthopedist

Ed Davis, DPM on 11/07/02 at 21:22 (099606)

Most plantar fibromatosis can be effectively treated via injection therapy -- Traimcinolone plus Wydase. Do a search on this site to find out more.
Ed

Re: plantar fibroma (?) podiatrist vs orthopedist

Ed Davis, DPM on 11/07/02 at 21:23 (099607)

One can check out the background and experience of any physician -- podiatrist or orthopedic.
Ed

Re: plantar fibroma (?) podiatrist vs orthopedist

Dave R on 11/07/02 at 10:53 (099563)

Irene,

I too have a plantar fibroma. Based on my unique experience I would first explore ALL other more conservative methods to treat the fibroma (see below).
If next year I do decide to have the surgery I will most likely go to an Ortho that has performed this surgery at least 5 times....if I can find one....and then ask him to define the proceedures and risks for the surgery (Steindler plantar fascial stripping)

Whether you use a Pod or an Ortho.....check for references....ask for them. And most importantly research your options thoroughly.

So far I've seen 3 Pods...their recommendations ranged from surgery immediately....to orthotics.

see this website below for the surgery details.............
http://www.podiatrynetwork.com/document_disorders.cfm?id=263

Two months ago I was scheduled to have surgery to remove a plantar fibroma from my right heel/arch. My pod performed an ultrasound were is was discovered that I had a wide thickening of the plantar fascia near the heel....his conclusion a large plantar fibroma...his suggestion..surgery.

The week before surgery I did alot of research and sought as much on-line advice as I could get. This led me to have questions that I needed to ask my Pod. I can definitely say that I did not receive all the important facts about the surgery....actually I was told the I would not miss the plantar fascia that was to be removed. I stopped in my Pods office and let the staff know that I had a couple important questions to ask my Pod about the upcoming surgery....and asked if he could call me either that day, evening, or sometime the following day. The staff person rudely told me that the Pod has other patients...and if I wanted to ask the Dr any questions I would have to schedule ANOTHER 'surgery counseltation' appointment later in the week. I left the office and cancelled the surgery. Also that same day I went to another Pod for a second opinion.

The second opinion also suggested surgery based on his firm belief in general that a tumor is a tumor and should be removed. However, he also suggested an MRI. I went back to my original Pod who then scheduled me for an MRI. Here's what the MRI revealed...........................

'39 yr old male has pain in the medial arch near heel' '

1. Large focal thickening of the central band of the plantar facia is noted at the plantar aspect of the medial arch with diffuse increased signal noted within its substance, approximately 8 cm distal to its calcaneal original. The MRI findings are consistant with a very chronic interfacial tear or developing plantar fibroma/interfacial fibrosis. Proximal and distal to this area the 3 bands appear normal in their signal intensity and morphology. It must be noted that there is no interfacila tear found. The plantar fat pad appears normal in its thickness and signal intensity

2. Mild tenosynovitis of the flexor hallucis longus tendon. Due to a mild amount of high T2 signal fluid is noted around the tendon from its myotendinous origin to the knot of Henry. High signal fluid causing distention of the tendon sheath is consistant with tenosynovitis. (all other observances of the right ankle and forefoot are normal) '

Basically what this MRI proves is that have plantar fasiitis at the insertion of the heel bone....may or may not be a fibroma/tear. And remember...I was on my way to a fairly painful and debilitating surgery...that is often not a success in the long run.

With the MRI results I went back to the Pod...he then suggested that we will persue wearing the punched-out orthotics. Based on my reseach I suggested...a below the knee cast to protect the foot and brace it to prevent rupture of the tendon....he agreed.

So I wore a removable walking cast during all day long for 3 weeks. In the morning and evening I apply cold and hot packs...to reduce the minor swelling and hopefully trigger some healing.

I've been wearing my newly adjusted 'punched out' orthotics since 10/31 and the heel/arch area is considerably less irritated. After 1 to 2 months of wearing the orthotics if there is no still problems I will reconsider the surgery.

That's where I am with this now....hope my little adventure is of help to you.

Re: plantar fibroma (?) podiatrist vs orthopedist

chuck on 11/07/02 at 15:44 (099590)

If you're dealing with HMO's, depending on the policy you have they won't pay for podiatry....although I've had HMO's pay for procedures they supposedly weren't supposed to cover so......

The way it was explained to me was this: orthopedists cover everything to the ankle, then anything below that is considered podiatry, but who knows? Again, it depends on the HMO contract you have and your faith in your Primary Care Physician.

Good luck and keep us posted as to your outcome

Re: plantar fibroma (?) podiatrist vs orthopedist

Dr. John Cozzarelli on 11/07/02 at 19:47 (099600)

Hi Irene:

Both doctors should have experience removing these. I would go with the doctor you feel most comofrtable with. A doctor patient relationship is an individual thing. In my practice I have probably operated on about 50 in the last 15 years.

Dr. John Cozzarelli

Re: plantar fibroma (?) podiatrist vs orthopedist

Ed Davis, DPM on 11/07/02 at 21:22 (099606)

Most plantar fibromatosis can be effectively treated via injection therapy -- Traimcinolone plus Wydase. Do a search on this site to find out more.
Ed

Re: plantar fibroma (?) podiatrist vs orthopedist

Ed Davis, DPM on 11/07/02 at 21:23 (099607)

One can check out the background and experience of any physician -- podiatrist or orthopedic.
Ed