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heel spur treatment and questions

Posted by stefani h on 1/29/03 at 10:56 (107241)

I have been seeing a Podiatrist since 11/05/02 for treatment of heel spur, which has involved weekly injection of steroids. I have had 12 shots in total. The pain is no where like when I first started, couldn't hardly walk in the mornings, but I feel that I should be healed by now. The doctor says give it one more month of treatment, then surgery.

Is this normal? I also have a very high arch, don't know if this has anything to do with it.I have also been taking otc motrin 800 tid, stretching and icing 3 to 4 times daily.

Am I going in the right direction?

Re: heel spur treatment and questions

SteveG on 1/29/03 at 12:03 (107242)

Wow - if I am reading this right, it sounds crazy. That is far too many shots! The limit is often thought to be 3 a year. With weekly shots, you are risking tissue damage and a rupture of the fascia; and to claim that this whole crazy process should end with surgery, I find it hard to believe that a pod would recommend such a treatment plan. Have you tried orthodics, a night splint, or the other treatments mentioned in Scott's heal book. Has your pod talked to you about ESWT. You need to find another pod in a hurry and to put an end to all those shots.

Re: heel spur treatment and questions

Dr. Z on 1/29/03 at 13:43 (107255)

too many shots. It could risk a rupture. How about physical therapy, taping, if no relief ESWT is the way to go. This is a non-invasive procedure that avoids foot surgery and all its risks and complications

Re: heel spur treatment and questions

stefani h on 1/29/03 at 13:49 (107256)

why would a specialist risk the event of rupture...............do you think I am being scammed? He does tape me up following the injection, tells me to wear it for 2 days and wear a support sock the rest of the time. It is terrible to think he may have caused me more harm.

Re: heel spur treatment and questions

SteveG on 1/29/03 at 15:17 (107257)

Stefani - I can't imagine what he is thinking. As I mentioned, that's an astonishing number of shots in so short a period of time. It does not matter that he tapes you after the shot. The risk of rupture and/or weakening of your heel pad goes up with the number of shots. You need to stop the shots and concentrate on the conservative treatments outlined in Scott's book. If these don't give you relief, then you might have to get the ESWT treatment that Dr. Z mentioned. Surgery is an absolute last resort. The fact that he even brought it up this early in your treatment is cause for alarm. In short, you need another pod ASAP. If you let us know where you live, someone here might be able to recommend one.

Re: heel spur treatment and questions

stefani h on 1/29/03 at 15:24 (107258)

Thanks for the information.........however I am enrolled in a HMO, so my choices are a little limited. I am in the Athens Georgia area.

Re: heel spur treatment and questions

SteveG on 1/29/03 at 15:30 (107260)

With the HMO, you might need to go to your primary care doctor and tell him your concerns and that you need referral to another pod - there should be more than one he can send you to. I can't believe the one they sent you to thinks he is giving you the standard treatment protocol.

Re: heel spur treatment and questions

Julie on 1/29/03 at 15:44 (107261)

Stefani, I'm sorry to say this, because I know you want to trust the doctor you are seeing, but this really cannot be right. Steroid injections can weaken the tissues, and although opinions differ, the consensus seems to be that 3 a year is the limit. I can't imagine why this podiatrist is treating you with so many, and I worry for you.

Please tell the doctor you want no more injections, and put the idea of surgery right out of your mind. It is an absolutely last resort, it deprives the foot of the supporting structure it needs, and there are a great many conservative treatments to be utilised first.

When you have found another podiatrist, I hope s/he will have a better idea of how to treat plantar fasciitis. A full examination should consist of your being watched (and possibly videod) while you walk, to determine if flawed biomechanics may have caused your PF. Once the cause is established a comprehensive treatment plan should be put in place.

Please take time to print out and read the heel pain book, for background and information, and ideas about self-treatment. But the important thing is to get under the care of a foot doctor who knows what s/he is doing. The one you have may well be doing you more harm than good.

Re: heel spur treatment and questions

Dr. Z on 1/29/03 at 16:40 (107268)

Steve G is really trying to get you some help. That amounts of steriod injections is VERY dangerous to your foot. IF you are near Atlanta there are many good podiatrists that can help you. As Steve G has told us your primary doctor can and must help you get standard podiaric help. Talk to him by making an appointment and talking to him face to fact

Re: heel spur treatment and questions

stefani h on 1/30/03 at 07:15 (107317)

I do appreciate all the help. Right now I am very concerned and will try to get in touch with my PCP today. Is there any way that I could tell right now if damage has already been done???

Re: heel spur treatment and questions

Julie on 1/30/03 at 07:57 (107320)

Stefani, worrying about it isn't going to help, so please try not to. I'm glad you're going to seek a new doctor: that's the best thing.

Try and stay off your feet as much as possible. And do read the heel pain book so that when you do see your new doctor you have a better idea of what to expect and what questions to ask.

Re: heel spur treatment and questions

stefani h on 1/30/03 at 10:30 (107349)

I have contacted my PCP and have asked for a referral to another POD with whom I spoke with on the phone and who agrees that the treatment that I have received is not acceptable. I hope to have an appt with the new doctor shortly. I will read The Heel Pain book this weekend, and will try to stay off my feet as much as possible, which is difficult.

I wear Birkenstocks 90 % of the time, and it helps. Learning how not to go barefooted is difficult, though. Thanks for the continued support and answers that you have given me.

Any continued advice is welcome.

Re: heel spur treatment and questions

SteveG on 1/30/03 at 13:01 (107371)

Stefani - Just be very careful. This would include your stretches. Don't do any wall stretches, stair stretches, and don't roll your foot on top of a golf ball -- although these are often recommended for PF patients, they are too aggressive, particularly for you after having had all those shots. The stretching you do should be very gentle. In fact, Julie teaches yoga and has outlined a series of gentle stretches on this board. Many of us have benefited from her advice. Do a search under 'Julies Stretches' and you can find them.

Re: heel spur treatment and questions

Julie on 1/30/03 at 15:59 (107382)

Stefani

Steve is right, and I agree absolutely with him that you should not do any strong stretching. If you want to have a look at the exercises Steve mentioned, just click on the word yoga - Scott has made it a link to the most recent posting of them. Even with these, take it very gently, and think of them not as a 'cure', just as a way of maintaining your range of motion.

I'm very glad you've already made contact with a new podiatrist and I hope this one will set you on the road to healing.

No bare feet! Very important!

Re: heel spur treatment and questions

FlaPod on 1/30/03 at 22:12 (107435)

12 shots in since November 5 is pure negligence. The only upside to that many injections is that if it causes the plantar fascia to rupture, then you've essentially done what he would have done with the surgery. If you go to the American College of Foot and Ankle Surgeons website, http://www.acfas.org they give a heel pain treatment algorhythm. There are so many other alternatives to consider prior to surgery. Do the tapings seem to help? If yes then you may a very good candidate for an orthotic (either custom or prefabricated). This will help control the biomechanics which is causing your heel pain. ESWT is also a very good treatment modality. You should run fast from this guy. He is doing you no good over the long run.

Re: heel spur treatment and questions

SteveG on 1/29/03 at 12:03 (107242)

Wow - if I am reading this right, it sounds crazy. That is far too many shots! The limit is often thought to be 3 a year. With weekly shots, you are risking tissue damage and a rupture of the fascia; and to claim that this whole crazy process should end with surgery, I find it hard to believe that a pod would recommend such a treatment plan. Have you tried orthodics, a night splint, or the other treatments mentioned in Scott's heal book. Has your pod talked to you about ESWT. You need to find another pod in a hurry and to put an end to all those shots.

Re: heel spur treatment and questions

Dr. Z on 1/29/03 at 13:43 (107255)

too many shots. It could risk a rupture. How about physical therapy, taping, if no relief ESWT is the way to go. This is a non-invasive procedure that avoids foot surgery and all its risks and complications

Re: heel spur treatment and questions

stefani h on 1/29/03 at 13:49 (107256)

why would a specialist risk the event of rupture...............do you think I am being scammed? He does tape me up following the injection, tells me to wear it for 2 days and wear a support sock the rest of the time. It is terrible to think he may have caused me more harm.

Re: heel spur treatment and questions

SteveG on 1/29/03 at 15:17 (107257)

Stefani - I can't imagine what he is thinking. As I mentioned, that's an astonishing number of shots in so short a period of time. It does not matter that he tapes you after the shot. The risk of rupture and/or weakening of your heel pad goes up with the number of shots. You need to stop the shots and concentrate on the conservative treatments outlined in Scott's book. If these don't give you relief, then you might have to get the ESWT treatment that Dr. Z mentioned. Surgery is an absolute last resort. The fact that he even brought it up this early in your treatment is cause for alarm. In short, you need another pod ASAP. If you let us know where you live, someone here might be able to recommend one.

Re: heel spur treatment and questions

stefani h on 1/29/03 at 15:24 (107258)

Thanks for the information.........however I am enrolled in a HMO, so my choices are a little limited. I am in the Athens Georgia area.

Re: heel spur treatment and questions

SteveG on 1/29/03 at 15:30 (107260)

With the HMO, you might need to go to your primary care doctor and tell him your concerns and that you need referral to another pod - there should be more than one he can send you to. I can't believe the one they sent you to thinks he is giving you the standard treatment protocol.

Re: heel spur treatment and questions

Julie on 1/29/03 at 15:44 (107261)

Stefani, I'm sorry to say this, because I know you want to trust the doctor you are seeing, but this really cannot be right. Steroid injections can weaken the tissues, and although opinions differ, the consensus seems to be that 3 a year is the limit. I can't imagine why this podiatrist is treating you with so many, and I worry for you.

Please tell the doctor you want no more injections, and put the idea of surgery right out of your mind. It is an absolutely last resort, it deprives the foot of the supporting structure it needs, and there are a great many conservative treatments to be utilised first.

When you have found another podiatrist, I hope s/he will have a better idea of how to treat plantar fasciitis. A full examination should consist of your being watched (and possibly videod) while you walk, to determine if flawed biomechanics may have caused your PF. Once the cause is established a comprehensive treatment plan should be put in place.

Please take time to print out and read the heel pain book, for background and information, and ideas about self-treatment. But the important thing is to get under the care of a foot doctor who knows what s/he is doing. The one you have may well be doing you more harm than good.

Re: heel spur treatment and questions

Dr. Z on 1/29/03 at 16:40 (107268)

Steve G is really trying to get you some help. That amounts of steriod injections is VERY dangerous to your foot. IF you are near Atlanta there are many good podiatrists that can help you. As Steve G has told us your primary doctor can and must help you get standard podiaric help. Talk to him by making an appointment and talking to him face to fact

Re: heel spur treatment and questions

stefani h on 1/30/03 at 07:15 (107317)

I do appreciate all the help. Right now I am very concerned and will try to get in touch with my PCP today. Is there any way that I could tell right now if damage has already been done???

Re: heel spur treatment and questions

Julie on 1/30/03 at 07:57 (107320)

Stefani, worrying about it isn't going to help, so please try not to. I'm glad you're going to seek a new doctor: that's the best thing.

Try and stay off your feet as much as possible. And do read the heel pain book so that when you do see your new doctor you have a better idea of what to expect and what questions to ask.

Re: heel spur treatment and questions

stefani h on 1/30/03 at 10:30 (107349)

I have contacted my PCP and have asked for a referral to another POD with whom I spoke with on the phone and who agrees that the treatment that I have received is not acceptable. I hope to have an appt with the new doctor shortly. I will read The Heel Pain book this weekend, and will try to stay off my feet as much as possible, which is difficult.

I wear Birkenstocks 90 % of the time, and it helps. Learning how not to go barefooted is difficult, though. Thanks for the continued support and answers that you have given me.

Any continued advice is welcome.

Re: heel spur treatment and questions

SteveG on 1/30/03 at 13:01 (107371)

Stefani - Just be very careful. This would include your stretches. Don't do any wall stretches, stair stretches, and don't roll your foot on top of a golf ball -- although these are often recommended for PF patients, they are too aggressive, particularly for you after having had all those shots. The stretching you do should be very gentle. In fact, Julie teaches yoga and has outlined a series of gentle stretches on this board. Many of us have benefited from her advice. Do a search under 'Julies Stretches' and you can find them.

Re: heel spur treatment and questions

Julie on 1/30/03 at 15:59 (107382)

Stefani

Steve is right, and I agree absolutely with him that you should not do any strong stretching. If you want to have a look at the exercises Steve mentioned, just click on the word yoga - Scott has made it a link to the most recent posting of them. Even with these, take it very gently, and think of them not as a 'cure', just as a way of maintaining your range of motion.

I'm very glad you've already made contact with a new podiatrist and I hope this one will set you on the road to healing.

No bare feet! Very important!

Re: heel spur treatment and questions

FlaPod on 1/30/03 at 22:12 (107435)

12 shots in since November 5 is pure negligence. The only upside to that many injections is that if it causes the plantar fascia to rupture, then you've essentially done what he would have done with the surgery. If you go to the American College of Foot and Ankle Surgeons website, http://www.acfas.org they give a heel pain treatment algorhythm. There are so many other alternatives to consider prior to surgery. Do the tapings seem to help? If yes then you may a very good candidate for an orthotic (either custom or prefabricated). This will help control the biomechanics which is causing your heel pain. ESWT is also a very good treatment modality. You should run fast from this guy. He is doing you no good over the long run.