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Question for Dr. Z. and Dr. Ed

Posted by Dan D. on 10/16/03 at 00:24 (134097)

Dr. Z and Dr. Ed,

I have had pf for six years now and have have been on crutches most of those six years. I read, Dr. Z, that you said that if you don't have first step pain that you are not a good candidate for ESWT. I'm having a hard time determing whether or not I have first step pain. The longer I am standing on my feet, the worse the pain gets. I can stand or walk for just a few minutes (less than 5 min) before the pain gets severe, and I have to get off them (with crutches I can go much longer, but am still limited to the amount of time I can be on feet even with crutches).
When I am off my feet for awhile, they do get tight. While nightsplints don't cure me, they help. However, I don't have a sharp pain in the morning upon my first step. It's a little tighter than usual, but the pain is about the same throughout the day - if anything worse at the end of the day due to being on them more. The pain is located in the typical place for pf - in the heels (I have it in both feet) where the pf connects to the bone. I have tried almost all the conservative treatment mentioned on this website (except taping). After 6 years, I am ready to do something a bit more aggressive. Do I sound like a good candidate for ESWT or a better candidate for the plantar fascia release surgery?
Thanks for any advice you can give me.


Re: Question for Dr. Z. and Dr. Ed

Ed Davis, DPM on 10/16/03 at 08:19 (134111)

The first step pain is very common with PF although it is possible to have PF without first step pain. Have your doc check to see if the tenderness is in the plantar fascia itself. ESWT may be helpful -- the downside is very small.

Re: Question for Dr. Z. and Dr. Ed

Dr. Z on 10/16/03 at 20:07 (134195)


As Dr. Ed states the downside for ESWT is very small. Has an mri been done. A complete lower extremity evaluation is very important to rule out of the possible causes of heel pain. A good physical examination is very important

Re: Question for Dr. Z. and Dr. Ed

Dan D. on 10/18/03 at 03:41 (134504)

Dr. Z,

Yes, I had an MRI done a few years back. It did not show any abnormalities. I've seen over 20 doctors in the past 6 years and most have diagnosed me as having pf (although some say it's atypical).
Are you saying that pf is worth a try even though I may not have classic first step pain that is usually associated with pf?

Re: Question for Dr. Z. and Dr. Ed

Dr. Z on 10/18/03 at 11:32 (134554)

I would have to examine you to make a fair determination. I just had a patient with a typical pf that I cured with ESWT. She was 18 years old. It was either ESWT or live with it. Her life is changed after ESWT. She did have an abnormal ultrasound and severe pain on palpatoin at the pf insertion

Re: Question for Dr. Z. and Dr. Ed

Donna C on 10/26/03 at 19:09 (135681)

I also have been battling atypical pf. My pain tends to increase throughout the day and the longer I stand on my feet. I have tried every conventional treatment except surgery. I am in the process of looking into Ossotron treatment. I also am concerned as to whether I am a good candidate for this procedure since I have never experienced first step pain. I have not had an MRI. How important is this before receiving treatement and what exactly would it show?