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Question for Dr. Z, Dr. Wander

Posted by Aly on 12/05/03 at 13:39 (139411)

Hi Drs.,

I've had PF for about 20 months, brought on by an injury. In the last 2-3 weeks, after trying taping, my foot pain has escalated and seems to have spread to the inside of my ankle below the ankle bone. I am feeling a constant pressure there now, and my feet are feeling a bit like there's sand in my socks.

My question is: I have been evaluated in almost every way (extensive blood tests, spinal MRI's, ultrasound of fascia that came back normal, saw a Neurologist but did not have nerve tests done). If this is TTS starting, is there really any point for me to formally diagnose it? If I'm treating my PF with rest, anti-inflammatories, etc., is there really anything else that can be done or that I should be doing? I don't want to do the rounds with the docs again, unless I really *should*.

Thanks as always for your advice...


Re: Question for Dr. Z, Dr. Wander

Dr. David S. Wander on 12/05/03 at 14:07 (139416)

Aly, first you need a diagnosis. If you have TTS there are things that can aggravate TTS such as poor biomechanics/pronating, non-supportive shoes, certain activities, weight gain, fluid retention, etc. Have the doctors ruled out an injury to the posterior tibial tendon in addition to possible TTS?

Re: Question for Dr. Z, Dr. Wander

Aly on 12/05/03 at 14:22 (139420)

No - was only given a diagnosis of Plantar Fasciitis. My original injury was to the place where the arch attaches under the big toe - no where near the ankle. My pain symptoms gradually moved up along the arch and into my heels. Aside from the neurologist checking for Tinel's sign many months ago, I have not been evaluated for TTS.

So, am I gathering correctly from your response that treatment for TTS might be a little different than for PF, and thus I should be checked? And is MRI the best next step?

Thanks for your help Dr. Wander, much appreciated.


Re: Question for Dr. Z, Dr. Wander

RACHAEL T. on 12/05/03 at 15:20 (139426)

Dr. Wander, I sometimes get 'fluid retention' in my feet & as you know I've had PF for almost 3 yrs....have done all the conserv. treatments + orthotics + 1 ESWT, & continue to have overall soreness when my feet seem 'fluidy' swollen. I am not overweight & yes, I do try to be active when I am feeling good. But, these setbacks of fluid retention or swelling in my feet really set me back sometimes....what causes them? Can I do anything to counteract?

Re: Question for Dr. Z, Dr. Wander

Dr. Z on 12/05/03 at 16:34 (139435)

I agree with Dr. Wander, get an MRI to rule out any post tib injury, ligament injury or joint surface injury. Then a proper treatment program can be set up

Re: Question for Dr. Z, Dr. Wander

Dr. David S. Wander on 12/05/03 at 18:04 (139445)

Fluid retention can be from a variety of causes. It can be from diet, circulation/lymphatic problems, metabolic causes, heart disease, kidney disease (I'm not trying to scare you) and many other causes. You may want to speak with your internist to rule out several of the above causes. Have you ever tried any form of compressive stockings to limit edema? Naturally, if the foot has increased fluid, it will contribute to the discomfort. It's like putting 10 pounds of s--t in a 5 pound bag!

Re: Question for Dr. Z, Dr. Wander

RACHAEL T. on 12/05/03 at 21:23 (139454)

Thanks Dr. W....for your reply. And, no,you didn't scare me as I just last week did all the bloodwork, chol., & yearly exam & everything came back just yesterday - ok! I am going to watch to see if it is something in my diet...I do love popcorn as a snack. Sometimes, I think it is just from the inflamm. in the bottom of my feet....? Could that be so?

Re: Question for Dr. Z, Dr. Wander

Dr. Z on 12/05/03 at 21:29 (139457)

Have you had you viens check out?. valve damage can cause swelling in your ankle and feet