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Diagnosed w/ PF & Heel Spur - need advice

Posted by Emily E. on 1/30/04 at 22:18 (143294)

My Podiatrist diagnosed me with PF and Heel Spur in July 2003. I received a total of 7 Cortisone injections from July to Nov. 2003 (2 injections in the months of Oct. & Nov). I cancelled my next appointment in Dec because I just couldn't face getting injection #8 mostly because they didn't seem to help much and because they are so extremely painful. Some posters on here say they've gotten a type of anesthesia prior to an injection, but my Dr. sprays a type of 'numb it spray which doesn't seem to work very well.

During my first visit the Dr. took x-rays, gave the injection, wrapped my foot and recommended several different kinds of running shoes. He recommended Adidas Poseidon, Asics Gel Foundation, Brooks Beast, Brooks Addiction, NB 1220 and/or 587, Nike Air Durham and Saucony Grid Hammer as well as Birkenstocks and the Birkenstock Blue Arch support. I got the Asics Gel, invested a small fortune in Birkenstocks and bought a pair of the Blue Arch supports. The Asics feel okay sometimes, but at other times I get more relief with the soft-bed Classic Arizona Birkenstocks. However, I get the most relief from the rubber type Birki Pacific (beach) shoes that I constantly wear around the house. I don't find much relief with the Blue Arch support mostly because I find them too hard… .no flexibility or cushion to them. I've ordered the Anywhere shoes recommended by someone on this site but I won't receive them until next week. I never walk barefoot because it's much too painful.

Bottom line, my PF is not much better than when I first started going to the Dr. My foot tends to feel a little better during the week after I get an injection and taped tightly, but then after 4 or 5 days the pain returns. My Dr. has never advised exercises, icing, physical therapy or setting a limit to the cortisone injections. I asked him once about ultrasound and he said that he used it many years ago but didn't find it to be very effective. Last time I saw him he explained in detail the ESWT procedure and what happens during surgery should it come to that. I'm sure my insurance covers the surgery, but not the ESWT procedure. I've read some postings about too many injections causing scar tissue. Could someone elaborate on that for me? If that's true, why would the podiatrist continue to inject me? Also, could some of you give me suggestions as to what I should do next. What is the difference between the stretching exercises and the Yoga exercises. I appreciate your comments…….Thanks! Emily

Re: Diagnosed w/ PF & Heel Spur - need advice

Julie on 1/30/04 at 22:34 (143296)

Emily

I happen to be awake and on line, so I'll respond to your post. I'm not a doctor, just another (recovered) PF sufferer.

I think you should consult another podiatrist. I don't mean to alarm you, but seven cortisone injections in four months is too many and you should certainly not have any more. My understanding from my reading what the doctors have said time and again here is that cortisone injections can cause weakening of the tissues, even ruptures. Two or three a year is thought to be the safe limit.

Next suggestion: read the heel pain book for information about PF and conservative treatment for it. Try the yoga foot exercises, avoid weight-bearing exercise, don't go barefoot (you don't, that's good!), and rest your foot as much as possible. Because PF is an injury, any activity that makes it hurt is re-injuring. There are differences of opinion as to how much rest is good - complete rest can obviously cause muscle wastage, but my approach to this is to carry on with one's life as far as possible, and with one's essential activities, and forego recreational walking and other weight-bearing as much as possible. I take it you don't run or do any other impact exercise?

But do see another podiatrist. From what you say it doesn't sound as though yours evaluated your biomechanics - most PF cases have a biomechanical cause (e.g. over-pronaton) and this needs to be established and addressed, possibly with custom orthotics.

You can tape your foot yourself: there are simple techniques described and illustrated in part 2 of the heel pain book. If taping gives relief, it means it is helping: it 'rests' the fascia and thus contributes to healing as well as to pain relief.
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Re: Diagnosed w/ PF & Heel Spur - need advice

Julie on 1/30/04 at 22:37 (143297)

PS. And do consider ESWT before even thinking about surgery, if everything else fails.

Re: Diagnosed w/ PF & Heel Spur - need advice

Kathy G on 1/31/04 at 09:12 (143308)

I'm not a doctor either, just have PF but I find the number of cortisone shots you've received to be alarming. Julie gave you excellent advice, beginning with finding another doctor. You were right to cancel that last appointment.

Good luck to you!

Re: Diagnosed w/ PF & Heel Spur - need advice

Emily in BR on 1/31/04 at 22:27 (143358)

Thank you both so much for responding. You don't have to be a doctor to give good advice especially when you're a 'recovered PF sufferer, although I would like to hear from them too. I appreciate your knowledge having suffered thru the effects of PF. You must have done something right somewhere down the line not to suffer anymore with the agonizing pain.

I've given a lot of thought about finding another doctor, but the one I have has a reputation of being one of the best Podiatrist in Baton Rouge. He said the cortisone injection is what gets the inflammation down along with wearing proper support shoes, but he readily admits there are other methods to treating PF. He mentioned orthotics once as a possibility, but never brought it up again. He's never mentioned anything about evaluating my biomechanics. In fact I'd never heard of this until you mentioned it in your post. As I said before, he's only discussed surgery as a possibility.....believe me I'd have to be wheelchair bound before I'd even consider the remote chance of surgery.

After reading your post I'm more concerned about the cortisone injections causing tissue damage. How do I know that the tissues haven't already been weakened after 7 injections in less than 5 months? Are there other symptoms or would it only show up with an X-Ray?

I plan to start the Yoga exercises gradually. I did the golf ball rolling under my heel several times today and I iced for 10 to 15 minutes twice today.....once this morning and once this afternoon. I think I may have over did it since it's been hurting more than usual tonight. Could I have over done the golf ball massage or icing? I applied a little pressure with the golf ball but only to the point that it hurt in a good way (if that makes sense).

Finally, I find the taping has always provided relief for me. I've only had my foot taped when I got an injection but I think I could do it too. I didn't realize it gave the fascia a chance to rest and heal. I just thought the pressure of the tape was to masked and ease the pain. Where do I get tape like the doctor uses? Can you recommend one....do I just use drugstore adhesive type tape?
Thanks again!
Emily in BR

Re: Diagnosed w/ PF & Heel Spur - need advice

Julie on 1/31/04 at 23:33 (143359)

Hi Emily

I still think you should see another podiatrist, whatever the reputation of yours. Perhaps he's coasting on his reputation - at any rate, he does not seem to have done well by you so far.

Biomechanical evaluation is very important, because if a biomechanical 'fault', or imbalance, in the way that you walk is the cause of your PF (and it is in many if not most cases) that cause needs to be addressed; injections and medication only address the symptoms. Do some research here: on the home page there is a place where you can find a list of doctors by area, and the comments of people who have seen those doctors (I think it's called 'Rate Your Doctor'). When you've got a few phone numbers, talk to them and ask them if it is part of their practice to evaluate their patients' biomechanics. You could also ask what conservative treatments they prescribe. Assuming you can get to speak to them (though the nurse or receptionist, if s/he is good, should be able to answer your questions) you will get an idea of how seriously they take PF.

I don't know the answer to your question about tissue damage, but if it has occurred, it wouldn't show up in an xray: xrays don't show soft tissues, only bones. Try not to worry about it. I hope one of the doctors will answer you on this.

The tape that I used was Leuko tape: it is made by the German firm Beiersdorf. You can get it in the States: if you key it into Google you will find sites where you can buy it on line. It's an excellent quality tape, but there are others. I liked Leuko tape because it held its tension so well, throughout a full day: some tapes will go slack after a short time.

I think you should probably be careful with the golf ball. I've never understood the point of it, unless perhaps there is scar tissue to be broken up, but that's not what you're dealing with: inflammation and injury are what you're dealing with, and I would have thought the golf ball would cause more pain, therefore more injury. But that's just an opinion. As a general rule, though, don't do anything that makes you hurt (even in a 'good way', if there is any such thing). The same with icing: it's often recommended, and many find it helpful. I didn't - it hurt while doing it, and it hurt afterwards, so I stopped. I know it's meant to reduce inflammation, but it didn't work for me, and others have found the same. There are differences of opinion among the doctors, too - some think it's good, others recommend heat. And the same applies to exercise.

The point really is that you have to decide, on the basis of experience, what works for you. But I think the most important thing is that you find another podiatrist, one who will diagnose the cause of your problem, and put a balanced treatment programme in place to address it.

I hope this is useful - all the best for your healing, Emily.

Julie
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Re: Diagnosed w/ PF & Heel Spur - need advice

Kathy G on 2/01/04 at 09:13 (143364)

Emily,

Julie said it all but while you're waiting for an appointment with another doctor, which I really think would be a good idea, why not try heat on your foot? Some of us have better luck with heat than ice and Dr. Z, a doctor who posts regularly here, strongly believes in it. It may help you.

The golf ball treatment has received mixed reviews. In my opinion, it's the rubbing that feels good and you could get the same results from someone who might be willing to massage your feet. For the most part, in my years here, it seems as though the majority of people think the ball will do more harm than good.

It's not that you're doing the wrong things. It's just that there are many medical experts who don't seem to quite understand PF and they prescibe treatments that hurt rather than help. When I went to PT, they had me doing wall stretches and stair hanging. That was about the time I found these boards and found out that neither is considered a good idea and that they may, in fact, make PF worse. Actually, my PF got much worse after PT and I just stopped going.

Good luck and please continue to ask questions. The treatment board is good as are all the others. The social board is fun and it can also be a great place to come and vent your frustration!:D

Re: Diagnosed w/ PF & Heel Spur - need advice

Dr. David S. Wander on 2/02/04 at 18:37 (143502)

Emily,

I am a doctor and also find the amount of cortisone injections you've received to be very alarming. There is a chance, that your doctor has given some of the injections with just local anesthetic, to attempt to block the nerve. If he/she has actually given you seven cortisone injections, I would ABSOLUTELY see another doctor, regardless of your doctor's reputation. Repeated cortisone injections can cause atrophy of the surrounding soft tissues and fat pad, and can cause a weakening and rupture of the plantar fascia.

Biomechanical evaluation is certainly important, and you may want to consider an MRI to determine whether there is a partial tear/complete tear of the fascia and/or a small stress fracture of the calcaneus. If your doctor has given 7 cortisone injections, DO NOT have another one.

Re: Diagnosed w/ PF & Heel Spur - need advice

john k on 2/02/04 at 20:40 (143505)

If you are even 10-15 pounds overweight and are prone to PF this can cause a flare up. It is kind of a cycle. Your feet hurt so you curtail your exercise and you put on weight and then your feet hurt more. I don't know if this describes you but it describes me to an extent.