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Dr. Z please read

Posted by cherlyn Z on 3/24/04 at 21:52 (147709)

Hi Dr.Z
I had bilateral ESWT done with you 10/17/03. I am still having morning pain which gradually gets better with time. I have noticed increased 'pulling' and pain at the heel and some numbness. I feel that maybe a second treatment may be in store. I have misplaced your Email address. I have not increased my activity really, but I do have more trouble standing for any great length of time.

Re: Dr. Z please read

Dr. Z on 3/24/04 at 22:10 (147710)


If you are stilling having pain and it has been four months plus then you are correct a second treatment is in order. E-mail (email removed) and they will arrange for a treatment session. Tell them that we talked. My e-mail is footcare@comcast.net

Re: Dr. Z please read

Will B on 4/02/04 at 14:06 (148311)

cherlyn Z, I had ESWT with a Dr, Ribald in Texas about 12 weeks ago. I have not noticed much if any differnce. In the beginning and for about 2 years I had the typical PF symtptom and location, but it changed to a non-forst stpe type to a (in heel) and around the heel type of pain. I spoke with Dr Z on the phone and have seen3 doctors about this pain. Most were baffled and really could not offer a true diagnosis. TO get a diagnosis you need tests, and .. a doctor that knows what type of test to give and how to interpret the test, and the proper eqipment to do the test with. In my case sI sinly found out that some doctors try to diagnose you by what you say - and that won't do it. It 'helps', but in the end you need to know what is wrong with your feet.

If you don't have first step apin in the morning that lessens as the day goes on, and you have a buring sensation, or 'ache' that lasts all day and get's worse, you may have nerve entrapment...you can get an MRI, and diagnostic ultrasoud, or bone scan to check for entraped neves to Tarsel Tunnel, or perhaps Baxter's. I was told by some Dornier techs and a few doctors that I cotacted in Austin TX that the Dornier device and be effective also for Chronic Insertional Achilles Tendonitis if used correctly. In my case I think I mat have TTS and some Tendonitis. Chiropratic treatment actually helped more than anything a podiatrist ever did, including injections. After I see the Chiropractor I am 85-90% relieved, but it only lasts for about 3-4 weeks. I am still waiting for the Dornier to have any effect at all. If it doesn't I will get a second treatment (with a concentration on the achilles). If that does not work im inclined to get to a better Podiatrist for some real tests to rule out nerve entrapment which I may have - which would very much explian why I get such great results with Chipropractic care and no results with injections or care from a podiatrist. A good doctor that can do the test is absolutely crucial for getiing a proper diagnosis. It's bad enought that many of us on this board have a sever problem with our feet, but it's even worse when doctors will not offer proper testing to get you a 'proper diagnosis' - so that you may be treated accordingly. You dont want to spend two years with TTS and get treated for PF.

Re: Dr. Z please read

Dr. Z on 4/02/04 at 14:30 (148313)

What did I tell you about your feet?

Re: Dr. Z please read

Will B on 4/02/04 at 22:38 (148337)

Well, you were not one of the doctors that were baffled, and to add to that I only spoke with you buy phone. When I say 'baffled'- that is probably not the correct way to put it for the other docs that I spoke with but rather 'not understanding' would be a better way to describe it. I think that they didn't understand the importance of MRI and nerve testing to test for entraped nerves.On the phone with you- you said that it sounded like I might no have PF (typical), but that I might have a combination of things like possible neuropathy, tendonitis (achilles), and maybe TTS, and .. you did say that tests would be able to figure this out. The problem is, that the docs I have seen (Marciano) in Grapevine, and the one you know (Lifchen) both told me I didn't need MRI - this bothered me right away as I explained to both that I did not have 'typical' first setep pain anymore - rather that it had 'morphed' into pain on the inner heel, around tha back of the heels, and on the enire bottom of the heel. Sometimes I can still slight pain at the spot of the original insertional point (classical PF spot), and incidentally that is where the pain was a 10 out of 10 for 2 years, and just walking was hard enough. That pain slowly went away with my own PT over time, but then the pain changed for the next year and a half to what I described. Oddly - even though this pain is not at the same pain level (maybe a 6-7 out of 10) it actually keeps me off of my feet more than before, as it is more disabling because I can't manage the pain with PT or strething as well - no pain in the morning now, but burns and fells like a dull 'ache' all day and I can't stand in one spot long.It hurts badly when I sit for any length of time. Before when it was A-Typical it would hurt in the morning and hot better as the day went on. I could isolate it with therapy and insoled because it was only in the typical spot. Not anymore. Now it actually fells more like a TTS type thing to me, and that's why I need tests to rule out certain things. Marciano said flat out 'no' in an email with me. To paraphrase the Email 'No MRI or ultrasound will be given' - Ok , my relationship with that doc ended there as he seemed to not understand the importance of the MRI or other tests. I used Ribald because he had the dornier availible, and I got a fair price on the ESWT, and the tech was experienced (which is important). You also told me that the Dornier would more than likely help with 'other' problems I might have, which I also believed mainly due to my own research that I have done for two years about both the Ossatron and the Dornier. I was going to travel to NJ to have it done by you but I saved alot of travel money by finding a Doc that did it here. You were fantastic in the phone with your help and I very much appreciated it. In one month I will be at the 4 month period with the Dornier, and so far nothing much has happened. But Im still hoping, and I will certainly give it another shot with Dr.Ribald and Dornier (second treatment). I do have hope. Yet - I still would like to have doagnostic ultrasound, MRI, and or nerve testing if this does not work out. I was actually stunned that all of the docs I have seen did not recommend any testing. All of them came highly recommended. For the Record, Ribald has been really good with me but still does not think I need and MRI. I think I do. I need my life back.

Re: Dr. Z please read

Dr. Z on 4/03/04 at 17:23 (148367)


Good luck with your ESWT treatment. There may or may not be other problems associated with your heel pain. Atypical pf is very difficult treat and could be nerve related. I suggest that nerve entrapement be ruled out if no relief from the ESWT first treatment Keep us updated

Re: Dr. Z please read

Sue P on 4/04/04 at 13:04 (148385)

Will, my husband has suffered for years (and tried all the conventional remedies) with plantar faciitis and heel pain. He received the same disappointing treatment from the Grapevine Dr. as you. If you can recommend a really POD in the area, we'd appreciate it. We did not know that ESWT was available in Texas...was yours done in Arlington or Ft. Worth perhaps?

Re: Dr. Z please read

Will B on 4/04/04 at 17:45 (148391)

Mine was done by a doctor Max S. Ribald 934 North Cooper St. Arlington TX (817) 860 9121. I got he info about docs in Texas that do the Dornier in Texas from:

Central Texas Ortho Partners, LTD.
(877) 309-7105

Dr Lifchen also came recommended and is in a few prestigious medical publications. He is part of the Baylor Medical Center Groups and his office is out of Irving (972) 254-0680.My experience with Lifchen was not very good. He seemed to want to start from ground zero with me (which is not always a bad thing) but when i explained the pathology of my injury to him - he basically tries to dell me on a regimen if NSAIDS and better shoe inserts. I got X-rays (again) and he gave me some high quality inserts and told me to put them inside my tennis shoes. He asked 'why' I was not putting them right away in my new Brooks shoes - and I told hm because the brooks feel pretty good as is. Verbatim from him 'If the insert that comes inside the shoe is thin you can use that insert inside your shoe'. He actually put the inserts he gave me inside of my brooks. I told him 'not' to do that please as I told him that I knew for several reasons that it was 'not' a good idea to do this - no matter the shoe because it can create an unstable, many times too tight environment in a shoe, especially a tennis shoe. He told me I would get 'used to it'. Again, I say I am stunned at times with what supposedly experienced doctors will tell you about simple things that are flat out wrong, and if you think about the fact that this person also operates on feet, that left me thinking about his judgement and decision making with simple things, much less a complicated operations or other matters. The doc you mentioned that I saw along with your Husband was much the same but in differning ways. Just being bright, or at the top of any medical class, or being advertised in the local paper- I found out does not make a doctor 'in tune' or 'up to date' with simple, or comlicated matters. Here is how I feel. If they don't inderstand the basics of foot care and shoe care, and understand how to diagnose - past verbal communication - then don't use that doctor. It's just that simple. Doctor Ribald I would recommend as a general Podiatrist. He communicates extremely well and is friendly, and understands that basics of foot care. But right now I am in the stage of 'wait and see' for my second ESWT. I would not recommend Marciano or Lifchen. Lifchen struck me as someone who had done many operations and does do the Ossatron ESWT, but as a pay by cash patient was going to charge me $4800.00 to $3250.00 for Ribald. Lifchen while coming across very knowledgeble, seemed to not understand basic footcare (sans putting inserts in my brooks tennis shoes even when I told him we would need to remove the inserts thet were 'in' the shoes as the inserts he gave me were full length and very, very thick). So lifchen was a no go for me. Even Marciano offered me a much better deal with ESWT with the Ossatron over Lifchen - but in final alalysis, since Ribald was much more personable, and understood basic foortcare on a personal level, and he offered the Dornier at a respectable per cash basis. I went with Ribald because I could accept the level of basic treatment he could give me. Later, if ESWT does not help I may need another podiatrist for testing (MRI, Nerve conductor tests etc) from possibly an Orthopedic surgeon. Problem is that podiatrists that understand how to test and that actually believe in them is another matter I have found out. Podiatrists like the ones on this board are hard to find locally here in DFW. I wish I could. Anyway - I will let you know what happens with me and I again think the Dr's here on this very important board. I am also thinking of starting a website dedicated to heel pain sufferers for people here in DFW, or where ever. I moderate a very respected PC (computer) hardware forum and I can't see wht I can't take the same hard work and help people that suffer from this type pain. I am in the process of gathering data on who offers what here (Ossatron, Dornier, Sonocur, Diag. MRI - etc.. ART, Pain Management). Eventually I would like to allow a few docs to moderate the Q and A section of the forums should I decide to do this, and link local ESWT services (all of them) locally on the web page.

Re: Dr. Z please read

Will B on 4/04/04 at 17:57 (148394)

By the way - I had mentioned taping, heat, ice and rest, stretching with all above doctors as part of treatment I had done. None recommended MRI or any other tests.

Re: Dr. Z please read

Sally B on 5/14/04 at 20:02 (150609)

To Will B re msg on 4/2/04-
You mentioned that you had chiropractic treatment. Can you tell me what kind?
I'm a PF sufferer 2 yrs now. Have had injections, inserts, orthotics, MRI, xrays (no spurs, just classic PF), pt, acupuncture, Rx meds, Ossatron ESWT last July and to date no relief from pain. Am now back to stretching, working w/tennis balls, new inserts. Am considering endo surgery but chiro if relief is possible I will try first.

Re: Dr. Z please read

Will B on 6/01/04 at 03:55 (151673)

Sorry Sally. I don't check this board much anymore. I get a release of the heels and Myofacial release, and have had the Graston techique done a few times. Check your area for a Chiroprator that handles heel pain. Also i'm looking into ART-(Active release therapy)currently. Already had ESWT and it didn't help a bit as of 5 months. Might go for retreat but im starting to think 4 podiatrists could not correctly diagnose TTS with nerve entrapement correctly. ESWT won't help that. Chiro and ART will (to an extent provided I don't need sugical release).

Some links for you to look at



I have also had ultrasound (not diagnostic) done. To date Chiropratic care has been 'the' only thing that has helped at all so far. The more podiatrists I saw the more I started to realize I needed something different, and also better. Meaning a really good orthopedic surgeon or sports doctor that also has PT on staff that understand real treatment and most importantly diagnosis. I found it hard to believe but true, in that... doctors are just like any other type of profession. Not any better as you might expect. You chances of finding a good one are just like finding a good auto mechanic really. The key is to find one that can first accuratly diagnose your condition with a variety of tests, then be 'good' enough to offer you appropriate treatment, and most importantly the correct treatment for you. Combine that with a good Chiropractor who also foes ART and Heel release and you'll be on your way to pain recovery.