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atrophy in heel pad with p. f., my patient

Posted by DR Ben Pearl on 6/02/04 at 09:09 (151770)

My patient sustained 20 cortisone shots in a 2 year period by another Dr. 5 year history p.f.
She has lost between 1/16 and 1/8 inch of heeel pad tissue;
failed orthotics.PT, Nsaids previous, - bone can 1 year ago

thoughts from the panel-
I am cautious about ESWT

Re: atrophy in heel pad with p. f., my patient

SteveG on 6/02/04 at 09:14 (151773)

First of all, she needs to sue her previous doctor. I read this sort of thing on the board and I can't understand how a professional can't know something that most of us picked up the first fet weeks. I am beyond amazed.

Re: atrophy in heel pad with p. f., my patient

dave r on 6/02/04 at 13:32 (151803)

Doesnt aggressive taping techniques keep the fatty tissue from migrating?
Your patient may want to try taping and lots of it..........Would a very soft orthotic help your patient?

Re: atrophy in heel pad with p. f., my patient

Terri H. on 6/02/04 at 13:38 (151804)

I wouldn't recommend ESWT if my life depended on it. It has been an absolute nightmare. The machine used on my foot was the Dornier Ultra.

Re: atrophy in heel pad with p. f., my patient

Ed Davis, DPM on 6/02/04 at 14:40 (151809)

Dr. Ben:
That is just 'nuts.' I would be on the lookout for a calcaneal stress fracture and consider a bone scan before doing ESWT.
Ed

Re: atrophy in heel pad with p. f., my patient

Dr. David S. Wander on 6/02/04 at 17:16 (151816)

Ben,

1) It's beyond belief that any licensed doctor would actually inject cortisone 20 times. Are you sure that all these injections contained cortisone and that some weren't straight local anesthesia for pain relief? I'm just trying to come up with an alternate answer since every reader on this board knows that 20 injections of cortisone constitutes malpractice.

2) A bone scan or MRI may give additional useful information. Obviously, the bone scan would 'light up' if there is a calcaneal fracture. The MRI should also show any bone marrow edema or fracture and will also show the integrity of the tendon and will allow for visualization of the plantar fat pad.

3) Although I rarely use heel cushions or Silipos heel cushions, this is a case may be the exception and one that you may want to discuss with your local pedorthist/orthotist to fabricate an orthoses that will support the plantar fascia as well as cushion the heel and add shock absorption at the area of atrophy. A combination of Plastazote and PQ may be beneficial. Speak with your local pedorthist/orthotist and I'm sure the two of you can find the right combination of materials.

Re: atrophy in heel pad with p. f., my patient

Dr. Z on 6/02/04 at 17:56 (151822)

I like MF plastic heel cups as a firt line of trial and error . If the problem is the fat pad then the game is over. An Ultrasound would help to evaluate the pf and surrounding tissue

Re: atrophy in heel pad with p. f., my patient

Dr Ben Pearl on 6/03/04 at 09:25 (151880)

I have ordered ultrasound test. The injections were kenalog with lidocaine, yes 20.