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PF question for podiatrist, take 2

Posted by Anne on 8/15/04 at 16:55 (158008)

I posted this a while ago, but was hoping to get a doctor's response, so I am reposting.:)
I was diagnosed with pf 4 years ago. I was working as a new grad rehab PT and typically stood 8-10 hours/day 6 days/week (oncall on day 7)and did a lot of squatting and lifting. I weighed 138 pounds, 65 inches and we had just got a new gym without carpeting. I was jogging to train for a triathalon at lunch on a treadmill and played barefoot sandvolleyball in the evening after work. I have a good arch, when not weightbearing, but I pronate in stance. I am kind of overly stretchy (ie I hyperextend at the knees and the elbows. The diagnosis was made the first time I went to see a doctor due to history and pain with palpation and there has never been any question about it. Unfortunately, it was very difficult to take time off of work and it took 4 months to see a podiatrist. I had been seen a gp about 1 month after the pain started, but saw a med student or resident who told me all I needed to do was lose weight. Noone prescribed orthotics for 21/2 years and though I asked for a referral to an ortho PT I was told you can't refer a PT to a PT, which I found to be rediculous. I had xrays taken in 2000 and 2002 which were both negative for heel sputs.

I have never had pain that 'traveled' on my feet and the pain has always stopped the moment I sat down.

I stopped running and playing barefoot sand volleyball immediately, but the hospital where I worked was not real sensitive and productivity and volume standards are hugely important, and the implication was 'tough it out'. It was made clear to me that if I couldnt stand all day or lift patients from the floor, then I couldnt do my job duties which are required. After 18 months of pain, I changed jobs to one that includes travel, so I get car sitting breaks during the day. It is still very difficult for me to do activities such as grocery shopping and I tried to go to Disney World last summer but couldnt make the walk from the car to the entrance. I stay off my feet for the most part after work and cook from a rolling office chair. I do swim and pedal a recumbant bike several times a week in attempts keep my weight from creeping up.

My husband and I have put off having a child, because of the fear of the additional weight gain with my feet and the reguired standing and lifting duties of my job. Unfortunately, I am now almost in my mid 30's and quickly running out of time. I have tried ice, night splints, Mobic, stretching, toe curls, and custom orthotics (which was effective for a while) I wear tennis shoes everyday except Birkenstocks at the pool. I have not tried the steroid shots or casting, because I didnt know how I would make it throught the day at work. I have seen a podiatrist and ortho MDs.

I have been trying to research the Ossatron. Will I be able to work as a PT soon after the treatment? What do doctors think is the success rate after 1 time? How much additional pain usually occurs if one has PF prior to pregnancy and then becomes pregnant? To make matters worse, I have recently been diagnosed with hip bursitis on the same side that my pf is worse, by an orthopedic dotor who feels the bursitis is due to 'sitting too much' and wants me to stand more. (I was diagnosed based on location of pain, no physical testing was done). In pediatrics, I am also expected to do standardized goss motor developmental testing, such as the Peabody, where I have to demonstrate jumping down from raised surfaces (up to 36 inches) and hopping on one foot. It is excruciating. Would it be in my best long term interest, to do something drastic, like change careers? My body weight is hard enough without the added effects of lifing 16 year old teens into and outof standers and wheelchairs and to and from the floor.

Thank you very much for your time. I apologize for being long winded.

Re: PF question for podiatrist, take 2

Dr. Z on 8/15/04 at 17:52 (158016)

Hi
Do you have the classic pf pain. This is pain after you sit for any period of time and try to walk, this is usually in the morning Is there pain at the pf insertion into the heel bone.?

Re: PF question for podiatrist, take 2

Anne on 8/15/04 at 20:42 (158034)

Dr. Z
I guess I have assumed that it is classic pf pain, but if you have any other ideas I am sure open to them. :)I saw 2 podis and 2 orthopods in total and when they pushed at the pf insertion at the heelbone that is where I feel the pain. Each one said 'yep, its plantar fascitis alright' after poking/palpating around. I have never had any forefoot or ankle pain or anything like that. I have had some lateral calf pain, but it may have been correlating with when I first started using the night splint. The calf pain has been gone for sometime. When the heel pain first started it was just on one foot and I thought that I had bruised it somehow and was surprised when I looked in a mirror and there was no bruise. It was a few weeks into my treadmill running and two days in a row I got paged during lunch and went straght to the floors without any stretching whatsoever. I had/have some pain in the morning and standing after prolonged sitting, but prolonged standing or walking has been what hurts the most.
Does this sound like classic pf, or do you think it could be something else since morning pain is not my biggest complaint?
Thank you so much!

Does it sound like classic pf to you

Re: PF question for podiatrist, take 2

Dr. Z on 8/15/04 at 20:44 (158035)

Hi

If you don't have classic morning pain it usually isn't pf. An MRI and or ultrsound in needed to confirm

Re: PF question for podiatrist, take 2

Anne on 8/15/04 at 22:28 (158043)

Dr. Z
Wow, I am surprised!! Noone has ever mentioned either test before or that it could be something else.
1.Is this something that I should ask a podi or ortho for?
2. What specifically would a MRI or ultrasound show if it IS or ISNT pf? What does the planar fascia look like in someone with pf in an mri or ultrasound?
3. I know that you cannot diagnose or anything on the boards, but what other diagnoses can I reasearch that maybe a better fit for my sypmtoms or I can ask my doctor about? (like a differential diagnosis list).
4. If it isnt pf, why did taping and orthotics seem successful initially?

I really appreciate your time and responses!!!!!!!!!!!!!! I have never spent more that a few minutes with any of the doctors I've seen. This has been so helpful!

Re: PF question for podiatrist, take 2

Julie on 8/16/04 at 01:37 (158048)

Dr Z, isn't pain when the insertion point is pressed the main indicator of PF? isn't it possible that Elizabeth has PF even if she doesn't have first-step pain? Perhaps she doesn't have first-step because the cause is something other than a shortened gastroc/soleus/achilles? In her case, the professional requirement to stand a lot, and lift people?

When I had PF my worst pain was always during prolonged standing, and walking, especially standing.
.

Re: PF question for podiatrist, take 2

Julie on 8/16/04 at 01:51 (158050)

I didn't mean 'Elizabeth', I meant Anne. Sorry, Anne!
.

Re: PF question for podiatrist, take 2

DavidW on 8/16/04 at 08:51 (158061)

All doctors. I also am very confused about the AM pain thing. I have never had pain in the AM nor pain to the touch. I do have pain if I stand for more than just a couple of minutes, and it progressively worsens the longer I stand. Walking is just as painful, but not as bad as just standing. Every doctor (all types) is confused about my symptoms because I don't have AM pain, yet their conclusion is PF?

Re: Clarification of am pain

Ed Davis, DPM on 8/16/04 at 13:47 (158110)

Post-static dyskinesia means pain occurring after rest. This is a common problem with PF but also other conditions. The longer the rest period, the more time the damaged body part, eg. the plantar fascia has to contract and thus the more painful the first few steps. We speak of am pain due to the long rest period during sleep.

The am pain is very common with PF so if it is not there, it simply acts as a signal that says 'it may be something else' so keep looking.

Some individuals have a generalized mechanical foot strain that worsens with time but without the am pain. Such individuals may be better helped via orthotics, stretching, strengthening, attention to workplace issues.

The am pain makes it more clear cut that there is a focal area of pathology or problem so ESWT can be aimed precisely at that area. Lack of an area to focus ESWT decreases the chance of success since it suggests that the problem may be more generalized, requiring a broader approach or view.

Having a focal area of pain is bad enough but it provides us a 'neat' target for treatment so modalities such as ESWT can treat a specific target with greater certainty.
Ed

Re: Clarification of am pain

Ed Davis, DPM on 8/16/04 at 13:56 (158113)

Post-static dyskinesia means pain occurring after rest. This is a common problem with PF but also other conditions. The longer the rest period, the more time the damaged body part, eg. the plantar fascia has to contract and thus the more painful the first few steps. We speak of am pain due to the long rest period during sleep.

The am pain is very common with PF so if it is not there, it simply acts as a signal that says 'it may be something else' so keep looking.

Some individuals have a generalized mechanical foot strain that worsens with time but without the am pain. Such individuals may be better helped via orthotics, stretching, strengthening, attention to workplace issues.

The am pain makes it more clear cut that there is a focal area of pathology or problem so ESWT can be aimed precisely at that area. Lack of an area to focus ESWT decreases the chance of success since it suggests that the problem may be more generalized, requiring a broader approach or view.

Having a focal area of pain is bad enough but it provides us a 'neat' target for treatment so modalities such as ESWT can treat a specific target with greater certainty.
Ed