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Withdrawal of fluid from bursitis as treatment?

Posted by Julia M on 1/18/05 at 13:18 (167469)

I've started having heel pain in one foot and my doctor suspected plantar fascitis. She referred me to a podiatrist. The podiatrist did not take a history or examine my feet but did take X-rays, which showed that I have heel spurs on both feet (only one is causing pain). The podiatrist said that heel spurs can cause a bursitis to develop, and that the cause of the pain in the morning is that fluid around or in the bursitis has redistributed itself. He then wanted to use a needle to drain fluid out of the bursitis to reduce the pain. Is this a common treatment? I've heard of cortisone injections, but not withdrawal of fluid. I haven't seen this method listed as a treatment on any plantar fascitis or heel spur site. I said that I would prefer to go with a more conservative treatment. The podiatrist then taped my foot and sent me home with a prescription for an NSAID. He suggested that I come back to be fitted for orthotics when my pain has reduced by 50%.

I'm frustrated because I have very mild pain that only flares up when I run. Once I stopped running on my general physician's suggestion, most of the pain went away. So what I'm trying primarily to do is find out how I can protect my feet going forward, and what kinds of activity I should and shouldn't be doing.

Has anyone had this treatment (withdrawal of fluid by needle) suggested to them?

Re: Withdrawal of fluid from bursitis as treatment?

Tina H on 1/18/05 at 13:34 (167473)

Julia, I'm hoping one of the doctors will answer this soon, but I can tell you that in the 6months I've been visiting this site almost daily, it's the first time I've heard of withdrawling fluid for treating pf????

Re: Withdrawal of fluid from bursitis as treatment?

Julia M on 1/19/05 at 08:09 (167519)

Yeah, I haven't seen anything about it either, so I'm wondering, can I trust my podiatrist? Part of me even wonders if it was a cortisone shot that he wanted to give, but then why would he describe it as a withdrawal of fluid? Have any podiatrists or doctors on these boards heard of this?

Re: Withdrawal of fluid from bursitis as treatment?

Dr. David S. Wander on 1/20/05 at 07:24 (167584)

First, it disturbs me that you said that the doctor never examined your feet or performed a history. I have a hard time with this, and if it's true I would not return to that doctor. The history is at least as important as the exam, if neither was performed get out of that office. Secondly, it is very well documented that plantar heel spurs rarely, if ever actually cause any pain, since the 'spur' is not a small sharp point but is actually a shelf of bone. Third, there have been many cadaver studies that have disputed that a 'bursa' exists below the heel. What does exist are fat chambers that are normal and should not be disturbed. This fat is often atrophied if multiple cortisone injections are given, that's one reason injections should be limited. In 20 years of practice, treating a lot of heel pain, I've NEVER removed fluid from a bursa below someone's heel, and I've ALWAYS performed a history and examination as I'm sure every other doctor on this site. My recommendation would be to find another doctor that will be more thorough and more mainstream.

Re: Withdrawal of fluid from bursitis as treatment?

Julia M on 1/20/05 at 10:19 (167600)

Thanks, Dr. Wander. I really appreciate your perspective on this.

The only history that the doctor took was a very general history on the forms I had to fill out before I saw the doctor. But this history was the standard questions about my general health, not my foot health. I did list the kinds of physical activity I'm doing on that form (running, walking, strength training), but there was no information about how often, how much, and especially, how the pain was related to exercise. I also brought in several pairs of shoes for the podiatrist to look at, since my regular doctor had recommended that I do that, and he never looked at them, either.

I expected him to at least feel my heels to locate where the pain was, and he didn't do that either. The only time he really touched my feet was when he was describing this injection that he wanted to do.

Thanks again for your perspective. I really appreciate it!