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Looking for an answer from the Docs (all....)

Posted by Robert B. on 2/02/05 at 19:04 (168343)

I am just wondering if all of your patients feel like guinea pigs when being treated for foot pain?

So far, I've had corti-steroid shots, no relieve. Night splint, no relieve, actually cause further damage and pain. Changed Doctors, he ordered MRI, x-rays, and EMG (which other doctor didn't do).

X-ray revealed moderate heel and Achilles spurs. MRI revealed stress factures in the Plantar and moderate rheumatoid arthritis. EMG revealed Baxter's nerve and nerve entrapment (moderate to severe). Most is the effects of previous spur surgery (15 years ago) and the formation of scar tissue.

So far it been (with new Dr), shots, no help. Orthotics, no help. 4 weeks of physical therapy (3X week) with heat, ultrasound, deep massages and stretching to break up scar tissue, no help.

Next Wednesday he plans to inject my foot again and cast my foot for 6 weeks. He says this is to put the nerve at rest?????? 'HOPING' it repairs it self. If this doesn't work, it's more shots. If that doesn't work, it off to a neurosurgeon to release the nerves. THEN we can look at the spurs and stress factures.

So my question is, why do I feel like a guinea pig?

Re: Looking for an answer from the Docs (all....)

Jacob G. on 2/02/05 at 19:55 (168347)

I always tell my patients that if you ask 10 different doctors the same question, you'll get 10 different answers. (And that's within the same specialty!) Like this website has mentioned, there is not one treatment for heel pain that works for everyone. That is why they call it the 'art' of medicine and unfortunately, that is why you feel like a 'guinea pig'. Complex cases get complex treatment plans. But the regimen should always start with the basics. Because there are so many 'basic' treatments, it's normal to feel frustrated and maybe even 'used' when they don't work. The way to try and not feel this way (and you may have already done this) is to seek out someone you feel is caring, conscientious, skilled, and dedicated to your pain/problem.....and stick with them. If treatment fails, ask them who they would recommend you see as a follow up. Ask them how they would see this problem through if you were their child or spouse. I wish you the best for a resolution.
Dr. G.

Re: Looking for an answer from the Docs (all....)

Dr. Z on 2/02/05 at 20:15 (168348)


You doctor needs to include you in the treatment plan, not just your foot problem. You need to have an explanation as why you are getting the treatment and what can be expected. For example. Your plantar fascia is inflamed . We need to give you an steroid injection to try and reduce the swelling in the fascia and we will tape this to rest the area. The purpose is to get the swelling out of the area so you will heal. Let see how you response. I need to see you in one week to evaluate how you are doing with this treatment. Do you think that this is a fair explanation and expectation of a treatment ?

Re: Looking for an answer from the Docs (all....)

Ed Davis, DPM on 2/02/05 at 21:33 (168355)

I can see how a patient could feel that way if a doctor is using a 'shotgun' approach, just moving from treatment to treatment.
I and Dr. Z follow a very systematic treatment plan that we explain in detail to our patients. We basically could flow chart the plan and the patient can understand the path of treatment that he/she is following.

Re: Looking for an answer from the Docs (all....)

Julie on 2/03/05 at 01:54 (168365)

As a patient, not a doctor, I would suggest that you need to inform yourself as fully as you possibly can about the various conditions from which you are suffering. There is a great deal going on in your feet, not just one thing, and the more you know about them the more you will be able to ask questions about your treatment. Not all doctors appreciate educated patients, but those who do usually find it easier to answer intelligent questions.

From your post I get a feeling of slight helplessness: why are these things being done to me and any aren't they helping me? I think you'll feel less like a guinea pig if you start doing some in-depth research. The more you know, the more actively you'll be able to participate in your treatment, and the less at sea you'll feel.

I hope your problems resolve.

Re: Looking for an answer from the Docs (all....)

Dan L. on 2/03/05 at 07:46 (168377)

Dr. Z

On several of your posts in the past I thought that you said that the plantar fascia wasn't inflamed but it was thickened. I think that you and Dr. Wondr used the term plantar fasciosis. Now your saying it's inflamed, and before you said it was thickened. Which one is it? If it is thickened on mri or ultrasound how will the injection of steroid help? I understand that taping helps rest the fascia and it seems logical that casting will also let the area rest. BUt you seem to contradict yourself when you talk about the fascia being inflamed one day and then say its not inflamed, it's thickened. If he already had injections of steroid cant more injections weaken the tissue and cause more problems if he has too many injections? THanks.

Re: Looking for an answer from the Docs (all....)

Julie on 2/03/05 at 08:27 (168378)

Dan. in case Dr Z doesn't see your question or reply, I feel sure that he was giving the inflamed fascia as an example. Inflammation of the fascia is plantar fasciitis. There is also a condition known as plantar fasciosis, in which the tissue is degenerated. He wasn't contradicting himself, just giving an example of a possible condition (inflammation) and the treatment for it.

Yes, too many steroid injections weaken tissue.

Re: Looking for an answer from the Docs (all....)

Dr. Z on 2/03/05 at 23:06 (168460)

I was not referring to a specific case. I was pointing out how a doctor should explain his or her treatment plan and how to explain the why you are doing a treatment. Yes you are very correct when you point out the dangers of multiple local steriod injections. A plantar fasciosis is a degnerative condition and a plantar fasciitis is an inflamed condition

Re: Looking for an answer from the Docs (all....)

angelas on 2/04/05 at 10:06 (168475)

Hi, I hope you do not mind me answering even though I am not a doctor. But your post really struck a cord with me. I am a fellow patient with many health issues, one of them being my feet.
With my many illnesses, I am learning that science has very few, if any answers for me over the years. I find this very hard to accept.
Someone told me the other day how amazing it was when they treated a friend with a very serious brain condition and she was cured. And how much medical science has to offer. I had to listen for some time to really get that again as it has been so long that any doctor has been able to address my health problems.
I don't have a treatable condition that would have a flow chart, a systematic program, or even a proper label!
I find that I am the one doing a lot of the suggesting of what to try or to test for next. And once in a while we hit 'pay dirt' and find a positive test result (after years of none), and something to treat (or not), but no cure. So yes I do feel very much like a quinia pig and get angry, frustrated and sad.
I have also learned that people with mental disorders spend many months or even years taking various medicines while professionals (and they are good ones) try to find the right treatment for them. There is no set cure for them. It is sad really.
Yes, I think in too many cases, when it comes to poor health we do become guinae pigs due to poor quality health care or medical science that just doesn't know yet. I understand how you feel and I wish there was a easier way.
I wish there were more doctors where we/I live like the doctors who posted to your question that we knew about.
I had TTS surgery and after 6 weeks post-op was told it failed. And then told goodbye. With all my health issues I find it hard to believe that one can be so sure that it did not work without more than asking if the pain was any better.
This is partly my fault for choosing a doctor too quickly (not doing more research plus the inconvenience and cost of traveling further away) and getting a Podiatrist who doesn't seem to be that good or care that much whether he succeeds or fails, at least through my eyes.
He was surprised when I seemed upset when he told me it failed.
I hope something I said clicked.
Take Care, Angela

Re: Looking for an answer from the Docs (all....)

Ed Davis, DPM on 2/04/05 at 20:29 (168524)

The answer to your question lies in my explaination of the 'treatment triad.' Please do a search on this site to read up on it. I have been trying to convince ScottR to make my 'treatment triad' part of this site or part of his heel pain book.

Re: Ed

Julie on 2/05/05 at 02:32 (168543)

And it's time he did. I have been disturbed for years by the hit-and-miss approach to PF and other foot problems taken not only by so many visitors to this forum, but by so many podiatrists. The treatment triad has always made sense to me, and I too have been hoping Scott would make it part of the site, or the book.

He won't see your post (I believe his name has to be in the subject line - maybe I'm wrong). Maybe it's time for you to email him and discuss it. It's ridiculous for this sensible way of looking at the problem not to be available here in a permanent place.

Re: Ed

Scott R on 2/05/05 at 08:12 (168550)

I made an auto link for the phrase 'treatment triad'

Re: Ed

Julie on 2/05/05 at 08:25 (168551)

Great, Scott. Thank you!