Whats amazes me........Posted by Fed Up Also on 2/21/05 at 07:55 (169543)
The Journal of Foot and Ankle Surgery published a Clinical Guide (Volume 40, Number 5, SEPTEMBER/OCTOBER 2001) outlining the various paths for treatment of numerous foot / heal pain with most treatments being completed in 6 months or less. From reading this board, no one has accomplished anything within the 6 months as outlined.
WHY, can any doctor answer this? Is it the pool? Hummer? Bigger house?
Seen by 2 podiatrists and a foot / ankle surgeon, got 3 different diagnoses and treatment plans. Shouldn't these be for the most part standardized? Who's right? Why does one say the others is wrong? One doctor said (qoute), 'The Journal of Foot and Ankle Surgery is crap, published by a bunch of doctors that just like to see their name in print.'
Is anyone else documenting any of their treating? I get the feeling that the AMA needs to get involved. Is podiatric foot care not regulated?
I read one post (john on 2/20/05 at 17:06) that mention that doctors don't know what causes PF or how to treat PF, well that doctor needs to change professions, how about becoming a sanitation waste engineer (trash man)?
How about these doctors sit down at their computers (for reasons other than surfing for a new car, vacation, etc.) and research PF, it easy, instead of a google search of Hummer 2, put in the term Plantar Fasciitis treatment, discard the junk sites and go to the site like AMA, American Academy of Family Physicians (AAFP), even WebMd.
By the way, since all these individual here can't get relief from their doctors, can they all go to your homes (the doctor) and soak their aching feet in the hot tubs they've paid for????????????? Be nice (they've paid you well), pick them up in your Hummer..............
Re: Whats amazes me........Fed Up Also on 2/21/05 at 08:06 (169544)
OK, to be fair just pickup the 17 year heel pain sufferer, the one in the wheelchair 99% of the time and the one with the guaze left in......quack, quack,
Come on sing along Dr.s 'Dr McDonald had a farm, EIEIO, and on his farm he had a pool (or hummer, lexus, etc. (you can fill in the blank) EIEIO, with a quack quack here and a quack quack there EIEIO.'
Re: Whats amazes me........Fed Up Also on 2/21/05 at 09:12 (169550)
OK, my final post to this thread, how about a patient (real story), on 3rd surgery in less than a year, 1st doctor failed to remove a cyst (duh, I missed that in the MRI, DUDE!!, does that Hummer come in any other color than yellow or gray?) during PF surgery and tore a tendon, didn't repair or admit mistake (hurry close it up, maybe no one will notice and I have a test drive scheduled this afternoon.....). 2nd doctor removed cyst and accidently cut plantar nerve (whoops, hey anyone in here know what this thing is, it looks like a piece of spagetti, spagetti, yeah that's it 2 weeks in Venice thanks to this surgery, yeah baby!!!!!!!!!), 3rd repaired tendon BUT couldn't repair nerve damage.
Patient will be on disability the rest of his life, hope SSI doesn't go broke before he dies.
1 doctor and 2 quacks = a disabled person - comments????????
Re: Whats amazes me........Fed Up Also on 2/21/05 at 09:43 (169552)
OK, I couldn't pass this up, copied from Ben Pearl, D.P.M., F.A.C.F.A.S. web site, 'Neuromas have traditionally been treated conservatively by padding the area or injecting cortisone into the area. Cortisone shots sometimes result in atrophy of the muscle or skin. An older treatment has come back into vogue called sclerotherapy. It involves injecting dehydrated alcohol into a neuroma, which causes chemical nerve degeneration over a series of three to five injections. Compared to cortisone shots sclerotherapy has a much better success rate of permanently resolving the pain associated with neuromas.
We now have 'VOGUE' treatments (Madonna should be happy) which cause 'CHEMICAL DEGENERATION of NERVES over a series of injections.
1. Why do I want a CHEMICAL DEGENERATION of a NERVE?
2. Don't I want a functioning nerves?
3. Wasn't Sclerotherapy developed in the 1920s for the treatment of spider veins (telangiectasias), small purple and red blood vessels?
4. Is it 'Dehydrated Alcohol' or 'Anhydrous Alcohol' ? Dehydrated Alcohol once rehydrated has the same properties.
This procedure doesn't degenerate nerve, it causes 'scarring within nerve' blocking the signals. Drawback, patient losses most if not all sensation to the area, injuries may go un-noticed causing a greater risk.
Re: Whats amazes me........Dorothy on 2/21/05 at 10:41 (169560)
Fed Up Also -
I'm not a doctor and this will do nothing to help you - but -
I'm really sorry that these really awful things happened to you.
I hope you can find some good help. You can find support and understanding at this website - and quite often good advice, too.
In any case, I just wanted to say that I am very sorry. You have plenty of reason to feel bitter and angry - and hurt - but I hope in time you will feel better in every way.
Best wishes -
Re: Whats amazes me........Fed Up Also on 2/21/05 at 11:26 (169568)
You don't need to be sorry for me, it's just the stories I keep reading of those that have put their faith in their Dr. hands searching for relief only to have continued pain and discomfort after months if not years.
I read on the BB of 2 individuals that have gotten some relief from Lipoderm Patches, how many podiatrist prescribe them? Not many if any at all, ask your Dr., mine said, 'They don't work because your skin on the foot is 8X thicker than the rest of your skin', he doesn't even want to give it a try.
Standardization within the podiatric society is the key to a successful recover of all.
There was Dr. that replied here that being a Dr. is an 'Art', OK, I'll buy that, but why do they need so many pratice drawlings before getting it right, it's OK for Van Gogh and Picasso but not for me
Re: Whats amazes me........Linda V. on 2/21/05 at 11:48 (169570)
Dear Fed up,
I am not a doctor, just a person with PF who HAS received significant improvements in the past 6-9 months. I am sorry your trouble sounds much worse, and you haven't found a way to get relief.
In defense of the medical profession though...it would be a lot easier for them to treat us if the human body wasn't so complex and different in every single person. Its not like trying to fix the electrical system on a Ford..where every wire should connect and work the same from point A to point B.
And its not just podiatry that advises different treatments for foot ailments. Each doc in each specialty tends to form their opinions on what works and what doesn't based on their education and past experience. Some orthos will say Toradol pills work well, others won't prescribe them. Look at all the different treatments for prostate cancer--surgery, radiation, hormone treatments, seed implantation. Lets face it, there may be only one way to diagnose and fix a refrigerator...but we aren't that simple.
And like Dorothy, I agree this board can help support you. Its a great place to vent, share, get support, and education on lots of topics.
Hope you keep coming back and reading. Its a great lift for all of us to hear from another member that their foot problems have resolved. Gives us all hope...which we all need to have.
Re: Whats amazes me........elliott on 2/21/05 at 12:16 (169573)
Fed Up Also,
Before you get too fed up, the standard neuroma surgery, which usually cuts out the nerve and any growth attached to it, also results in nontrivial sensory loss, something a patient accepting surgery likely would far prefer to the continued pain. Most don't feel that sensory loss when walking, but might if they scrape their sole against a wall. (I myself have had neuroma surgery.) The idea of the series of sclerosing alcohol shots is also kill the nerve, hence sensory loss results too. There is debate as to which is preferred, with the standard surgery, more tried and true, probably having a higher probability of success (the doc also gets to see what's going on in there and act accordingly) and the shots known as being painful. But the shots avoid surgery.
Re: Whats amazes me........Fed Up Also on 2/21/05 at 13:05 (169578)
Mercy Medical Center, Maryland has an outstanding article on Interdigital Neuritis, diagonoses, treatment and follow-on care.
Article discusses conservative treatment (not very successful, 20%) and how a proper neurectomy is accomplished (hey docs, read this...)
Re: Whats amazes me........Dr. David S. Wander on 2/21/05 at 13:38 (169579)
Sclerosing injections are an alternative to surgical intervention. Some patients are not surgical candidates for various reasons. Sclerosing injections do basically cause scarring of the nerve. I have performed traditional neuroma surgery from a dorsal incision (top), surgery from a plantar incision(bottom) and sclerosing injections. In almost 20 years of practice, I have rarely seen any patient that had a sensory deficit that would cause he/she to not have protective sensation/feeling in the area. There are various nerves that innervate the area, and removing a neuroma should not result in complete sensory loss to the toe(s). Some patients do describe a decrease in sensation along the incision and the adjacent sides of the toes.
More recently, release of the ligament above the nerve has been utilized to 'decompress' the area and leaves the 'neuroma'/nerve completely intact with no damage to the nerve. This procedure is gaining greater acceptance since simply releasing the ligament that is compressing the nerve results in significantly fewer complications.
Surgery of any kind should be avoided if possible, but if a 'neuroma' is suspected the procedure of choice should be a decompression of the ligament which causes the least trauma and leaves the nerve intact. For great information on this topic, visit Lee Dellon, M.D.'s website.
I hope this information helps.
Re: Whats amazes me........Dorothy on 2/21/05 at 14:02 (169581)
Elliott - Are you a doctor?
Re: Whats amazes me........Dorothy on 2/21/05 at 14:26 (169585)
Fed Up Also -
I don't feel sorry 'for' you. I doubt that your experience is any worse than that of many people's experiences here or many people's out in the world who do not visit this board. Nonetheless, your experience sounds awful and you sound understandably angry and bitter. I am not an unskeptical fan of the medical profession, although many people on this website are. Too many undergo tests and surgeries and take medicines without having any idea about why or what they are doing. It amazes me. I am not an unskeptical fan of the patient group either. I think that responsibility and accountability should be the foundation of both doctor and patient. Unfortunately, that relationship is skewed toward the doctors' favor, much to the detriment of patients, but I don't think patients are doing a very good job of things either. It's just that doctors' bad or careless behavior can have serious, life-changing consequences for patients.
I read Julie's posts about her medical and dental care in London and she has consistently good experiences, so I wonder: is this Julie's personality? is it England? is it luck? are there better doctors and dentists there? I do not personally know of anyone - not anyone - who has a very high percentage of good doctor and dentist experiences. Are we just undeserving bums with rotten personalities? Are all these doctors all around the U.S. just inadequately trained? Rotten personalities with fat egos? What is the deal?? I had a good doctor once, back in the 1970s; he moved away. I've never had another one. But at least I would recognize one if I saw one, having had one in the past!
You still have my best wishes for improved health; it is what I wish for everyone here, including me. No more posts from me on this; I can be as negative as the next guy - I'm just trying not to be...
Re: Whats amazes me........Julie on 2/21/05 at 16:27 (169590)
It's obviously my personality, Dorothy. What else could it possibly be?
1. Luck. I've had two major medical experiences, apart from which I've been in excellent health all my life and had very little contact with doctors. In both, I've been fortunate in my doctors: a consultant breast surgeon, and a consultant neurosurgeon. Oh, and I had a knee arthroscopy which now doesn't seem 'major' - done by a good orthopaedic surgeon, no problems. I also have a good GP.
2. England. With (I believe) few exceptions, most doctors in this country work for the National Health Service, for a salary. Some have a private practice as well, but it would probably be true to say that on the whole their motives for being doctors are good motives; i.e. they are not entirely money-driven. I think that must make a difference.
Re: Dr. WanderFed Up Also on 2/21/05 at 19:01 (169593)
What is the average time for your patients and treatment plan suffering from:
1. Morton Neuroma
2. Baxter's Nerve
3. Plantar Fasciitis
I realize that not every patient is the same so I looking at an average time frame.
Re: Dr. WanderFed Up Also on 2/21/05 at 19:38 (169594)
Part 2 of my questions:
ESWT, what is your impression of this procedure. I realize that the FDA has approved three machine however most insurances (if not all) will not pay for it. The following also don't agree on the outcome and don't stand behind it:
1. New England Journal of Medicine (20 May 2004)
2. Journal of American Medical Association (18 Sept 2002)
3. Journal of Family Practice (Dec 2002)
4. American Journal of Sport Medicine (2002)
Re: Whats amazes me........elliott on 2/21/05 at 22:26 (169603)
Dorothy - No, a patient.
Re: Whats amazes me........Ed Davis, DPM on 2/21/05 at 22:33 (169604)
Most Americans, and I speak as one, often spend more time on choosing a house or a car, than place effort into finding good docs. There are plenty of good ones out there and plenty of good resources. This board is a sounding board for those who may be dissatisfied and is not representative of the hundred of thousands of patients who are.
Many look to their insurance book to see 'who is covered' by their plan. Believe me, I cannot think a worse way to look for quality as that is rarely on the minds of those who compile the insurance book.
Reasonable ways to look for good docs include asking the opinion of a primary care doctor whom one trusts (hopefully not a primary care doc selected from the insurance book). Other things to look for include networking with other patients, invluding visits to forums. Americans, and I again inclide myself, can be somwewhat reticent about their experiences -- various social clubs, organizations, places of worship include places to network. There is much online information listed about docs including their histories (good and bad) including disciplinary records. Accomplishments such as publications, board certifications can be helpful. A source of board certified podiatrists includes http://www.acfas.org
If one needs good orthotics, one can do a backward search by finding those podiatrists who use an accredited orthotic lab -- see the http://www.pfola.org website and find out if one's chosen practitioner is using such a lab.
Yes, it may take some effort to find quality among practitioners but it is an effort that, using the net, can be accomplished fairly quickly and can yield worthwhile results.
Re: Whats amazes me........Ed Davis, DPM on 2/21/05 at 22:46 (169605)
If you take the time to read Scott's Heel Pain Book you will see a reasonable
degree of standardization of diagnosis and treamtent does exist. I empathize with your dilemna but coming to the 'Ask the Doctors' board to criticize the medical profession as a whole and not ask specific questions, which this board is here for, staffed by doctors who are willing to donate their time to help you will not yield many answers from doctors.
I agree that the search engines are filled with junk sites and is a real problem associated with the internet. Search engines are not structured, for the most part on relevance of information or information quality unless one queries specialty medical search engines. Specialty organizations like the American College of Foot and Ankle Surgeons (ACFAS) have very specific protocols including flow sheets ( http://www.acfas.org ) containing more information than general medical sites.
This site contains Scott's Heel Pain Book, an entity, that has very uselful and well organized information on heel pain. This site is ranked well in most search engines. What efforts have you done to self educate yourself in this area before proceeding with treatment?
Re: Whats amazes me........Julie on 2/22/05 at 02:13 (169613)
Ed, yes, I know. My short post, written late at night, quickly, and half with tongue in cheek because I was tickled by Dorothy's reference to my happy medical experiences, omitted to say that I know there are good, unselfishly-motivated doctors (like yourself) in America, just as I know there are bad ones, and horror stories, here in England.
Yet there is a difference, which I believe is largely due to the fact that doctors in the UK are, by and large, employed by the health service and are not 'in it for the money'. That is not to say that there aren't doctors in the US who aren't equally ungrasping. Just that there is a cultural difference.
Another difference is that our National Health Service, towards which everyone who has ever been in employment has paid contributions, is free to all at the point of use. People who cannot afford, or on principle do not want, private health insurance, are in no danger of bankrupting themselves with medical bills (I refer to Dorothy's other post, on the social board).
Re: Dr. WanderDr. David S. Wander on 2/22/05 at 07:20 (169616)
You're correct, this is a very difficult question to answer since there are so many variables. My treatment plan for Morton's neuroma usually involves the following:
1) Intial exam with thorough history and physical
2) X-rays to rule out an adjacent bone pathology such as a stress fracture that has symptoms that can overlap with 'neuroma' symptoms
3) A thorough explanation with models and drawings to assure that the patient understands the tentative diagnosis and treatment plan.
4) On the first visit I will usually apply a metatarsal pad and strapping to see if simple biomechanical control can reduce symptoms.
5) In addition to the padding, I will make recommendations regarding shoe wear.
6) I will recommend ice 20 min/hour to the area
7) If upon a return visit there is continued discomfort, an injection of cortisone and local anesthetic will be utilized.
8) If upon the return visit there is still discomfort, I will sometimes, but not often give a 2nd injection. I DO NOT give more than 2 cortisone injections in the area due to the possibility of tissue atrophy.
9) I explain to the patient that cortisone is not a cure and may simply relieve symptoms.
10) If there is still no relief I will discuss surgical intervention and sclerosing injections and the pros and cons of both.
11) If I am suspicious that there may be something else going on, I will order a bone scan (as previously stated, stress fractures can sometimes mimic 'neuromas' and are not always evident on plain x-rays), diagnositic ultrasound or on rare occassion an MRI with contrast.
12) If surgical intervention is required, my preferred choice of procedures is a decompression, since there is significantly less trauma.
13) The success rate of conservative care in my practice is directly related to the amount of time the symptoms have been present. I would say that patients that are seen within a few weeks of the onset of symptoms have a very high success rate with conservative care (>90%) and those that have has symptoms untreated for greater than 6 months have a significantly lower success rate with conservative care of about 60%.
14) A 'neuroma' is really an inaccurate term and the pathology is actually a perineural fibrosis or thickening of the nerve. As previously stated, newer thinking has started to treat this as a nerve entrapment, not a true pathology of the nerve.
15) This is a basic protocol that I often use, and each patient plan differs depending upon the patient's needs, expectations, symptoms, etc.
16) Although I am a big proponent of physical therapy, I have not found PT or oral anti-inflammatory medication to be useful treating this condition.
I'll try to get back online later to answer your questions about Baxter's neuritis and plantar fasciitis. However, if my office I do basically have a 'flow sheet' that is handed out to patients detailing the condition being treated and the protocol used in our office. I find that this is also excellent from a practice management standpoint, since patients dont' give up and do realize that if he/she fails one treatment there are other options available that our office has discussed.
Re: Dr. WanderDorothy on 2/22/05 at 09:34 (169619)
Dr. Wander -
While I do not have the problem referred to here, I was very impressed by the usefulness of this learning tool and feel that you've done a service by sharing this. Plus, it was just very nice of you!
Re: To Dr. Wander re MN DecompressionDarlene on 2/22/05 at 11:57 (169630)
Thank you for sharing the information on Morton's neuroma. I would like to share what I learned from my personal experience as a patient.
1. Proper patient screening needs to be done for MN decompression surgery. In my case I had my MN for 20 years and it was fairly large. While my pod gave me a 90% success rate, I have since learned that is not the case where the MN has had 20 years to grow and develop scar tissue. It is also less likely to work for a large neuroma.
2. By about the 1 year mark the ligament reattaches and the symptoms often return. Perhaps this should be presented as a short term treatment.
3. Cutting the ligament changes the structure of the foot. The bones move apart in the MN area, but are then closer together in the adjacent web spaces.
4, I think we need to see some good quantitatve research on this, preferrably at least 5 years out.
Regarding the traditional neurectomy here is what I have learned. Some doctors cut the ligament, some doctors partially cut the ligament, some doctors leave the ligament intact and some doctors cut the ligament and then reattach it before sewing up. It seems to be all over the place.
Re: Whats amazes me........Ed Davis, DPM on 2/22/05 at 12:46 (169633)
An important point is that doctors really only one determinant of the health of a nation. That health is a function of diet, exercise, lifestyle and very importantly, self education about one's conditions(s).
The third has been greatly facilitated by the internet yet habitually underutilized as too many have abdicated that self responsibility.
Re: Whats amazes me........Julie on 2/22/05 at 14:09 (169639)
I agree with you completely, Ed. I think that what both our countries need is a National Illness Prevention Service. NIPS.
Let's run that one up the flagpole and see it anyone salutes it. :)
Re: Whats amazes me........Dorothy on 2/22/05 at 14:20 (169640)
I'm saluting it now! Great acronym, too.
Re: Whats amazes me........Julie on 2/22/05 at 16:06 (169650)
Thank you, Dorothy. I thought so too. Inspired, really.
Salutations to you. ;)