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PF: Misdiagnosed or "morphed" ??

Posted by Scott Mc on 4/28/05 at 15:40 (173879)

My PF was diagnosed nearly 4 years ago. I had all the classic symptoms and every standard podiatric treatment (orthoses, 2 cortisone shots, presciption anti-inflammatories, night splints, and physical therapy that included massage and stretching/strengthening) and well as Dornier's ESWT in 9/04.

None of these worked. The pain is no longer 'classic' PF (heel pain in am). The balls-of-feet and the arch are as painful or more painful than the heels. The pain is lowest upon getting out of bed and worsens over the day, as I stand and walk. By evening, it seems unbearable.

What's up? A midiagnosis? Or, can PF morph into other problems? I noticed the change about 1/2-way thru the 4-years. Within 10 days of the ESWT, I was carrying a heavy backpack for 3 weeks, as I toured Britain (that's just the way the timing worked out). I am in more pain since the ESWT and tour.

What now? New DPM will have a look at orthotics and seems to be suggesting an diagnostic MRI and infra-red for treatment. COMMENTS?

Re: PF: Misdiagnosed or "morphed" ??

Dr. Zuckerman on 4/28/05 at 19:07 (173890)

Hi

An MRI is a good idea. It is possible that plantar fascia was CURED but was part of something else ie posterior tibial tendon dysfunction and or some other lower extremity dysfunction ie knee hip and or lower back

Re: PF: Misdiagnosed or "morphed" ??

Monte on 4/29/05 at 08:09 (173911)

Scott...sounds like me.
Strange. I often wonder what is going on besides PF. I will be going for an MRI soon....not expecting much...but I never had one yet in the 4 years of suffering with PF. I have had ultra sounds which show that the fascia looks OK and the inflammation has gone down....But, like you, the pain is more distal.
Monte

Re: PF: Misdiagnosed or "morphed" ??

Steve on 4/29/05 at 15:08 (173933)

Sounds like me too, although I have had it for 6 years. Now seeing a pain mgmt. specalist who had diag. it as neropathic pain. Am on 600 mg neurontin each day. Not sure if this helps. Pain seems worse when sitting at desk and not active. I never go barefoot(which helps) and swim alot which also helps.

Re: PF: Misdiagnosed or "morphed" ??

Scott Mc on 5/01/05 at 12:59 (174023)

So, who knows? I suppose Dr. Z could be correct re potential 'posterior tibial tendon dysfunction'. (What's that?) But, we patients gain an understanding of our own bodies and pain. Some by reading, but most my experience. I will 'bet the house' that Dr. Z's speculations on related knee, hip, and lower back problems are not accurate. DPMs and others like to go off on 'neuropathic tangents'. Be careful, you'll end up wasting hundreds (thousands?) on inconclusive tests. I'll also hold off on the MRI for a few weeks. They are very expensive. Well worth it if they help diagnosis and treatment, too many times; howevever, they end up being (yet another) waste of money.

Re: PF: Misdiagnosed or "morphed" ??

john king on 5/01/05 at 17:07 (174044)

I am not casting stones but sometimes docs diagnoses neuropathic pain syndrome when they just don't know what else to say. My docs at the VA said I had neuropathic pain from Agent Orange exposure 35 years ago. If that is true then I am probably a dead duck as they say I have DMII from AO as well and peripheral neuropathy from AO. Maybe this is why my feet hurt so bad. No tests have ever been conclusive except the DMII.

Re: PF: Misdiagnosed or "morphed" ??

john king on 5/01/05 at 17:10 (174045)

Scott and Steve

Maybe you will send me your email addresses. Our pain seems to have common factors. I know that after many years of symptoms I am pretty disabled by this thing.

John King

Re: PF: Misdiagnosed or "morphed" ??

Scott Mc on 5/04/05 at 15:04 (174250)

I have 2 sets of pain syndromes. 15 years ago, I acquired the muscular pain-fasciculation syndrome (see Hudson et al, 1978, J. Neurology). It is characterized by very small twitches (not convulsion, not spasms, not etc.) in calves and hamstrings and an aching (not stabbing, not cramps, not etc) pain. There seems to be no treatment.

4 years ago, I got PF. I may now be a complicated or variant of PF. I'll bet an MRI would be (another) waste of money. I firmly believe the 2 pain syndromes are not related. They do not feel similar and are separated by a non-painful ankle. They came on 12 years apart. Still, DPMs and MDs like to try to link them but they are not related. Watch out for diagnosis involving 'neuropathies'. Most neuropathies can't be treated. You can waste thousands on worthless diagnostic tests.

Sorry to be so hopeless, just trying to save ya'll some $$. My e-address is (email removed)

Re: PF: Misdiagnosed or "morphed" ??

Ed Davis, DPM on 5/05/05 at 21:39 (174351)

Scott:
Look at the shape of the plantar fascia in Scott's Heel Pain Book. 'Typical' plantar fascia just means that the pain is at the insertion of the fascia (the area with the circle on it). The fascia can hurt anywhere along its course.

Also if there is a biomechnical problem placing too much strain on the fascia, you can make part of the fascia better by ESWT but are you addressing the areas of excess strain? One means of doing so may be via orthotics.
Ed

Re: PF: Misdiagnosed or "morphed" ??

Scott Mc on 5/06/05 at 10:11 (174378)

Dr. Davis: I agree with your 1st statement. But, local DPMs love to focus on heel pain. If you mention arch and/or ball-of-foot pain, they'll go off on a tangent.

I have worn orthotics for 18 years. Got first set after PF #1 (one foot only). Added to one shot of cortisone, they worked like a charm and I was basically cured for the next 15 years.

I was wearing the orthotics when I got PF #2 (both feet). I got this PF from 2 soccer matches--I believe from shoes with 'too stiff' soles (I had replaced the worn out but flexible shoes). 4 year laters, the PF is worse then ever--despite every treatment in (and out of) the book.

1st DPM, this time around, OK'd my orthotics and proceeded with 'standard treatment'. He later made me another set of orthotics with extremely high arches that shifted the pain's focus to the arch. I had to go back to the original pair. Am now going to another DPM for orthotics #3. He also is pushing 'infra-red' (Anodyne) treatment.

I had ESWT in Sept. 04. No improvement, maybe worse.

Trying to avoid invasive surgery but am very tired of all these ineffective treatment. I am becoming less functional; cooking and cleaning at end of day is so painful that often skip them. (HELP!) SMc