Concerned about podiatric treatment

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Greetings,
I’m going to do venting as a non-podiatrist, but as a person involved in a medical field—and as a long time runner and one who made his first visit to a podiatrist over 30 years ago.

Most of my podiatric experiences have been great over the years. I’ve not always been helped, but I felt like I was thoroughly examined from 1980-1998. I haven’t needed a podiatrist since ’98. But I needed one in June of this year—and I’ve got to tell you that the time provided to me, the lack of testing procedures and treatment given has been abysmal as compared to my treatments from 1980-1998.

Since May of this year I’ve been to, two Des Moines, Iowa area podiatrists, and one from another part of Iowa. I’ve attempted to select those clinicians based on symptoms of bilateral plantar fasciitis. One Dr. gave me a pair of over the counter soft orthotics and told me to call him later—no testing was done. Another Dr. saw me numerous times—again no testing was done and these services were provided by him at a teaching hospital. The third didn’t offer any testing—and made me soft orthotics. I’ve emailed him twice requesting my prescription so I could see what it was and I’ve not received any word.

I’m a long time runner with an interest in lower limb biomechanics as well as in orthotics—but I’ve got to say that the medical help I’ve received in Iowa is not good advertisement for the profession, for communication from Dr.’s or for orthotics.

I am beyond words and highly frustrated.

Sincerely,

Doug Potter email: silverwoodwood1@mchsi.com

 

Mr. Potter;

I am sorry that you feel you have not been evaluated well by the podiatrists you have seen so far.

Plantar fasciitis is a at times a difficult problem to treat, but in general a sports medicine fellow from the American Acadedmy of Podiatric Sports Medicine is a great place to get a very thourough evaluation of what biomechanical issue might be exacerbating your foot pain.

If you go to the website www.aapsm.org you will find a list of sports medicine academy members and fellows. There is at least one in Des Moines and another towards the west of the state. I know them both and I'm certain these very competent sports medicine practitioners will be able to address your symptoms.

Sincererly;
Bruce Williams, D.P.M.
Past President, AAPSM

 

Thanks Bruce. Yes, that's the first thing I did. Perhaps if I'd have gone back to him he eventually would have been more thorough, but not on my initial visit he wasn't. I went to the next Dr. who I hoped would be more thorough, but he wasn't. It's almost as if "plantar fasciitis" is a catch all phrase. I wondered if part of the problem could have been insurance, although I have all the insurance needed for various tests. I know there are blood tests that might reveal something other than a mechanical defect, but because I've obvious pronation problems, its almost as if they think they can tell by looking at my feet what the problem is. Very frustrating. I know in Des moines I could only find one AAPSM Fellow, out of all there podiatrists we have here. I'll check again. Again, thank you.

 

As a follow up to my original letter, I wonder why none of the three podiatrists that I've seen over the past month, didn't take any xrays or advise blood work? It's puzzling and frustrating to continue to suffer foot pain while feeling inadaquately treated. I'm trying not to be critical, however ... .

 

Doug;

if your initial presentation is textbook plantar fasciitis then x-rays may or may not be ordered or taken in office. Often an x-ray will not show a spur and regardless, it is rarely if ever that having a spur on x-ray will be helpful in creating a treatment plan.

Now, if you presented with significant swelling and signs of inflammation, you should most definitely have an x-ray taken. Pain in the abscence of definitive inflammatory signs, swelling, increase in temperature and redness, does not always necessitate an x-ray.

Blood works is rarely ordered in the treatment of plantar fasciitis as well for similar reasons above. In general, bloodwork is reserved for looking for more obscure causes of chronic pain such as chronic arthritis of varying type.

Infections present as an inflammatory state and would usually necessitate bloodwork and or the taking of a culture if there is an open wound.

It is possible you could have a non-traditional cause of your foot pain, but unless somethign jumps out at the clinician to make them investigate that further from you H&P or the physical exam, then traditional conservative treatment plans are followed until little or no improvement is made. The more investigation may be necessry via x-rays, MRI or blood work.

I wish you luck in resolving your symptoms.
Sincerely;
Bruce Williams, D.P.M.
Past President, AAPSM

 

Well said Bruce. If it walks like a duck and quacks.... it usually is a duck Common things are common and rare things are rare, and it's probably more common to have a common pathology with an unusual presentation than to have a rare pathology. And, plantar fasciitis is as common as a bag of common things. Hope that makes sense.

 

I'm not so concerned about calcaneal spurring because I've had them for years. I'm more concerned about things like neuropathies TTS and some of the other less obvious processes. I really don't want to go to an orthopod because I'm not sure they have knowledge in orthotics or biomechanics that may need. I

 

Is it likely that you have a neuropathy? Are you an alcoholic and/ or do you have any medical conditions which might predispose to neuropathy such as tertiary syphallis, diabetes etc? I assume TTS, translates as tarsal tunnel syndrome- positive Tinnels sign/ symptoms reproduced on neural tensioning? Have you tried activity / footwear modification, low-dye taping, anti-inflammatory medication/ icing and a pair of over-the-counter foot orthoses? Do you walk like a duck and quack? :morning:

If you are not happy with the care you have received thus far, go elsewhere. Diagnosis by e-mail is not possible.
here you go: http://www.podiatrytoday.com/article/4735
" When ordinary heel pain attributed to plantar fasciosis does not respond to conservative care or changes in nature during the conservative or surgical treatment phase, clinicians should start to think about nerve entrapment as being the culprit"

Has your heel pain not responded to conservative care?