First, to my request before you stop reading. If you like or feel there is value in the content on the Angry Orthopod please spread the word on social media or any way you feel you can. This is particularly true when you have personally benefited as a result. This is a groundswell process and thus requires your support. Thank you.
please spread the word on social media or any way you feel you can
I know, you have been losing sleep at night wondering, “Where did he go?” As arrogant as I am, even I don’t believe that. OK, I was not actually on a sabbatical. I electively retired from active clinical practice to change careers. I am still in the medical field with just a different angle on things. This change has made me busier than a rooster in a henhouse. Things have finally settled and I am back, angrier and sassier than ever.
Even though clinical practice for me is over after 3 decades, my desire to help you all here has only strengthened. Make no mistake, the experience that has allowed me to question and challenge mainstream establishment medicine is alive and well.
As a reminder, I am not angry at you unless you give me a reason. I am angry (code: trying to make a change and promoting preventative and non-operative health) at my medical colleagues who, in my humble hubris opinion, are all too often not giving needed time and/or non-operative treatment enough of a chance and opting too quickly for surgical solutions. How convenient.
my desire to help you all here has only strengthened
Recently I read a transformative book that confirmed my long-held conscious realization that surgery wasn’t all that. Professor (Dr.) Ian Harris, the author of Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence, is a seasoned Australian orthopaedic surgeon, traumatologist and serial researcher. Amazon sums it up perfectly, “For many complaints and conditions, the benefits from surgery are lower, and the risks higher, than you or your surgeon think.” Dr. Harris focuses more on the ineffectiveness of many common mainstream surgeries accurately covering the evidence that they are all too often no better than doing nothing and can clearly cause harm. I would vehemently add that there are many curative non-operative treatments out there that are either unknown by your doc or are suppressed.
When it comes to the risks and surgical complications, we surgeons have a saying you need to know: “The risk of complications for [insert your surgery here] is about 1%, until it happens to you, then it is 100%.” And every surgery brings the risk of harm into play. Period. Harris covers this point to perfection.
Don’t get me wrong, surgery definitely has its place and can be life-changing, but only after an informed, careful consideration and a collaborative decision process between surgeon and patient. You are in control and you have the right and power, and you should make these critical decisions for yourself. I highly recommend this book whether surgery is a consideration or not.
surgery…a collaborative decision process between surgeon and patient
Last request, which concerns requests. I welcome your requests for blogs on subjects that might be of interest to you and others. Please keep focused on basically foot and ankle issues. I will be selective on which are chosen especially if there are numerous requests.
Finally, I am in the process of answering many of your regretfully neglected comments/questions you all have posted over the past 18 months. Even if your problem has resolved or the question is “off the table” for you, I will still answer because the questions are excellent and the answers are good for all to see.
Stay healthy my friends,
I would like any suggestions you might have for fat pad atrophy in the ball of the foot? I have orthotics? Are there any stretches that would help? Also, I have read about injections… thoughts on that?
My second question has to do with scar tissue. I had plantar surgery for a stump neuroma 6 months ago. What do you recommend for breaking up the scar tissue? And how long does it really really really take to heal. My surgeon thought 6 months and I would be good as new. That’s not happening.
Any help would be greatly appreciated.
It is interesting reading some of these questions. It is sort of, “Who put those words in your mouth.” You ask about fat pad atrophy, but I must question the source. How did you arrive at this conclusion for diagnosis? I suspect that you were told this or you read it and I think it is very likely untrue. I have always been very cautious about making this diagnosis for two reasons.
First and foremost, this is a problem of which there is no return, there is no way to fix it or a meaningful way to make it more comfortable. It is the end of the road. Second, true fat pad atrophy is decidedly rare. So, the odds are against it.
What if your fat pad “atrophy” was nothing more than forefoot overload secondary to equinus (calves too tight)? This is very common and leads most commonly to second MTP synovitis. You better hope it is! If this is the case, then I do have a stretch for that. Stretch your calves! Interestingly, stretching your calves would actually help actual forefoot fat pad atrophy to some degree as any pressure relieved will help.
You may ask, “How do I test for equinus?” While all my colleagues are in a race writing article after article to find the best way to test for equinus I ask, no I am actually published asking, “Why?” I will stop here on this subject to write a blog about it. The short version is, why not stretch, what do you have to lose especially when the majority of non-traumatic acquired foot and ankle pathology is a direct result of equinus?
As far as the Morton’s neuroma revision, these can be tough for the doc and the patient. I have had a few difficult ones as well. First, my question is, was it ever a Morton’s neuroma? And I will never know in your case. Let’s assume it is/was. In that case, breaking up scar tissue is the right move and it works at a high percentage. This requires your efforts, desensitizing massage. This is nothing more than digging in deep with your thumb directly at the stump end neuroma. Start easy, and as your problem improves, you will massage deeper. And be patient! You can obtain good instruction from a physical therapist or even Youtube.
I hope I have helped you and others.
Stay healthy my friends,
I am 6 months out from surgery. How long does it take to heal from stump neuroma surgery through the bottom of the foot? And for the scar tissue to no longer be an issue?
So, this was surgery number two. Give it a year and start deep cross friction massage. Look up cross friction massage on YouTube or visit a PT and let them show you how it is done. This activity can be a lifesaver for painful incisions and stump neuromas.
Stay healthy my friends,
After 2 years of trying all the usual treatments for plantar fasciitis in my left foot (orthotics, cortisone injection, shockwave therapy), I came across your very valuable website and started the calf stretching as recommended by you. As it continued to worsen, about 9 months later I consulted an orthopaedic specialist/surgeon (foot/ankle). Based on the MRI and physical examination he told me that the plantar fasciitis had mostly healed however the ongoing cause of my pain was atrophy of the heel pad, for which there is no actual “cure”. He was quite positive about being able to manage it though and arranged for an orthotist to custom make a UCBL orthotic which I have worn for about 6 weeks now. I can actually walk around properly for the first time in about 3 years. There is still pain but without the UCBL, I struggle to walk even from bedroom to bathroom. So while I am ecstatic to have got some mobility back (essential for my job as a teacher too) I wonder what the future holds. I am a 53 year old otherwise healthy 60 kg woman. I continue the calf stretching just in case there is any lingering PF. Do you have any experience with the outcomes of these UCBL orthotics?
Many thanks for your work
Definitely keep stretching, but if you indeed have the rare heel fat pad atrophy your options are limited as you have been told. Do you have fat pad atrophy on both sides?
I am in hopes that you do not have heel fat pad atrophy and a nasty, resistant case of plantar fasciitis. Fat pad atrophy is truly rare and is often the call when a doc does not know what else to do. The classic symptom is pain bottom of heel walking barefoot on a hard floor that does not improve with more steps.
UCBL inserts, which I know quite a bit about, but little experience, can certainly help as it appears they are for you. Another much less expensive option is the M-F Heel Protector. Seriously, that is the name. Silicone heel wedges might be an option at some point as well.
Best of luck and thanks so much for being a teacher taking care of our children.
Stay healthy my friends,
just thank you ! . . I have shared your site with friends
Thanks you. Much appreciated. It is a labor of love and I am trying to help people where too many of my colleagues can’t or won’t. AND it keeps me angry.
Stay healthy my friends,
Plantar flexed 4th metatarsal head. I am actually feel the bone when I rub the bottom of my foot. A few years ago I had stump neuroma surgery and the head is very near the incision. I wish I had never had surgery. I have tried offloading the area. Are there stretches, taping, etc that will help. Thanks in advance for your time.
Surgery is undoubtedly a two-edged sword. No matter how “simple,” there are risks to every surgery, even in the best of hands, and unfortunately, you learned this the hard way. It sounds as if your fad pad is reduced, as well as a scar adjacent or under the 4th MT head. I doubt the level of your MT head has changed, but it sure feels like it. Beware of that language, BTW. It has the connotation of “we can surgically fix it by raising it” (Weil osteotomy or other MT osteotomy). I would avoid any additional surgery at this point unless there is some specific issue that is clearly amenable to taking on that risk again.
Unfortunately, there is not much that can be directly done for your problem. Indirectly reducing additional forefoot load by calf stretching will help, but to what degree. You will never know until you do it consistently. I think I asked you to massage before, and there is certainly nothing to lose digging in there with cross friction massage. Metatarsal pads (Hapad), which I am sure you must be quite familiar with, may or may not help, but they are inexpensive. Finally, custom cushioned orthotics may help, but they are quite expensive, and I found them to basically never work for your particular problem. Final finally, visit a physical therapist as see what tricks they might have up their sleeve. They can be very helpful in so many areas and are too often underappreciated. I know this might be difficult to believe, but they might even know something I do not.
Not sure I helped, sorry.
Stay healthy, my friends,