I’ve been an orthopaedic surgeon for over 25 years. I specialize in foot and ankle, but I’m interested in other areas of medicine as well. In short, I’m passionate about medicine, as well as the truth… That’s why I’ve taken to the web. I’m going to use this as a springboard to discuss real issues in medicine, and hopefully guide patients to a better experience with their medical needs.
Some, namely my colleagues, may find my point of view dissenting. For that, I don’t apologize. My goal is to help the patient, not win a popularity contest. For those of you reading, I appreciate your time.
If you have any issues you would like to discuss, you can post on the entries here, tweet me @angryorthopod, write on my Facebook page at Angry Orthopod or find me on Quora.
-AO
I know this post is older but after reading it I felt the need to pass something on.
I developed PF almost 3 years ago after a two-week course of prednisone which caused my feet to swell to the point that I could only wear this pair of flip-flops that I used by the pool. I walked in these exclusively for three weeks until I could get my feet back into normal shoes comfortably. The next week there was that nasty pain in my arch.
Podiatrist insisted I wear a popular brand of OTC insoles. I dutifully complied but they made the pain so much worse and they were hurting my opposite foot as well. She insisted I would get use to them and to “tough it out”. After 6 weeks I started to develop lateral pain in both feet. She used some foam to build up the insole, but that didn’t help. I switched on my own to an insole that seemed a little friendlier to my feet but since my arches were “normal, or neutral” and strong, I started to wonder why I was using these insoles at all.
Nearly 18 months later and still dealing with not just PF but lateral foot pain, my brother’s friend notices me with my shoe off massaging my feet at my niece’s birthday party. He’s a personal trainer and asked what the deal was. After explaining my long journey through Hades he suggested that I take the insoles out, put the factory insoles that came with the shoes back in and give it two weeks. What did I have to lose?
It was a rough two weeks, my feet were screaming at me because of the lack of artificial support but they settled down and I realized after two weeks that my PF seemed to be nearly gone, the lateral pain in that foot was gone completely and the lateral pain in my “good” foot was better but not gone.
I was relieved and furious at the same time. Almost a year after removing those insoles I am still dealing with lateral pain in my non-PF foot and so I found a new podiatrist who diagnosed peroneal tendonitis for which I am alternating an AirCast boot and a sports brace.
I know personally for me, I will never put an orthotic in my shoes again, regardless of the ailment.
This is a very eye opening story for everyone not because it is unusual, but because it is extremely common yet basically unknown. For some reason arch supports/orthotics in the US are the rage and in my opinion way over prescribed. I find in my patients who have orthotics or had them in the past caused more the original or even another new pain (like you) or do nothing at all. Yet we do as the doctor says and keep on wearing them. All in all they really don’t cause any real harm in most cases except to one’s cash flow.
On the other hand calf stretching is amazingly unpopular, yet very beneficial in most cases because it solves the problem at the source, the calf contracture. So you pick your solution. Spend money on the quick cure that does not work, orthotics. Or stretch your calves for free and slowly fix your problem the right way.
Dawn, you made the right decision. Now make one more and stretch your calves.
Stay healthy my friends,
AO
Hi Dr. AO, I had ankle surgery about 12 years ago, after being hit by a car. I had a medial malleolus reattached with a few screws, they have since been removed (11 years ago). I have lost a small amount in the range of motion compared to the good foot. I have suffered from PF on and off thru the years. I run about 20-30 miles per week. On a good note, doctors and PTs have prescribed calf stretching thru the years. However, this time, stretching cause sharp pain at the insertion point of the PF. Trigger point or foam rolling causes immediate relief but does not last…is it ok to stretch the calf thru the pain?? Working on ankle mobility to see if that can help as well. Thanks
Hi Susan,
Your question has frankly upset me a bit, so the morning got off to a good start. Thanks for that.
As long as you have reasonably characteristic plantar fasciitis the pain is acceptable with stretching. Just make sure to modify the amount of your foot is on the step which will also adjust the intensity of the stretch. More foot on the step means less intense stretch and vice versa. Of course, never get too far off the step as the intensity actually reduced due to inhibition and the metatarsals get overloaded unnecessarily. I don’t mind some easily tolerable pain during the stretch process or after. What I do mind is a trend to worsening over time.
Stay healthy my friends,
AO
Hello Dr. AO,
I have suffered from PF for about 2 years. My doctor prescribed ASTYM therapy which had no effect whatsoever after 10 treatments, so he did a steroid injection, inserting the needle into several areas of my heel. He called this “swiss cheesing it,” and described the goal of causing an inflammatory response so by body would heal itself. It worked for nearly 5 months! No pain whatsoever. Then it came back. I got an MRI which show very mild thickening of the plantar fascia, but prominent varicose veins. I told my dr that I felt a burning sensation in my heel even at rest and that morning pain was not the worst as is typical with PF. He feels my problem is nerve entrapment. My nerve conduction test revealed no obvious problem with the nerves. He said it could be Baxter’s nerve entrapment and surgery (tarsal tunnel release) could help but there are no guarantees. Should I forgo the surgery and just do your calf stretches? Would this work for burning nerve pain?
In addition to my above question, I am also wondering about this: when I do your recommended stretching, I feel WAY MORE stretch in my non affected leg. That is to say…my leg and foot with the problem already feel stretched out. How can I adjust the stretch so that it does more to my leg with the sore and burning heel?
Hi Lisa,
My first answer is absolutely forgo the surgery and stretch! I must fess up that I know little about ASTYM therapy. What I do know, it like just about everything else treating plantar fasciitis, does not address the root cause. In the case of plantar fasciitis, the root cause is equinus. No doubt it may help in some way, but it is off the mark in my angry opinion. This would explain why it worked-and then it didn’t. The root cause was not addressed!
As to your second question, the sensation of there being a stretch I agree seems to be necessary. However, in reality it is not. I have had countless patients comment no stretch was occurring, yet as they stuck with it at my insistence they ultimately resolved their problem at pretty much the same as those who felt a stretch. Having said that, you can increase your stretch force by shifting your body weight to the affected side by just reducing the weight bearing on the opposite side. Think of it as sort of shifting your weight to one side.
Now for the anger! Why would a doc do a Nerve Conduction Study (NCS) for heel pain? Even if one believed in Charley Baxter’s nerve, a NCS would never detect it. Sorry, those are the facts. To be frank, Baxter’s nerve is much like plantar fasciosis and chronic plantar fasciitis. These are made up diagnoses to explain when all the BS treatments, that do not address root cause, fail. “Oh, your treatments failed because you have a different, and more severe problem. You have Baxter’r nerve. Time to step up the treatment plan and consider surgery.” Noooooooo.
Stay healthy, my friends,
AO