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SECOND OPINION EPISODE #903
FOOT PAIN
Announcer:
MAJOR FUNDING FOR "SECOND OPINION"
IS PROVIDED BY THE BlueCross AND BlueShield ASSOCIATION,
AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED, AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD
COMPANIES. FOR MORE THAN 80 YEARS,
BLUE CROSS AND BLUE SHIELD COMPANIES HAVE OFFERED HEALTH CARE COVERAGE IN EVERY
ZIP CODE ACROSS THE COUNTRY
AND SUPPORTED PROGRAMS THAT IMPROVE
THE HEALTH AND WELLNESS OF INDIVIDUAL MEMBERS
AND THEIR COMMUNITIES. THE BlueCross AND BlueShield ASSOCIATION'S
MISSION IS TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO
ALL AMERICANS. NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM
AND ON TWITTER @BCBSAssociation.
"SECOND OPINION" IS PRODUCED IN ASSOCIATION WITH
THE UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.
Salgo:
WELCOME TO "SECOND OPINION," WHERE YOU GET TO SEE,
FIRSTHAND, HOW SOME OF THE COUNTRY'S LEADING HEALTH CARE
PROFESSIONALS TACKLE HEALTH
ISSUES THAT ARE IMPORTANT TO YOU.
I'M YOUR HOST, DR. PETER SALGO, AND TODAY WE'RE HAPPY TO WELCOME
PHYSICAL, OCCUPATIONAL, AND MASSAGE THERAPIST BOYD BENDER.
OUR "SECOND OPINION" PRIMARY CARE PHYSICIAN, DR. LISA HARRIS.
DR. JUDY BAUMHAUER FROM THE UNIVERSITY OF ROCHESTER
MEDICAL CENTER. DR. DOUGLAS HALE FROM THE
FOOT AND ANKLE CENTER OF WASHINGTON.
AND DAVE HELLER, WHO'S HERE TO SHARE HIS CASE WITH US.
BY THE WAY, THIS IS A CASE THAT OUR PANELISTS, ALONG WITH YOU
AT HOME, WILL BE HEARING FOR THE FIRST TIME.
SO LET'S GET RIGHT TO WORK. DAVE, SEVERAL YEARS AGO, YOU
WERE TRAINING TO GO -- AND I'M NOT MAKING THIS UP -- AN EXTREME
ELK HUNT?
Heller
CORRECT, YES. AND YOU HAD TO HIKE IN
60 MILES. CORRECT. YOU WANT TO TELL ME
ABOUT THIS?
Heller
WELL, ACTUALLY, A FRIEND OF MINE WHO LIVES IN COLORADO,
IN THE NORTHWESTERN PART, DOES AN ANNUAL ELK HUNT, WHERE THEY
GO INTO FEDERAL LANDS AND HIKE ALL THE WAY IN AND SPEND ABOUT
TEN DAYS TO TWO WEEKS. AND IN PREPARATION, I DECIDED TO
START WORKING OUT -- PROBABLY ABOUT SIX MONTHS
BEFORE THE HUNT. SO, DOING REGULAR PHYSICAL
ACTIVITY -- I AM A PLUMBING CONTRACTOR -- I'M IN PRETTY GOOD
SHAPE AND DECIDED THAT I NEEDED TO WORK ON STRENGTH OF MY LEGS,
AS WELL AS INCREASING MY LUNG CAPACITY, WIND, BECAUSE
WE'LL BE AT 11,000 FEET. SO I STARTED WORKING OUT, AND
ONE OF THE WORKOUTS WAS ON A TREADMILL, AND I BECAME
QUITE PROFICIENT ON THE TREADMILL AND DECIDED THAT I
WOULD PUT IT ON AN INCLINE AND THEN START TO RUN ON AN
INCLINE ON THE TREADMILL. BUT THE THING IS THAT, WITH
WORKING OUT ON THIS TREADMILL, AFTER PROBABLY ABOUT 2½ MONTHS
OR SO, I SUDDENLY GOT A TREMENDOUS PAIN
IN MY RIGHT FOOT AND DECIDED I SHOULD GO TO OUR
LOCAL PODIATRIST AND SEE WHAT'S GOING ON WITH THE FOOT.
Salgo:
NOW, HAD YOU -- WELL,
FIRST OF ALL, WHAT DID THE
PODIATRIST TELL YOU?
Heller
WELL, HE TOLD ME THAT I HAD PINCHED A NERVE
IN THE FRONT PART OF MY FOOT, JUST BELOW MY TOES.
Salgo
ALL RIGHT, AND HAD YOU EVER HAD ANY FOOT PROBLEMS
PRIOR TO THAT?
Heller
ACTUALLY, NO. I WAS BORN FLAT-FOOTED.
I'VE WORKED IN CONSTRUCTION SINCE I'M 14 YEARS OLD, WHICH
INCLUDES JUMPING INTO DEEP EXCAVATIONS AND JUMPING OFF OF
SCAFFOLDING AND LADDERS AND TRUCKS AND THINGS LIKE THAT.
SO I WANT TO STOP FOR A MINUTE, BECAUSE EVERYBODY I KNOW
HAS HEARD THE PHRASE, "FLAT FEET."
WE HAVE A PICTURE OF A FLAT FOOT.
THAT'S WHAT A FLAT FOOT LOOKS LIKE.
WHAT ARE WE LOOKING AT? ANYBODY WANT TO HELP ME OUT
HERE?
Baumhauer
WELL, IT'S A FOOT THAT IS SORT OF SAGGING IN.
WE CALL IT "PRONATING." AND ESSENTIALLY, THE STRUCTURE
OF THE FOOT IS QUITE FLAT, SO IF YOU WALKED ALONG THE SAND,
INSTEAD OF HAVING A LITTLE ARCH IN YOUR FOOTPRINT IN THE SAND,
YOU'D NOTICE YOUR WHOLE "FLINTSTONE" FOOT WOULD BE
SITTING THERE. SO I WANT TO TALK ABOUT THE
TREADMILL FOR ONE SECOND. SO, THE TREADMILL, THE
REPETITIVE, CONTINUED WALKING AT THE EXACT SAME SPEED,
WITH THE EXACT SAME STEP, MAKES ANYBODY WHO HAS ANY NEAR
FOOT PROBLEM VULNERABLE. IT WOULD BE BETTER TO WALK
OUTSIDE. CHANGE YOUR TERRAIN, CHANGE
THINGS AROUND SO THAT YOU'RE NOT DOING THE EXACT SAME THING.
YOU ACTUALLY HAVE AN ABNORMAL GAIT ON THE
TREADMILL BECAUSE OF THE STRUCTURES IN THE FRONT.
YOU CHANGE YOUR NATURAL GAIT, AND WE SEE A LOT OF PROBLEMS
THAT OCCUR WITH PEOPLE --
Bender:
WELL, ALSO, PETER, YOU'VE MENTIONED THAT HE CHANGED
TWO VARIABLES AT THE SAME TIME. YOU INCREASED THE INCLINE OF THE
TREADMILL AND THEN STARTED RUNNING, WHICH CAN OFTENTIMES
CAUSE A PROBLEM.
Hale:
YEAH, ON A TREADMILL WITH THE ELEVATION, YOUR HEEL
CORD GETS TIGHTER, YOUR FOOT'S GOING TO FLATTEN OUT MORE,
YOU'RE GOING TO PUT A LOT MORE FORCE THROUGH YOUR FOOT, ALSO
THROUGH THE FRONT OF YOUR ANKLE AND YOUR FOREFOOT, WITH GOING ON
AN INCLINE ON A TREADMILL.
Salgo:
AND NOW YOU'VE GOT FOOT PAIN.
AND SOMEBODY'S TOLD YOU YOU'VE GOT A PINCHED NERVE.
NOW, YOU'RE ON YOUR FEET ALL DAY, AND YOUR FEET ARE HURTING.
Heller:
CORRECT.
Salgo:
WHAT HAPPENED?
Heller:
I WENT TO, AGAIN, A LOCAL FOOT DOCTOR, PODIATRIST,
DETERMINED IT WAS A PINCHED NERVE IN THE FRONT OF THE FOOT,
WHICH HE GAVE ME A SHOT OF CORTISONE, I BELIEVE, SOMETHING
LIKE THAT, AND SAID, "BY THE WAY, YOU HAVE REALLY FLAT FEET."
AND I SAID, "YEAH, I'VE BEEN TOLD.
I NOTICE HOW MY WORK BOOTS WEAR OUT, YOU KNOW, ON AN ANGLE,
AND SO FORTH, LIKE THAT." AND HE SAID, "I'D REALLY LIKE TO
FIT YOU WITH ORTHOTICS."
Salgo:
ALL RIGHT, SO, LET'S STOP AGAIN.
BECAUSE YOU'VE SEEN YOUR PODIATRIST.
DID YOUR PODIATRIST GET ANY X RAYS, ANY STUDIES?
JUST LOOKED AT YOUR FOOT?
Heller:
ACTUALLY, HE DID X RAYS.
Hale:
I WOULD ASK, WHERE WERE YOU HURTING AT, WHAT LOCATION WAS
YOUR PAIN?
Heller:
THE FRONT PART OF MY FOOT, JUST BELOW MY TOES,
WAS WHERE MOST OF THE PAIN WAS. JUST IN ONE FOOT AT THAT
PARTICULAR TIME.
Harris:
AND WAS IT CONTINUOUS, OR JUST OCCURRED WHEN YOU WERE
EXERCISING?
Heller:
NO, THAT WAS CONTINUOUS -- AFTER I HAD DONE WHATEVER DAMAGE
I DID, THEN THAT WAS IT, THAT WAS START OF.
Salgo: EVEN AT REST?
Heller:
YES.
Salgo:
EVEN SITTING OR LYING IN BED, IT WOULD HURT?
Heller:
IT ACTUALLY -- I GUESS SITTING OR LAYING IN BED, IT
WASN'T BAD, EXCEPT WHEN YOU GOT UP.
THEN IT WAS BAD.
Salgo:
OKAY, SO, IF SOMEONE CAME INTO YOUR OFFICE WITH FOOT
PAIN, HOW WOULD YOU WORK IT UP?
Harris:
WELL, THE FIRST THING IS TO GET SOME OF THE HISTORY
THAT WE'VE ALREADY ASKED -- WHAT WERE THE ACTIVITIES?
ONE OTHER QUESTION WOULD BE, DID YOU BUY NEW SHOES?
OR WERE YOU USING OLDER SHOES? I'D WANT TO EXAMINE
THE SHOES THAT YOU BROUGHT IN THAT YOU WERE WEARING DURING
YOUR EXERCISE AND THE ONES THAT YOU WEAR
DURING THE DAY. AND THEN A GOOD EXAMINATION OF
THE FOOT, INCLUDING A SENSORY EXAMINATION, SO WE WOULD CHECK
TO SEE IF THERE WAS ANY LOSS OF SENSATION ANYWHERE
IN THE FOOT.
Hale:
I WOULD DO EXACTLY THAT. I THINK EVERY PATIENT, YOU HAVE
TO START WITH A GOOD HISTORY. YOU CAN'T DO TUNNEL VISION.
YOU HAVE TO FIND OUT, DO THEY HAVE ANY ARTHRITIS THEMSELVES OR
IN THEIR FAMILY, ANY OTHER MEDICAL ISSUES
YOU MAY BE DEALING WITH? AND THEN EVERY PATIENT NEEDS
AN EXCELLENT PHYSICAL. SO YOU NEED TO LOOK AT THEIR
SKIN, YOU NEED TO LOOK AT THEIR BLOOD SUPPLY, YOU NEED TO LOOK
AT THEIR NERVE STATUS. AND THEN YOU NEED TO DO A GOOD
MUSCULOSKELETAL EXAMINATION TO FIND OUT EXACTLY WHAT
STRUCTURE IS HURTING, WHERE THEY'RE HURTING AT, TO MAKE THAT
DIAGNOSIS. SO A DIAGNOSIS NEEDS THE PROPER
EXAM TO GET THAT DONE.
Bender:
I WOULD TAKE IT EVEN FURTHER WITH THE PHYSICAL EXAMINATION.
WITH THE COMPLAINT OF JUST -- THE PROBLEM ON THE ONE SIDE --
IS, PEOPLE ALWAYS HAVE A HISTORY OF OLD INJURIES, NOT JUST AT THE
FOOT OR ANKLE, BUT AT THE LOW BACK.
AND THERE COULD HAVE BEEN AN OLD DISK INJURY THAT HEALED A
LONG TIME AGO, BUT NOW IT'S MANIFESTING ITSELF IN A WAY
WHERE THERE'S A LOT OF WEAKENED MUSCLES IN THE LOWER LEG,
THAT MAY CAUSE THAT FOOT TO FLATTEN MORE THAN IT NORMALLY
WOULD.
Salgo:
WHAT I'M HEARING IS VERY INTERESTING.
YOU'VE LOOKED AT THE FOOT. BUT YOU'VE THOUGHT BEYOND
THE FOOT.
Harris:
YOU HAVE TO. TO THINK OF OTHER THINGS
WHICH MIGHT BE IMPIN-- THAT'S VERY INTERESTING.
IMPINGING ON THE FOOT. WOULD YOU DO ANYTHING ELSE?
Baumhauer:
THINK WHAT'S INTERESTING ABOUT THE STORY IS, HE SAYS,
"WHEN I'M AT REST, I'M DOING BETTER, AND WHEN I GET UP AND
USE IT, IT HURTS MORE." SO I ALWAYS THINK THAT'S
MECHANICAL FOOT PAIN. AND NOT -- IT TAKES ME A LITTLE
BIT AWAY FROM NERVE PAIN.
Harris:
NERVE, THAT'S RIGHT.
Baumhauer:
SO I'M THINKING MORE, IT'S BONES, JOINTS, THAN THE NERVES,
THAT ARE PRIMARILY THE PROBLEM.
Salgo:
ALL RIGHT. BUT DAVE GETS CORTISONE
AND GETS AN ORTHOTIC. WHAT'S AN ORTHOTIC?
WHEN DO YOU PRESCRIBE IT? WHAT'S IT SUPPOSED TO DO?
Harris:
AND, ACTUALLY, I JUST WANT TO JUMP IN WITH MY
NON-ORTHO EXPERTISE. STARTING AN ORTHOTIC WHEN HE HAS
ACUTE FOOT PAIN THAT'S UNRELATED TO, YOU KNOW,
HIS FLAT FEET. I'D WANT TO TAKE CARE OF THE
CURRENT PROBLEM BEFORE I STARTED PRESCRIBING ORTHOTICS FOR
A CHRONIC PROBLEM.
Salgo:
WHAT IS AN ORTHOTIC?
Baumhauer:
AN ORTHOTIC IS SOMETHING THAT YOU APPLY TO THE BOTTOM OF THE
FOOT -- IT CAN BE DISPENSED OVER THE COUNTER OR CUSTOM-MOLDED.
Salgo:
IT'S AN INSERT.
Baumhauer:
IT'S AN INSERT.
Salgo
GOES IN THE SHOE. AND IT'S SUPPOSED TO STRAIGHTEN
YOUR GAIT AND MAKE EVERYTHING BETTER.
Baumhauer:
IT'S SUPPOSED TO SUPPORT THE FOOT IN AREAS THAT REQUIRE IT,
TO TRY AND DECREASE PAIN OR IMPROVE FUNCTION.
IN HIS PARTICULAR CASE, I'M NOT CLEAR EXACTLY WHAT THE
ONGOING DIAGNOSIS WAS, BUT I'M SUSPICIOUS THAT THEY THOUGHT IT
WAS A NEUROMA OR SOMETHING LIKE THAT,
WITH THAT CORTISONE INJECTION DISCUSSION.
AND SOMETIMES, AN OVER-THE-COUNTER ORTHOTIC
WITH A LITTLE PAD CAN HELP SPLAY THE FOREFOOT OPEN A LITTLE BIT
AND ALLOW THE NERVES TO BE A LITTLE LESS SQUISHED,
IF YOU WILL.
Salgo:
BUT THAT'S DEPENDING ON THE DIAGNOSIS OF THE NERVE
IMPINGEMENT. SO THE $64 TRILLION QUESTION IN
TODAY'S HEALTH CARE ECONOMY, HOW DID THOSE ORTHOTICS WORK OUT
FOR YOU, DAVE?
Heller:
WELL, NOT WELL AT ALL. I THINK THE ORIGINAL, FIRST SET
OF ORTHOTICS -- BY THE WAY, THEY WERE --
OH, I KNOW WE'RE GOING TO HEAR ABOUT MORE.
OKAY, MADE THE PAIN BETTER, WORSE?
THE PAIN GOT WORSE? WHAT?
Heller:
WELL, THE INITIAL PAIN SEEMED LIKE IT WAS IMPROVING.
I MEAN, BECOMING LESS. BUT I DON'T THINK IT HAD
ANYTHING TO DO WITH THE ORTHOTICS, BECAUSE THE ORTHOTICS
WEREN'T DEALING WITH THE INITIAL REASON WHY I WENT THERE.
Hale:
DID YOUR INJECTION TEMPORARILY RELIEVE YOUR
SYMPTOMS?
Heller:
I HAD THREE DIFFERENT INJECTIONS.
Hale:
BUT FOR, LIKE, AN HOUR AFTER YOUR INJECTION, DID YOUR PAIN
GO AWAY?
Heller:
IT NUMBED IT FOR A WHILE. OR IT FELT A LITTLE BETTER.
Hale:
SO, IF YOU LOOK AT, IF WE DO A DIAGNOSTIC INJECTION, WHETHER
IT'S ON A JOINT OR ON A NERVE, IF YOUR PAIN GOES AWAY 100% FOR
AN HOUR, THERE'S A GOOD CHANCE YOU'RE AT THE RIGHT SPOT.
IF YOU INJECT A NERVE AND YOU SAY, "MY PAIN DOESN'T GO AWAY,"
IT MAY BE THE JOINT THAT'S AT ANOTHER AREA OF YOUR FOREFOOT.
SO THE BIG QUESTION IS, DOES THAT DIAGNOSTIC INJECTION
RELIEVE YOUR PAIN? 'CAUSE IF IT DOESN'T, MAYBE IT'S
NOT THE NERVE, MAYBE IT'S YOUR JOINT.
FOREFOOT PAIN IS COMMONLY JOINT ISSUES ALSO.
I'LL BACK UP ON THE ORTHOTIC ISSUE -- SO, A LOT OF PEOPLE
COME IN, THEY'RE NOT COMING IN BECAUSE THEY FEEL FINE.
THEY'RE COMING IN BECAUSE THEY HAVE A FOOT-PAIN ISSUE.
SO YOU'RE TRYING TO HELP THEM RESOLVE THAT PROBLEM.
SO THE FIRST THING TO LOOK AT IS SHOES -- A LOT OF TIMES, THEY'RE
WEARING AN UNSTABLE SHOE. THEY'RE WEARING A SHOE THAT'S
NOT PROPERLY FITTING FOR THEM. SO IT'S GIVING THEM PAIN IN A
CERTAIN AREA BECAUSE OF THEIR SHOE GEAR.
SO A LOT OF TIMES, WE CAN CHANGE THE SHOE AND MAKE THEM MUCH
BETTER. THE OTHER THING IS AN
OVER-THE-COUNTER INSERT, AND A LOT OF TIMES, WE ARE REBALANCING
THE FORCES IN THE FOOT. SO WE'RE USING AN
OVER-THE-COUNTER INSOLE INITIALLY TO REBALANCE THOSE
FORCES, TO MOVE FORCE TO AN AREA THAT DOESN'T BOTHER THEM.
Salgo:
NOW, I WAS LISTENING TO YOU, DAVE -- I CAUGHT A WHIFF
OF, YOU WENT TO THE FIRST ONE, YOU TRIED THE ORTHOTIC, IT
REALLY DIDN'T WORK VERY WELL, TIME WENT BY, I HEARD THERE WAS
AT LEAST ONE OTHER ORTHOTIC. WAS THAT WITH A SECOND
PODIATRIST?
Heller:
CORRECT.
Salgo:
OKAY, AND THAT DIDN'T WORK VERY WELL?
Heller:
THAT DIDN'T WORK VERY WELL.
Salgo: SO LET ME GUESS.
YOU WENT TO A THIRD PODIATRIST.
Heller:
WENT TO A THIRD. THIS PARTICULAR FOOT SPECIALIST
ALSO DID SPORTS MEDICINE, AND HE WORKED WITH A LOT OF PEOPLE WHO
RAN MARATHONS AND THINGS LIKE THAT.
SO HE AGREED THAT YES, I HAVE FLAT FEET, AND YES, I COULD USE
ORTHOTICS. AND OF COURSE THE OTHER ONES
WERE NOT PROPERLY ADMINISTERED. BUT IN THE MEANTIME, HE DECIDED
THAT I ALSO HAD HEEL SPURS.
Salgo:
A BONE SPUR ON YOUR HEEL?
BOTH FEET.
Salgo:
IN THE INTERESTS OF EDUCATING AMERICA, WE'VE GOT
A BONE SPUR. CAN WE PUT THAT UP
AND HAVE A LOOK? THERE IT IS.
WHAT ARE WE SEEING HERE? SOMEBODY WANT TO --
Hale:
WE'RE SEEING A SPUR AT THE BOTTOM WHERE YOU TYPICALLY
SEE PLANTAR FASCIITIS.
Salgo:
PLANTAR FASCIITIS IS WHERE THAT FASCIA, SOME OF THE
CONNECTIVE TISSUE IN THE FOOT, HOOKS ON.
Hale:
SO THE CONNECTIVE TISSUE ON THE BOTTOM OF THE FOOT HOOKS ON
AND PULLS, AND YOU GET THAT SPUR.
SO WE KNOW HEEL SPURS ARE COMMON WITH AGING, FROM STUDIES.
PEOPLE WHO HAVE HEEL PAIN HAVE A HIGHER CHANCE OF HAVING
A HEEL SPUR. BUT YOU DON'T HAVE TO
TAKE THE HEEL SPUR OFF TO GET THEM BETTER.
Salgo:
LET'S PAUSE FOR A MINUTE, BECAUSE THAT'S A HEEL.
AND IF YOU FOLLOW THE BOTTOM, THERE'S THAT LITTLE HOOK-Y
THING ON THE BOTTOM. THAT'S THE BONE SPUR.
Hale: CORRECT.
Salgo: AND THAT HURTS.
Harris: WELL...SOMETIMES.
Hale:
IT MAY OR MAY NOT. MAY OR MAY NOT.
Harris:
RIGHT, SO GETTING AN X RAY AND SEEING A BONE SPUR
DOES NOT TRANSLATE INTO FOOT PAIN.
Baumhauer
AND THE OTHER THING IS, PATIENTS SHOULD REALIZE THAT YOU
DON'T HAVE TO HAVE YOUR BONE SPUR OUT.
SO 35% OF PEOPLE HAVE AN X RAY JUST LIKE THAT AND NO PAIN
WHATSOEVER. SO DON'T TREAT THE X RAY.
Salgo:
SO BONE SPURS DON'T NECESSARILY NEED TREATMENT.
BONE SPURS DON'T NECESSARILY CAUSE PAIN.
JUST FINDING A BONE SPUR ON AN X RAY, DAVE, DOESN'T NECESSARILY
MEAN THAT'S WHAT'S CAUSING YOUR TROUBLE, CORRECT?
Heller:
CORRECT. HOWEVER, I BELIEVE THAT, WITH WEARING THE
ORTHOTICS, NOW BOTH FEET HURT. OKAY, REMEMBER, I STARTED OFF
WITH ONE FOOT WITH WHAT I THOUGHT WAS A PINCHED NERVE.
NOW BOTH FEET HURT.
Salgo:
SO NO GOOD DEED GOES UNPUNISHED.
Heller:
BY THE TIME I GOT TO THE THIRD FOOT DOCTOR, OKAY,
HE IS NOW SAYING, "YES, THEY'RE FLAT, YES, YOU NEED THIS, BUT
YOU'RE ALSO --" AND I WAS EXPERIENCING PAIN IN MY HEEL.
BOTH HEELS. SO THIS IS WHEN HE DETERMINED
THAT I HAD HEEL SPURS.
Salgo:
BUT THERE'S NO GUARANTEE THAT THAT PAIN IS FROM THE SPURS, IS
WHAT I'M HEARING FROM MY PANEL.
Hale:
THE SPUR IS A SECONDARY\ THING, NOT A PRIMARY THING.
Salgo:
WHAT TREATMENT DID YOU GET FROM YOUR THIRD DOCTOR?
Heller:
WELL, ACTUALLY, I WENT TWICE A WEEK FOR, I WOULD SAY,
FIVE OR SIX MONTHS, BUT THERE WAS ALL TYPES OF, YOU KNOW,
CERTAINLY THE WHIRLPOOL THING. YOU KNOW, THERE WAS DIFFERENT
TYPES OF STIMULATION.
Salgo:
THIS IS YOUR AREA OF EXPERTISE, ISN'T IT?
DOES THIS STUFF WORK? THERE'S MASSAGE
AND ELECTRIC STIMULATION...
Bender:
IT CAN WORK IN THE ACUTE PHASE, BUT IT'S CERTAINLY NOT
SOMETHING THAT'S GOING TO HEAL THE PROBLEM.
AGAIN, YOU HAVE TO GET BACK TO WHAT IS CAUSING THE PROBLEM.
OKAY, AND ALL OF THESE OTHER THINGS MAY BE WAYS OF TREATING
IT, INITIALLY.
Salgo:
OKAY, SO THE ACUTE PHASE MEANS IT CAN MAKE YOU
FEEL BETTER, BUT IT DOESN'T NECESSARILY FIX THE PROBLEM.
Bender:
IT DOES NOT FIX THE PROBLEM.
Harris:
WHEN HE'S FIRST HURTING.
Salgo:
WHEN YOU'RE FIRST HURTING.
Harris:
HE'S NOW INTO CHRONIC PAIN.
YOU'RE NOW INTO – YEARS INTO THIS.
WHERE DID YOU GO NEXT?
Heller:
WELL, THAT PARTICULAR SPECIALIST FINALLY DECIDED THAT
HE COULD GO NO FURTHER WITH ME AND THEN RECOMMENDED A
RHEUMATOID GUY. MAYBE I HAD SOME R.A. IN MY
FOOT.
Salgo:
"R.A." MEANING "RHEUMATOID ARTHRITIS."
Heller:
MEANTIME, YOU KNOW, THE FOOT -- BOTH FEET ARE NOW
TO THE POINT WHERE I'M KIND OF HOBBLING A LITTLE BIT.
Baumhauer:
I THINK WHERE HE'S FALLING SHORT --
SO APPLYING SOMETHING TO THE BOTTOM OF HIS FOOT, SENDING HIM
OFF TO PHYSICAL THERAPY, YOU KNOW, WE'RE ALL SORT OF
QUESTIONING, WHERE'S THE DIAGNOSIS, AND WHERE
IS IT GOING? YOU KNOW, THERE ARE A LOT OF
OPTIONS HERE. IF IN FACT YOU HAD HEEL SPURS,
PLANTAR FASCIITIS, IF IN FACT THAT WAS THE CASE, YOU KNOW, THE
MAINSTAY OF TREATMENT IS STRETCHING EXERCISES THAT YOU DO
AT HOME. SO THAT COSTS YOU NOTHING BUT
YOUR TIME, BUT IMPORTANT FOR YOU TO GET BETTER.
AND, YOU KNOW, I ALSO WANT TO INTERJECT, BECAUSE
THE CARE GIVERS THAT YOU'RE TALKING ABOUT ARE ALL DIFFERENT
PEOPLE, SO THERE'S PODIATRISTS AND THERE ARE ORTHOPEDIC
SURGEONS THAT ARE FOOT AND ANKLE SPECIALISTS, AND THE
RHEUMATOLOGISTS ARE INTERNAL MEDICINE SPECIALISTS.
SO YOU HAVE ACTUALLY SORT OF MIXED AND MATCHED, I BELIEVE,
TO MANY DIFFERENT PEOPLE.
Salgo:
WHICH IS NOT NECESSARILY A BAD THING,
IF THEY WERE GETTING SOMEWHERE.
Hale:
I THINK THE MOST IMPORTANT THING IN ANY MEDICAL
CASE -- WE SEE A LOT OF THIS, WHERE PEOPLE ARE GETTING
TREATED, BUT YOU REALLY NEED TO GET AN ACCURATE DIAGNOSIS.
SO YOU HAVE TO DO WHATEVER IT TAKES TO GET THE DIAGNOSIS,
WHETHER IT'S FURTHER DIAGNOSTIC STUDIES, BUT THE MOST IMPORTANT
THING IS LISTENING TO THE PATIENT, HEAR WHAT THEY'RE
TELLING YOU, WHERE THEY HURT, DOING THE PHYSICAL EXAM, DOING
THE APPROPRIATE STUDIES AND WORKUP TO GET THEM A DIAGNOSIS.
ONCE YOU GET THEM A CLEAR DIAGNOSIS, NOW YOU CAN SET A
TREATMENT PLAN IN PLACE, VERSUS TREATING BUT NOT REALLY
HAVING A DIAGNOSIS.
Harris:
HAD YOU HAD ANY OTHER STUDIES DONE?
I HEARD THE ONE X RAY, BUT DID YOU HAVE AN MRI
OR ANYTHING ELSE DONE?
Heller:
YES, SOMEWHERE IN BETWEEN THE THIRD PODIATRIST/FOOT DOCTOR AND
THE RHEUMATOID GUY, I DID GO IN TO MENTION THE HOSPITAL OF
SPECIAL SURGERY IN NEW YORK, WHICH IS EXTREMELY PRECISE
WHEN IT COMES TO ANY TYPE OF ORTHOTIC SURGERY AND THINGS
LIKE THAT. AND I SAW ONE OF THEIR TOP
FELLOWS, AND WE DID THE -- STARTING OFF WITH THE REGULAR
X RAYS, CAT SCANS, MRIs, SO FORTH AND SO ON.
AND NOW WE WERE STARTING TO GET, YOU KNOW, WHAT THE REAL
SITUATION AND THE REAL PROBLEM WAS.
Salgo:
SO WHAT I'M HEARING IS THAT NOW, FOR THE FIRST TIME,
YOU'RE GETTING A BATTERY OF STUDIES ON THIS FOOT, OTHER THAN
JUST A PLAIN X RAY.
Heller:
CORRECT.
Salgo:
AND YOU'RE DOING WHAT EVERYBODY ELSE HERE HAS ASKED
YOU TO DO -- OR ASKED THEM TO DO -- GET THE RIGHT DIAGNOSIS.
IF YOU'RE TREATING THE WRONG DIAGNOSIS, YOU'RE NOT GOING TO
GET BETTER. SO WHAT DID THEY TELL YOU AT THE
HOSPITAL FOR SPECIAL SURGERY?
Heller;
WELL, BASICALLY, BECAUSE OF, I ASSUME, BEING BORN
FLAT-FOOTED, THAT THE TENDONS ON BOTH FEET WERE TORN, AND IT
WOULD REQUIRE A SURGERY THAT SOUNDED QUITE EXTENSIVE, WHERE
THEY ACTUALLY CUT THE BONE AT THE BOTTOM OF THE FOOT,
AND THEN THEY TAKE A BONE FROM MY HIP, PUT IT INTO THE BOTTOM
OF MY FOOT, AND THEN I GUESS THE TENDON WOULD REATTACH ITSELF
OR WHATEVER. WELL, THE PROCEDURE FOR EACH
FOOT IS ABOUT EIGHT MONTHS.
Salgo:
WELL, THE PROCEDURE ISN'T, RIGHT, IT'S THE RECOVERY?
Heller:
WELL, THE RECOVERY IS ABOUT EIGHT MONTHS, SO WE'RE TALKING,
YOU KNOW, OVER A YEAR AND A HALF OF MY LIFE TO BE, YOU KNOW,
DEDICATED TO THESE FEET. SO, AT THAT POINT, I SAID,
"UH, MAYBE NOT." HE RECOMMENDED TO WEAR THESE
SMALL BRACES AND TRY THEM OUT TO SEE IF THEY WOULD EASE PAIN.
THEY'RE NOT GOING TO CORRECT THE PROBLEM, BUT THEY MAY MAKE IT
MORE BEARABLE FOR YOU TO FUNCTION, TO WALK AROUND.
Salgo:
I WANT TO STOP YOU RIGHT HERE, BECAUSE NOW WE'VE
DESCRIBED AN OPERATIVE PROCEDURE.
THIS IS THE FIRST TIME SOMEBODY'S SAYING, "I'VE DONE
ALL THE STUDIES, I'VE GOT A DIAGNOSIS, AND I'M GOING TO FIX
YOU WITH SURGERY." DOES THIS SURGERY SOUND
RATIONAL?
Baumhauer:
WELL, I HAVE TO TELL YOU, YOU HAVE ME,
LIKE, OFF BALANCE HERE, BECAUSE YOU STARTED OUT WITH
FOREFOOT PAIN. OKAY, FOREFOOT PAIN, PAIN IN THE
BALL OF YOUR FOOT. THEN YOU SAID, "NOW I HAVE
HEEL PAIN." I DON'T KNOW IF IT WAS FIRST FEW
STEPS IN THE MORNING PAIN, THAT KILLED YOU WHEN YOU GOT OUT OF
BED, LIKE PLANTAR FASCIITIS IS, BUT NOW YOU'RE MOVING INTO, "I
GOT POSTERIOR TIBIAL TENDINITIS," WHICH IS THE TENDON
ON THE INSIDE ASPECT OF YOUR FOOT, THAT ALLOWS YOU TO -- WHEN
IT RUPTURES OR ELONGATES, FALLS IN.
SO THEN YOU GOT THREE DIFFERENT THINGS GOING ON.
Salgo:
I CHEATED -- I READ A LITTLE BIT OF YOUR STORY.
I KNOW YOU GOT A SECOND OPINION FROM ANOTHER ORTHOPEDIC SURGEON,
WHO ALSO RECOMMENDED SURGERY.
Heller:
CORRECT.
Salgo:
AND THEN, ON THE VERGE OF DOING THE SURGERY, SOMEBODY
SAID, "DON'T." SOMEONE SAID TO YOU, "YOU KNOW,
MAYBE AT YOUR AGE, EIGHT MONTHS PER FOOT, NOT SUCH A GREAT
IDEA." AND YOU DECIDED TO FORGO THE
SURGERY, AND YOU WOUND UP -- YOU'RE WEARING BRACES NOW.
CAN YOU SHOW US THE BRACES THAT YOU'RE WEARING?
Heller:
YEAH, THEY'RE A STRAP-ON. THEY GO UNDER THE FOOT.
I BASICALLY HAVE TO WEAR THESE -- ACTUALLY,
I WEAR THEM ALL THE TIME. THEY'RE DOING NOTHING TO CORRECT
THE PROBLEM, THEY'RE JUST MAKING IT LESS PAIN.
Baumhauer:
THEY'RE SUPPORTING YOU.
Heller:
SO, TO ME, IT'S GIVING ME SOME SUPPORT DOWN THERE, AND
THEREFORE TAKING AWAY DISCOMFORT.
Salgo:
SO LET ME SUMMARIZE WHERE WE ARE, IF I MAY.
YOU HAD AN INJURY. THEN YOU WENT TO -- I'M COUNTING
HERE -- THREE PODIATRISTS, TWO ORTHOPEDIC SURGEONS.
YOU'VE HAD A LOT OF ORTHOTICS, MASSAGE, ELECTROTHERAPY,
ACUPUNCTURE, CORTISONE, LOTS OF OTHER TREATMENTS,
AND YOU'RE STILL IN PAIN. THIS HAS BEEN QUITE A STORY.
SO I WANT TO BE SURE WE'VE SORT OF SUMMED UP WHERE WE ARE.
A THOROUGH EVALUATION TO DETERMINE THE CAUSE OF FOOT PAIN
IS NECESSARY IF YOU'RE GOING TO GET SUCCESSFUL TREATMENT.
WHEN IT COMES TO THE TREATMENT OF FOOT PAIN, ONE SIZE DOES NOT
FIT ALL. AND THE CAUSE IS EVERYTHING.
IF YOU'RE TREATING THE WRONG CAUSE, IT'S NOT GOING TO GET
BETTER. FAIR ENOUGH?
CORRECT. ALL RIGHT, SO WE NEED TO
MOVE ON. OF COURSE, DAVE IS HERE WITH US
TODAY. YOU'VE HAD FOOT PAIN NOW
FOR MANY YEARS. NO TREATMENT SO FAR HAS BEENABLE
TO MAKE YOUR PAIN REALLY GO AWAY.
IS IT FAIR TO SAY THAT SOME PEOPLE SIMPLY HAVE TO PUT UP
WITH FOOT PAIN? IS DAVE GOING TO HAVE TO PUT UP
WITH FOOT PAIN FOR THE REST OF HIS LIFE, IS THAT IT?
Baumhauer:
WELL, I THINK YOU'VE NOW TRIALED HIM.
YOU'VE PUT HIM IN BRACES, AND HE SAYS, "I'M BETTER IN THE
BRACES." RIGHT?
Heller:
CORRECT.
Baumhauer:
SO HE IS BETTER. SO NOW HE'S BETTER IN THE
BRACES, SO YOU'VE -- YOUR HYPOTHESIS IS THAT IT WAS
A TENDON PROBLEM. AND HE SEEMS TO BE SUPPORTED
WITH THAT TENDON PROBLEM. AND THAT'S -- AND NOW HE HAS TO
DECIDE, "AM I GOING TO LIVE IN THESE BRACES?
IS THERE ANOTHER TYPE OF BRACE OPTION OR ORTHOTIC OPTION FOR ME
TO SORT OF STEP DOWN INTO? OR SHOULD I HAVE SURGERY FOR
THIS PROBLEM?" THAT'S REALLY WHERE HE IS IN THE
DECISION MODE.
Salgo:
RIGHT. I WANT TO COME BACK TO YOUR PROBLEM.
NOW, LISA, SHOES. CAN YOU SHOW US THE SHOES YOU'RE
WEARING TODAY, PLEASE?
Harris:
I GUESS SO.
Salgo:
THANK YOU. THEY HAVE HEELS.
VERY HIGH HEELS. ARE THESE GOOD SHOES TO WEAR
ALL DAY, EVERY DAY?
Baumhauer:
I WOULD TELL YOU THAT NO MATTER WHAT YOU SAY, IT'S LIKE,
"COULD YOU STOP WEARING THOSE?" WELL, SOME PEOPLE FEEL GOOD
IN THOSE. AND IT'S ABOUT HOW YOU FEEL.
SO I BELIEVE THAT WE'RE GOING TO HAVE PEOPLE WEAR HIGH HEELS.
SO WE'RE GOING TO HAVE TO DEAL WITH IT.
WHAT YOU WANT TO DO IS HAVE THEM WEAR THEM OCCASIONALLY, NOT
THEIR EVERYDAY SHOES, JUST TO EVENTS,
JUST WHEN THEY LOOK GOOD ON SITTING ON A CHAIR.
BECAUSE SHE'S NOT WEIGHT-BEARING ON HER FOOT WITH THOSE
HIGH HEELS. SHE JUST LOOKS GREAT.
Salgo:
I'LL ASK THE PROVOCATIVE QUESTION -- YOU WEAR
THESE ALL DAY, DON'T YOU?
Harris:
ALL DAY, EVERY DAY.
Hale:
I'LL ADD TO THAT -- A LOT OF FOOT SYMPTOMS ARE CAUSED
BY A TIGHT ACHILLES TENDON, OR THE TENDON ON THE BACK OF
YOUR LEG, SO A LOT OF PEOPLE GET FOOT PAIN BECAUSE OF THAT.
SO A LITTLE BIT OF HEEL LIFT WILL TAKE FORCE OFF YOUR FOOT,
SUCH AS YOUR PLANTAR FASCIA, YOUR MIDFOOT.
SO A LITTLE BIT OF A HEEL HELPS A LOT OF PEOPLE.
Salgo:
NOW, LET ME JUST RATTLE OFF VERY QUICKLY, NOW, A COUPLE OF
THINGS. CROCS -- YOU LIKE THEM?
Baumhauer;
I THINK IF THEY FEEL GOOD ON YOUR FOOT, IT'S FINE WITH ME.
Salgo:
EARTH SHOES? BIRKENSTOCKS?
Hale:
EARTH SHOES HAVE A NEGATIVE HEEL ON THEM, WHICH MEANS THE
HEEL IS LOWER THAN THE FOREFOOT, SO FOR MOST PATIENTS, THAT'S NOT
A GOOD SHOE FOR THEM. FOR SOME PATIENTS WHO HAVE A LOT
OF MOTION IN THEIR ANKLE, THAT SHOE WORKS FOR THEM.
Salgo:
PEDICURES -- GOOD OR BAD?
Baumhauer:
I THINK PEDICURES, YOU'VE GOT TO MAKE SURE YOU HAVE A PLACE
THAT IS CLEAN AND STERILIZES -- OR AT LEAST CLEANS -- THEIR
EQUIPMENT. SO YOU HAVE TO BE A LITTLE
CAREFUL WITH THAT.
Harris:
AND I JUST WANT TO DOVETAIL ON SOMETHING THAT JUDY
SAID ABOUT CROCS, OR EVEN IF YOU TALK ABOUT FLIP-FLOPS
OR OTHER SHOES LIKE THAT. IT'S IMPORTANT THAT YOU DON'T
HAVE PAIN, BECAUSE WHAT A LOT OF PEOPLE DO IS GRIP WITH THEIR
TOES TO KEEP THE SHOE ON THEIR FOOT, AND THEN THEY
START DEVELOPING FOOT PAIN.
Salgo:
I WANT TO GET ONE RECOMMENDATION, MAYBE, ONE
SENTENCE FROM THIS WHOLE GROUP, THE BEST THING YOU CAN DO TO
KEEP YOUR FEET HEALTHY.
Hale:
I THINK THE ONE THING IS A GOOD SHOE.
AND EVERYBODY'S FOOT STRUCTURES DIFFERENTLY.
DIFFERENT PEOPLE LIKE DIFFERENT TYPES OF SHOES.
BUT A GOOD, SUPPORTIVE SHOE, A SHOE THAT DOESN'T CAUSE YOU
PAIN, IS THE BEST SHOE FOR YOU.
Baumhauer:
A GOOD SHOE, DON'T SMOKE, WATCH YOUR WEIGHT, I MEAN,
ALL THESE THINGS LOAD ONTO YOUR FOOT.
Salgo:
I JUST WANT TO COMMENT ON THAT -- THAT'S REALLY
IMPORTANT. WE HEAR THIS ON ALMOST
EVERY BROADCAST. DON'T SMOKE -- BAD VASCULAR
DISEASE CAUSES BAD FOOT DISEASE. DON'T GET TOO HEAVY -- NOT ONLY
DOES IT PUT PRESSURE ON YOUR FEET, BUT IT CAN LEAD TO
UNCONTROLLABLE DIABETIC PROBLEMS, FOOT ULCERS, SEPSIS,
LOSING YOUR FOOT. BAD. OKAY.
Bender:
AND EVEN IF YOU WALK 20 TO 30 MINUTES A DAY, THAT'S GOOD
ACTIVITY FOR YOUR FEET.
Salgo:
EXCELLENT.
LET'S STOP FOR A MOMENT AND WE'LL SUM UP WHERE WE'VE BEEN,
THEN WE WILL GO FORWARD A LITTLE BIT AFTER THAT, BUT THIS IS
A COMPLICATED SUBJECT. THAT BEING SAID, THERE IS A LOT
YOU CAN DO TO KEEP YOUR FEET HEALTHY AND PAIN-FREE,
SUCH AS WEARING GOOD SHOES APPROPRIATE
FOR THE SEASON, LISA. NOT SHARING THE PEDICURE
TOOLS -- THEY'VE GOT TO BE CLEAN.
FINALLY, LISTEN TO YOUR FEET. THEY DO TALK TO YOU.
YOU SHOULD CONSULT A PROFESSIONAL WHEN UNRESOLVED
PAIN OR OTHER PROBLEMS IMPACT YOUR ABILITY TO WALK AND TO
PERFORM YOUR EVERYDAY ACTIVITIES.
YOU KNOW, DAVE, I UNDERSTAND THAT PEOPLE WHO KNOW YOU SAY
THAT YOU'RE ALWAYS UP. YOUR SPIRITS ARE HIGH, AND THEY
WOULD NEVER KNOW THAT YOU HAVE FOOT PAIN.
HOW DO YOU GET THROUGH THE DAY LIKE THAT?
Heller:
WELL, ONE OF THE THINGS I'VE REALIZED ABOUT PAIN IS THAT YOUR
BODY AND YOUR MIND WORK VERY WELL TOGETHER WHEN IT COMES TO
SOMETHING THAT DOESN'T FEEL GOOD.
I HAD JUST HAD ROTATOR-CUFF SURGERY, I HAD FALLEN OFF AN
EXTENSION LADDER, I HAVE AN INDIRECT HERNIA,
I HAVE AN ENLARGED PROSTATE, I HAVE ABOUT FIVE OR SIX THINGS
GOING ON. SO, YOU KNOW, THE FEET ARE
IMPORTANT, 'CAUSE THEY GET ME FROM POINT "A" TO POINT "B,"
BUT THEY'RE NOT MY WHOLE LIFE.
Salgo:
ALL RIGHT, WELL, I WANT TO THANK YOU VERY MUCH FOR
BEING HERE, BRACES AND ALL.
Heller:
BRACES AND ALL.
Salgo:
UNFORTUNATELY, WE'RE OUT OF TIME, AND I HOPE THAT YOU'LL
CONTINUE THE CONVERSATION ON OUR WEB SITE.
THERE, YOU WILL FIND THE ENTIRE VIDEO OF THIS SHOW, AS WELL AS
THE TRANSCRIPT AND LINKS TO THE RESOURCES THAT WE CAN
PROVIDE. THE ADDRESS IS
SecondOpinion-tv.org. AGAIN, THANK YOU FOR WATCHING.
THANK ALL OF YOU FOR BEING HERE. I'M DR. PETER SALGO.
I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."
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