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Searching file 26

Message Number 261275
Re: Cheilectomy & Osteotomy Recovery and possible future surgery View Thread
Posted by L on 10/13/09 at 16:04

Hi...5 days out from a right dorsal cheilectomy and have been wearing a cushioned orthopedic 'boot' for support along with the crutches. I am putting more and more weight on my heel and have expereinced little pain by doing this. I will return to work tomorrow, and feel strong enough to do so now (weak from not being hungry due to pain meds for 3 days). While I am frustrated by my limitations, I know in the long run I am much better off having had the surgery. I am eager to get back to my athletic lifestyle and moving forward.

Result number: 1

Message Number 261011

Re: Iran View Thread
Posted by marie:) on 10/02/09 at 15:10

Let's not leave out the bankers and the auto execs. This is my conservative side coming out. I don't believe in using up what we may need later down the road. This care free 'I want it now' attitude has gotten us in alot of trouble. Saving is a good thing.......I don't differentiate between cash and natural resources. It's all about keeping the upper hand and saving for that rainy day. I don't want to be out in the rain when the oil reserves in other nations dry up. When Republicans were pushing the drill now bill they forgot to mention that a good chunck of the oil will be sold to other nations........like China. They refused to put any limitations on who the oil on our soil would go to.

Result number: 2

Message Number 260638

Re: Need Help Fast have big plans suffering from Plantar Fascitis View Thread
Posted by Dr. Wedemeyer on 9/16/09 at 22:38

Kay that's alright, I realize that many people who find this site are in chronic pain and frustrated. I imagine that it's difficult to focus and that after recounting your history multiple times that small details can get lost along the way. They are important though.

From what you describe I have to ask if you have any low back issues or have in the past, previous treatment for low back pain and has this been ruled out as a cause or concomitant?

What you describe is nerve entrapment. Being placed on Neurotin is not always a panacea for neuropathic pain, like everything it has a benefit and it also abject failures to mediate your pain. It is also not diagnostic.

Your description sounds a lot like lumbar radiculopathy AND Tarsal Tunnel Syndrome occurring concomitantly (double crush syndrome) but it could also be TTS and heel pain syndrome such as chronic PF, fat pad displacement or lateral plantar nerve entrapment at the heel (Terri) . Either way the etiology of your complaint sounds mechanical in nature since you do experience relief when you are not weight-bearing.

Result number: 3

Message Number 260508

Functional leg length discrepancy View Thread
Posted by BrianPK on 9/11/09 at 14:41

When making orthotics, who makes the call as to addressing a functional leg length discrepancy, my chiropractor says that my hips are 'off' by about 25mm and after a time has given me a 1/4' pad to wear under my insole or orthotic. I saw one pedorthist who said that the functional discrepancy was so large that it might be necessary to actually bring up my whole foot not just the heel, but, he wasn't willing to make that call. It seems to help as I am having buttock pain. When I asked about making a more exact adjustment or if more was needed or if the whole foot adjustment would help more I got a non commital response. Who generally makes the call on these type of adjustments ?

Result number: 4
Searching file 25

Message Number 259850

Re: plantar fascitis surgery and sciatica View Thread
Posted by Dr. Wedemeyer on 8/18/09 at 23:37

Beau I do not believe that is the question that was asked. Misty asked if her low back pain could be caused by her plantar fasciitis. While faults in normal gait can exacerbate a sciatic complaint, they are typically a concomitant feature of the sciatic patient and not the etiology of the sciatica. Also she is complaining of bilateral pain, I can think of several differentials here that have nothing to do with her feet.

Result number: 5

Message Number 259675

Re: Stair stretching - medical studies View Thread
Posted by Dr. DSW on 8/13/09 at 14:43

Here is just one study that supports my view that patients with plantar fasciitis should refrain from weight bearing stretching exercises, and in my opinion, should always avoid the 'stair stretch'.

Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF.
Department of Physical Therapy, Ithaca College, University of Rochester Campus, New York 14623, USA. benedict_digiovanni at urmc.rochester.edu

BACKGROUND: Approximately 10% of patients with plantar fasciitis have development of persistent and often disabling symptoms. A poor response to treatment may be due, in part, to inappropriate and nonspecific stretching techniques. We hypothesized that patients with chronic plantar fasciitis who are managed with the structure-specific plantar fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol. METHODS: One hundred and one patients who had chronic proximal plantar fasciitis for a duration of at least ten months were randomized into one of two treatment groups. The mean age was forty-six years. All patients received prefabricated soft insoles and a three-week course of celecoxib, and they also viewed an educational video on plantar fasciitis. The patients received instructions for either a plantar fascia tissue-stretching program (Group A) or an Achilles tendon-stretching program (Group B). All patients completed the pain subscale of the Foot Function Index and a subject-relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function, and satisfaction with treatment outcome. The patients were reevaluated after eight weeks. RESULTS: Eighty-two patients returned for follow-up evaluation. With the exception of the duration of symptoms (p < 0.01), covariates for baseline measures revealed no significant differences between the groups. The pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia-stretching program with respect to item 1 (worst pain; p = 0.02) and item 2 (first steps in the morning; p = 0.006). Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the plantar fascia-stretching program. CONCLUSIONS: A program of non-weight-bearing stretching exercises specific to the plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

PMID: 12851352 [PubMed - indexed for MEDLINE

The name of the article is below, and published in the Journal of Bone and Joint Surgery (American Edition) as cited below.

Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006 Aug; 88(8):1775-81.
[J Bone Joint Surg Am. 2006]

However, despite this study and other studies that can be found on the internet, my 'opinion' is simply based on my 20+ years of practice treating this condition. I've tried every treatment imaginable, and have had patients enter my office that have attempted every treatment imaginable. With the proper supervision, eccentric/concentric stretching exercises can be beneficial.

But in my experience, patients that have plantar fasciitis have a prolonged recovery and increased discomfort and often have increased pain and/or end up with more injury to their plantar fascia when performing weight bearing stretches, especially what I personally refer to as the 'dreaded' stair stretch. I find this to cause the most damage with lingering pain in my practice.

When I have patients d/c this stretch, the results are often dramatic and their recovery is often improved significantly. There is an orthopedic surgeon that actually sells a video, claiming that he can 'cure' plantar fasciitis without orthotics, without injections, without medications, without shoe modifications, without night splints, without ANYTHING other than HIS video. And ironically, his video is based completely on the 'stair stretch'!!!!!

He basically sells a video stating that if you follow his video (after you purchase his video) all you have to do is follow HIS stretching program to rid yourself of heel pain forever, and it's ALL based on the stair stretch!!!

You can do whatever you'd like to do, this forum is simply for advice. I provide the best advice I can based not just on 'studies' or literature that I read, but based on 'real' patients that I have treated over the past 20+ years. I know what works and what makes sense. Therefore, as a reader of this website, you have the opportunity to take the information and either incorporate it into your treatment regimen or you can simply ignore my advice/opinion and do whatever you believe is correct or right for you.

Result number: 6

Message Number 259142

Re: Hyperpronation surgery? View Thread
Posted by Dr. Wedemeyer on 7/26/09 at 17:46

Carla

I can commiserate your frustration, I was a patient once as well. Dr. DSW wrote something that everyone considering this surgery should be aware of:

bbv.cgi?n=259120

I trust and value his surgical opinion and have seen many patients with implants who still require orthoses and appropriate footwear. That said implants, like orthoses, ESWT, Topaz etc are all treatments and all treatments have successes and failures, cheers and jeers. They have limitations and should as Dr. DSW has stated 'The HyProCure implant can work very well in the correct patient'. I would bet the Dr. would agree to any surgery being subject to the same caveat.

You wrote 'You CAN'T wear sandals, heels, or any other nice shoe with them'. This is not true Carla and the type of shoe primarily being worn by the patient is an important part of the selection and design process for the orthoses that I dispense. SOME shoes and manufacturers are strictly not well designed for in-shoe devices. High heels are typically out yes, but some patients can wear them for short periods of time, it really depends. They are of course completely inappropriate for orthotics (and foot health in general...sorry)

There are myriad companies offering shoes, sandals, clogs etc. that either have the depth to accommodate custom orthoses, many sandal manufacturers (NAOT comes to mind have removable beds) and are stylish and not very expensive. The trick is in finding a Certified Pedorthist (CPed) who can help you with your selection choices. I also recommend you research the doctor prescribing your devices and if he/she does not place an emphasis on biomechanics, have them write a script that a CPed can fill (hopefully the one who helps you with your shoe selection).

Try the ABC website search for a CPed:

http://www.abcop.org

Good luck

Result number: 7

Message Number 258939

Re: Dr. Comfort shoes View Thread
Posted by Jeremy L, C Ped on 7/18/09 at 22:08

Some models (most particularly the athletic ones) have an exaggerated amount of forefoot rockering, which would help with what you describe. The brand itself is made especially to meet with prescription guidelines for Medicare's Therapeutic Shoe Program, and thus may not necessarily meet the needs of all people. It's key limitations are in overall durability. Their models are fine for older, more sedentary individuals, but the midsole compounds are not substantial enough for those who are more physically active. There are certainly plenty of brands/models who make shoes satisfying the needs of the latter.

Result number: 8

Message Number 258511

Re: flat feet View Thread
Posted by Jeremy L, C Ped on 6/30/09 at 21:38

In re-reading your post, there is something else I would like you to consider.

Orthotic labs (and similar businesses) are licensed to work as wholesale producers. Their limitations on selling items to consumers extends beyond any clinical/ethical considerations. They are also limited through their state business licenses.

Why do you have such a keen interest in acquiring materials from orthopedic labs?

Result number: 9

Message Number 257144

Re: posterior tibial tendinitis View Thread
Posted by Dr. DGW on 4/26/09 at 11:46

The simplest way to generally determine if you have PTTD is to perform walking on the ball of the foot. This exacerbates the PT tendon when there is pathology but should not light up PF. Additionally only your doctor can really make this diagnosis based on your history and the physical examination, which includes palpation and manual testing of the tendon by stressing the PT muscle.

Beyond that seeing a foot specialist to determine what stage of PTTD you are suffering as the treatments vary according to the progression of the condition (I-IV). Your doctor should also determine of you have PF concomitantly as this is a common occurrence and often treating the PTTD will help the PF complaint. Physical therapy can be very helpful.

Stage I-2 PTTD is often treated successfully with custom functional orthoses (CFO's)that modify the rate and degree of pronation at the he subtalar joint. Shoe wear is important to the effect of the orthoses and I prefer a neutral lasted shoe with a CFO.

Stages III-IV are treated with an ankle and foot orthoses (AFO), a brace made specifically for this problem. This is all assuming the level of damage to the PT tendon is amenable to conservative care. The last option is surgery to repair the tendon and correct the progressive heel valgus deformity.

Last word is I often see patients who have been afforded CFO's and find the design of some of them inadequate for PTTD. The modification of choice for pronation related pathology is a Kirby medial skive built into the heel of the device and of course the knowledge set and learning curve necessary to determine how much skiving, inversion of the cast, arch height and material to be used comes with training and experience.

Result number: 10

Message Number 256981

Re: Lateral Column Destabilization View Thread
Posted by Dr. Ed on 4/19/09 at 11:02

Terri:

Your question suggest that the orthotics you have are not helping. Orhtotics can be highly effective for lateral column instability provided that the prescription is correct. Often the orthotic shell need have increased support at the calcaneocuboid joint. That may be accomplished by increasing the convexity of the orthotic shell in that area and/or extending the rearfoot post distally under the joint. Additionally, forefoot valgus posting, preferably extrinsic, may be needed based on the foot type. Individuals with forefoot valgus or who propel off a midtarsal joint that is not completely pronated are more likely to get lateral column pain after plantar fascial release surgery in my experience. I realize that I have listed some technical terms but have no other way to describe what components an orthotic need have in order to be effective.

If there is any limitation of ankle dorsiflexion (upward motion of foot on ankle) that need be addressed as it can lead to additional midfoot and lateral column stress/strain.

Manipulation of the calcaneocuboid joint can be a useful adjunct.

Very occasionally, a calcaneocuboid joint fusion is needed but conservative treatment usually is effective.

Dr. Ed

Result number: 11

Message Number 256920

Re: upper arch pain? View Thread
Posted by Mita M on 4/15/09 at 22:21

I have pain in the top hump of both feet, i.e., on the top of the arches. Walking is becoming increasingly painful. Orthotics seem to push my feet out of my sneakers. So I wear New Balance sneakers for fallen arches, with roller bar stability. Plus Thorlos socks. But nothing is helping. What should I do?

Result number: 12

Message Number 256788

Re: Heel Pain: Rheum or Neuro issue or both?? View Thread
Posted by Dr. Wedemeyer on 4/09/09 at 23:15

This is obviously not a simple case and we can only comment on what you have told us here, which is much more complete than many of the questions presented. Thank you.

The problem is that you can have a positive ANA test and have no symptoms at all of an autoimmune disease such as Lupus or a connective tissue disorder. To complicate matters you have a + CRP and high sed rate all of which point to chronic inflammation.

Along with that you have a + EMG bilaterally at the lower extremity and a + L4-5 radiculopathy on the left but no low back history. Thus far all test other than bone scan and EMG's are negative.

I feel that your rheumatologist is on the right track. This is not simple PF. Given your age, the symptoms revealed and your denial of a spinal component I would wait for the spinal MRI. If that is negative I would suspect bialteral TTS and if it shows disc involvement or spinal stenosis (which you don't appear to show symptoms of but should be ruled out) I would differential double crush versus TTS and concomitant possible early onset of an inflammatory arthritis or connective tissue disorder that is not yet symptomatic.

To answer your question, no it is not typical for TTS patients to have positive lab work of this type. TTS is a neurologic disorder, which I am sure that you already are aware of.

Dr. DSW and I are huge proponents of rheumatologist and neurologist referral in cases such as these. Personally I wouldn't wait two years to offer such a referral if what I initially thought was PF didn't resolve timely.

I hope that you will follow up with us and report back. It is very educational for the readers who may have a similar presentation who were possibly misdiagnosed.

Result number: 13

Message Number 256728

Re: Who got cured? View Thread
Posted by joannem on 4/08/09 at 06:05

My recovery has been due to a combination of things. First and foremost rest - stayed off my feet for as long and as often as possible. This was for many months - I took every opportunity to stay off my feet. Icing as often as needed. Pain killers - voltaren rapid 25s. No high heel shoes or shoes with a thin or non-supportive sole. No physical or weight bearing exercise. Calf stretches 2 x 30 second calf stretches twice a day as prescribed by podiatrist. A good fitting pair of prescription orthotics. An office job where I am not on my feet much. Time and patience. I do not believe I will ever be cured as it is an ailment that I have and always will now have. It is however under control and manageable. I know I still have plantar fasciitis if I 'overdo' things such as wear incorrect shoes, or bad orthotics, or spend hours on my feet at a time. For 90% of the time I have no problem, can go for regular walks, classes at the gym, cycling, just as long as I am careful to limit what I do or it will flare up. I recognise and mostly know my limitations and this has enabled me to enjoy a relatively normal mostly pain free life.

Result number: 14

Message Number 256617

Re: Good Feet question View Thread
Posted by Dr. DGW on 4/04/09 at 12:57

I have to agree with most of what Mike has stated here in the numbered paragraphs. I would add to paragraph 3 that if you have serious foot problems you should obviously see a foot specialist physician, I believe that most people make that choice but some appear to try to manage their own care, often with poor results and delaying appropriate care.

I actually feel that there are some very good off-the-shelf inserts available and when combines with the appropriate footwear these can really help people with PF symptoms resolve. I prefer the Powersteps and was recently introduced to Down Unders by our very own Jeremy. The Down Unders are my opinion are one of the very best OTS inserts that I have come across to date. Good medial to lateral support, deep heel cup and a wide variety of builds and materials for our individual feet (they're so good I am for the first time considering making space to offer them retail within my office).

Lastly I am not sold on MBT's. I would like to see any third party peer-reviewed studies that this shoe ' has been proven to cure PF in approximately a month, on average.'

No offense but while they have their merit they are in fact an expensive version of a simple rocker bottom sole addition that can be added to most shoes and this modification is widely employed in the clinical pedorthic setting. I feel that they are oversold as a panacea, as are custom orthoses. Like custom orthoses there are a percentage of the population who will have success when that design is chosen appropriately for that condition. On the flip side there are contraindications to an aggressive full length rocker sole.

I have encountered numerous injuries to the lower extremity, specifically the Achilles tendon from wearing these shoes. One obvious contraindication would be ankle equinus where the lack of available range of motion is limited and the ankle is forced to repetitively achieve ankle dorsiflexion wearing the MBT. In spite of equinus being present the staff at retail outlets simply ignore that referral to a qualified physician is often warranted and obviated by selling the customer this shoe.

Bottom line in addition to what Mike has written you should obtain an examination and diagnosis even for what many consider to be a common and treatable ailment such as PF as there may be concomitant factors that are important in the design of your treatment. An 'evaluation' by anyone less qualified is simply counter productive and could be deleterious to your recovery.

Result number: 15

Message Number 256611

Re: Question about shoes imitating barefoot running View Thread
Posted by Jeremy L, C Ped on 4/04/09 at 07:42

Marketing, marketing, marketing, marketing.

The truth is that MANY traditionally made running shoes are perfectly acceptable for that type of strike path and propulsive element for the foot. Some modern designs may seem easier, but don't necessarily make the actual gait 'better'.

My suggestion is two-fold. Find a trainer in your area who is professionally familiar with this type of running gait; it's benefits and potential problems. Have him/her assess if it may be a reasonable idea for you. Having that verification, go to someone who knows how to match shoes for both foot shape and the desired gait type. You'll likely find that you don't need a Newton, Velocy, or any other boutique brand/model to satisfy your needs.

Best wishes for you getting back to enjoying your running.

Result number: 16

Message Number 256518

Re: Can you have Plantar Faciitis in your toe, or feel it in your toe? View Thread
Posted by Dr. DGW on 3/31/09 at 17:14

Pain in the Hallux may be a sign that other biomechanical problems are contributing to your PF or that you have a concomitant PF and one of myriad other contributing factors.

Result number: 17

Message Number 256512

Question about shoes imitating barefoot running View Thread
Posted by Kirtti on 3/31/09 at 14:59

Hi, I was a runner for 21 years before giving in to long standing knee injuries and quitting. I had managed to run 10 miles a day even with the pain, until I moved and ran on the beach for about a year - Then I had to stop. I realized only later that the instability caused by the sand was the final culprit.

A couple of years ago, I read about some new shoe design which mimicked the barefoot pattern of midfoot striking, and about how these new shoes were allowing injured runners to run again. They were too expensive for me, so I waited. I recently googled for 'barefoot running shoe' and found that a lot of information is out there - different models and theories, etc. There's even a 'Chi Running' school which recommends certain shoes for their techniques (but normal ones, like New Balance - nothing radical sounding).

Yikes. All I want to do is run again. Is there anything to this barefoot/midfoot strike thing and are there certain shoes or orthotics that can create the barefoot stride for runners?

Thanks!

Result number: 18

Message Number 256356

Re: Jeremy, question about Morton's Neuroma shoes & orthotics View Thread
Posted by Jeremy L, C Ped on 3/24/09 at 21:36

Based on all you wrote, I'm not sure how effective I can be without a direct evaluation. It certainly sounds like you have more challenges than most people who develop neuromas. Here a few things to keep in mind:

1. Your one doctor is right in that ALL unstructured shoes (Clarks, or any other brand) run the risk of irritating heel tissue. They are purposely made without any internal structure that could provide support to the midfoot. The sole benefit for you is that the forefoot will manipulate itself right to your specific flex point.

2. Both of your athletic shoes typically have dedicated forefoot flex positions. When fitting properly, they should do their part to adequately reduce/eliminate neuroma pain. When they do not it is most commonly because the wearer's ball length varies significantly from their overall foot measurement. With cases where the wearer has a functionally longer ball length, even most credibly made shoes can cause forefoot pain. Please, have an experienced fitter properly measure you with a Brannock Device to confirm or rule this out.

3. If an appropriate shoe is hard to come by due to limitations among your local retailers, there is the potential option of modifying one of your shoes. The Dyad is a good example, where it's rockered forefoot shape can be augmented with a springplate installed inside the midsole. This will effectively reduce forefoot pressures, and maintain a softer feeling inside the shoe (especially if the stock inlay is modified with a reasonably sized and placed metatarsal pad).

Good luck. I hope you're able to find some relief.

Result number: 19

Message Number 256321

Re: Plantar Fascitis pain alomst gone View Thread
Posted by Jeremy L, C Ped on 3/23/09 at 20:48

Kabes, I'm glad to hear you have had so much improvement. I would, however, be cautious regarding that particular recommendation for shoe searches. That site, as well as many others, do not keep up to date with brand buy-outs and the product stripping that commonly occurs after those consolidations. Although the athletic shoes mentioned on their site are quality models, there are no delineations regarding foot type/shape/fit. Some of the models are also miscategorized. The best part of the entire page is at the bottom:

'Torsional and Flexion Stability are desirable features to assist in protection from the adverse impact of excessive pronation and to help those individuals with plantar fasciitis. Lateral stability is also desired to lessen the possibility of ankle sprains.

The current commonly used terms of stability and motion control are poorly chosen and inappropriately used. The way these terms are used in shoe descriptions does not reflect biomechanical function and are confusing and potentially misleading. We choose to define shoes function in degrees of protection from over pronation (which is a form of stability and motion limitation) using the term 'pronation control'. This method is used rather than creating confusion by the use of two similar terms taken to mean something different than they should. Many of the shoes we rate as offering mild pronation control are often categorized as 'neutral' shoes.'

For those with PT tendon issues, there are three build elements that should be requisites in their footwear:

1. Solid midfoot shank, such that the shoes does not easily twist.

2. A molded TPU heel counter to reduce excess heel eversion. Extended counters are even better for those presenting significant excess heel motion.

3. A medial rearfoot post is mandatory. I personally prefer the tri-density posts built by Brooks, as they ease the foot into reduced heel eversion at contact.

Result number: 20

Message Number 255660

Re: Recovery at the end of 2009 View Thread
Posted by Rick R on 3/06/09 at 07:47

Dr. Z,

If we are at the beginning of the end of the automobile as we know it it is by design. Our entire nation is geographically laid out based on the transportation system of roads and automobiles. The change that you speak of would require mass migration and a complete change in housing. If natural market forces were left alone we'd evolve in that direction in time without a crisis.

The car makers have been making precisely what people want. No doubt that the automitive industry was caught flat footed in the 70's by immerging competition that was employing superior manufacturing techniques and better filling market niches.

Don't confuse that with what happened now. They were making precisely what people wanted. What possible motivation would they have for doing otherwise? They didn't make what some whish people wanted. You may have noticed that unlike the 70's the world wide automitive industry is in a world of hurt. There are very real resource limitations and environmental concerns. But we are being played by selfish ideology that if not restrained could lead to profound human suffering.

The big 3 focused resources on trucks and SUVs for one reason alone, their margins were greater and they had an obligation to the shareholders to make money where it was to be made. Greater margins mean that the price people were willing to pay was well in excess of the cost. Smaller cars were less desireable to the consuming public because we weren't willing to pay enough over cost to make it prudent for them to be made in deference to the trucks and SUVs.

The automotive industry didn't have a good answer to last summers oil cost surge. This kind of rapid market change will allways favor one end of the product offering spectrum. If they learned the lessons of the 70's they's have rapid change over plans. But rapid is relative, who knows what would have been if the financial market didn't collapse and oil didn't drop.

This time it's all about the capital or lack of. At the root in my opinion is the insestuous relationship between our elected officials and the robber barrons. And it hasn't changed.

When the risk of lending was deferred to the American people through government underwriting of Freddy and Fanny what could possible be expected other than for risk not to have its proper place in decision making balancing the potential returns. Find any business where someone else takes the risk and you will get risky decisions. It's pretty simple.

Rick

'One of the methods used by statists to destroy capitalism consists in establishing controls that tie a given industry hand and foot, making it unable to solve its problems, then declaring that freedom has failed and stronger controls are necessary.' --Ayn Rand

Result number: 21

Message Number 255636

Re: Nerve entrapment? View Thread
Posted by Dr. Wedemeyer on 3/05/09 at 11:21

The burning that you describe indicates a nerve issue and it could very well indicate a concomitant low back generated radiculopathy (although I suspect spinal stenosis or a metabolic concern given your descrition). I would consider discussing this with both your chiropractor and your podiatrist because a neurologic/rheumatologic consult and a spinal MRI may be in order.

You stated 'I also felt relief from the burning discomfort in the bottoms of my feet'. This statement leads me to believe that you have a bilateral presentation and other causes should be investigated as PF does not typically affect both feet and is not typically described as 'burning'.

The fact that you are seeing a DC to begin with warrants asking is this for a low back complaint? Are you diabetic or do you have a family history of any rheumatologic disorders? Why after two years has neither doctor offered an othopaedic or neurologic consult?

I do not know what your treatment protocol is but if general manipulation to the lumbar spine or the extremities yields positive results then more specific manipulation may also be indicated.

Result number: 22

Message Number 255475

Re: What could my options be now? View Thread
Posted by Dr. Wedemeyer on 2/26/09 at 17:49

I agree completely with Dr. DSW's comments and would only add that there could be an endocrine or rheumatologic etiology to your complaints.

Given your history and failed previous treatment a full work-up is in order. I also agree that you may have PF concomitant with a nerve disorder. In either case you do reveal back pain so an orthopedic spinal specialist evaluation is indicated.

There are myriad causes of neurologic insult that can mask as a foot issue, nerve entrapment etc. I urge you to make the appointment and after you have seen the doctor we can discuss this in greater detail. These issues are too complex for an internet forum and require a physician's diagnosis.

Result number: 23

Message Number 255274

hallux rigidus View Thread
Posted by joann s on 2/19/09 at 15:26

I had artificial joint put in for hallux rigidis,i am now having bone erosion and MD wants to do arthrodesis with bone graft from iliac crest.What is success rate and what will my limitations be later. I ball room dance and work out alot .not ready to have limitations. thanks surgery is scheduled for end of march

Result number: 24

Message Number 254877

Best way to let foot heal after Cortizone injection? View Thread
Posted by Jillm on 2/07/09 at 14:51

I'm on my 2nd set of Cortizone injections in the heel. Went in through the side and man does that burn!!!!! It's been 4 days since the injection and my heels hurt so much-more than before the injection. I think this is normal. Dr. said I don't have any limitations and she's having me wear these elastic cuffs around the arch-said to wear all the time except sleeping and showering. Is there something else I can do to make the Cortizone more effective? Total rest? ice?, etc? I don't want many more of these shots, so I'll limit my activity any way to give the Cortizone a better chance. I'm not that active as it is because they always hurt so much. thanks for any ideas. I'll confine myself to the bed if it would help. Jill

Result number: 25

Message Number 254754

Re: worried about test View Thread
Posted by Kelly L on 2/04/09 at 05:38

Have you tried Cymbalta? It has REALLY helped with the shocks and burning. I don't know what I would do in your shoes (pardon the pun). I know in my case it got so bad I would have done anything!! I know alot of people on here talk about The Dellon doctors I have visited their web site and they seem extremely knowledgable. Maybe you could look into that. Just do not give up. After everything I have been through, I am still glad I had the surgeries. I am not cured, but I do have more good days and I have also learned my own limitations. Good luck and keep me up to date! :)

Result number: 26

Message Number 254007

Re: To Dr. Wedemeyer View Thread
Posted by Dr. Wedemeyer on 1/14/09 at 13:40

Ryan

Read these limitations and then tell me if you still find that with all of these caveats and prohibitive scope of practice language that your original response is valid:

http://www.apta.org/AM/Template.cfm?Section=Top_Issues2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=22369

The battles between the PT and Orthotic & Prosthetic professions should interest the DPM's, Cped's and Orthotists on the board, especially with regard to Medicare Beneficiaries.

Result number: 27

Message Number 253602

Re: Varicose Veins & Plantar Fasciitis View Thread
Posted by Dr. Wedemeyer on 12/31/08 at 14:16

I am not aware of any causal link established between PF and varicosities although vericose veins can become severe in nature and generate pain due to inflammation.

Therefore differentially diagnosing the pain from PF and varicosities should be a given and they can exist concomitantly, confusing diagnosis further.

Result number: 28

Message Number 253441

Re: Downside of ESWT View Thread
Posted by LindaM on 12/23/08 at 17:56

I've only had an MRI of my left foot (although my PF is bilateral) and there was nothing unusual showing with regard to my foot. Interesting that you mention my back, however, because I herniated a disc about a year ago. I think the herniation was caused by my awkward gait from the PF as well as trying to wear uncomfortable orthotics. The back is much better (after several months of PT and an epidural), but the feet are still a problem.

Early on, my pain level was through the roof.....8-10 most times. Now my pain is about a 5 when I'm standing in one spot for any length of time. I try to avoid ever standing more than 20 minutes (which given my prior lifestyle, is a huge limitation). I have no idea how high the pain level would go if I didn't spend most of my time trying to find a place to sit or perch. I've avoided 'experimenting' with standing longer because I'm always terrified of taking a turn for the worse.

Walking (in my air heels) is not as bad as standing. I can actually cover a few miles on soft surfaces. Harder surfaces (sidewalks, the mall, etc.) are still a problem.

Result number: 29

Message Number 251979

Re: Palin the scapegoat???? View Thread
Posted by wendyn on 11/07/08 at 18:14

I don't know Marie - maybe you're right. I hate to think that a party could set someone up to fail like that...it seems to nasty. I do beleive that you'r right in the sense that if she was being set up, she does not have the 'streets smarts' to figure it out.

I have known people who seemed very similar in personality to Palin and if I have her 'type' pegged right, then she had NO idea about what she DIDN'T know. These are truly the most dangerous people to put into any position of authority - I've seen disasters result in business when this happens. Sometimes people find it impossible to admit that they don't know - I suspect out of insecurity. When you can't admit you don't know something and you refuse to learn more in order to improve yourself (because that would be acknoledging your limitations) then you end up with a shell of arrogance. I think these people actually start believing that if they always tell themselves that they know it all and are in control, then everyone else will believe it too.

Palin looked honestly shocked at McCains conscession speech. Some quoted her as saying that the outcome was unanticipated. Really? She really didn't anticipate that things were not going well? That's too bad and really amazying. I think that if she had ended up as your VP it would have been a disaster.

I have been impressed to see the press seem to defend her a lot over the last few days. They've talked more about how the attacks on Palin are reflecting badly on McCain and the party (rather than just eating up the gossip and going after Palin again).

On a side note, I was just watching CNN and there was an analyst on there who was gorgeous. He was about 40ish and had a goatee/beard (I'm all about the facial hair). Anyway - they didn't have his name up so I can't tell you who he was. Hmm.

It's pretty rare that I consider anyone on tv attractive enough to really notice and even talk about. Perhaps I am having an off day? Perhaps anyone who talks about politics is just starting to look really appealing to me?

I must go and study for a Spanish exam that I have tomorrow. Enough procrastinating for one day!

Result number: 30

Message Number 251679

Re: Sacro-iliac joints and MBT-shoes View Thread
Posted by Jeremy L, C Ped on 10/30/08 at 21:19

Keep in mind that the specific design of MBT shoes is to de-stabilize the gait. As you found, this can help in cases of lower extremity arthritis. As you also found, it can have profound limitations on thoracic joints. You might be able to find more satisfactory relief by having stable walking/casual shoes modified with a reduced version of a SACH heel. Many C Peds and all experienced cobblers can perform this modification.

Result number: 31

Message Number 251120

Re: Cortisone Shot in Both Heels - Nitrous Oxide? View Thread
Posted by Dr. Wedemeyer on 10/13/08 at 01:20

Robert Undifferentiated Arthritis can be a difficult clinical diagnosis because you obviously have some of the symptoms of Ankylosing Spondylitis, Reiter's Syndrome, Psoriatic Arhtritis, Irritable Bowel Disease etc but possibly inconclusive lab testing and non-specific symptoms and findings. This is more than likely because you are young and the onset of your condition is early.

I would assume that you have seen specialists. The radiographic findings of many of the spondyloarthropathies overlap yet many key diagnostic features are distinctive to each, as well, all of the spondyloarthropathies share an affinity for the axial skeleton (the spine) and certain peripheral joints.

I am unfamiliar with any of these commonly causing heel pain prior to spondylosis and demonstrative spinal changes affecting the spinal nerve roots with two caveats; Reactive Arthritis (Reiter's) and possibly Psoriatic Arthitis.

Enthesopathy of the tendons is not uncommon in these diseases and could be the root cause of your heel pain as the Achilles tendons are often a site of involvement. Changes in the hands, dactylitis or 'sausage digit' appearance on xray would lead me to suspect Reactive or Psoriatic Arthritis. The lack of these changes and other features would probably lead your doctor to diagnose you at this time with Undifferentiated Arthritis as the diagnosis is inconclusive.

The necessity of differentiating heel pain from PF or as a result of Achilles tendinopathy from inflammatory arthritis vs. concomitant PF is the key to your doctor arriving at the appropriate treatment. Cortisone may be one of those treatments but it is temporary and repeated infections could come at high cost.

Result number: 32

Message Number 250387

Re: Reflexology View Thread
Posted by Dr. Wedemeyer on 9/21/08 at 20:25

Perhaps the allopathic model has limitations as well, maybe that is why there are numerous medical offices in my area offering 'integrative and wellness care' when just ten years ago those terms were anathema....?

Result number: 33

Message Number 250192

Tina Faye and Sarah Paulin View Thread
Posted by john h on 9/15/08 at 09:13

On SNL this past Saturday they had a skit with imposters for Hillary and Sarah Paulin. Tina Faye played Sarah Paulin. This was the best look alike of a candidate I have ever seen. For a moment I really thought it was Sarah Paulin. She had the looks, dress, voice, down to a T. It has always been hard to imitate Hillary but I bet Tina really is pulling for Sarah as this will give her a job for the next 4 years. Actually Tina is a political activist and even for money she is unlikely to vote for Sarah Paulin. They even showed this skit on the Today Show it was so funny.

Result number: 34
Searching file 24

Message Number 249823

Re: Canada & Oil & Gas Drilling View Thread
Posted by Rick R on 9/03/08 at 15:49

Hi Wendy,

We in the states have this tendency to pretend to care about the environment and people by imposing limitations or protections on our country and outsourcing the environmental catastrophe, our jobs and human suffering for that matter.

I applaud your commitment to do your part. You are making lifestyle compromises so that we can play games down here. We have resources that we refuse tap into while you chase after more environmentally impactfull ones. We also don't have the long term alternatives appropriately funded and prioritized. On this latter point we seem to be waking up.

The other thing I think that needs to be kept in mind is that there are less chic ways to be prudent with energy and resources. Buying a new electric car causes all of the energy of it's production to be consumed. I can't tell you how that compares to the energy saved in it's lifetime. I listened to my minister preach on the evil SUV's but she buy's a new Volvo wagon every year and lives in a house three times the size of mine with a few less people stuffed inside. She flies her daughter to see the big rodent in Florida and such. Frankly ignorant as can be, so she doesn't qualify as a hypocrite.

I see no reason to revert to cave dwelling and giving up those things we once considered as signs of progress. Pure waste for ego gratification can still burn my tail feathers. Obviously there is a reasonable level where conserving is the answer but it's far from the only answer. We need a rectal cranial extraction to start with.

Go Cubs!

Rick

Result number: 35

Message Number 249759

my left foot View Thread
Posted by jhulz2004 on 8/31/08 at 16:24

on my left foot the second to last toe is different then the others. it curls under the third toe. it looks ugly why is this

Result number: 36

Message Number 248408

Re: Theta orthotics View Thread
Posted by Jeremy L, C Ped on 7/11/08 at 21:39

Well, it's well documented here regarding my opinions on self-casting. I hold full weight bearing casting in even greater disregard. So, to me, there are some initial limitations to this device.

That said, clearly this doctor has helped a number of people. What's not so clear is whether he is making a unique device for every person who submits an order, or if her has a library of inserts consisting of graduated lengths and 'theta' angles. My bet is that it's the latter.

From the design he describes, this kind of device would likely be effective for the same person who could find success with an Alzner insert. The advantage is that there is greater variety in arch heights/theta angles. I would be extremely wary regarding this device on anyone with lateral column issues. Those with plantar-flexed metatarsal bones (of almost any type) may also find challenges.

Result number: 37

Message Number 248321

Re: heredity is equal to evolution View Thread
Posted by scott r on 7/08/08 at 14:01

I don't know anything about ascorbyl palmitate. You might have mentioned it before. Wiki says it's the 'ester' form i keep hearing about that a company used to charge too much for. Wiki also questions its absorbability but without a reference.

Result number: 38

Message Number 248292

Re: heredity is equal to evolution View Thread
Posted by Dr. Ed on 7/07/08 at 18:57

One form of vitamin C that there is far to little information about is ascorbyl palmitate. It is the only fat soluble form of vitamin C. That means that it can cross cell membranes that the water soluble ascorbic acid cannot cross. In theory, it should be stored longer in the body as it should become repository in fatty tissue.
Ed

Result number: 39

Message Number 248280

Re: heredity is equal to evolution View Thread
Posted by scott r on 7/07/08 at 08:22

Yes, as Carl Sagan made famous: 'We are all star stuff.'

I believe in the many-world's interpretation of quantum mechanics and that every possible universe containing every possible thing has been created. Any limited or finite view of the Universe will never be an ultimate theory because it will beg the question of what defined its limitations and specifications. A finite universe cannot be generated from nothing, but an infinite universe(s) can. Nothingness is the yin to everythingness's yang. I am not speaking figuratively with vague, but simply trying to convey the most common interpretation of quantum mechanics. Everything is real, and i do mean everything. But for ethical and moral reasons, it's always best to believe that God does not exist even if He is the everything itself. The reason is that belief in a higher power relieves the individual of responsibility to change the world and/or do what's right. If one follows their religion's ideas of responsibility, it's still not right. It's still 'passing the buck' of responsibility and 'shifting the blame' when things go wrong. Part of ethical behavior is accepting the blame, taking the charges, and assuming the lead as best you can. To be a pansy in the back is not ethical unless you're a woman of child-bearing age or old with nothing to offer except historical perspective and entertaining tales. Taking the lead includes not following a religion, especially if it ignores observed facts of the world. Taking the lead includes inventing your own personal philosophy of ethical behavior, that can be changed if your knowledge increases.

Result number: 40

Message Number 247265

Re: Please help... if this is not plantar fasciitis, then what is it? View Thread
Posted by Dr. Wedemeyer on 6/02/08 at 01:18

Alex

By proximal we mean closer to a nerve root (spinal) than peripheral such as an entrapment in the foot or ankle itself.

Dr. Nordyke brings up a great point that is often the cause of what you describe; equinus. This is limitation of dorsiflexion (bending the top of the foot towards the shin with the knees extended (locked). If you cannot dorsiflex the ankle in this way 10-15 degrees that is equinus. You can see how walking with this toes pointed down attitude of the ankle can cause myriad problems in the calf and Achilles tendon (among other forefoot symptoms).

Dr. Nordyke's other suggestion of a injecting a local anesthetic could prove diagnostic as well.

Is the pain on the bottom of the feet or back of the heel? The calf involvement leads me to suspect equinus until ruled out completely. You may also have fat pad atrophy or atypical PF. Some PF sufferers do not have first step morning pain though more rare.

I would see an orthopedist with foot/ankle training. Your case may be very easily diagnosed with a fresh history, orthopedic exam and diagnostic testing if warranted.

To be honest there are so many possible differential diagnoses with heel pain that we may have ideas for you (and are always happy to answer your questions) but given the length of your complaint and failed treatment a comprehensive examination with a specialist is warranted.

Result number: 41

Message Number 247203

Re: Oil is not overvalued View Thread
Posted by scott r on 5/30/08 at 05:13

Speaking of sidewalks: we had some kids from netherlands, austria, and brazil visiting us. They were making fun of us for driving 7 miles across town instead of riding a bike 'like everyone else'. It took 20 minutes. I thought that was a little crazy, but at 20 mph, it would have taken 20 minutes. We think of kids riding 2 miles to school on a bike is far.

Yes, we're inflexible when it comes to energy use, and supply is also inflexible. And the trend for use going up and supply going down will continue. That's why my investments center on alternative energy. Since we're not as efficient as the rest of the world in energy use, and since all things are created by energy, the fall in the dollar will continue. In ten years, a best case scenario is that oil is $300/barrel and that china will have 50% more buying power on the world market than the U.S. They'll also own $4 trillion worth of the U.S. government in bonds, which will be cashed out to buy U.S. stocks, real estate, and political influence (lobbies being only one method). They are fully aware that economics is the new warfare. The ignorance of the voting U.S. population on these type of things is astounding to myself and the rest of the world. This is how the Chinese form of communism is smarter than U.S. democracy. The war is over. We lost.

My point is that besides energy, my other investments are copying the best large hedge funds: betting on the continued collapse of the dollar which will lead to more competitive basic manufacturing on the world market. Also singapore and brazil and looking into malaysia (like Brazil, they own all their food and oil). And APPLE.

But besides my gloom and doom, the improvements in technology will be equally astounding. Teen society has already been re-engineered since the advent of myspace and youtube 3 years ago, and the pace is getting quicker. Google, amazon, and ebay are 10 years old. The smartest people in the world are saying that in 20 years or less, there will be no technical limitation on life span. 400 pound carbon nanotube cars run by roof-top solar and electric motors (i've done the calculations...we could do it today cheaper than a regular cars using carbon fiber...another investment)

But back to the point: the U.S. is so wasteful, it can't compete on the world market. All wealth and power goes back to energy. Currencies are correctly being tied more directly to the energy that supports their value.

Result number: 42

Message Number 246933

Re: Einstein on God View Thread
Posted by scott r on 5/18/08 at 06:47

I think Einstein's work in physics in his 20's was the most fantastic stretch of discovery about nature, far more difficult and imaginative than Newton's work. But i think he was very naive and simple-minded when it came to thoughts on religion and God. He also seemed to be on a moral 'high-horse'. I believe the best physicists are completely stripped of any notion of or desire for a God. By definition, such beliefs are against the 'religion' of physics, which is the religion of non-religion, of disbelief, of 'show me', with the slight caveat that the new discoveries are made by speculation. But even more so i dislike Born's comment 'Stop telling God what to do' because it is hypocrisy. Here is why it's hypocrisy: Quantum mechanics insists that nature is random because trying to observe anything more accurately than plank's constant (uncertainty principle) is affected by the observation. Observation ultimately requires a photon because our physical sensations and brains and computers and physical sensors require photons to change energy states that result in thought and information changes. A single photon striking the thing being observed is the basis of the derivation of the uncertainty principle. No one has found a way to observe anything without bumping it with a photon or something else with energy content and this bumping creates the limitation of the uncertainty principle. Physics requires at least a way to observe, or it's not physics. So the uncertainty principle is not proof that 'God' or nature is random, it is a description of our observation limitation. Physicists think it's proof that the world is ultimately random, but that randomness is only the result of the basic tenant of the physics religion: a thing must be observable if it is to be considered a part of reality. That's why it's hypocrisy. They themselves are telling 'God' that if he doesn't let us use at least one photon to observe His world, then He is playing dice. And BTW, don't let my comments ever be confused with someone who believes in any sort of God. I'm not against 'Him' or people who believe in 'Her', I just don't think anyone's in control of the universe, including the God of Randomness. As I've posted before i sadly believe everything is real, and that nothingness is so real it does not exist, and that this nothingness is the yin-yang source of this ultimate everythingness. This is basically the many-worlds view of quantum physics which explains away the randomness (we take every path, but we can only remember one historical path). My meta-physical philosophy is sad (to me) even though it logically balances out to no net good or bad. I do not view extreme pleasure in one part of the universe as just compensation for extreme pain in another, or extreme good for extreme bad, or extreme hope for extreme despair.

Result number: 43

Message Number 246452

Does a heal spur increase the risk of getting plantar fasciitis again ? View Thread
Posted by hadashi on 4/30/08 at 13:09

I like running marathons (about 1 per year), and approx. 6 months ago I decided to try running my next marathon barefoot. Probably I exagerated a bit with my (barefoot) training, as about 2 months ago I got some pain in the heel. I took an X-ray, and they found a tiny heel spur.
But the pain was not very strong, so my orthopedist said that I could still run the barefoot marathon if I tape a heel-spur-cushion (silicon) under my heel, but that after the marathon I should remove the heel-spur with a (costly) shockwave therapy.
I used that cushion, and everything went well. I finished my training, and last weekend I did a whole marathon barefoot, without any pain (with the cushion). Apparently the inflammation of the fascia has healed, as now I don't have main anymore, even without the cushion.

But the heel spur is probably still there... My question is if the mere presence of the heel spur (if the plantar fascia healed in the meantime) increases the risk of inflamming the plantar fascia again. If so, I will undertake the shockwave therapy and remove the spur; if not, I'll save the money. Could you give me any hint on that ? (I would like a second opinion, as the orthopedic who suggested me the shockwave therapy wanted me to do it at his private lab).
For sure I will continue running barefoot, as I like it too much. But I'll do everything I can to reduce the risk of getting plantar fascia again.

Thanks in advance :-D

Result number: 44

Message Number 246446

Re: Obama Finally Gets The Message View Thread
Posted by john h on 4/30/08 at 08:22

He has been better than many stand up comics this past week. His imitation of White people going to church was hilarious as was his imitation of the way white people talk. Thing is he was being serious.

Result number: 45

Message Number 246248

Re: Question about Surgery Center/OR Nurse View Thread
Posted by Dr. DSW on 4/23/08 at 06:23

There are several concerns. First, you can always request another nurse anesthetist for your next procedure. And YES, you can and should call the director of nursing and discuss your concerns.

However, despite the horrible situation you were in, the nurse anesthetist DOES have some guidelines she may have to follow, and despite your pain management doctor's 'orders' to push more medicine, the anesthetist is ultimately responsible for your SAFETY.

Some of the medications she was giving you may have limitations according to your height/weight, and she may have been concerned regarding over-dosage, etc. So although I'm sure she wasn't intentionally attemtping to keep you in pain, she MAY have been concerned for your actual safety due to constantly increasing the dosage.

That is one POSSIBLE explanation that the DON may have to look into, but if you are concerned about the next round of injections, you can always request another anesthetist/anesthesiologist and even request to meet with that person a week PRIOR to the procedure to discuss your concerns.

Feeling that much pain during a procedure with all of the medication available today is simply unneccessary. There are multiple choices, and that can be discussed ahead of time.

Result number: 46

Message Number 246181

Re: This goes both ways View Thread
Posted by scott r on 4/22/08 at 05:00

Oh, i want to jump in. This looks fun. C. Peds aren't scientists? Hmm interesting thought. Neither are doctors. Remember the phrase 'More art than science' ? haha Actually the ONLY definition of science is 'ideas whose validity is determined by observation'. Humans require that the usefulness of the ideas do not change based on position in time and space. This allows the scientific ideas to useful to physical humans who need control over physical objects regardless of the objects' and the humans' identity or position or orientation or movement in space and time. This gives science the ability to replace other ideas by physical force. 'Might is right' is a restatement of the definition of science. By tradition, when two ideas have equal validity, we select the simpler explanation as a matter of convenience even though that is not scientific. Non-checkable ideas are not considered science. Science is the opposite of faith. Photon transitions (i.e. electrical impulses) are the only method by which humans receive information and think. So photons are ultimately the only method by which humans can invent and check scientific ideas. However, this is not a requirement of science, but no way of getting around this has been found. The photon limitation is the source of the probabilistic nature of quantum mechanics (see Heisenberg uncertainty principle).

meters=i*c*seconds
mass (kg) = -1*(warped time^2)
energy = (warped distance)^2

c is the conversion factor from seconds to meters so that:
E = -1 * M * c^2 (from above relationships)

Energy is not exactly mass, but the negative of it. One is the warping of time^2 and the other is the warping of distance^2. Force is the warping of distance.

This is found in appendix 2 of Einstein's relativity.

Result number: 47

Message Number 245794

Re: Keen shoes? View Thread
Posted by Jeremy L, C Ped on 4/13/08 at 18:51

To me, that's not an adequate question to be addressed here. That shoe would likely provide enough support for a segment of the population, but there's no way any of us would know if it's sufficient for you. It's best to check into it yourself, and have an experienced professional personally evaluate its level of appropriateness.

There are limitations for for some:

1. Those with significant rearfoot instability should seek a different model, as this does not have the deep heel seat that was a staple back when Mark Keen was still involved with the brand.

2. The arch set is back under the talo-navicular joint, so those with weak mid-tarsals will either feel there is not adequate support, or they will have a sense of the support feeling too aggressive back near the heel.

3. It is a slimmer last than traditional Keen styles, so those who enjoy their sport sandals may not experience a similar fit.

4. Some newer model Keens lack the midfoot shank that used to be a consistent feature throughout their line. Careful inspection should be made to ensure the forefoot flex point is intact, and there is not too much midfoot twist in the sole.

Result number: 48

Message Number 245124

Re: 4 weeks post op View Thread
Posted by Laurie C. on 3/26/08 at 19:19

During my non weight bearing, I was doing pilates on the floor and the arm bike (which is incredibly boring), but it got me some cardio. Before I was back doing yoga, I was just bicycling on a recumbent bike after my PT got me started on that and then just weight lifting. I remember going to yoga around 8 weeks and some things were difficult, but I was completely in the pilates classes at about 8 weeks with no limitations. I've never enjoyed running so that wasn't an issue for me.

After my last surgery in December for ligament reconstruction on my ankle, I was pretty much unable to do any lower body workouts for 8 weeks. On my 9th week, my PT had me on the bike for 10 minutes and said I could go up to 20 if I had no pain later that day. I went up to 20 immediately the next day with no pain and then up to 30 min with PT approval (again with no pain).

Result number: 49

Message Number 243953

And the Clyde goes to ..... View Thread
Posted by Jeremy L, C Ped on 3/01/08 at 08:57

In running the risk of facing consternation from my governing body by creating my own awards named after the 'Father of Pedorthics', here are winning I came across at the most recent spring shows:

Best Return to Classic Construction

For several years I had been dismayed by the erosion of quality midfoot support construction, which Lowa had been exhibiting in their technical products. They weren't alone. Scarpa and other historically excellent brands also succumbed to short cuts in product integrity, one could only assume in the hopes of boostering margins and volume. Lowa has now returned to the form I once knew them in the past, most notibly with their trekking collection. The Pinto and Jannu are low top walking shoes possessing quality of construction uncommon in the last 30 years. Full length nylon shanks and blown PU midsoles make these light and incredibly supportive and sturdy. Asymmetrical upper lasting/construction and the use of visco foams in the collar assist in providing excellent fit for those with narrow heel dimensions. Wake up, Merrell; this is what you used to make!


Best New Import

Arcopedico has been distributed in the US for a number of years, and although they are light and flexible, they had limitations for those with significant foot support maladies. The US company that imports this brand now has two new offerings that have little compromise: Dromedaris and Caminhar. The former graphically looks much like Dansko, but has greater pedorthic versatility. Most of their products feature well-made, removable inlays. Although the soles have that similar chunky look, their heel pitch is less severe, making them more appropriate for those with forefoot maladies and lateral support issues. pricing is also competitive given the quality of their upper materials and construction. The latter is what comfort is about, providing versatile fit with a soft, conforming footbed. The brand is not what would qualify as broad under any definition, but what they offer is exceptionally made for the price. They have various footbed shapes to accommodate various foot types, and all use a denser-than-usual visco foam in their footbeds, covered with soft suede. No compromises were made in support, as all their models possess steel shanks.


Best Use of Classic Construction in a New Category:

Fit Flop is one of many brands trying to make footwear double as an exercise regimen through simply wearing them. Although I still have a trusted tester seeing how effective they truly are, I have reason to believe they are a credible contender. What's most interesting is that their flipflops use classic California insole construction to provide excellent rearfoot control, with a soft and flexible metatarsal area, finished with a firm toe space to aid in propulsion. Couple that with a sole profile that should accelerate and aid in gait physics, and there is reason to be optimistic in a 'healthy' thong sandal. I'll provide more functional results as I have them.


Most Intriguing New Construction:

This is a tie for me. Asgi is a women's dress and casual brand developed with the input from a podiatrist. 'Doctor approval' does not always excite me (more on that in another post), but there are reasons to like this brand. One is that they consider themselves a fashion house, which helps younger (or those wishing to act and dress young) consumers find comfortable shoes that don't look 'old' or orthopedic. It's not so good for many pedorthic retailers who may find difficulty restocking successful or preferred styles. Their claim to fame is two-fold. All their models possess a modern variation on the old Avia cantilever outsole. This helps stabilize and cushion the gait. Of perhaps greater interest is the insole, which offers good fit and support. More interestingly, the underside of the device has a TPU Morton's extension. The combination of everything makes these shoes a possible winner for women with weak midtarsals, bunions, and plantar fasciitis that is secondary to forefoot supinatus deformity. Women with heel inversions and/or any type of forefoot valgus/first metatarsal drop/sesamoiditis should avoid the brand at all cost, except in cases where a knowledgable fitter properly modifies the insole.

As I wrote last year, I was extremely apprehensive regarding Crocs' acquisition of the Bite brand. Bite always had well made products, and a responsive customer service team. Being a small and dedicated company, they could truly adapt themselves to their base. One of my fears is realized: Bite is seen almost as an afterthought by the Crocs customer service department, who must be accustomed to being volume order takers. What has improved is the freedom to develop by the founder of Bite. Not having to share time with normal business details, he has been left to do what he does best, and most of the results are extremely promising. All Bite products now offer a footbed similar in nature to Crocs clogs; however, they are a much higher quality, and more supportive, polyethylene. There is a new construction in their golf line which should again allow those with more narrow foot shapes to enjoy the brand. For those with opposite foot shapes, their Orthosport lasted shoes still exist. New golf models are using an interesting EVA outsole, which ridiculously reduce weight. I'll have to see how much durability and playability may be compromised. Do NOT even consider their 'golf clog'. This thing is a monstrosity that must have been a pet request by Crocs' management. I don't care what they say in their slogans or other marketing; simply placing spikes on a foam clog does NOT make it a golf shoe. How embarrassing. I really like the new casual sandal models. In addition to still permitting the use of prescription orthotics, they have convertible uppers that can change from slides or thongs to more fully supporting configurations.

I've had a love-hate relationship with Spira ever since their days as the Springstep brand. No single cushion technology inspired me as much as their Wavespring (except for a Hytrel technology developed by Reebok that was sadly never released) in reducing impact shock without sacrificing stability. Like most brands, they had growing pains in their product integrity, and what they introduced last year was their best so far. That is now changing, again. Although their new visible technology looks impressive, what's really interested me was its ability to FINALLY produce a seamless flex across the metatarsal springs. The new product will not be something suitable for those with extreme motion issues (whether in heel eversion or inversion), but it's an extremely foot friendly technology, and works well with prescription orthotics. Good work, and keep up the product improvements!


Special Achievement Award:

In these days of manufacturers shifting manufacturing to substandard facilities in the need of eking additional margin, it's gratifying to see a handful of brands sticking to their messages of product integrity and durability. In addition to the continued work from Ecco, I would especially like to recognize Neil M for their hard work. They used to make some of the finest OEM merchandise for other, previously credible brands, and continue to manufacture some of the finest, and best value men's shoes in the world. They also added a new last to accommodate more shape needs. Thanks for keeping the faith in real shoes!

Result number: 50

Message Number 243703

Re: Bush approval rating............19% View Thread
Posted by john h on 2/25/08 at 13:20

Marie: I agree that Hutchinson would be an excellent candidate for VP. She has been sort of low profile in the past year.

I never watch The View but my wife had it on when I stopped by the house this morning. They were sure being critical of Hillary and cheering Obama. They showed a Hillary clip where she was sort of imitating Obama and his style of speaking. That clip sure put her in a bad light whether you like her or not. She is sinking faster than an anchor in water. I would like to be a fly on the wall when Hillary and Bill have their private moments this past few weeks. Obama has the Black vote nailed down and appears to have those under 30 backing him. These younger people usually do not vote but this year it appears to be in vogue to vote so these young people are going to come out and vote. I think if Obama and McCain were a horse race the odds would be Obama 5-2 to win. If by November we have some sort of clear cut perceived victory in Iraq McCain could get back into this thing. Obama still says he will bring all the troops home. Sure wish he had not have said that as this only gives our enemies more reason to hang on and fight. His statement about bombing in Pakistan with or without their approval was dumb to say the least and he will have to answer to that. With Obama or with McCain the war on terror will be going on as long as any of us are alive. We may quit fighting by the Islamist are in this for the long run or eternity which ever comes first.

Result number: 51

Message Number 243698

Re: Bush approval rating............19% View Thread
Posted by john h on 2/25/08 at 12:14

Marie: I agree that Hutchinson would be an excellent candidate for VP. She has been sort of low profile in the past year.

I never watch The View but my wife had it on when I stopped by the house this morning. They were sure being critical of Hillary and cheering Obama. They showed a Hillary clip where she was sort of imitating Obama and his style of speaking. That clip sure put her in a bad light whether you like her or not. She is sinking faster than an anchor in water. I would like to be a fly on the wall when Hillary and Bill have their private moments this past few weeks. Obama has the Black vote nailed down and appears to have those under 30 backing him. These younger people usually do not vote but this year it appears to be in vogue to vote so these young people are going to come out and vote. I think if Obama and McCain were a horse race the odds would be Obama 5-2 to win. If by November we have some sort of clear cut perceived victory in Iraq McCain could get back into this thing. Obama still says he will bring all the troops home. Sure wish he had not have said that as this only gives our enemies more reason to hang on and fight. His statement about bombing in Pakistan with or without their approval was dumb to say the least and he will have to answer to that. With Obama or with McCain the war on terror will be going on as long as any of us are alive. We may quit fighting by the Islamist are in this for the long run or eternity which ever comes first.

Result number: 52

Message Number 243574

Re: JSB Orthotics Questions View Thread
Posted by Jeremy L, C Ped on 2/23/08 at 07:13

Allow me to share that most insurances have specific descriptions regarding what is covered with orthotic therapy. Most include casting, construction, fitting, and adjustments under one umbrella fee. Evaluative charges are left to the discretion of the provider. As far as adjustments to your orthotics, I suggest first calling your insurance supplier and find from them what the specific policies are for this course of treatment. There is likely a stated period of time that adjustments can be made that are included in your coverage. Be sure to bring a written copy of this policy with you for your appointment. I can also share that our offices do not charge office visits for orthotic follow-up within three months of dispensal. This is a policy that may not be universally shared by other practices, and some may wave it should they proceed with more extensive procedures/treatments.

As for JSB, they are a reliable central fabrication company. They make better than average devices, and to the precribers' specifications. Their pricing to the prescriber is fair and just for what they provide. Pricing that is forwarded to the patient is either at the sole discretion of the doctor or dictated by the patient's insurance limitations (to the doctor's enrollment agreement, the patient's specific group policy, or both). I certainly wouldn't hold JSB responsible for anything price related.

It certainly sounds to me like this is a dialog that needs to be directed with your doctor.

Result number: 53

Message Number 243516

Re: Posterior tibial tendon dysfunction View Thread
Posted by Donna E on 2/22/08 at 09:43

I have been dealing with p.t.t.tear, and tendonisis in both feet, wore boot cast on foot for 8 weeks, and was basicly off of feet most of the time trying to heel,also do ice and moist heat 3x a day, take an anti-inflamitory, had orthodics made that support flat foot and hold up side of foot, am now doing theropy 3x week for 6 weeks, and find all is helping, still have pain but, much better, and am able to be on feet more, and walk for longer periods of time.I recommend sports medicine theropy. Theropy has strenghtened me, along with ultra sound, deep tissue massage, mild stretching-hang in there it isn't easy but, beats surgery I hope to avoid that. I will always have to be careful, and know I can't do all I want to but, have to learn your limitations. Along with this I also have arthritis,and fibromylgia. Dr. has recommended richie brace but,I really don't want that, its hard enough getting orthodics in shoes. Theropist recommended motion control sneakers by brooks, as he said, they take getting use to like the orthodics did but, are very helpful.I was born with flat feet have had pain for several years and am thankful to be at the place I'm at now. I am 60 years old but, have dealt with all this a long time.I will continue exercises at home when theropy is completed which is only 4 more sessions.

Result number: 54

Message Number 243151

To DanW re: getting a wheelchair View Thread
Posted by BritaT on 2/13/08 at 03:33

I noticed your posting on the DRs board and just wanted to comment about the 'complete rest' approach because I tried it for awhile. First of all, I empathize with you and completely understand how frustrating it is to have different opinions and no satisfactory results. I have been suffering for over 3 years.

I have only tried conservative measures, so I'm not sure how having had the surgery will affect you differently, but I did try about 2&1/2 weeks with a wheelchair and being on my feet less than 15 minutes the entire day. It certainly is psychologically challenging. I'll never look at people in wheelchairs the same way again. I did not do enough stretching of the fascia and found my foot actually got worse so that every step was painful. I'm not sure what would have happened if I would have kept it up, but I would recommend doing some stretching and massaging of the fascia throughout the day. Also you would have to be careful not to escalate activity too rapidly after since you would be very weak.

I also think that a removable walking cast would give the fascia a rest without the atrophy and let it heal in a lengthened position, but it sounds like you have it in both feet, so this may not work. I have knee problems in the opposite leg so I couldn't use it.

I ended up just being on my feet for a minimal length of time but not total rest. I have had slow improvement over the past 1&1/2 years but still can't work on my feet or shop in a mall. I am also considering shockwave and I hope you finally find relief. I am around your age and it is hard to see the rest of your peers living a full life when you have limitations.

Result number: 55

Message Number 242871

Re:To kindred spirits who totally understand-I salute you! View Thread
Posted by Dottie on 2/06/08 at 20:19

I applaud you for putting up with the bull 'sheet' and all the haters but still put in your time, do your job and THEN go to school! What a woman! I was going to sign up to continue my paralegal studies but then this foot got so bad, then my job got even worse that I felt pretty trapped. I decided I could handle either the foot pain OR the emotional abuse pain but NOT both. So I am opting for surgery. The sooner I do it, the sooner I recover. I don't trust the new boss lady so I feel that I better get my procedures done while I have the good insurance. Plus it's funny. In our business, financial, the bosses come and the bosses go. Every couple years somebody buys somebody else and we merge into something else...and WHAM, new boss. I work through the pain until I can take off for the surgery.

I straight up asked the boss lady (out of town boss) why she hated me the other day. I finally had to because she treated me like 'sheet' every darn time she spoke to me. She said 'I don't hate you.' Uh...ok. Whatever. I still will give everything I've got to do a good job for the people who I work directly with in my own office, as well as give her everything I've got. It's never good enough for that one woman but I keep trying. Then I can leave & have my surgery knowing I did all I could do within my power to take care of my responsibilities before they tore my foot up!

I dunno. Maybe it's like in the animal kingdom when the pack or herd attack the weak member. Those of us who limp or have some physical limitation bring out the evil in some people and they 'attack' us in some hurtful way? Jeez I sure hope I'm wrong about that!

Result number: 56

Message Number 242489

Re: cheilectomy recovery timetable? View Thread
Posted by JeanP on 1/28/08 at 17:14

I had my cheilectomy surgery last Monday, January 21st, on my right toe by an orthopedic surgeon who specializes in foot and ankle. I've had problems with it the last 10 years and finally broke down to do something about it because in the past year, I was having more pain even when I wasn't walking. I did not have constant pain in my toe but I was concerned about walking on the outside of my foot and that it would cause ankle, knee, hip and back problems later. I read the posts on this website before my surgery so wanted to add my experience to it.

My surgery was on an out-patient basis. Basically, it was scheduled for early in the morning and I had to go in 2 hours ahead of my scheduled time but once I went in for surgery, I was heading back home after 1 1/2 hours. My dr prescribed Percocet for the pain which I started taking soon about noon the day of my surgery. I had read that you should stay ahead of the pain. However, I really didn't need it because I never really hurt. I stopped taking it the next day due to some side effects and just took ibuprofen. They sent me home with my foot wrapped in bandages and a velcro sandal. I was not on crutches. I was told I could put full weight on the foot as tolerated which I've been able to do with no problem or pain. I kept my foot elevated and iced the first 4 days but have been walking around more the last few days. I haven't been able to bend my toes due to the bandages but I have noticed some tendernous in my arch. I'm not sure but I'm wondering if that's not due to the dr bending my toe during surgery which the inside of my foot is not used to. I've enjoyed the break from my hectic schedule (read 2 books while I was off) but am starting to get bored now. I am now 7 days post-op and go in tomorrow to get my dressing changed. I'm anxious to see how it looks. I'll also find out what my limitations are. I'm expecting to go back to work Feb 4 (14 days post-op) which he'll also confirm at the appt. However, I don't get the stitches taken out until next week. All-in-all, I am not disappointed I had the surgery at this point, especially since I had not pain. The one thing I'm trying to train myself to do now is walk more normal instead of on the outside of my foot which I've done for years.

Hope others have the same great experience I've had.

Result number: 57

Message Number 241818

Re: How long until back to normal walking, exercise. etc View Thread
Posted by Nursing Student/ Carla on 1/10/08 at 23:24

Dear JW, I had surgery 3 weeks ago and still not 'back to normal'. But it has been so long since I have had 'normal' not sure what that is. I honestly believe if you take it easy until you absolutely have to do something that you will be better off. I can wear a normal shoe but it really hurts at the incision site. My shoes are a little heavy also so I bought some Crocs today. Those are wonderful. Why do you have to wear athletic shoes and Motorcycle boots by March 20th? I wouldnt push anything because I wouldnt want to have to do this surgery again. You know your own limitations. Listen to your foot....be careful, Caral

Result number: 58

Message Number 241566

Re: heel pain View Thread
Posted by Jeremy L, C Ped on 1/05/08 at 07:08

Those arch support stores do help some people; however, they have significant limitations. The vast majority are staffed by lay sales people, not certified professionals of any field. No-one in those stores is qualified to make a proper analysis or diagnosis. As I already mentioned, the devices they sell do help a number of people, but they are charged at a rate that is far more expensive than similar devices through any medically certified professional.

These stores do offer some advantages. They are almost entirely operated as walk-in retail businesses, so apppointments are not necessary. They almost all have evening hours. Due to the extraordinary amounts of TV advertising they do, they provide a greater awareness to the general public regarding some elements of conservative foot care.

All that said, here is the truth. You could see a real doctor, have an honest diagnosis, be provided a pre-molded insert AND appropriate levels of care, all for less than what these 'Good Feet' stores charge for a set of their devices. Even for those who do not have health insurance. Does anyone else see the difference in real value between these two sources?

Result number: 59

Message Number 241416

Re: scared of surgery View Thread
Posted by Laurie C. on 12/31/07 at 14:43

I had TTS surgery in the spring instigated by an injury that was caused by an ankle sprain. I have had a full recovery of the TTS in spite of recent ankle ligament reconstruction surgery.

The TTS is completely resolved. I only have some residual numbness in my little toe which will probably resolve as well. I had been active with exercise prior and since including pilates, yoga, weight lifting and recumbent bicycling. I feel that I have had a complete recovery from that surgery.

Limitations were mainly 4 weeks of non weight bearing and about 4 weeks of PT. After that the main problem I noted with regards to exercise was with my yoga exercises, but I now believe that was more of a function of my other ankle problems.

Hope my two cents helps. It wasn't as bad for me as many people had posted on this board.

Result number: 60

Message Number 241413

scared of surgery View Thread
Posted by AnneT on 12/31/07 at 13:11

Folks: I was a very active athlete. Got TTS by hiking in snow for 4 hours last March. I was misdiagnosed with PF in May, and started an aggressive stretching routine, maybe a mistake?? I was rediagnosed in October after my feet and ankles got completely cold and very painful after adding a toe pointing stretch to my stretch routine.
I have been extremely debilitated by this problem.
My athletic life has been completely taken away except for lifting weights with my upper body, and then only when I can walk good enough to get to the fitness room in the back of our building. Just driving and walking in very limited situations like the grocery store cause pain and problems. Mornings are almost unbearable
and I seem to get more and more debilitated.
This has completely turned my life around and not in a postitive direction.
My podiatrist said he has never seen TTS caused by a sudden injury.

Did any of you get this condition from a sudden injury?
What are the limitations after surgery?
Did you experience a full recovery?
Were you able to return to athletics?
Is there any chance for non-surgical recovery when a person has had this condition for 10+ months?
Do any of you stretch now? Does it help?

Any help or advice would be greatly appreciated!


Does anyone know a good foot surgeon in the Denver Area?

Result number: 61

Message Number 241212

Re: Runners? View Thread
Posted by Jeremy L, C Ped on 12/24/07 at 17:21

Although most cross trainers aren't stout enough for constant medial-lateral motion, this one you are using does have a version of New Balance's graphite material extending into the midfoot. With that, one might expect this shoe to integrate well with orthotics. My guess would be that there's either something happening fit oriented which is not permitting your foot to expand well on impact, or you have some type of limitation in midfoot flexibility where a little more shoe torsion could be helpful. Has your doctor made any remarks regarding your foot function or biomechanics?

Result number: 62

Message Number 240902

Re: Differentiating back from foot probs View Thread
Posted by Dr. Wedemeyer on 12/16/07 at 21:17

Dr. G as usual is dead on in his assessment.

Typically stenosis presents with a high level of low back pain and very specific symptoms of weakness and a feeling of cramping in both limbs.

Stenosis like disc herniation is a very broad term and in and of themselves are not very specific. It is possible to have an uncontained disc with free fragments abutting the theca or the nerve roots (plural) causing bilateral similar symptoms although it is not common. It is also possible to have a central disc with concomitant congenital stenosis or spondylolisthesis causing the stenosis where the contact area is greatly amplified.

I have only seen a few cases of a positive bilateral straight leg raise and each had a combination of the above.

Result number: 63

Message Number 240748

Re: forensic specialist cont'd View Thread
Posted by pattik on 12/13/07 at 15:53

ok ok this stuff is over everybody's dpm head. i needed to dump some stuff. most of this is legal....and unfortunately i am there.

i saw a frequent dpm practioner in here. it was a nightmare.

and i sanctioned dr. wander for his reticence sp? in responding to some questions.....i couldnt imagine ANY dpm being held responsible in court for the advice here.
a little speculation is good for the brain....

i do need help. i need help to think of this systematically. i think. lol.

and re: the recent x-ray scene 9/07

'orthogonal wb views of lumbar spine are present w/out comparison. no acute blah blah blah. there is a tight disc space narrowing at the L5-S1 levelwith disc desiccation. the is a rather tight posterior disc space narrowing at L3-L4. mild to moderate post disc space narrowing is also seen at the L4-L5 level. paravertebral soft tissue appear marked. mild dextroscoliosis.' scoliosis, peripheral neuropathy and primary sjogrens syndrome are in my medical hx.

i have a sacral xray taken by my hip surgeon post ankle surgery. his comments are not as above and maybe had hip doc limitations. but they will be for comparative views.

so i do know that some aspects of my peroneals originate L5-S1 (i think). all emgs needle insertion lower extremity. i cannot do a straight left leg lift. possibly an artifact of surgery.

speak to me guys.......anything. tell me your kids names. i want these whack jobs to take responsibility for what they did.

Result number: 64
Searching file 23

Message Number 239395

Re: Dr. Wedemeyer--spinal decompression View Thread
Posted by Dr. Wedemeyer on 11/13/07 at 02:20

Julie I recently commented to one of the posters here that a proximal disc can initiate a distal neuropathy via the 'double crush' mechanism. This means that TTS concurrent with lumbar disc findings are not uncommon.

They should also rule out spinal stenosis as the mechanism since you describe prolonged sitting producing burning in the feet. This is not typical of PF sufferers, the pain of PF is more typical with weight bearing. If sitting initiates the burning and you feel any weakness or cramping, try bending forward and resting your elbows on your knees. If this reduces your symptoms you may have spinal stenosis and a disc or any space occupying lesion will be amplified.

The piriformis syndrome is another clinical consideration that should be ruled out. Although it is a highly debated entity it is a cause of sciatic nerve irritation in muscle imbalance syndromes and a small number of women have a congenital defect where the sciatic nerve passes through the muscle belly, causing pressure on the nerve.

I have seen a small percentage of women present with bilateral piriformis muscle (an external rotator of the hip) and similar symptoms with or with disc involvement. If you tend to hold your legs together or cross them while sitting, try allowing them to stay apart in a relaxed position and see if this changes your symptoms.

Epidurals are a band-aid, But in extreme cases they can provide immediate relief albeit short lived. I feel that until you have an accurate diagnosis(es)you will not obtain relief and this includes all of your doctor's input and an orthopedic workup.

Chiropractic is certainly a much safer route than medication or surgery but it has it's limitations and contraindications as well. In my opinion given the complexity of your symptoms and multiple sites I would cautiously proceed with an orthopedic evaluation and once you have a firm and accurate diagnosis and are informed in your options, proceed with the least invasive if it is indicated. Blindly engaging 'spinal decompression' at this time is ill-advised until you know more and could exacerbate your symptoms.

Keep us informed and good luck.

Result number: 65

Message Number 239391

Re: Dr. Wedemeyer--spinal decompression View Thread
Posted by Dr. Wedemeyer on 11/13/07 at 00:27

Julie B

I do not entirely recall the specifics of your case, I lost the thread unfortunately.

Did you have an MRI and what were the findings?

Often the pain referral of sciatica is present prior to positive findings of peripheral neuropathy on EMG. I would not rely solely on the EMG as an affirmation that you have lumbar nerve root involvement. Orthopedic examination and your history should comprise 90% of the diagnosis and EMG, MRI the confirming 10%.

Do you have sciatica (leg pain that crosses the knee, burning or lightning pain) or do you have numbness, , tingling or a combination of the above? Is it right or left and which feet or foot is affected and is it the sole and outer edge or the big toe?

I am not sold on 'spinal decompression' therapy. It is quite simply traction and all of the bold claims and marketing in the world do not support it's profligate cost to the patient and the doctor. The main company that sells the unit that most DC's purchase has been involved in escalating legal trouble from several states, insurers, patients claiming personal injury and doctors pursuing class action law suits.

The problem is that it is very easy to convince a person in pain with a complex problem that that machine and the $4-6K price tag for treatment is the cure all for disc complaints. The lack of peer reviewed studies proving their grandiose claims of success (they are in fact all proprietary or borrowed from another machine manufacturer), slick marketing and up-front payment and the questionable credibility of the distributor should make anyone think twice before beginning this treatment.

I also am highly suspect of any DC who after your failure with traditional chiropractic treatment and/or Cox distraction, did not refer you out for orthopedic consult. It appears that he/she is instead trying to sell you on yet another treatment of which they recently became a proud owner of this machine.

At any rate you could have a concomitant PF complaint unrelated to the lumbar disc or an altered gait due to low back pain which precipitated the PF. Yours is a difficult case and trying to dx it over the internet is not something I would advise over the advice of your doctors but it sounds as though you have several doctors working with you.

Have you had an orthopedic spinal specialist consult?

Result number: 66

Message Number 239269

Re: Insoles View Thread
Posted by Dr. Wedemeyer on 11/09/07 at 14:39

Billy I personally own one such machine and have not made an orthotic from it in quite some time. The truth is that most of those 2Dimensional pressure pads offer great information for gait analysis but do not produce a true custom orthotic. Most of these systems should be categorized as 'customized' library systems.

I have experienced the Aetrex system first hand and it does offer a decent library orthotic as an option for those who do not need a therapeutic device, it has it's limitations.

They are also weight bearing and it is widely accepted that the preferred method of casting is non weight bearing, subtalar joint neutral using plaster or optics. Weight bearing tends to capture the foot deformity, where STJ neutral captures the foot in it's most efficient neutral position from which a prescription orthosis can built.

If you truly need a custom rx, seek out a doctor who specializes in the foot and ankle and either have him/her fill the script or take it to a CPed who can then fit you.

Result number: 67

Message Number 238984

Re: UNLOCKING OVERPRONATION View Thread
Posted by Julie on 11/05/07 at 01:34


Laurie, IT'S working as well as well as ITS limitations allow. ;)

As you pointed out earlier, these systems can't differentiate between words used incorrectly in different contexts, as long as the word itself exists.
.

Result number: 68

Message Number 238921

Re: Powerstep inserts, etc View Thread
Posted by Jeremy L, C Ped on 11/04/07 at 06:46

In addition to what Dr. Wander stated, there are also presently more OTC devices that meet a wider variety of fit and functional treatment than existed several years ago. In many cases, these are more than simply arch supports. Some, like Powerstep, Vasyli and Down Unders, follow a philosophy of first ray function. Others, like Birkenstock Balance and Superfeet Green, do an adequate job of creating lateral calcaneal control. Some others, like Lynco and Alzner, place an apex beneath the cuneiform and provide support to those with Lisfranc hypermobility. So when out of pocket costs come into question, or limitation of insurance assignment, there are far better than no pedorthic treatment at all.

Result number: 69

Message Number 238885

Re: acid load View Thread
Posted by Scott R on 11/03/07 at 13:25

It's rare i hear anything new about vit c, but ascorbyl palmitate is new on me. Wiki says it's fat soluble which means to me it's probably less natural and doesn't absorb as well. The reason for using it i assume to be because it absorbs more slowly. The ascobate ion of the various water-soluble forms you mentioned goes to 1/4 th the initial blood levels in 6 hours. The sudden spike of a 2,000 mg dose after a meal can reduce blood sugar and increase the effectiveness of existing insulin helping to prevent or reduce some symptoms of diabetes. So the ups and downs of taking C 3 times a day are not all bad.

The whole acid thing is too complex for me to worry about except to eat good food, exercise, and take supplements and not be afraid of ascorbic acid. For example, exercise removes excess CO2 which is acidic in solution and concurrently the acidic H+ ions are converted to H2O in this combustion process we call life. The H+ being the theoretical cuplrit in ascorbic acid (hydrogen ascorbate)

Result number: 70

Message Number 238879

acid load View Thread
Posted by Dr. Ed on 11/03/07 at 10:04

ScottR:

Acid load should not be an issue with Vitamin C if the non-acidic versions are used. I prefer ascorbyl palmitate, the fat soluble version although the so-called 'mineral ascorbates' such as magnesium ascorbate, potassium ascorbate and calcium ascorbate are good options. I am not certain if the moeities of 'Ester-C' are acidic.

Ed

Result number: 71

Message Number 238809

Re: UNLOCKING OVERPRONATION View Thread
Posted by Jeremy L, C Ped on 11/02/07 at 07:47

Dr. Kiper, I too have respected your knowledge and experience in conservative foot care. You and I possess care philosophies that share commonalities as well as divisions, but that exists among professionals in all disciplines.

That said, you are now making a considerable twist on the truth. Yes, your articles possess a good amount of helpful information. There is also a consistent pattern among them:

1. They are all unsolicited articles on orthotics

2. They all provide evidence, in your perspective, on the limitations to traditional orthotic therapy.

3. They all specifically mention either fluid silicon dynamic devices or SDO's as the remedies for this treatment paradigm.

In respect of time as I am getting prepared to see patients, I only collected a limited number of examples. But here are the the last three unsolicited posts you made on orthotics:

1. Level of Difficulty to Fit with Orthotics
9-26-2007
message #236640

2. The Frustration and Disappointment of Custom Foot Orthotics
9-17-07
message #235859

3. Orthotic Therapy - What it Takes - What to Look For
8-19-07
message #234168

This is not imaginary, and certainly could come across to some as being a shill. If there's something you wish to discuss off-board, I have always been open and available. I'm willing to end this line of dialog, as it appears to be causing ire among our colleagues here. Of greater importance, it's causing frustration for those people are seeking help to their pain through this site.

Result number: 72

Message Number 238556

Re: Back Pain & Insoles View Thread
Posted by Dr. Wedemeyer on 10/28/07 at 15:47

Beyond that, lower back pain is predominently from a rotation of the hip on one side. In my opinion, this most commonly comes from a difference in the range of pronation that we all have and as we grow up the brain recognizes this disparity and rotates the ileum (hip) on one side forward or backward to compensate for this difference in pronation.
_________________________________________________________________________

Dr. Kiper while there is some modicum of truth in this statement, low back pain is clearly not predominantly as a result of simple nutation of the ilia on the sacrum due to pronation. In fact the majority of my low back patients do not have concomitant pronatory issues which significantly effect their low back.

While uncontrolled subtalar pronation is well documented as a cause in the incidence of some cases of pelvic dysfunction causing an increase in the lumbar lordosis and/or functional LLI's, postural syndromes, facet pain etc; it is not the primary etiology.

I would argue that the vast majority of acute low back complaints are due to deconditioning, weak abdominal and core spinal musculature, postural syndromes and frankly stress on the disc due to flexion compression and axial laoding.

Years back I noticed that a few of my patients seemed to have the same pattern of functional LLI with rotation of the 4th or 5th lumbar and nutation of the pelvis forward on the side of lumbar rotation. As I began to learn about orthoses and study gait I found that many of these people could be helped by addressing certain postural patterns and functional weaknesses (or hypertonicity) in the lower extremity musculature along with correcting the foot biomechanical fault and gait patterns.

Interestingly the combination of a proper orthosis and manual manipulation yielded better results for this population than either alone. I also achieved even better and more lasting results by adding rehabilitative exercises to address dysfunctional muscle patterns along with the manipulation and orthotic.

This makes a very good case for the need for DC's and DPM's to work together offering their unique skills for this patient type.

Again though, this is not the majority of low back patients. The majority of low back pain is discogenic with attendant myospasm and yes, chiropractic is very effective in these cases. An orthosis may aid in ground reactive forces transmitted up the chain that exacerbates the disc or facet but I would not qualify it is the primary etiology or treatment for low back pain.

Stress on the disc in an increased lumbar lordosis does not always effect the lumbosacral articulations and quite frequently is found higher up at the 3rd and 4th lumbar discs. facet pain even at the first lumbar triple joint does respond to orthotic and shoe wear prophylaxis.

Your statement that many of these patients symptoms would recur I completely agree with. As I have mentioned before it appears to be a similar concept to handedness and muscle dominance.

Result number: 73

Message Number 238208

Re: Questions about SDO's View Thread
Posted by Dr Kiper on 10/22/07 at 10:01

Jeremy,

It is unfortunate, that your perception of my statement that properly fit orthotics can be used for prevention as well as intervention is regarded as being that of an “arch support sales person rather than a serious practitioner”. This really is an ignorant and malicious remark. If one disagrees with the valid opinion of an educated, experienced and licensed professional, who has been making orthotics longer than you’ve even been in school, then state it as that, a difference of opinion. But to relegate me to being a salesperson, when my intent is to help educate the public at large that there is an orthotic based on new technology that is a health benefit to wear in active adults and growing children is both again ignorant and professionally mindless to what an orthotic can do. It is the limitation of traditional orthotics versus the newer technology that lets you think this way.

Because you have limited experience with shoes that have some silicone technology, does not make you an expert in the technology that I use. I’ve made Silicone Dynamic Othotics for and treated many patients and have had very few failures primarily because it’s the patient that does not follow the procedure. You cannot do what I do; you do not know how to do what I do. Instead you make a nasty remark that shows both your fear of another technology and the fact that you don’t understand the science and technology of fluid mechanics and how to apply it to function. I can understand that, it’s not easy to grasp.

Not seeing orthotics as a health benefit to growing the postural health of a child in development is both shortsighted and based on years of paradigms mired in old fashioned thinking. Of course that thinking is reliant on the fact that traditional orthotics can not be fitted and refitted consistently the way fluid technology can. It not only varies from practitioner to practitioner, but it varies even for the same practitioner.

Fluid can be calibrated and repeated to within the same gram weight over and over again. This would also allow it to be consistent between other practitioners

It is also an error on your part to accuse me of making a “single orthotic prescription”.
Either you’re dyslexic or I’d rather not say what I personally think, but fluid technology offers a variety of prescriptions for the person and their biomechanics, not the problem. In my opinion their problems are the result of their functional biomechanics that accumulates over time as well as other contributing factors.

The unique feature of fluid technology is that it can be fit to almost anyone because it is based on principles of science. I am able to prove this with modern computer technology, and I am able to challenge anyone to a comparison of results in the fit and use of the SDO and traditional orthotics. If the conditions could be set up, I could absolutely beat anyone, consistently and by huge margins. It’s smart that none of you dare accept my challenge because then you’d have to face the truth of everything I’ve said, and you’d be left with egg on your face.

Result number: 74

Message Number 238038

Re: Att: Larry View Thread
Posted by larrym on 10/19/07 at 09:00

Dr Kiper, do you mean proof as in some questionable 'studies' done on my own devices or do you mean results based proof? Due to HIPAA I cant throw names out there but the reason I have these elite athletes referred to me is that I get results. I do zero advertising and I spend about $200 per year on donuts or flowers to detail my referrals.

While all my patients are treated great, the elite athletes present greater challenges. Think of it as going from a school bus mechanic to an indy car mechanic...you mess up you get fired. I can understand your excitement for your device but to continue to say that everyone doesnt get it, its too complex for them, its based on science, our technology is old etc. etc. is just plain wrong.

This is the simplest way I can explain it but the key to controlling a foot FUNCTIONALLY is dependent on several factors. Durometr or firmness of materials (not saying harder the better in all cases, just that is a factor) Geometry i.e. angles, elevations, depressions, wedges etc. Patient education regarding break in and wearing instructions. Footwear is also crucial as it can make or break a device.Prescription, meaning diagnosis and most importantly, what the practitioner sees is correct and their skill and experience being such that they know what modifications, materials and footwear the particular patient needs to have success.

IMHO, you have cut corners in most of these areas and your hail mary is that its pascals theory and advanced technology that should explain and prove everything. Yes you get results as well all do. Your pressure tests are static and the device is a soft accomodative device that will control certain motions in certain parts of the foot. Yes, it is a nice cushion as many visco elastic and fluid derivatives are. But, they also have their limitations.

Result number: 75

Message Number 237990

Re: Pics View Thread
Posted by Dr Kiper on 10/18/07 at 09:30



I’d like to repeat for the 3rd, 4th or 5th time that I had misstated where the SDO ends. When I said the orthotic ends at just behind the met heads, similarly to a traditional orthotic, I meant the “functional” part (where the fluid ends). The material end of the orthotic, the leading edge of the orthotic ends just anterior to the met heads. In this way, the met heads are actually the physical end of the “functional” orthotic.

In this way, fluid is much more accurately imposed up to the met heads and forms a much more accurate biomechanical functional control, concurrent with STJ neutral. A traditional orthotic has a lip or a ledge that the forefoot drops over, not counting a forefoot post which further drops the forefoot into an unnatural position.

Don’t you think since the met heads drop over this edge, that is taking away from the precise biomechanical position of the functional mechanics? I do. It’s a poor design.

I’ve also repeatedly asked you for your proof that traditional orthotics work. Other than somebody else telling you they work, how do you know? What can you point to that indicates, that traditional orthotics scientifically work?

You keep referring to the SDO as NOT being functional. I’ve offered scientific evidence that they are “functional”, you keep dodging my simple question as to what proof do you have? I’d like you to address this question instead of dodging it and repeating something that I’ve clarified several times.

So, once again, what proof, what scientific proof do you offer that shows traditional orthotics work?

I’ve also asked whether your technology can answer the following:

Can you verify pronatory forces occurring?
How about heel strike, reduction in pronatory velocity?
Can you measure ground reactive force?
Can you see the tarsus locking, how about the hypermobility of a 1st or 5th ray?
Can you see the 1st metatarsal loading during a gait cycle and distribution of forces?

These are the makeup of biomechanical function. Tell me I’m wrong, I dare you.
You sir, do not understand “true” biomechanical function in my opinon. You only see it as a device that conforms to traditional convention. If you’re making the same thing as everyone else, then yours must be functional too.

I can see all of that and more and I can demonstrate the efficacy of biomechanical control with fluid technology. Here I am offering scientific proof or at least one avenue of proof that fluid technology works. You give me just one shred of proof also.

Why don’t you respond? You keep asking for proof. Or do you refute that computer pressure tests have no validity at all?

The problem as I see it, TRADITIONAL TECHNOLOGY since its conception has been dependent on evaluation of Range of Motion studies predicated on degrees of motion and angle measurements.

Normal range of motion is variable and average values have been created to fit that picture. Anything outside of the average are considered “abnormal”.

To achieve these angles/degrees of motion requires controlling dynamic motion through artificial means such as static rearfoot or forefoot posts (a very poor design and often uncomfortable to boot). Because of the inaccuracy of finite angles/degrees through eyeballing and manipulation, accommodations are often necessary and performed with cutouts, padding and spot heating or adding some material in bulk to change the angles thought to effect alignment change and/or comfort.

Making this happen, begins with the perception that rearfoot control is the key to functional alignment.

FLUID TECHNOLOGY is a new concept, obviously not well understood. In reality, of the two technologies, only the FT is based on principles of science known as fluid mechanics based on Pascal’s Principle. Validation can be seen through ground reactive force measurements, which are at least half the necessary validation and quantifies results which can be used to evaluate biomechanical efficiency. This in a small way is scientific proof that FT offers “functional” control.

Instead of trying to control the foot through the rearfoot, to obtain calibrated angles and degrees, FT works through the midfoot allowing the foot to move naturally through its ROM, yet limiting overpronation at the MTJ, supporting, stabilizing and “locking” the tarsus. It disallows the rearfoot to pronate excessively through a retrograde effect.

That said, FT reduces the velocity of pronation beginning at heel contact and dampens heel strike as well. This can be verified through computer analysis.

Your limitations of a different way to deliver biomechanical control is your stumbling block. Hopefully, new people with advanced biomechanical knowledge will be open to simply looking at the technology, give it a chance. Allow the opportunity to test it and if a formal clinical study was desired, that would be great.

Part of that openness to trying the new technology is understanding that like a traditional orthotic, adjustments may be necessary. Just as with traditional if a patient complains that the orthotic hurts (standing or walking) or is causing a new problem such as you described with your experience.

Rather than immediately bash what was wrong, allow the practitioner to assess and correct. In your case there was too much fluid in the prescription created for you, yet SEVERAL TIMES you only said you’ve tried it and that’s what happened, it didn’t feel right, you know what feels right etc, etc, etc. BUT NO OPPORTUNITY WAS GIVEN TO CORRECT THIS.

You make a big deal as did others that I don’t examine the patient. I’ve addressed this in previous posts. That is one of the biggest advantages with this NEW TECHNOLOGY that is eluding you and the others. It’s not like treating a diabetic or an infectious process, Do you treat this at all?

I can take a history by phone, which by the way has already been diagnosed by someone else who did have the opportunity to examine the patient and I simply guide them through a process of where I don’t need to see them standing on the orthotics. Because I know what to expect from the performance of fluid mechanics (true science is predictable), I know what to expect biomechanically, and therefore only need to hear how they feel standing on the orthotics. I’m looking for reactions in proprioception. This is information that I need and use to determine biomechanical functionality.

Rather than make the kind of various traditional adjustments your technology requires, I only need to add or reduce fluid volume. In this way the foot actually “self posts” which is another new concept that escapes you.

Obviously it’s too much for you to grasp, probably because like others, people get stuck in their paradigms.

New technology should be looked at and given a fair chance. You’ve not done that. You’re stuck in the middle of the 20th century.

As for your statement “if Root was describing a fluid orthosis. He clearly was not and in fact he was describing a FUNCTIONAL orthosis. “—you are correct. He was not thinking of a “fluid” orthotic, if he was aware of it’s technical superiority and functional capability he would have stated so. But his description does describe a fluid orthotic. The fact is that FT is a better functional orthosis than anything you can show me.

One last thing. Please, if I’m busy with other people at the PFOLA show, don’t badger me with technical questions. My agenda is to fit anyone interested in this technology, give them a chance to evaluate a computer analysis and discuss anything, separately, later. I will not have the time to stop what I’m doing to answer one person’s questions.

If I have the time, I’ll do so, but I’m not going to be interrupted by someone else’ agenda.

I’ll test you with a corrected prescription and if you want to open a dialogue, I’ll do so at a later time here on the boards or privately—your choice. I’m not sure why you want to waste your time or mine, because I know you’ll NEVER, EVER accept this.

Result number: 76

Message Number 237890

Re: My mother's foot problem View Thread
Posted by Dr. Ed on 10/16/07 at 18:29

Another factor to consider in the elderly is fat pad atrophy under the heel bone and/or metatarsals. While there may be a limitation to what can be accomplished with inlays or orthotics additional help can come from external shoe modifications. Some shoe modification options include metatarsal bars and distal rocker soles. Such modifications must be used with caution in the elderly due to potential effects on balance. That is
where the professional portion comes in to help make such determinations.

Dr. Ed

Result number: 77

Message Number 237582

Re: L5,S1 nerve root View Thread
Posted by Dr. Wedemeyere on 10/12/07 at 12:23

Julie,

Dr. Ed called it. This illustrates why a history (and physical examination) are crucial. Now that Julie has discussed the past history it becomes much very clear why at least one side of her body is having these symptoms.

You could very well have TTS concomitantly and lumbar disc referring to the other foot. It is not uncommon for a lumbar disc patient to lean away from the side of involvement and place a great deal of stress on the medial ankle in doing so by favoring the painful limb.

When was your MRI taken? If the disc is a protrusion and re-aggravation of the prior complaint, I would have a second radiologist read the films to rule out a central disc first. From there your physician can narrow the diagnosis based on the EMG/NCV studies and exam findings.

Result number: 78

Message Number 237528

Re: So this wall stretch thing... View Thread
Posted by Dr. Wedemeyer on 10/11/07 at 18:27

Scott

Muscular involvement is only one of many reasons that people get PF as you well know. A sudden change in shoe wear, weight gain, pregnancy, occupation, sports activity, shoe wear, congenital limitations and factors, previous injury, repetitive strain/sprain etc are but a few of the etiologies of PF. many of these factors can affect the lower leg musculature concomitantly.

It is interesting that work comp claims are divided into AOE vs COE claims (AOE being an injury, accident or perspicuous event and COE would be the repetitive stress or slow onset cases where the true etiology may not be known). An AOE injury certainly can begin as an acute complaint and become chronic. The same is true for the COE complaint but neither is considered 'chronic' per the American Medical Association Guidelines until a period of time passes and pathologic changes occur either objectively in examination findings (such as a lack of range of motion or a positive Straight Leg Test in a lumbar disc complaint)) or histologically (as in fasciitis becoming fasciosis), on EMG/NCV, MRI etc. confirming a PATHOLOGICAL change consistent with the presenting complaint, or subjectively as the patient reports a worsening of their condition over time and treatment fails to produce a lasting benefit.

The point is there is always an acute phase of CARE (not the injury, but the treatment) in any musculoskeletal concern and there is not always a chronic phase of the same CARE for the illness. Treatment is afforded accordingly and the standard for a tendon or ligamentous versus a muscular injury is dramatically different. This is medical fact.

I illustrate it this way to separate the ideation that the complaint and the treatment phases are the same, which I think is causing some confusion. They are related but mutually exclusive.

So when you say a tight gastrocnemius do we know that the tight muscle (gastroc) is a painful, protective response to an acute or chronic tear of the Achilles, or simply a ‘tight’ muscle that exacerbates the PF? Without the benefit of an appropriate examination and diagnosis one never knows and one should never guess in my opinion.

The big problem with the internet is that it is extremely limited in providing a structured approach to learning examination and orthopedic diagnostic skills, the history, imaging studies etc.

In the absence of these skills, I feel it is wrong and often deleterious to simply guess and risk further injury.

I would also add that in practice we know that about 10% of all patients that we see become chronic pain patients (roughly). I feel that the people who post here represent that portion of the scale much more than the 'typical' patient who presents to our offices. You rarely hear from the patients who heal and are no longer searching for answers.

Result number: 79

Message Number 237372

fractured heel question View Thread
Posted by Tina on 10/08/07 at 23:37

I fractured my heal March 19th 2007. 4 fractures, found after I was told the day of my initial x-ray that I just had a spraned ankle. Radiologists called Dr. and they told my daughter as she called due to I was passing out. After about 4 month seeing the foot Dr., he said I now see why the back of your foot was hurting, the x-ray showed scaring where the bone there had broken and I knew that pain was terrible on top of the fractures. He said it probably was pulling on the a/tendon. I had no protection after about 7 weeks in a cast, he put me in a boot but the back was open, it seemed to get hit all the time and hurt bad. I think I was non weight bearing for about 9 weeks. Never could walk in that boot. The last visit I had with foot Dr. is when he saw the other broke bone. Well I did go to a therapist, he showed me stuff to do and I have done that every day 3 times a day most days. I have not gone back because in the beginning I could not drive due to right foot. I have since worked to the point that I can walk but it took about 5 months and the foot Dr. told me he wanted me out of that boot asap, so that is what I did within days of having the boot. I tried all kinds of shoes, the swelling did not let me use any thing except sandals. I have the compression sock I wear every minute of everyday, except baths. I have times when my foot simply locks up and it is unbearable to move it much less walk or bear weight on it. Gradually I have managed to work through the pain and get the foot going again. I still can not lift my weight to push off like a normal gaint with my foot. Running is impossible. The joint in the middle of my foot/ankle simply will not let me do that. The foot Dr. said it was not damaged, then he said it was some. That only time will tell if it will hold up. He suggested not having surgery because it would only give me 1 16th added height. I am not worried about the height. I am worried that I will always have this limp and I can't get that joint to work right. Only x-rays was done on me. Again the Dr. Felt other than casting, boot after that, the natural healing process was best in my case. It hurts all the time, just hurts more when I am on it much, and sometimes it is like it just locks up and hurts really bad.
I do not know if I should just live with it like it is or get another opinion. I can't even sit with my foot down for long as it swells and turns red/purple and hurts bad.
Do you have any suggestions for me. I am trying to do everything I can to get it working right. I am a very active person, or was anyway. I can not even run around with my grandchildren now. The pain seems to wear me out just for a grocercy run or something like that. Uggggh! I want to believe in my Dr. but I am 47 and not ready to slow down this much. I still jet ski, camp, work and all that stuff we all do. Any suggestions on how I can help myself or seek help. Again I do theropy on my own everyday at least 3 times a day. Do you think I will ever be normal again like I want to. I hate the pain and the limitations. It gets depressing and I am not one to be like that. Thanks so much in advance.

Result number: 80

Message Number 237190

oops ignore the above post View Thread
Posted by Dr. Wedemeyer on 10/04/07 at 23:54

Denisea,

1st met joint mechanics are very complex. I understand your thinking, to bolster the action of the 1st met but actually quite the opposite is true if your 1st ray is truly hypermobile. Many hypermobile 1st MTP joints are plantarflexed and require a reverse Morton's extension or first ray cutout. This works extremely well with a plantar-flexed first ray, hallux limitis, sesamoiditis, and severe forefoot valgus deformities.

You could also have sesamoiditis and should be evaluated by a professional to rule this out. A hypermobile 1st ray can cause concomitant sesamoiditis and PF especially with a varus forefoot. The resulting supinatory action of the forefoot during gait is murder on the plantar fascia. Your provider may also consider a 2-5 bar modification to the orthotic.

There is also the relationship of the rear foot to consider and a deep heel cup and additional posting may be necessary to make the aforementioned modifications work.

What this all means is that there is help but trying to modify a device or manufacture one on your own could be disastrous to the health of your foot.

Have you seen a foot specialist or been referred to a Cped?

Result number: 81

Message Number 237189

Re: Speaking of MTJ..... View Thread
Posted by Denisea on 10/04/07 at 23:53

Denisea,

1st met joint mechanics are very complex. I understand your thinking, to bolster the action of the 1st met but actually quite the opposite is true if your 1st ray is truly hypermobile. Many hypermobile 1st MTP joints are plantarflexed and require a reverse Morton's extension or first ray cutout. This works extremely well with a plantar-flexed first ray, hallux limitis, sesamoiditis, and severe forefoot valgus deformities.

You could also have sesamoiditis and should be evaluated by a professional to rule this out. A hypermobile 1st ray can cause concomitant sesamoiditis and PF especially with a varus forefoot. The resulting supinatory action of the forefoot during gait is murder on the plantar fascia. Your provider may also consider a 2-5 bar modification to the orthotic.

There is also the relationship of the rear foot to consider and a deep heel cup and additional posting may be necessary to make the aforementioned modifications work.

What this all means is that there is help but trying to modify a device or manufacture one on your own could be disastrous to the health of your foot.

Have you seen a foot specialist or been referred to a Cped?

Result number: 82

Message Number 236817

Re: Stretching painful View Thread
Posted by Louis S. on 9/28/07 at 01:47

You know it's important to note that this study showed that BOTH the 'new' PF stretch and the Achilles tendon stretch were effective at reducing pain. Also, this study has been criticized by a third party:

'unfortunately the trial update is plagued by a fundamental methodological flaw - the failure to include a placebo or control group for comparison. Accordingly, the conclusion from the trial that the “long-term benefits of the stretch include a marked decrease in pain and functional limitations and a high rate of satisfaction” is incorrect.

The authors also admit problems:

'Yet, study limitations do exist. There were attrition rates of about 20% at the eight-week study period and again at the two-year follow-up evaluation. This could have led to altered results.'

Also, they did not study things such as a combined protocol where you start with the gentle PF and follow up with the Achilles tendon stretch, which possibly could be better than either by itself.

Personally, I think it's a great stretch to help PF. But I don't think we should throw the baby out with the bathwater. Some people like to think in terms of black and white, but I don't see that this must be an either-or proposition.

Regards,
Louis S.

Result number: 83

Message Number 236640

Re: Taping for Plantar Plantar Fasciitis View Thread
Posted by Dr Kiper on 9/25/07 at 13:14

I don't disagree with this. Most of the patients respond as you say, sometimes even within hours let alone days and weeks.

My feeling is that there is a limitation of a shell orthotic to carry it's therapy all the way in many cases. I believe the limiting factor is that a shell restricts too much of the 'normal' motion necessary to good healthy gait.

Result number: 84

Message Number 236639

Re: Taping for Plantar Plantar Fasciitis View Thread
Posted by Dr Kiper on 9/25/07 at 13:14

I don't disagree with this. Most of the patients respond as you say, sometimes even within hours let alone days and weeks.

My feeling is that there is a limitation of a shell orthotic to carry it's therapy all the way in many cases. I believe the limiting factor is that a shell restricts too much of the 'normal' motion necessary to good healthy gait.

Result number: 85

Message Number 236625

Re: johnh need your opinion on new aircraft? View Thread
Posted by john h on 9/25/07 at 10:36

Marie this has been one of the most controversial aircraft in many years. Some services absolutely do not want it. I think the Navy/Maries are probably the only one that do. It has had all sorts of mechanical problems and a number of crashes. Very very difficult to fly and it will be a maintenance nightmare. My personal opinion is that it should not have been built but I am not at all close to what is its planned mission. The Harrier is the only hybrid that seems to have been successful. The Osprey is designed to replace the CH-46 Chinook and CH53 helicopters. In no way can this aircraft do what a helicopter can do. It cannot hover over water, not cleared to hover over unprepared landing zones. It has a tremendous down-wash from its rotors which places further limitation on it and this has not been resolved. I think they have been working on this aircraft since 1994. I have flown all kinds of aircraft from fighters, bombers, helicopters, transports and small aircraft but I would want no part of this machine. I would think it would be a real nightmare in a desert environment. Many of my fellow pilots who meet in organization think it is a boondoggle. Someone must like it. Aircraft cost per hour are measured in man hours and parts used per flying hour. I would bet this one will lead the pack. The guy that first flew this baby should be awarded some sort of bravery medal.

Result number: 86

Message Number 236547

Re: Taping for Plantar Plantar Fasciitis View Thread
Posted by Dr Kiper on 9/23/07 at 11:05

The SDO is only one of a couple of orthotics using fluid technology.
The technology while limited to only a few people is not proprietary, it is available to anyone willing to use it.

It should be considered for the patients who have had innumerable poor results with traditional orthotic. This web site is full of patients like that, yet most everyone considers only making the same technology orthotic, a shell. Patients repeatedly talk about having several pairs made and all failed. I've seen more doctors willing to try untried and untested surgeries more than a conservative approach to orthotic therapy.

True, traditional orthotics do work for many and when they do, they do a good job as long as their comfortable. Surely those who prescribe traditional technology are aware of this. Too often however, because casting methods are not consistent, many patients eventually fall into chronic cases because they do not fit the new optimal position the foot has grown into. It is the limitation of the normal motion of the foot that is restricted with a shell orthotic, that is a major problem.

But it was the concept of Dr Root, that an orthotic 'control' abnormal motion. What developed was a rigid platform for the foot to walk on that did not match the way the foot walks. He stated however, that an orthotic should fit the 'natural' motion of a foot and not restrict it.

A traditional orthotic does not do this as well as fluid technology.

The SDO or fluid technology orthotics are a superior product for the biomechanical structure of the greatest majority of people out there. It is not for every condition such as CMT, post polio, CP or spastic flat foot. I've commented on a couple of those before.

The patients who in the past have failed with the SDO is because they failed to follow the procedural instructions. Rather they went their own way and hopd it would work. During the SDO TRIAL I set up the conditions that those involved follow my instructions of daily reports to determine muscle reactions, once those normal reactions occur it's a matter of moving to the next step and either regulting the time worn or adjut the Rx with more or less fluid, it's that easy to make it work.

As for petty attacks, let me remind you that I never spoke about the SDO before you were criticizing my articles on this board which were general in regards to fluid mechanics. You came out several times and criticized me or the product. It wasn't until Dr Z challenged the SDO TRIAL. Once that was done, only he recognized that it was an accomplisment that was unique.

Result number: 87

Message Number 236377

Re: Question about plantar fasciitis View Thread
Posted by Dr Kiper on 9/19/07 at 17:41

What I am saying is that while Alex may have a congenital short muscle or fascia, yes, it is the working mechanism of the arch involving “normal” overpronation, which “results” in a tight muscle or fascia. It is the “normal” inefficiency of our mechanics that produce the biomechanical problems we see.

Congenital issues are usually evident as in the case of a “clubfoot” deformity.

As to your statement, “some who don’t over pronate”, I would disagree. Everyone overpronates, underpronators aka supinators also overpronate, they just pronate less within their range of allowable range of motion, or stated another way, their range of motion of pronation is less (a shorter range of motion, as it were) than that of a pronator.

Over pronation is the full range of motion of pronation for that step at the moment (jumping, running etc results in hyper pronation). It is the mechanism by which the foot comes to a slow and gradual completion in order to absorb shock from the ground and propel us forward. This is a normal foot. While some have better mechanical efficiency and perform say to a level of a superior athlete or people who don’t develop any painful problems until later in life, they too over pronate.

Over pronation is excessive motion that can be assisted with a proper fitting orthotic that minimizes (not eliminate) the excessive range of motion available.
The more precise the orthotic minimizes overpronation, the more efficient the entire lower extremity..

This is why OTC orthotics can be so helpful, in that they reduce/minimize some over pronation. They are not however precise enough in their limitation of the excessive motion to prevent or in most cases resolve fully further biomechanical breakdown.

In my opinion it takes years of cumulative foot steps, hundreds and thousands of times/day that results in issues like the one above, from overpronation. As I mentioned earlier, I believe the demographics of most biomechanical issues seen by podiatrists and chiropractors are probably between 40-60 years of age.

As to your question about % of supinators and cavus, while both are supinators cavus I’m guessing from my experience is about 5%. Supinators as a class is the majority of the population.

Result number: 88

Message Number 236376

Re: Question about plantar fasciitis View Thread
Posted by Dr Kiper on 9/19/07 at 17:39

What I am saying is that while Alex may have a congenital short muscle or fascia, yes, it is the working mechanism of the arch involving “normal” overpronation, which “results” in a tight muscle or fascia. It is the “normal” inefficiency of our mechanics that produce the biomechanical problems we see.

Congenital issues are usually evident as in the case of a “clubfoot” deformity.

As to your statement, “some who don’t over pronate”, I would disagree. Everyone overpronates, underpronators aka supinators also overpronate, they just pronate less within their range of allowable range of motion, or stated another way, their range of motion of pronation is less (a shorter range of motion, as it were) than that of a pronator.

Over pronation is the full range of motion of pronation for that step at the moment (jumping, running etc results in hyper pronation). It is the mechanism by which the foot comes to a slow and gradual completion in order to absorb shock from the ground and propel us forward. This is a normal foot. While some have better mechanical efficiency and perform say to a level of a superior athlete or people who don’t develop any painful problems until later in life, they too over pronate.

Over pronation is excessive motion that can be assisted with a proper fitting orthotic that minimizes (not eliminate) the excessive range of motion available.
The more precise the orthotic minimizes overpronation, the more efficient the entire lower extremity..

This is why OTC orthotics can be so helpful, in that they reduce/minimize some over pronation. They are not however precise enough in their limitation of the excessive motion to prevent or in most cases resolve fully further biomechanical breakdown.

In my opinion it takes years of cumulative foot steps, hundreds and thousands of times/day that results in issues like the one above, from overpronation. As I mentioned earlier, I believe the demographics of most biomechanical issues seen by podiatrists and chiropractors are probably between 40-60 years of age.

As to your question about % of supinators and cavus, while both are supinators cavus I’m guessing from my experience is about 5%. Supinators as a class is the majority of the population.

Result number: 89

Message Number 236211

BME - Calcaneum View Thread
Posted by AngelFrances on 9/17/07 at 12:49

This injury to my foot happened June 2005, so I will give you a brief history:
-currently 40 y old
-injured left foot in June 2005, going down stairs
-x-ray next day . . . suspicion of 'avulsion fracture' but not conclusive
-told to keep off it and wrap it . . . could take 6-8 weeks to heal
-September 2005 (8 weeks after injury) still in lots and pain and major limping
-went to ortho surgeon at UofA Hospital
-more x-rays, showed nothing, said very severe sprain and may take 8 months to heal
-told to wear air cast for 2 weeks and to get physio for 3 months
-after 3 months of physio absolutely no difference in pain or limping
-in January 2006 went to ortho surgeon again, took x-rays weight bearing, still showed nothing
-gave steroid injection into ligament around ankle, helped ease pain somewhat for about 1 month
-by June 2006 still having chronic pain and limping, ortho surgeon sent me for bone scan
-results of bone scan showed 'moderate uptake at calcaneocuboid joint'
-in August 2006 sent me for steroid injection into cuboid joint done by fluoroscopy
-pain relief at last!!!! felt great, but it only lasted about 6 weeks
-in October 2006 sent me again for injection into cuboid joint done by the radiologist
-pain relief again!!! felt almost perfect!!!! but it only lasted about 6 weeks
-went to ortho surgeon again in May 2007 to discuss ongoing pain and movement limitations (even walking can hurt)
-had MRI in June 2007
MRI RESULTS SHOWED: Focal intense marrow within the anterior process of the calcaneum - it is unusual to have marrow edema of just one bone in coalition but difficult to exclude fibrous coalition.
-Found paper that discusses using vasoactive substance iloprost that seems to have success with BME; the surgeon said he would look into but it's not something that is done here (Edmonton, Canada).
-Surgeon is leaning toward bone drilling.
-How successful is bone drilling?
What other options are there? I used to be so active (squash, dancing, etc.). Now all I can do is walk and not even that well some days - just depends how the pain is.

Any advice would be appreciated.



-

Result number: 90

Message Number 236202

Toe Implant Problems View Thread
Posted by Julie R. on 9/17/07 at 09:51

About 8 years ago (at age 39) I had a total joint replacement of my left big toe. This is a double-stemmed implant, I believe it is a 'Swanson' implant. I have had nothing but problems since the implant. I have been to the doctor repeatedly over the years with complaints about the pain and swelling that has never gone away. I've consulted with several orthopedic doctors as well as the podiatrist. All x-rays show the implant to be in perfect alignment with no suspicion of loosening.

I am fairly convinced that I am allergic to or have a sensitiviy to the implant. I am extremely allergic to metals -- can't wear jewelry, watches, metal belt buckles, etc. or I break out in a rash. Although I've asked if this could be the problem, the doctors essentially tell me that titanium is hypo-allergenic and it's unlikely I could be allergic. As I mentioned, the foot has continual pain, it stays swollen, and I have a constant tingling sensation.

I have tried to avoid further surgeries as long as possible, but feel I need to take some action in the near future to get some relief for this situation. I understand the potential options could be:
1)Replace the current implant with an implant consisting of different materials.
2)Fuse the foot with a bone graft (from my hip or a donor bone)
3)Remove the implant and don't replace it with anything

Are there other options available? Can you provide any specific recommendations, including positives and negatives to those possibilities? At this time I am 47 years old and try to be quite active, although the foot pain and a recent fibromyalgia diagnosis pose limitations.

I would greatly appreciate any advice you can provide.

Result number: 91

Message Number 235904

Re: hip causing plantar fascitis? View Thread
Posted by Julie on 9/11/07 at 01:46

Dr Wedemeyer

Yes indeed, I agree. There are manifold causes of musculoskeletal problems, and they all need to be looked at. And the whole person needs to be treated, not just the foot or the spine. We are definitely on the same planet. :)

I wasn't saying that habitual body use is the only cause of musculoskeletal complaints. But it is a very common cause that is not often considered by us here (apart from excessive pronation) with the frequency that treatments and exercise are considered. Todd's problems - hip and lower back as well as foot - and his observation that chiropractic adjustments help but do not have lasting effect, brought this vividly to mind. Clearly something is going on that hasn't yet been identified.

In his second post he tells us that he is young (28) so we know that his problems aren't due to degenerative disease. He also tells us that he has been treated with a wide variey of techniques by many practitioners of different disciplines, and nothing has helped. They can't all have been incompetent practitioners or worthless techniques, so something is going on that hasn't been spotted. It is possible (I would guess probable) that the cause of Todd's problems lies in something he is habitually doing, and that none of the practitioners who have treated him have spotted it, or asked him to think about what it might be.

Two things in Todd's second post leap out at me. If I were working with him as a student, I would suggest that he first look at his guitar-playing technique, and see if it might be stressing his right hip and lumbosacral area.

Many if not most musicians - instrumentalists, singers, conductors - have musculoskeletal problems related to their profession. (As you probably know, FM Alexander developed the Alexander Technique through his observation of his own problems. A public speaker, he lost his voice, and through intensive observation discovered that the cause lay in the way he was using his body. The AT has its limitations, but the principle - of looking at oneself to discover what one is doing every single day of one's life to cause a problem - is sound. It's not just treatment and exercise we need to think about. It's what we do, habitually, that escapes our notice because we don't often know we're doing it.)

The other thing that strikes me is that Todd says he does yoga every day. I would need to know exactly what his practice consists of before hazarding any guesses, but I'd be willing to bet that there is something - perhaps just one posture - that he is doing every day which, if he simply stopped doing it, might have a beneficial effect. Or it could be, more generally, the way he has been taught to work on himself. I say this as a safety-conscious teacher and trainer who over almost 40 years of practice has developed more than one problem due to repeated, enjoyable practice of one or two wonderful postures - without realising, until they caused me problems, that they were problematic for me.

If a student of mine were to ask me what exercises are 'good for a sore neck' and if I knew that she habitually carries a heavy bag on one shoulder, I wouldn't give her an exercise. I would advise her to get rid of the shoulder bag, lighten her load, and put it into a rucksack.

Now I'll stop talking about Todd behind his back, as it were, and address him in another post about yoga!
.

Result number: 92

Message Number 235791

plantar fasitis post surgery View Thread
Posted by JO on 9/09/07 at 08:32

I had a full plantar fascitis surgery in June and felt much! better almost one month later however I still have swelling in my foot which occurs I think from being on them all day and then they start killing me again with pain-is this ever going to stop? or will I have this problem my whole life? I am a 55 year old female and started having an intermitant pain in my heel about 4 years ago and continually got worst- I tried many treatments prior to surgery- What do you think and what specialty of Dr.can I go to regarding this ongoing problem? thanks-- Jo

Result number: 93

Message Number 235763

Re: neuropathy View Thread
Posted by Dr. Wedemeyer on 9/08/07 at 15:54

Dr. G's suggestion is worth looking into Jan, although I would be cautious of salesmanship and paying upfront thousands of dollars for the treatment.

A lot depends on the type of stenosis also. Judging by your post it is affecting one side (right) so it could well be forminal stenosis. What are your other diagnoses? Is there a concomitant disk protrusion?

I assume that you have had radiographic studies, can you post the results here?

Result number: 94

Message Number 235746

Re: Crocs new model - Relief/MBT View Thread
Posted by Caeles on 9/08/07 at 11:44

I have been suffering from plantar fasciitis and I have been wearing MBT shoes. They are very stiff and have a negative heel so it takes the pressure off your heel. It's a completly different walking experience and take getting used too, but I went from limping all the time (with orthotics) to gaining quite a bit of mobility. They are VERY pricey though. Zappos has them.

I wear imitation Crocs around the house and they are really comfy. I want to try the Crocs relief because I yearn for ventilation and a less stiff shoe some of the time. They seem to get good reviews. Do they really mold to your feet?

-Caeles

Result number: 95

Message Number 235201

Re: Suggestion View Thread
Posted by Dr. Wedemeyer on 8/30/07 at 11:29

Scott I seriously doubt that there are ulterior motives to the response you're discussing. One very important point that you must understand is that there are certain key descriptions and symptoms that tie in to the history which may lead us believe the problem may be of a serious nature. The only person able to determine that is one with training and experience and that is a fact.

How many times has anyone had a cold and tried chicken soup or an OTC cough syrup only to have their condition worsen and ultimately they had to see their doctor? Sure people can try the basic advice on the site but at what point does it becomes a question of medical necessity that is better served by a professional?

I agree with Dr. Z and don't get me wrong; I do understand what you are trying to accomplish and in one sense it is plausible to construct a sort of intake sheet for the site. I think where it becomes questionable is when you start to offer advice based on your own limited experience and background. No offense but it is something that you should consider.

You could take all of the data that you have collected and crunch it with a history and intake of the type doctors have you fill out in their offices if you're determined to reinvent the mousetrap. The problem with PF as we all have witnessed is that it is a multifactorial condition with many variables and concomitants and there is no one treatment that works every time for every patient.

Result number: 96

Message Number 235152

Re: QUESTIONNAIRE: Kevin C. View Thread
Posted by Scott R on 8/29/07 at 17:03

I'm flattered that the doctors keep calling the question-response system 'advice' when they won't refer to their own questions and responses as advice. I wonder if they might be intimitated by it's popularity and effectiveness. But they shouldn't worry, i can't keep answering all the people trying to use it.

Result number: 97

Message Number 234597

Healing and the Mind View Thread
Posted by Arizona on 8/18/07 at 12:15

'No doubt a man is very often himself the cause of the disorder of this physical mechanism. It is this disorder which he calls illness, whether it is physical or mental. Sometimes it is his neglect, sometimes an unbalanced condition of his mind or body which causes it; sometimes conditions around him cause an illness. Nevertheless, to have a yielding attitude towards illness is not the right thing. No doubt it is a good thing to look upon the illness of which one has been cured as having been a trial, a test, an ordeal through which one was passing and which one has left behind; thinking that it was for the better, that one is now purified, that one has learned a lesson from it, that one has become more thoughtful and considerate towards oneself and others by an experience like this. To think, 'What I am going through it something that I must continually bear', is not the right attitude. The attitude should be, 'No, this is not my portion in life. I will not have it, I must not have it. I must rise above it, I must forget it. I must do everything in my power to overcome it, by a thought, by a feeling, by a belief, by a good action, by progress, by a conception, by healing, by whatever method.' There must be no limitation.
'Sometimes a person says, 'I believe only in healing, I will not touch medicine, it is material'; that is wrong also. Sometimes a person says, 'I only believe in medicine, I have no faith in healing'; that is wrong, too. To grow towards perfect health, to bring about a cure, one must heal oneself from morning till evening. One should think, 'Every ray of the sun cures me, the air heals me; the food I take has an effect upon me; with every breath I inhale something which is healing, purifying, bringing me to perfect health.' With a hopeful attitude towards a cure, towards health, towards a perfect life, a person rises above disorders which are nothing but inharmonious conditions of mind or body, and makes himself more fit to accomplish his [or her] life's purpose.
'It is not selfish to think about one's health. No doubt it is undesirable to be thinking about one's illness all the time, to worry about it, or to be too anxious about it; but to care about one's health is the most religious thing there is, because it is the health of body and mind that enables one to do service to God and to one's fellow-men [and fellow-women], by which one accomplishes one's life purpose. One should think, 'I come from a perfect source and I am bound for a perfect goal. The light of the perfect Being is kindled in my soul. I live, move, and have my being in God; and nothing in the world, of the past or present, has power to touch me if i rise above it all.' It is this thought which will make one rise above influences of inharmony and disorder, and will bring a person to the enjoyment of the greatest bliss in life, which is health.'' (Khan, H.I. (1961, 1978). HEALING AND THE MIND WORLD: THE SUFI MESSAGE OF HAZRAT INAYAT KHAN (VOL. 4). Barry and Rockliff Publishing, pp. 47-48.) (*Note: Khan, a Sufi mystic, originally wrote this and other volumes around the year 1912.)

Result number: 98

Message Number 234546

Re: question for doctors Dr. Wedemeyer View Thread
Posted by Dr. Wedemeyer on 8/17/07 at 12:21

Amy it depends on your symptoms and for PF they truly vary although certain key symptoms appear . It is always possible if not probable to have a concomitant PF due to structural and postural changes in the spine, hips or knees. Your body is a contiguous unit and connected by a vast network of tissues that supply motion etc.

A loss of the integrity of a motion segment (spinal disc + the joints above and below) can significantly affect sites distal to the pathology. More likely this is due to biomechanical changes and the PF and fascial thickening is unfortunately a 'bonus' due to altered gait.

Result number: 99

Message Number 234324

Re: Surgeon is recommending a brace but offers no suggestions View Thread
Posted by Dr. Wedemeyer on 8/12/07 at 22:24

Larry what type of AFO are you referring to? Do you provide AFO's for your patients? I am curious because in some states Cped's cannot go above the malleolus.

My experience with ankle gauntlets is that like any other cast, boot or solid ankle orthosis with a diabetic patient there are concerns but a properly casted and fitted AFO is a far better fit and far safer than an FO for a diabetic. Kate said she has PN but she did not state if she was diabetic unless I missed it.

Peroneal muscle overactivity/spasm due to AFFD/PTTD is a given and PTTD is always the more emergent of the two problems in terms of pain and deformity. Additionally there are frontal, sagitttal and transverse plane deformities beyond the capability of a FO stage II and beyond. This is exactly why the Arizona brace is enjoying such huge success.

Also if she does have a mild PTTD and given the PN, previous surgical hx a solid ankle AFO would provide the stability for her to heal where a FO will not. Every therapeutic device has it's limitations

Kate can you post your physicians reports? This case has me very curious. I really believe there is a piece of the puzzle missing.

Result number: 100

Message Number 234054

Obesity and Pronated Foot Type May Increase the Risk of Chronic Plantar Heel Pain: A Matched Case-Control Study View Thread
Posted by Amy on 8/07/07 at 16:53


Obesity and Pronated Foot Type May Increase the Risk of Chronic Plantar Heel Pain: A Matched Case-Control Study


Damien B. Irving; Jill L. Cook; Mark A. Young; Hylton B. Menz

BMC Musculoskelet Disord. 2007; ©2007 Irving et al., licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Posted 07/30/2007

Abstract and Introduction
Abstract
Background: Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors.
Methods: Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (± 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test.
Results: Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 ± 5.4 kg/m2 vs. 27.5 ± 4.9 kg/m2; P < 0.01), a more pronated foot posture (FPI score 2.4 ± 3.3 vs. 1.1 ± 2.3; P < 0.01) and greater ankle dorsiflexion ROM (45.1 ± 7.1° vs. 40.5 ± 6.6°; P < 0.01) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI ≥ 30 kg/m2) (OR 2.9, 95% CI 1.4 – 6.1, P < 0.01) and to have a pronated foot posture (FPI ≥ 4) (OR 3.7, 95% CI 1.6 – 8.7, P < 0.01).
Conclusion: Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress may not play a role in CPHP.

Background
Chronic plantar heel pain (CPHP) is one of the most common conditions affecting the foot and has been reported to account for 15% of all adult foot complaints requiring professional care.[1] It is usually observed in the 40 to 60 year old age bracket, but has been reported in people from 7 to 85 years and appears to be more common in females.[2] Symptoms typically include pain under the medial heel during weight bearing, especially in the morning and at the beginning of weight-bearing activities.[1,3]

As with many conditions where the true pathology is unclear, CPHP has become a generalised term encompassing a broad spectrum of conditions affecting the heel, including subcalcaneal bursitis, neuritis, plantar fasciitis and subcalcaneal spur.[4,5] However, plantar fasciitis is considered to be the most common cause of pain and the terms are used interchangeably in the literature.[1] Due to the apparent heterogeneity in the conditions grouped together as CPHP, it is difficult to determine a definitive aetiology for the condition.[6]

Many causative factors for CPHP have been hypothesised in the literature and are commonly characterised as intrinsic or extrinsic. Intrinsic factors are characteristics of an individual that predispose them to injury.[6] Those suggested in the literature include limited first metatarsophalangeal joint (MPJ) range of motion (ROM), limited ankle dorsiflexion ROM, leg length discrepancy, reduced heel pad thickness, increased plantar fascia thickness, excessive foot pronation, reduced calf strength, calcaneal spur, older age and increased body mass index (BMI).[1,7,8] Environmental and circumstantial influences acting upon an individual are known as extrinsic factors, and include prolonged standing, inappropriate shoe fit, previous injury and running surface, speed, frequency and distance per week.[1,6,7] Empirical evidence for most of these factors is limited or absent,[9] meaning that the role (if any) of each of these factors in the development of CPHP is poorly understood.

In an attempt to help address this lack of empirical evidence, a matched case-control study was undertaken to examine the association between CPHP and a number of causative factors suggested in the literature. Factors for inclusion into the study were selected because they each had a small amount of evidence supporting an association with CPHP,[9] which required further investigation. As it was obviously impractical to examine all factors requiring further investigation, the authors attempted to select those factors that are routinely assessed by clinicians in the management of heel pain. It was hypothesised that pronated foot posture, increased BMI, decreased ankle dorsiflexion ROM, increased occupational lower limb stress and decreased calf endurance would all be associated with CPHP.

Methods
Participants
Case Group. The data source for the case group was a recent CPHP randomised controlled trial.[10] In this trial, advertisements were placed in local and state newspapers requesting volunteers over the age of 18 who had experienced plantar heel pain. Participants with a history of plantar heel tenderness and/or pain upon arising in the morning or on recommencing activity after periods of rest were included in the study. Exclusion criteria included any history of trauma to the heel within the previous 12 weeks, symptoms lasting less than six months, pregnancy, seronegative arthropathies or any skin lesion over the plantar aspect of the heel. Participants who had received a steroid injection or orthotic device or had commenced a conservative treatment such as stretching exercises or heel pads within the previous eight weeks were excluded. Continuation of conservative treatments that had been commenced prior to the eight week period was allowed, however no such participants were identified.

Participants with bilateral heel pain were included and the first 80 eligible participants were used in the study. Case group participants ranged in age from 20 to 82, with a mean of 52 years. Forty-seven participants (59%) were women and the median duration of symptoms was 12 months, ranging from 6 to 96 months.

Control Group. The control group consisted of 80 participants each individually matched for age (± 2 years) and gender to a case group participant. All participants reported that they had never experienced plantar heel pain. Exclusion criteria were the same as for the case group and control participants were recruited using the same methods as the case group with advertisements placed in newspapers requesting volunteers. The first 80 volunteers that could be matched to a case group participant were included in the study.

Procedures
Case group data collection was carried out in January 2004 and all testing was undertaken by the same investigator.[10] The same testing equipment and procedures were used to assess the control group over a three-month period from December 2005 to February 2006. All testing of the control group was also all undertaken by the same investigator; however, this was a different investigator to the one that carried out the case group testing. The study was approved by the Faculty of Health Sciences Human Ethics Committee of La Trobe University, and informed consent was obtained from all participants.

Outcome Measures
Foot Posture. The Foot Posture Index (FPI)[11] was used to assess foot posture. Prior to data collection, both the case and control group investigator were instructed by the same podiatrist with experience in the use of the index.

The FPI is a system for observing and rating static foot posture, incorporating six criteria with the participant standing in a relaxed bipedal position. These criteria include (i) talar head palpation, (ii) observation of curves above and below the lateral malleoli, (iii) frontal plane alignment of the calcaneus, (iv) prominence of the talonavicular joint, (v) congruence of the medial longitudinal arch, and (vi) abduction/adduction of the forefoot on the rearfoot. Each of these criteria are scored on a 5-point scale (ranging from -2 to +2) and the results combined, resulting in a summative score ranging from -12 (highly supinated) to +12 (highly pronated).

The reported inter-tester reliability of the original eight-item FPI has ranged in the literature from an ICC of .62 to .91, while the intra-tester reliability has ranged from .81 to .91.[11] No reliability statistics have been published for the revised six-item FPI used in this study. The FPI is also a valid measure of foot posture, having been shown to be associated with the midstance position of the foot when walking[11] and to be moderately correlated with arch height measurements taken from x-rays.[12]

Body Mass Index. The formula of weight in kilograms divided by the height in meters squared was used to calculate BMI.[13] Participant weight was measured to the nearest tenth of a kilogram using a digital set of scales and height to the nearest centimetre by measuring a point on the wall perpendicular to the superior aspect of the skull.

Ankle Dorsiflexion Range of Motion. The Dorsiflexion Lunge Test was used to assess ankle dorsiflexion ROM. Testing protocol followed the procedure outlined by Bennell et al.,[14] which involved the participant lunging their knee as far as possible over their foot without the heel lifting off the floor (Figure 1). At the maximum lunge point, the investigator recorded the angle of the tibia to the vertical (to the nearest tenth of a degree) as a measure of ankle dorsiflexion ROM. Three measures were taken and the mean used for statistical comparisons. This test has been demonstrated to have an intratester reliability of ICC = .98 (SEM = 1.1°) and an intertester reliability of ICC = .99 (SEM = 1.4°).[14]



Figure 1.
Dorsiflexion lunge test procedure.

Occupational Lower Limb Stress. The Occupational Rating Scale[15] was used to quantify the amount of stress placed on the lower limb during a typical working day. The scale is a seven-item questionnaire that quantifies time spent sitting, standing/walking, walking on uneven ground, squatting, climbing, lifting/carrying and weight carried. Responses to each question are summed, with a maximum total score of 60 indicating a high level of lower limb stress. The scale has been shown to have excellent test-retest reliability (ICC = .97).[16]

In order to attribute any difference in mean Occupational Rating Scale scores between the case and control groups to the presence of CPHP, co-morbidities were assessed using question 20 of the FHSQ. This question required participants to indicate any conditions for which they were taking medication.

Calf Endurance. The Standing Heel Rise Test was used to examine calf muscle performance. Testing protocol followed the procedure outlined by Ross and Fontenot,[17] which required the participant to stand on one leg and repeatedly lift the stance limb through a maximum plantar flexion ROM until fatigue (Figure 2). Due to the repetitive nature of the procedure, the test is thought to predominantly assess the endurance capabilities of the calf musculature[17] and therefore the number of heel raises achieved was used as a measure of calf endurance. To ensure that the test was a true indication of calf endurance, participants from the case group were asked to indicate whether heel pain or calf muscle fatigue limited their performance. All participants identified calf muscle fatigue as the limiting factor. The test has been shown to have excellent retest reliability (ICC = .96, SEM = 2.07 repetitions).[17]



Figure 2.
Standing heel rise test procedure.



Data Analysis
Statistical analyses were conducted using SPSS, version 11.5 for Windows. All variables were explored for normality using the skewness statistic and observations of the normal and de-trended Q-Q plots. With the exception of the Occupational Rating Scale and co-morbidity questionnaire, all variables were compared between the case and control groups using two-tailed independent samples t-tests. The Occupational Rating Scale could not be transformed into a normal distribution, so was analysed using the non-parametric Mann-Whitney U test. Chi square tests were used to compare the groups on the prevalence of co-morbidities. Level of significance was set at P < 0.01, to account for the fact that multiple comparisons were made between the two groups. For participants with bilateral heel pain, only the more severely affected limb was used in order to meet the independence assumption of statistical analysis.[18]

Logistic regression was performed to determine the relative contribution of each of the variables found to differ between the case and control groups in the univariate analyses (i.e. BMI, foot posture and ankle dorsiflexion ROM). Prior to undertaking the logistic regression, FPI scores were dichotomized into pronated (defined as FPI ≥ 4) or not and the Dorsiflexion Lunge Test as excessive (lunge ≥ 47°) or not. These boundaries were selected on the basis of the upper quartile, as no widely accepted cut-off values have been reported in the literature. Body mass index was dichotomized as obese (BMI ≥ 30 kg/m2) or not as defined by the National Institutes of Health.[13] Before entering these independent 'predictor' variables into the logistic regression, a series of chi-square analyses were undertaken to ascertain whether they were correlated. A non-significant chi-square was calculated in each case and taken as evidence that the predictor variables were not correlated to each other, thereby meeting the independence assumption of logistic regression.

Results
Univariate Comparisons
When compared to the control group, the case group was found to have a significantly greater mean FPI score (t = 2.93, P = 0.004), BMI (t = 2.85, P = 0.005) and mean Dorsiflexion Lunge Test angle (t = 4.23, P < 0.001). For height and weight analysed individually there was no difference between the groups. The case group had a significantly lower mean Occupational Rating Scale score for mean weight carried (z = -2.98, P = 0.003). There was no significant difference between the groups for the prevalence of co-morbidities ( Table 1 ), the Standing Heel Rise Test ( Table 2 ), or for the sitting, standing, uneven ground, squatting, climbing, lifting/carrying or total score sections of the Occupational Rating Scale ( Table 2 ).

Multivariate Comparisons
Results of the logistic regression analysis are shown in Table 3 . Of the three variables entered into the model, two were found to be significant independent predictors of CPHP: an FPI ≥ 4 (OR = 3.7, 95% CI 1.6 – 8.7, P = 0.002) and a BMI ≥ 30 kg/m2 (OR = 2.9, 95% CI 1.4 – 6.1, P = 0.004). The Hosmer and Lemeshow Goodness of Fit Index was non-significant (χ2 = 2.85, df = 4, P = 0.58), indicating an acceptable goodness of fit. The model classified participants into the CPHP or control group with an accuracy of 66%, indicating that a substantial amount of variance remains unaccounted for.

Discussion
The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. Univariate analyses showed an association between CPHP and increased BMI, pronated foot posture and increased ankle dorsiflexion ROM, whilst occupational lower limb stress and calf endurance showed no association. Multivariate logistic regression showed that those with CPHP were 3.7 times more likely to have a pronated foot posture (FPI ≥ 4) and 2.9 times more likely to be obese (BMI ≥ 30 kg/m2).

The association found between a pronated foot type and CPHP is supported by research indicating that increased strain is placed on the plantar fascia when the foot is placed in a pronated position.[19-21] It is important to note that while foot posture has been shown to alter slightly over the course of a lifetime, the change is so slow that it essentially remains constant from one decade to the next.[22] This means that although causality cannot be established in case-control studies, the foot posture of the case group participants is unlikely to have altered after the onset of the condition, and therefore pronated foot posture may also be a risk factor for CPHP.

The association found between increased BMI and CPHP is also supported in the literature, with four of the five previous studies to examine BMI in a non-athletic population also finding an association with increased BMI.[9] The control group appeared to be representative of the wider population, as the proportion of the group found to be obese (BMI ≥ 30 kg/m2) was the same value as for the Australian population in the 45–54 year age bracket (21%).[23] Due to the fact that this study cannot establish causality, it is unclear whether increased BMI existed in the case group participants prior to the development of CPHP, or whether the pain associated with the condition caused participants to reduce their physical activity, thereby leading to an increase in BMI. However, it is plausible that increased BMI may be a risk factor for CPHP, as individuals with increased BMI experience higher vertical forces under the heel during gait,[24] leading to higher internal stresses within the heel,[25] which may lead to damage of soft tissue structures and the development of symptoms.

The identified association between increased ankle dorsiflexion ROM and CPHP was contrary to the common clinical perspective that decreased ankle dorsiflexion ROM is a causative factor for CPHP. This hypothesis is based on the theory that equinus (ankle dorsiflexion less than 10°) during gait causes abnormal compensatory pronation of the subtalar joint, which in turn increases stress on the plantar fascia.[26] Although this theory is widely accepted, research evidence to support it is weak.[27] Cornwall and McPoil[27] found that a mild-to-moderate loss of passive dorsiflexion ROM (the study group had a mean ROM of 9.6°) had little or no effect on the frontal plane function of the rearfoot during the stance phase of gait. The participants were found to compensate for their dorsiflexion deficit with alterations in gait timing. This may explain why only one of three previous case-control studies found an association between decreased ankle dorsiflexion ROM and CPHP.[9]

A possible explanation for the identified association with increased ankle dorsiflexion ROM is that a non-linear relationship may exist between ankle dorsiflexion ROM and plantar fascia strain. If the relationship were U-shaped, both extremes of movement (increased and decreased ROM) would predispose to CPHP. To further substantiate this hypothesis, research would be required to determine whether increased translation of the tibia over the foot increases strain on the plantar fascia.

A criticism of the Dorsiflexion Lunge Test is that the test procedure makes no effort to control for pronation or supination of the foot. As increased subtalar joint pronation is known to increase the amount of dorsiflexion that can occur at the midtarsal joint, it is plausible that the increased ankle dorsiflexion ROM observed in the case group may have been due to the fact that the group was also found to have a more pronated foot posture.[28] However, chi-square analysis indicated that scores for the Dorsiflexion Lunge Test and FPI were not correlated (data not shown), indicating that dorsiflexion was likely to be increased independent of foot posture in the case group participants.

A number of differences exist between the current study and previous literature with regard to dorsiflexion testing methods and results. All previous studies to address the association between ankle dorsiflexion and CPHP examined subjects with the knee extended.[9] Since knee extension biases the gastrocnemius muscle whilst knee flexion has a Soleus bias, it is possible that tightness in the gastrocnemius muscle may have gone undetected in the case group. Also, the Dorsiflexion Lunge Test scores reported in the current study are slightly lower than those documented in the literature.[14,29] Because ankle dorsiflexion ROM decreases with age,[30] this difference is likely to be due to the fact that the mean participant age in the current study was approximately 30 years greater than in these previous studies. In summary, the findings of the current study question the role of decreased ankle dorsiflexion ROM in the development of CPHP and suggest increased ankle dorsiflexion ROM as a previously unconsidered causative factor.

Prolonged standing is often cited as a causative factor for CPHP,[1,6,7] based on the theory that prolonged tensile loading of the plantar fascia predisposes individuals to the condition.[31] There is a weak level of evidence to support an association between prolonged standing and CPHP,[9] however, no previous study has adequately defined prolonged standing. Consequently, there are no data to indicate what activities are commonly performed whilst standing and therefore the nature of the stresses placed on the lower limb.[9] This study was the first to examine prolonged standing in detail, using the Occupational Rating Scale to quantify the stresses placed on the lower limb during an average working day.

As there was no significant difference in the presence co-morbidities between the case and control groups ( Table 1 ), any differences observed between the groups on the Occupational Rating Scale can be cautiously attributed to CPHP. However, no association was found between CPHP and average time spent sitting, standing, walking on uneven ground, squatting, climbing, lifting/carrying or total stress placed on the lower limb. The one significant difference found between the groups indicated an association between CPHP and reduced weight carried. Although this association was identified, it is unlikely that this factor has a role in the development of CPHP. It is more likely that the pain associated with CPHP causes sufferers to carry less weight than they otherwise would.

Although no association was identified with CPHP, it is unclear from these results whether occupational lower limb stress plays a role in the development of the condition. Due to the case-control design of the current study, it is possible that the case group participants experienced higher occupational lower limb stress prior to developing CPHP. The participants may have simply reduced their activity levels, as a consequence of their pain, to a level comparable to the control group. As participants were asked to answer the Occupational Rating Scale according to their current work status, no retrospective comments can be made regarding the association between CPHP and past working history. However, keeping this limitation in mind, it can be cautiously speculated that greater occupational lower limb stress may not be a risk factor for CPHP as previously thought.

No association was identified between calf endurance and CPHP. The Standing Heel Rise Test scores reported for the case and control groups were substantially lower than those reported in the literature, however, this was to be expected. Ross and Fontenot[17] examined a far younger (21.2 ± 1.3 years) and more physically active sample of air force cadets and Lunsford and Perry[32] examined a younger (male: 34.7 ± 8.5; female: 29.3 ± 5.0) sample using a test procedure that allowed a reduction of up to 50% in plantarflexion ROM before termination. As with occupational lower limb stress, it can be speculated from these findings that decreased calf endurance may not play a role in the development of CPHP.

The findings of this study need to be interpreted in light of a number of study limitations. A different investigator was used for each group and no pilot study was conducted to examine the correlation between the investigators for any of the outcome measures used. The Dorsiflexion Lunge Test and Standing Heel Rise Test have structured protocols and the Dorsiflexion Lunge Test has demonstrated high inter-tester reliability in previous studies.[14] It is therefore unlikely that a change in investigator would have substantially altered the results of these measures. The FPI protocol involves a degree of subjectivity due to its observational nature and a change in examiner may have influenced the results. However, the authors are confident that the procedure is reliable enough between examiners to dichotomise participants as having pronated feet or not. Finally, as previously acknowledged, a case-control study cannot imply causation. As such, further research is required to definitively establish whether the associated factors identified in this paper are in fact risk factors for CPHP.

A representative clinical population with heel pain was used in this study; participants were included according to clinical signs and symptoms (chronic plantar heel pain) rather than diagnostic imaging. As CPHP can include a range of pathologies affecting the heel including plantar fasciitis, sub calcaneal bursitis, calcaneal periostitis and subcalcaneal spur, a pain diagnosis was considered the most appropriate method of selecting participants. These conditions can exhibit a combination of osseous and soft tissue pathologies (including calcaneal spurs, plantar fascial thickening, cortical irregularities and fat pad abnormalities[4]) that have variable imaging findings.[33-35] The sample would have been reduced to a specific sub-group of people with CPHP if a single imaging modality had been used as the inclusion criteria. Furthermore, diagnostic imaging is not always necessary for the diagnosis of CPHP, and many health professionals who frequently treat the condition (such as podiatrists and physiotherapists) rely on clinical criteria. We therefore believe that the use of a clinical diagnosis for inclusion into the CPHP group provides results that can be generalised to the broader population of people seeking treatment for heel pain.

A final limitation is that the overall classification accuracy of the model was relatively low (66% of cases correctly classified), which indicates that there may be other variables of importance that were not included in our test battery. Further research is required to determine whether the inclusion of other postulated risk factors can improve the classification accuracy of the multivariate model.

Conclusion
Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, decreased calf endurance and occupational lower limb stress do not appear to play a role in CPHP.

Result number: 101

Message Number 233937

Re: Post op problems View Thread
Posted by Norm G on 8/03/07 at 20:12

Thank you all for your supportive comments. I had a turning point of sorts yesterday when a therapist was watching me attempt to walk looking at my feet and stumbling down the hall. She screamed, 'don't look at your feet!' So I listened and soon i was able to walk with somewhat more coordination though the pain and numbness still severely limited my pace. Today, I had a full 90 minute assessment by a very competent young therapist who demonstrated my extreme limitations in range of motion and partial contractures of my four smaller toes. I hate to have more hope but I really believe we all need a champion to guide us through this very difficult recovery and sadly that is not the surgeon who performed the procedure. I will keep you updated and thanks again.

Result number: 102

Message Number 233883

Just in case... View Thread
Posted by MariaM on 8/02/07 at 15:40

...you missed this post I wrote in reply to KellyL, I wanted to make sure everyone got to read it.




I just want everyone to know they are not alone. I feel as if the physical symptoms are talked about a lot on here and the emotional are ignored a bit because maybe it's not the most comfortable subject.

I was a perfect 19 year old before this happened to me. Care free, happy, exploring my passion of running, loving every minute of life... Three years later, I am struggling to find a balance, but with the help of several professionals, I am finally succeeding.

This kind of condition breaks you down and it breaks you down slowly. One day your hopes are up because it's a good day, and the next day they come crashing back down. It's so hard to shake feelings of hopeless and to accept your new limitations. You feel alone, left out, and lost.

The waiting period of recovery is even worse. I struggle with letting go of the old me and accepting the new one, or holding on to the old me in hopes she will be back one day. This limbo is intolerable. I hate uncertainty.

Sorry for the ramble. I hope this post helped just a little bit.

Don't let go of your hope and know that it is quite normal to feel sad, anxious, or depressed while suffering from a condition like this. Talking to a therapist has done wonders for me. Don't be afraid to if you haven't already.

Lots of love.

<3 Maria

Result number: 103

Message Number 233820

Re: Heartbreaking View Thread
Posted by MariaM on 8/01/07 at 08:16

Hi Kelly! I'm so glad my post helped you a little bit. I just want everyone to know they are not alone. I feel as if the physical symptoms are talked about a lot on here and the emotional are ignored a bit because maybe it's not the most comfortable subject.

I was a perfect 19 year old before this happened to me. Care free, happy, exploring my passion of running, loving every minute of life... Three years later, I am struggling to find a balance, but with the help of several professionals, I am finally succeeding.

This kind of condition breaks you down and it breaks you down slowly. One day your hopes are up because it's a good day, and the next day they come crashing back down. It's so hard to shake feelings of hopeless and to accept your new limitations. You feel alone, left out, and lost.

The waiting period of recovery is even worse. I struggle with letting go of the old me and accepting the new one, or holding on to the old me in hopes she will be back one day. This limbo is intolerable. I hate uncertainty.

Sorry for the ramble. I hope this post helped just a little bit.

Don't let go of your hope and know that it is quite normal to feel sad, anxious, or depressed while suffering from a condition like this. Talking to a therapist has done wonders for me. Don't be afraid to if you haven't already.

Lots of love.

<3 Maria

Result number: 104

Message Number 233690

Heartbreaking View Thread
Posted by MariaM on 7/29/07 at 08:34

Reading some posts is just so heartbreaking for me to hear that anyone feels the way I do. I would never wish this upon anyone. I wish more people knew about TTS. The only person besides my doctor who knew about TTS was Frank Shorter, a gold medalist in the marathon. I met him in Miami and I mentioned my TTS. I was shocked that he was familar with it because I always get a blank stare and a 'What's that?' when I tell people what is wrong with me.

The reason why I wish more people knew about TTS is because of the damage it does emotionally. It's amazing how so many emotional problems can come from a chronic disorder. I developed anxiety, a mood disorder, a sleep disorder, and *gasp* an eating disorder in the 3 years that I have had TTS. I am doing great in all of those areas now with the help of therapy, medicine, and some hard work, but it's always a battle because I am still not the same girl I was before the TTS. I have so many limitations still.

Please keep smiling everyone and know that you are not alone. Feel free to vent about your own experience in response to this post.

<3Maria

Result number: 105

Message Number 233468

Re: BTW Jen View Thread
Posted by DavidW on 7/24/07 at 13:34

Jen R, I believe that the deep massage that I was getting was very similar to ART. It worked great, but I do not believe it would have resolved my cronic PF ultimately, although it did help tremendously. I feel that if I had done the Graston first, I could have resolved my PF much quicker, although this is impossible to know in hindsite. The Graston sessions were painful and left me completely sore, like a full blown PF relapse, although I could function with no more limitations that regular PF pain. I made sure to always take it easy for a couple of days after each session and avoid any unnecessary walking or standing. Fortunately I have a sitting job. I started to really feel a real decrease in pain after a dozen or so Graston sessions.

Result number: 106

Message Number 233336

Re: Finally able to put weight on my foot and walk!!!! View Thread
Posted by wannabewell on 7/21/07 at 20:47

Thank you all for the support. Norm, I'm sorry to hear that you aren't doing so well. How long have you been dealing with tts? I've had it for many many years and thought that I would never be able to live a normal life because of the limitations in walking. I'm hoping that since I don't feel the pins and needles anymore and can finally put weight on it that that means my surgery was a success. Korda I tried walking at the 3 week point to but my incisions seemed to be opening and my foot kept swelling and burning. I figured that when it was time for me to put weight on it I would know and today felt like it was time. How long has it been since you had surgery now? If you haven't reached the point that I have please don't get frustrated like I was. Things should get better. This is the first time since surgery that I have smiled all day. Misty how long have you been dealing with tts? Is it bilateral? Please keep us posted on your progress. Korda and Norm it would be great if the two of you could do the same.

Result number: 107

Message Number 233299

Re: Shoe Question- Jeremy View Thread
Posted by Jeremy L, C Ped on 7/21/07 at 08:02

In that line of work, on that kind of primary surface, there are several factors beyond fit that are important. There is absolutely no give in terrazzo, so having some element of cushioning in a shoe is vital. In addition to non-slip soling, having the soles sealed to protect against delamination would be a good benefit. I don't have any reservations about your Naot choice; however, there are others that offer specialty models for duty application. Of the brands I'll mention, please be sure top investigate which ones will do a better job matching your foot shape and functional requirements:

Klogs These have always been effective in the kind of work environment you have. Their standard construction is indestructible and orthotic friendly. They absorb shock well and have surprisingly good stability. They can also be ungodly hot. If you tend to be warm natured, that would be my most sincere caveat against this brand.

Spira Their Classic Walker absorbs shock better than almost any shoe in existence. That said, it is definitely not for everyone. There are fit and functional limitations for some people, so shop wisely. Although their soles are stamped as non-skid, I would classify them as slip resistant.

Standing Comfort This is an awesome duty shoe brand. They are made by Drew, so they share that brand's broad selection in last shapes and widths. They are completely orthotic friendly, most have double depth, and the standard insert is one of the better ones around. They can also be heavy. Their cushioned midsoles are completely encapsulated by a completely non-skid rubber sole. This makes them as durable as tanks, but also weighs close to the same.

Skechers They have been further improving their functional designs, and are now set to release duty specific models. I haven't had a chance to handle these yet, but am fully confident in their reliability.

That should get you a start.

Result number: 108

Message Number 232727

Re: ? For Dr. Wander View Thread
Posted by Dr. David S. Wander on 7/10/07 at 12:34

Minimal amounts of bone resorption may not show up on x-ray, and if they do, the bone changes may lag behind the actual bone changes as I had stated in a previous post. X-ray changes sometimes lag behind actual bone changes by 7-10 days.

However, I will continue to be persistent with my point that a CT scan should really be the next step if there are any questions, because it shows the greatest bone detail, and traditional x-rays have their limitations.

Result number: 109

Message Number 231844

Nutrition and healing View Thread
Posted by Dr. Wedemeyer on 6/20/07 at 01:13

It occurred to me that there are a lot of doctors and health professionals available to answer questions and all manner of products available here and yet nutrition during healing is a topic I never see discussed.

Since many of the complaints here are soft-tissue disorders (whether primary or as a concomitant sequelae) and nutrition is paramount to healing at the tissue level; I am curious if any of you are interested in the subject.

I'm not suggesting unproven or controversial adjuncts, herbs and expensive fad nutriceuticals, but basic primary diet and supplements found in food that promote healing after soft-tissue trauma or in this case plantar fascitis/fasciosis.

let me know please.

Dr. W

Result number: 110

Message Number 231753

Re: General Questions about TT View Thread
Posted by Laurie C. on 6/18/07 at 08:57

I had my surgery about 9 weeks ago. I am so pleased with the fact that I did it. The relief from the burning and humming in my feet seemed to occur within two days after surgery. I am walking normally now and still only have some mild burning in my toes at night. I didn't have an advanced case like your's sounds. I was diagnosed with it and several months after dx. I had it surgically fixed (after other less invasive procedures).

It is a procedure that only takes about an hour and you do go home the same day.

I am back exercising with some limitatios, but I'm pleased at the progress and I feel that I'm __her ahead of the game than I thought I would be. I was on crutches for 4 weeks and went to PT for 4 weeks (starting at about 4 weeks post op).

Hope this information helps.

Result number: 111

Message Number 231488

Re: wearing crocs View Thread
Posted by Sandy P on 6/13/07 at 07:09

My mistake, I wear New Balance 600. What triggered my foot was I was extremely hot w/ my tennis shoes on so I went to Walmart and bought a pair of hard as ____ imitation crocks, knowing they would cool me off and I something my kids would wear b/c I knew I would never again. The one time was enough to make me pay dearly. Thanks for the search tip.

Result number: 112

Message Number 231456

Re: Morton's Nueroma Post Pain View Thread
Posted by Dr. Ed on 6/12/07 at 18:50

Arlon:

You have a diagnosis that is not easy to make so considering the fact that we cannot inspect your foot online there are significant limitations as to the direction we can provide. CRPS has numerous variants so I would still keep that on the list. Have you had radiographs? MRI? I believe that an opinion from a pain clinic is of value so some travel on your part may be needed.
Dr. Ed

Result number: 113

Message Number 231103

Re: Newly Diagnosed View Thread
Posted by Laurie C. on 6/04/07 at 22:12

Misty,

I'm a newbie myself, but a little more experienced 'newbie' than you. I am 8 weeks post op. I was on crutches for 4 weeks, but was only expected to be on for 3 weeks. I went to PT and am now walking without any limitations.

I am back at the gym doing my yoga (with modifications), my pilates and riding a recumbent bike. I am also doing my weightlifting. the only thing that I see significant regression in is my ability to leg press - it used to be 80 pounds and is now about 40 pounds. I also can't ride the bike for more than 20 minutes at a time, but I'm at the same intensity.

Overall, I am so glad that I did it as quickly after diagnosis as I did. I didn't have any obvious visible nerve damage and my symptoms of burning, humming in my foot and other oddities have just about disappeared.

The only thing that I would suggest is wearing an ace bandage on the opposite ankle if you do get the surgery. I put so much weight on that ankle that I have tendonitis in and it's more painful than my 'bad' foot. It feels greatly improved when I wear the brace so I think if I had used it prior when I was on crutches, I may not have developed the tendonitis.

Result number: 114

Message Number 230841

PTTD, toe deformities, multiple surgeries View Thread
Posted by Becca on 5/30/07 at 23:37

Hi, I will try to be brief. I have a combination of problems in each foot, and have had 2 surgeries and many many procedures to attempt to right things. I trust my surgeon, but my problems are extremely rare, and I wanted to throw them out here in the hopes that maybe someone has some ideas.

I'm 22, and I've been diagnosed with congenital toe deformities, leading to progressive soft tissue damage such as PTTD, problems with the FHL, spring ligament, and tarsal tunnel syndrome (twice). My surgeon, who is an expert in PTTD. Says he's never seen such a combination of extensive damage in someone so young. I'm 15 months post from tendon repairs, ligament repairs, a tarsal tunnel release, ant/post calcaneal osteotomy, iliac crest bone graft, and removal of the accessory navicular in my right foot, 7 months post from all of that plus a tendon transfer in my left foot. At around 6 months post in _each_ foot I developed a pain on the outside of my foot about an inch and a half behind my 5th toe. It's sore to the touch, stabs when I walk on it, and while it will go away with rest, when it's particularly bad from overuse (standing for more than 20 minutes) it will become a chronic pain. It's not a stress fracture, we've checked. The best way I can describe it is that it feels like I'm grinding the bone into the ground.

My surgeon's original theory was that the arch in my right foot was a little too high, which it is, and that the higher arch was causing extra stress on the outside, hence the pain. I've even got a surgery date booked for the middle of July to remove, shave down, and reinsert the bone graft. However, a few weeks back my left foot started with an identical pain, which through all the theories out the window, because the arch is now at a normal height, it is not too high. Personally, my theory is that even having a normal arch, or something else that was done is causing the problem, because it did not exist before the surgeries, but that the correction is necessary, so we need to find another way to relieve the pain. That's where I run out of ideas, I don't know what should be done. My surgeon has both feet back in cam walkers until I can see him in 2 weeks.

I haven't tried orthotics yet (I stopped wearing them after the surgeries) and while they may potentially work, I'm not yet at the point where I'm willing to settle for wearing orthotics for the rest of my life. At the same time, the limitations from the pain make it very difficult to rejoin the life I had before my problems intensified.

I know this is a long shot, but if anyone has any ideas, no matter how off the wall, I'd really appreciate the input. Even ideas for things to search on would be helpful.

Becca

Result number: 115

Message Number 230638

I'm home for the summer and healing up! View Thread
Posted by MariaM on 5/27/07 at 06:22

Hello everyone! I made it through the semester without dying... barely! Somehow, despite going back to school too soon after both surgeries, I wound up with 5 A's and 1 B+ (yup, stupid me took 18 credits too). I was proud :)

I'm home for the summer now so that I can heal properly. No more walking miles everyday just to get to classes and function. My goal is to rest for the next 3 months. The killer has been the bilateral PF I developed after returning to a way more than active lifestyle too soon. The fascia is right next to the main nerve that was compressed for me so the inflammation is not helping.

My doctor McDreamy expects a full recovery, but somehow I don't see how I will ever run again. According to him, I will. He's more than confident. I just need to be patient and get rid of this PF for good.

I can walk and stand for longer than ever at this point. I do yoga. I ride the stationary bike (conservatively, of course) without the consequence of not being able to move for several days afterward. In fact, the stationary bike is so helpful to me when I am in discomfort. I guess it gets the blooding pumping and the swelling out of my feet.

I still can't believe this ever happened to me at such a young age, but I am a better, more compassionate person for it. If anyone is hesitant to go to therapy for your mental well-being, don't be. It was probably the best decision I ever made. Chronic pain can eat you up inside. I still have difficulty dealing with my limitations, but I am working on it.

I love you all and hope you are doing well! Give me some updates! I'm off to the beach, but I want to see how you all are doing by the time I get back later today!!! I think of you all often, because I know your pain all too well.

Enjoy the holiday weekend <3

Maria xoxoxo

Result number: 116

Message Number 230593

Re: Shoes for pool/Going barefoot View Thread
Posted by Jeremy L on 5/26/07 at 06:44

For something as limited in wear as a deck shoe at a pool would be, it's certainly reasonable to wear a high quality injected foam clog. And as you stated, it's performance would likely improve when paired with a good OTS insert. My favorite suggestions have always been Waldies and Klogs, depending upon the fit and function necessary to achieve with each individual patient. Dr. Wander also gets good results from some of the Crocs.

Be cautious of imitation brands (Waldies was the original). They use lower quality foams which break down faster and could easily place your foot/ankle in a compromising position.

Result number: 117

Message Number 230525

Re: stupid question View Thread
Posted by john h on 5/25/07 at 10:22

Julie: This will give some credence to your support of non weight bearing stretching. However I have found one large study done on rats that is somewhat different than this one.

Scientific Article

Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain

A Prospective, Randomized Study

Benedict F DiGiovanni, MD, Deborah A Nawoczenski, PhD, PT, Marc E Lintal, MS, PT, Elizabeth A Moore, MS, PT, Joseph C Murray, MS, PT, Gregory E Wilding, PhD and Judith F Baumhauer, MD
Investigation performed at the Department of Physical Therapy, Ithaca College, University of Rochester Campus, Rochester, New York

Benedict F. DiGiovanni, MD
Judith F. Baumhauer, MD
Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address for B.F. DiGiovanni: benedict_digiovanni at urmc.rochester.edu. E-mail address for J.F. Baumhauer: judith_baumhauer at urmc.rochester.edu

Deborah A. Nawoczenski, PhD, PT
Joseph C. Murray, MSPT
Department of Physical Therapy, Ithaca College, University of Rochester Campus, 300 East River Road, Suite 1-102, Rochester, NY 14623. E-mail address for D.A. Nawoczenski: dnawoczenski at ithaca.edu

Marc E. Lintal, MSPT
Department of Physical Therapy, University Orthopedics Center, 101 Regent Court, State College, PA 16801

Elizabeth A. Moore, MSPT
Department of Physical Therapy, The Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10605

Gregory E. Wilding, PhD
Division of Biostatistics, Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Building 26, Buffalo, NY 14214

In support of their research or preparation of this manuscript, one or more authors received grants or outside funding from the Research Designated Fund of the New York Physical Therapy Association. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Approximately 10% of patients with plantar fasciitis have development of persistent and often disabling symptoms. A poor response to treatment may be due, in part, to inappropriate and nonspecific stretching techniques. We hypothesized that patients with chronic plantar fasciitis who are managed with the structure-specific plantar fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol.

Methods: One hundred and one patients who had chronic proximal plantar fasciitis for a duration of at least ten months were randomized into one of two treatment groups. The mean age was forty-six years. All patients received prefabricated soft insoles and a three-week course of celecoxib, and they also viewed an educational video on plantar fasciitis. The patients received instructions for either a plantar fascia tissue-stretching program (Group A) or an Achilles tendon-stretching program (Group B). All patients completed the pain subscale of the Foot Function Index and a subject-relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function, and satisfaction with treatment outcome. The patients were reevaluated after eight weeks.

Results: Eighty-two patients returned for follow-up evaluation. With the exception of the duration of symptoms (p < 0.01), covariates for baseline measures revealed no significant differences between the groups. The pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia-stretching program with respect to item 1 (worst pain; p = 0.02) and item 2 (first steps in the morning; p = 0.006). Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the plantar fascia-stretching program.

Conclusions: A program of non-weight-bearing stretching exercises specific to the plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.



Related articles in JBJS:


Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis. A Prospective Clinical Trial with Two-Year Follow-Up
Benedict F. Digiovanni, Deborah A. Nawoczenski, Daniel P. Malay, Petra A. Graci, Taryn T. Williams, Gregory E. Wilding, and Judith F. Baumhauer
JBJS 2006 88: 1775-1781. [Abstract] [Full Text]



This article has been cited by other articles: (Search Google Scholar for Other Citing Articles)

Result number: 118

Message Number 230383

Re: stupid question View Thread
Posted by David G. Wedemeyer, DC on 5/23/07 at 15:23

John as I stated before it needs to be determined is this acute, chronic or a sub-acute injury prior to implementing stretching of any kind as well as a diagnosis that it is in fact PF. Example:

'A patient walks into the office and states they have pain on the bottom of the foot following stepping off a curb and twisting their ankle. This was over one year ago and he/she has also had increasing pain on the outside of the ankle'.

On visual exam and palpation she is determined to have posterior tibial tendon syndrome stage 2 and concomitant PF. Would I advise this person to perform weight-bearing calf raises to strengthen the calf/soleus or begin passive PT and non weight-bearing stretches to evaluate her response prior to leaving her to her own devices and possibly rupturing the tendon thereby causing more pain and disability? More than likely he/she would be prescribed the passive non weight-bearing stretches and possibly new shoe wear and a brace until he/she heals enough to tolerate active exercise.

Early (acute)PF does not respond well to active weight-bearing exercise in my experience, the inflamed fascia needs time to heal and passive PT works wonders for these patients, ART, Graston (or just plain good old myofascial release like I perform), electrical muscle stim, ultrasound etc.

As the condition becomes more chronic (as it is in low back cases) weight-bearing exercise tends to achieve greater gains. The sooner you can get a patient to actively participate in their rehabilitation the better the outcome in my experience. Sticking solely to passive modalities increases the patients reliance on the provider and increases disability time.

The science and art in any practice is to know when each is appropriate. There is no magic bullet in treating these people John but providers with experience in treating PF know when to have the patient bear weight while stretching and when not to. Often passive stretches are not only inappropriate they are harmful and vice-versa.

DW

Result number: 119

Message Number 230078

Re: How Do You All Do It? View Thread
Posted by Ralph on 5/17/07 at 17:05

Sue,
I think that anyone that has had a life changing illness feels sadden, frustrated, angry and a whole lot of other emotions after it happens. After all what happened wasn't part of their plan for their life.

People forget that they really suffered a loss and like any other losses in their life they need time to grieve and through this process move toward acceptance of their new limitations and continue on living with the cards that were dealt to them.

Some go through the grieving process faster then others but eventually either on their own or with the support of others they learn to cope and adapt.

Obviously you've tried a lot of treatments but still continue to suffer. I'd suggest that you continue to try the things you feel may help and even consider seeing a Physical Medicine Doctor that can help set up a home exercise program for you.

Pushing yourself to the limit might cause more harm then good so perhaps you should be more like the tortoise when doing your exercises trying to make slow and steady progress.

It sounds like you have a wonderful trip coming up. You can go on that trip and use all the handicap items available and be happy and more comfortable or you can go on that trip and be totally miserable. It's like looking at the glass half full or looking at the glass half empty. The glass is the same but the way you view it makes a world of difference. The same is true for your trip. Go and enjoy it regardless of whether you have to use a wheelchair, or sit on park benches or rest in the afternoon or even allow others to do things without you. Enjoy what you can do and don't worry about the things that you can't for right now. Hopefully in time you will be able to look back on this trip and say inspite of my circumstances, I learned to change the things I could and to accept the things that I couldn't and because of that I enjoyed my trip.
Ralph

Result number: 120
Searching file 22

Message Number 229546

Re: Crocs for PF? and Spira View Thread
Posted by David G. Wedemeyer, DC on 5/10/07 at 14:59

Jeremy their SWW202 appeared like a well constructed shoe. Why would you not recommend this with an AFO? One patient has concomitant DJD in the same leg knee and could only find relief with this shoe.

Please email me drdavwed at sonic dot net, I am curious.

Thanks,

DW

Result number: 121

Message Number 229097

Re: Jobless rate rises View Thread
Posted by Dorothy on 5/04/07 at 09:40

Marie -

With gas prices - at least where we drive - at $3.00/gallon and up, with heating/cooling prices going skyhigh, with mortgage and housing in serious trouble and concomitant foreclosures, with military invasions and occupations and losses, with debtor status in export/imports and national debt, with no strong national industry of any kind, with an increasing influx of illegal immigrants who are using public services and not contributing to them, with wages having been static for years, with the imminent draw on resources from 'baby boomers' life changes (retirement, health, residential changes)- and these are just the points that come easily to mind - how in the world can it hold together? It baffles me that it is holding together now.

Result number: 122

Message Number 228943

Re: wearing shoes!!! View Thread
Posted by Jeremy L on 5/01/07 at 14:32

Perhaps. Please also keep in mind that there are limitations to effectively making modifications on them.

One key example is in the contour of an individual's medial longitudinal arch. The classic Birk shape places the apex of this arch at the navicular-cuneiform joint. Although this works well for some people, those with higher, more defined arch shapes have this contour interfere with the plantarflexion of their first ray. This commonly results in callusing and blisters in the midfoot.

Brands like Chaco and Keen place the apex of their footbed shape beneath the talo-navicular joint. This is far more effective for the population type I described above. Like Birkenstock, many of the styles made by these two brands are also typically modifiable.

Result number: 123

Message Number 228849

Adrenalines GTS7 weekly report View Thread
Posted by J. on 4/30/07 at 13:04

Thanks a lot for the good input. As a matter of fact, after a search for Brooks related posts in this forum I had suggested her to look for the Ariels. Unfortunately, I forgot to stress the huge differences between models of the same brand (something I've learnt here), so she ended up buying the Adrenalines gts7.

As she will only have an appointment to modify her inserts in a week (few days before the half marathon=no time for testing) we have tried the shoes only with the original insoles. Running with them as such produced some degree of bunion pain, and a pinching pressure-like pain at the base of the second and third toes in both feet.

We then tried some small modifications, the first consisted of taping little pieces of canvas on the originals insoles that imitate the pattern of the functional inserts in the zone below the metatarsals. Bad practice I know, but we felt it was better than just sitting to wait. Surprisingly enough that helped. The bunion pain was mostly gone and the pinching pain was present only at the base of her left second toe. For the next try I'll suggest a slightly wider zone for the canvas of the left foot.

I also hope this all turns out well for her, as I will be around to take the blame. Thanks once more.

Result number: 124

Message Number 227690

Imus and the law of unintended consequences View Thread
Posted by john h on 4/13/07 at 12:24

In this morning's USA Today it is reported that CBS will lose $15 million in annual revenues because of firing Imus. Of course this is just the tip of the iceberg as local stations will also lose revenue and other entinities that have fired Imus will lose revenues. When you lose revnue you have to cut jobs. Probably many of the lost jobs will be African Americans. I think the Law of Unintended Consequences will come into play here.

Imus is the sole supporter of a Boys and Girls Ranch he, his brother, and wife created. It purpose it to help young boys and girls in need of help. I suspect he will still keep it up and running. I do not know but clearly think many of these young boys and girls are African American.

There is another Chairtable Foundation he is largely involved with. Once again I do not know if his loss of pay will effect the amount of support it will receive or any lost jobs.

This post is not to suggest that Don Imus should or should not be fired but to make people aware that there are consequences that may not be intended.

He is a wealthy man an hopefully can keep these very good foundations up and going. The following is a complete explanation of how the Ranch works. It is lengthy but if you are interested about its mission and how it works then here it is.

Introduction to the Imus Ranch
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Updated: 11:26 p.m. CT July 1, 2004
This is the place to learn everything you always wanted to know about the Imus Ranch, and probably quite a few things you don’t.

The Imus Ranch is an authentic, working cattle ranch nestled beneath a majestic mesa in the rolling hills near Ribera, New Mexico, 50 miles northeast of Santa Fe. Its sole purpose is to provide the experience of the great American cowboy to children suffering from cancer or serious blood disorders, and children who've lost brothers and sisters to Sudden Infant Death Syndrome (SIDS).

It is extremely important that all parents and children understand the fundamental philosophy of the ranch: it is not a camp! It is a working cattle ranch. Our objectives for the kids are to encourage in them a sense of achievement, responsibility and self-esteem through hard work and fun, while restoring their pride and dignity. Many have become convinced that because they are sick they are not normal. At The Imus Ranch they quickly discover they can do anything any other kid can do. Each child who visits the ranch is treated as a typical kid. Our policy forbids any mention of illness by ranch employees. The child life specialists, the doctors and nurses are responsible for addressing such issues when and if they come up.

Of course, the children themselves are free to initiate conversations on any appropriate matter with anyone. The Imus Ranch will always respond with patience, love and understanding.

The ranch is a magnificent facility. Nearly 4,000 open acres surround an old western town that rivals any movie set in Hollywood. All of the kids become part of our extended family living together in a stunning 14,000 square foot adobe hacienda; the architectural masterpiece that comprises the main ranch house. Their days are spent side-by-side with Don, Deirdre, Fred and the Ranch wranglers doing chores and learning to care for and ride their very own horse. As they round up our Texas Longhorns, herd and feed sheep, buffalo, chickens, goats and donkeys, the kids not only become intimate participants in the dawn to dusk rhythms of the ranch but also develop enriching lifetime bonds with animals. Often, it's been demonstrated that when children suffering from these frightening illnesses are given the opportunity to participate in programs such as those offered by the Imus ranch, the experience can actually contribute to healing and recovery.

The ranch also features a state of the art greenhouse and two acre garden, gigantic old-time barns, an indoor riding arena, an outdoor professional rodeo arena, a gorgeous, magnificently designed swimming pool, miles of trails and thousands of trees. There are two ponds for watering cattle that also contain hundreds of fish; trout in one, bass in the other.

The ranch has been designed to host ten children, two child life specialists, a doctor, a nurse, and EMT personnel for each session.


YOU AND THE IMUS RANCH

Think of your visit to the ranch as a summer job. Our experience has taught us that some kids think we're kidding when we say you will be working. We are not. You will be required to perform daily chores. You will be responsible for your very own horse and required to pitch in feeding all of the other animals. You should think of yourself as an unofficial employee of The Imus Ranch and a member of the Imus family. We understand that the ranch is not for everyone. There are certain fundamental physical requirements and other considerations that you should discuss with your parents, your doctors and your child life specialists. Below is a list of frequently asked questions and answers that may help you decide:

Who selects the children who go to the ranch?
The Tomorrows Children Fund and the C. J. Foundation for SIDS. New Mexico children and kids from other areas are selected by the hospitals or organizations they are associated with. The ranch provides advice about physical requirements but does not exercise any decision on who is ultimately selected.

How old do I have to be to come to the ranch?
Between 10 and 16 years of age.

What are the physical limitations?

You must be physically fit enough to work and ride a horse. The work can be demanding and you should consider that when making your decision whether to come to the ranch.

What does my trip to the ranch cost?
Nothing. All expenses are provided including airfare and transportation to and from the airport in New Mexico.

How far is the ranch from the airport?
A little over a hundred miles. Travel time is about an hour and a half.

How long will I be at the ranch?
Seven complete days. You leave on the morning of the eighth day.

What kind of activities will I be participating in?
You will be required to do daily chores (helping collect laundry, working in the garden and the greenhouse, pitching in in the kitchen, and performing other ranch chores). You will be responsible for feeding, grooming and care of your own horse.

What's a typical day?
6:00 a.m. Rise and shine
6:30 a.m. Feed your horse and other animals
7:00 a.m. Breakfast
8:00 a.m. Chores or horse lessons
12:00 p.m. Lunch
1:00 p.m. Rest and relaxation
2:00 p.m. Chores or horse lessons
5:30 p.m. Feed your horse and the other animals
6:30 p.m. Dinner
7:30 p.m. Evening activities (fun stuff)
9:30 p.m. In your room and lights out

What happens if I don't feel well and can't participate in regular activities?
It is important to remember when you choose to come to the ranch that you are agreeing to a certain level of responsibility. Not feeling well enough to do chores is understandable... not wanting to do them is not. We will always leave it up to you, the child life specialists and the doctors to make the final determination on the status of your health. Regardless, you will always have things to do and someone to love and help you.

What happens if I get sick and am not able to fly home?
The saloon (infirmary) has been designed, stocked, and staffed by the Hackensack University Medical Center. If you need special medical attention, but do not need to be hospitalized, there are two bedrooms in the saloon for you to stay in that are identical to those in the main ranch house (they are beautiful). All decisions on the status of your health, in these cases, will be made exclusively by the doctor. The ranch will ultimately do whatever is recommended, including flying your parents to the ranch, or you back home -- all at the ranch's expense.

What is the ranch telephone policy?
Parents may always call the ranch office. In the case of a genuine emergency, children will be available to take calls. In all other instances children are not allowed to make telephone calls. The ranch policy is identical to many camps kids attend in which they are not allowed to call home for the initial ten days they are at camp. Kids are at The Imus Ranch seven days.

May I bring a cell phone, computer, walkman or CD player?
No. The child life specialists are responsible for enforcing this policy.

What should I bring to the ranch?
a light windbreaker jacket
two swimsuits
hooded raincoat or poncho
two sweatshirts
two or three pairs of comfortable jeans
five long sleeve (light) shirts
one pair of hiking or other type of boots. (Remember, you will have cowboy boots and they are comfortable)
one or two pairs of sneakers
two pairs of pajamas
seven or eight pairs of socks
seven or eight pairs of underwear
five or six T-shirts

The ranch supplies all linens, blankets, pillows and towels. So remember... the ranch will supply cowboy boots, Wrangler jeans and shirts and Resistol cowboy hats. You'll be given Imus Ranch baseball caps and T-shirts as well. They are fabulous. You should bring a toothbrush and any other special toiletry items you require. The general store will be stocked with almost everything else you might need ...toothpaste, soap, shampoo, sun-screen... whatever.
If you do not have any of the above listed items contact Samantha Gordon at the TCF, or the Imus Ranch at (505) 421-IMUS. Anything you need will be provided so don't worry about it!

Is there a laundry policy?
Yes. We have complete laundry facilities so it's no big deal to wash, say, your favorite pair of jeans every night. You and the child life specialists are responsible for washing your own clothes and setting up your laundry routine. The head of housekeeping will help you master the machines in the laundry room. You're expected to observe all laundry room rules including removing lint from the dryers after each use and keeping the room clean. Please report any machine malfunction immediately. And very important: all of your clothes must be marked with a laundry marker.

What's the weather like?
New Mexico has a dry, warm, agreeable climate. The Imus Ranch elevation is nearly 7,000 feet. During the summer, our average daytime temperature is 85 degrees (though it can get into the 90's). The thin, dry air radiates heat quickly after sundown and summer nighttime temperatures average a cool 50 degrees. Summer also brings frequent gusty afternoon thunderstorms and breezes. It is comfortable even when it's hot, although you have to be especially careful when exposed to the sun because you can burn quickly. Plenty of sun screen is essential and should be applied every two hours. In the winter, snow falls throughout the state and January temperatures vary from about 55 degrees in the south to an average of 35 degrees in the north where the ranch is located. It is not uncommon to have three feet of snow at the ranch in December.

Is there a swimming pool?
Yes. The pool is chlorinated and swimming is strictly supervised and only allowed when there is an accomplished, accredited life guard on duty. The pool is a replica of an old time swimming pool hole and the design and landscaping are striking.

Will I be able to write and receive letters or send and receive E-mail
Letters, yes. E-mail, no.

Do I need spending money?
We can't think of any reason you would. In the unlikely event you do, the ranch will provide it.

What will I be eating?
A healthy diet of all-natural, organic whole foods, fresh fruits and vegetables. We are a vegan ranch. We serve no meat, fish, poultry or dairy products. We can and will respond to basic special dietary needs, but our menu generally reflects an all-American cuisine in both selection and preparation. We are non-denominational in all respects including the preparation and serving of foods.

What if I don't like the food? Will I starve?
No. We'll find something healthy that you do like (pizza?). Almost everyone who has been to the ranch loves the food and goes home with a new and enlightened attitude about their diets.

Where will I sleep?
In the main ranch house in your own room with one other child. Each room has its own individual bathroom and shower.

Do I get to pick whom I room with?
You should work that out on your way to the ranch with the advice of the child life specialists.

Will girls and boys sleep in separate rooms?
Yes.

Are sleeping quarters air-conditioned?
Yes.

Where do the child life specialists stay?
In the main ranch house in bedrooms next to yours.

Will there be someone at the ranch who I know?
Yes. Other kids, the child life specialists and the doctors and nurses.

If I get scared or lonely will there be someone to talk with?
Yes. The child life specialists. In addition, you will make new friends at the ranch.

How many nurses and doctors will the ranch be staffed with?
One doctor. One nurse. Two child life specialists. One or two EMT specialists.

Who are the medical staff?
The TCF and The Hackensack University Medical Center supply the medical staff personnel. When children sponsored by organizations other than TCF and Hackensack visit, the ranch itself will make arrangements for necessary medical personnel including child life specialists. The Emergency Medical personnel are supplied by the ranch and are licensed by the state of New Mexico.

Where is the closest hospital?
Santa Fe, New Mexico. 40 minutes by car.

If a medical emergency arises, will the infirmary be stocked with all necessary medications for each child?
We have been assured by the TCF and The Hackensack University Medical Center that to the degree that it is practical and possible, it will be. Each group of children will be accompanied by doctors and nurses who they're familiar with. They are ultimately responsible for your medical well being and we have placed our trust in them, as have you.

How will discipline be handled?
All discipline will be administered by the child life specialists with the exception of fundamental guidance from the ranch managers (Don, Deidre & Fred) and ranch hands in instructing the kids about chores and activities, and to insure safety. For example, if Don asks a child to perform a chore and the child refuses, a child life specialist would then be summoned to reconcile the matter. Under no circumstances will any ranch employee discipline, reprimand or chastise a child for any reason. All disputes will be resolved by the child life specialist. Children are expected to follow instructions and to cheerfully perform their chores and assignments and to follow safety instructions at all times. It cannot be stressed enough... in choosing to come to the ranch you have agreed to participate in all of the activities with good humor and enthusiasm to the best of your ability.

Will there be volunteers assisting at the ranch?
No. All employees are paid and have passed stringent security clearances and background checks. They will abide by a basic manual instructing them in their relationships with the children. They and the children will be closely supervised at all times by Don, Deidre and Fred Imus. Remember, there are only ten kids per session. Close personal supervision and care are assured.

What is the role of the child life specialists while they are at the ranch?
To supervise the children when they are not engaged in ranch activities... in the evening, from dinner until breakfast the next morning and during the hour or so they have after lunch. We have discovered that when child life specialists or doctors or nurses participate in ranch activities with the kids it detracts from the experience of the children and defeats the fundamental purpose of the experience of The Imus Ranch. It is important to remember the child life specialists and the doctors and nurses are not volunteers. They are paid full salaries and on occasion need to be reminded that they are not on vacation. We remind them. The ranch requires that the doctor and nurse be present at the infirmary (not out jogging or bird-watching) during the hours the kids are engaged in ranch activities. Similarly, EMT personnel stationed at the infirmary are expected to be present there, available and ready for immediate duty when and as needed.

Who selects the doctors, nurses and child life specialists?
The Hackensack University Medical Center, the Tomorrows Children's Fund, The C.J. Foundation for SIDS and other organizations who send children to the ranch. The Imus Ranch ultimately reserves the final determination on the suitability of all personnel.

May staff (doctors, nurses, child life specialists, EMT personnel) bring family members?
No, they may not.

Where do the doctors and nurses sleep?
In one of the bunkhouses in the town or near the main house.

What if my child cannot attend the entire session?
We are not prepared to accommodate partial sessions.

If it rains, what happens?
The animals still have to eat. Aside from that, we're prepared with an indoor riding arena, an art barn and a great house for lots of interesting things to do, rain or shine.

If a child gets homesick, what happens?
Parents can help a lot by letting kids know that getting homesick is not unusual (even for adults). Remember, the kids are going to be with people they know. Further, the child life specialists we've met have terrific natural rapport with the children which will help enormously to ease any anxieties. In the end, the ranch will do whatever it takes to make everyone happy.

May kids leave the ranch and return home before their session ends?
Of course.

Will the ranch allow children who are on medical maintenance?
Yes. As long as they meet the basic physical requirements the ranch has outlined and have been approved by the hospital.

Will there be formal religious services?
No, but children and staff will be allotted the time they request for any observance they feel appropriate.

Is there a policy manual for the ranch?
Yes. Each employee has one and much of the information is contained in the information you are reading.

Malpractice insurance?
Malpractice insurance is the responsibility of the hospital, the TCF and any other organization that provides doctors, nurses and child life specialists. The ranch carries significant liability insurance and each child and their parent will be required to sign a standard release/consent form.

Is Hanta virus an issue?
We will take every precaution and will not place the children at unnecessary risk while always relying on the advice of medical staff.

Guns?
All guns are under lock-and-key and protected by trigger locks. It is a cattle ranch in New Mexico and there are coyotes, mountain lions and wild dogs. Our only goal is to protect the children and we will be rigorously responsible in that effort.

Well then, is the ranch safe?
Yes. It is foolish, however, not to be prepared.

There are lots of animals -- horses, cattle, sheep, buffalo -- are they safe?
Yes. Accidents, of course, can happen. But with close supervision, a competent medical staff and cooperative kids we should keep mishaps to a minimum and of little consequence. But again, it is a working cattle ranch in New Mexico and we can't be too careful.


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Result number: 125

Message Number 227108

Re: Dr ED View Thread
Posted by David G. Wedemeyer, DC on 4/08/07 at 14:37

Jim you should definitely see an orthopedic spinal specialist, pain in the testicle is a warning sign there is sacral involvement. You could very well have a concomitant TTS but regardless your symptoms suggest spinal involvement and are of greater concern.

keep us posted and good luck.

DW

Result number: 126

Message Number 226660

Re: To Hope View Thread
Posted by Ralph on 4/03/07 at 10:45

Hope,
The best thing you did was to have that talk with your daughter. She now knows that you don't want her to quite just because of your health.

Since you seem to be relatively close with the other mother perhaps the two of you could come to an agreement that she would be the traveling mom (surrogate) in your behalf on road trips. Catherine says to invite her over and you and Scott explain the situation. Ask her is she would be willing to help you guys and in return maybe Scott could get the girls to local stuff.

I think people are willing to help and that you're daughter already knows how painful it is for you to travel so she understands that your not able to be there but on the other hand she would still be able to participate and come home and tell you about it. You will need to accept the fact that at times you are just going to have to hear about a meet instead of actually being there.

There may be times that you want to go but then you'll have to accept the fact that you will be putting yourself in a position of greater pain for that week-end. Trading off and going only when you feel you can tolerate the pain may be your only solution at this time.

Remember we have to work around our limitations and each of us in pain have them.

The way that I explained to Catherine and my doctor and other about my burning pain is to try and paint pictures with words. I'd say things like imagine yourself putting your hand on a stove top leaving it there for a few minutes and suffering a really severe burn. That's the type of pain that I experience and feel 24/7 only multiply what you imagine by 10 or 20 times. There isn't enough pain meds for me to take that will turn it off because the nerves that are causing my pain are on automatic and never turn off the pain. I'd have to be artificially put to sleep and kept in that state to not feel the pain that I have. My condition is called RSD. In addition to the extreme pain I have my muscles atrophy and I lose range of motion. I lose muscle because the nerves serving the affected areas of my body are not sending the correct signals instead I'm only receiving pain signals that never turn off. If you'd like to read more about my condition I have a web site that you can go to that explains it really well. Leave it at that.

I think the only way that you are going to get through this is to eliminate the guilt you feel. It's not your fault that you have RSD and it wouldn't be your fault if you had some other medical condition that prevented you from doing all the thing that you'd like to do with and for your family.

Reality, however, sets in and we need to begin to work with what we have and work within the realms of what we are able to do. No one can ask more of us and we cannot allow ourselves to feel guilty.

Guilt will only put us into despair and make us feel bad about yourself. We already feel bad so lets try our best not to pile more on.

You have RSD, I have a different condition, there are mothers that have Strokes, others with cancer, others will mental illness, others with MS, some born without arms, some without lower bodies. You name it someone has it. The best we can do is try and accommodate our particular situation. I don't like to use the word handicap because many people believe it or not would not change their life if they could. I read the other day that some parents that were born blind want to genetically change things so they can have blind children. They don't consider their blindness a handicap at all. Bottom line is we have to work within the restrictions placed on us as long as we are alive. Those restrictions I think will always be changing especially as we age.

I'm sure by now that you've had a family meeting so that everyone of your kids knows about your limitations and about RSD. They should also know that you are doing the best you can to deal with this painful situation and will always be there to talk with them and share as much as you can their individually active lives. That being said, however, you are greatly limited because of the amount of pain that you are in 24/7. They need to know that just because you cannot physically attend meets or games it doesn't mean that you don't care about them. It just means that you are counting on them to make certain they fill you in on all the exciting details and any disappointments they might have had so you can experience these things with them because you love them and want to be kept informed.

Now on to P.T. I read an article on P.T. and RSD and I'm going to try and find it again. It was good from the stand point that it talked about fear, RSD pain and what the author, a doctor, called the good pain. The good pain was another way he used to describe a way to break through the pain associated with RSD. Reading the article would be helpful if I can find it. Unfortunately I didn't book make it.

No sense worrying before you get approval for P.F. You're not there yet so but that worry on the back burner. When approval finally comes and you have a starting date call the P.T. a day ahead of your appointment and tell her/him your fears. Explain your previous experience in general terms and that now since you've lost more range of motion you are really afraid of increased pain. At that time also ask them about desensitization and is that something they would consider doing so that you might experience less pain when your leg, foot and ankle need to be touched.

I'm not exactly certain how they desensitize body parts accept I remember my P.T. telling me that in my case she would have started touching the area very lightly with something like a cotton ball. Remember now my situation was completely different then yours so how your P.T. would do it might be entirely different. When I was having the problem my P.T. also told me to purchase pure silk undershirts and boxers and get them oversized so they would cover the painful area on my back, butt and upper legs. I did this and it helped because silk is slippery and seems to slide not stick.

You could always ask Scott to purchase a 1/4 yard or less of a white silk material and see if you could lay it on your ankle or touch it with the silk. You could also try touching the area very gently and extremely lightly with cotton balls to see what you experience. Desentization takes patients and time.

My test is on Fri and I can't wait. I don't like the heart flips that I'm having and even though they tell me that they are nothing serious I'm having a difficult time believing them. So much so that last night I was giving serious though to going to the ER. Needless to say I've decided to lay low until that test is done.
Ralph

Result number: 127

Message Number 226295

Re: To Hope View Thread
Posted by Ralph on 3/30/07 at 13:44

Hope,
I'm certain that you will experience some discomfort when you begin P.T. again but a good P.T. will go at your pace not theirs. You need to go with a positive attidute knowing that in the long run it's going to help you.

I remember you mentioning something about water therapy too and that should be good. Again they will need to concentrate on how you tollerate each move and begin to desentise the area involved. It's going to be a slow process and you may never get your foot flat without surgery but I bet if you talk to some people at RSD HOPE they will tell you that you are going in the right direction.

WC should have never pulled you from P.T. Before you start again you might make some calls to different centers to see who has had the most experience treating RSD patients. You are going to need a P.T. that understands the condition and knows that each patient is different and has limitations.

After all you guy have been through I think I'd move. Jinks doesn't begin to describe what has happend to you and your family members.
I know it's easier said then done.

Does WC have to approve each time you want to see your PM? If so can you plan to have 2 week appointments instead of spacing them out so far apart?

You always seem to be between a rock and a hard place on every move you try to make. Just once I'd like to see you be able to say 'the heck with WC' I'm going to see such and such a doctor and get him to treat me.

I honestly believe if you own insurance paid for this you'd be seeing a better out come then what you've experienced because you could have move forward more quickly with possible better doctors. Makes you want to chuck WC and go it alone.

Let me know what you find out if you contact that doctor in Florida.
Ralph

Result number: 128

Message Number 226063

Re: To John h - running/walking on incline View Thread
Posted by Esther H on 3/27/07 at 10:49

I have skied before with PF and I just put orthotics in my ski boots. On this particular trip we just watched our son and his friend ski. I had surgery in May for PF, and I am still not (and may never be) at 100%. I feel much better now, but I know my limitations most of the time, and I think skiing would be too much pounding on my foot.

Result number: 129

Message Number 225898

Re: sandals .... Merrell/Dunham View Thread
Posted by Jeremy L on 3/24/07 at 19:48

You'll find that footwear isn't all that different than other industries. Imitation is the sincerest form of flattery. All one has to do is look at what Crocs, et. al., have done to Waldies. There are hordes of outdoor category brands doing very similarly behind Merrell's lead.

As with any other footwear category, the biggest difference among brands is the last shape they use in the construction of their products. In general Dunham offers a bit more of a combination fit than the standard last of Merrell. Most of their shoes also come in a variety of widths. As far as the cushioning, I wouldn't expect Dunham to be a whole lot different than what Merrell offers.

Result number: 130

Message Number 225879

Re: Tarsal Tunnel or neuropathy?? View Thread
Posted by MariaM on 3/24/07 at 10:00

wannabewell,

I had an MRI and a nerve conduction test, both showed no signs of a problem. I also had a negative tinel test, believe it or not. Thank goodness my doctor believed what I was telling him. He diagnosed me with TTS right away and then after several more visits he narrowed it down to medial plantar nerve compression on both feet. He had an idea of what was obstructing my nerves but no real proof. I am a 22 year old college student and I couldn't live my life in such pain with such limitations. I was only getting worse and worse as the months went on. I told my doctor I wanted the surgeries ASAP. He went in not knowing exactly what he would find, but he found what was obstructing my nerves.

You MUST find a doctor you trust. He could have easily written me off just like the other 4 doctors I saw did, but he didn't. He chose to trust me, especially when seeing me sit in his office and cry every appointment about how I just want to be normal and run again.

I don't know if this helped at all, but keep plugging away until you find someone you trust.

Result number: 131

Message Number 225723

Re: Help Please!!! View Thread
Posted by Mary G on 3/22/07 at 14:12

Nancy,
I had TTS surgery in December 2006. I was told to start slowly taking steps with my walking boot. I increased my distance a little more every day. First few days it hurts like HELL! But a little less every day. I felt like the bones on the bottom of my foot were hitting the floor. Weird pins and needle sensations. But it does get better. Just take your time. You know your limitations. I did not think I would ever be able to wear a shoe again. It gets better although heels are out of the question :)

Result number: 132

Message Number 225137

Re: Good days and bad ones View Thread
Posted by Geri on 3/14/07 at 19:41

I know we are all looking for more good days than bad days!! Here is a description of a good day today. After 5 yrs of dealing with TTS (surg. 3 1/2 yrs) I played 9 holes of golf today for the first time. I used a flag (handicapped), so that I could drive to my ball on all holes. What a thrill! Our course is very hilly so when it is sloppy wet I will not be able to play, but I usually have more pain when it is rainy anyway. I shot a terrible score today, but it did not matter because it felt so good to be back. I have compromised as I have in all my life decisions, I now play 9 holes where before I always played 18 holes. The increase in neurontin has given me some of my life back.
To all you recent surgical TTS people, never give up! You can have a fine and happy life with limitations. I still have some pain 'all of the time', but can sleep at night and alter my activity according to that days pain. Best wishes to all of you.

Result number: 133

Message Number 224563

Re: Sorry Marie here is the real explanation! View Thread
Posted by marie on 3/07/07 at 19:59

Yeah but who told Armitage? What you pasted as a response does not cover that.

Result number: 134

Message Number 224551

Sorry Marie here is the real explanation! View Thread
Posted by jim on 3/07/07 at 18:47

I cannot reveal my source or it my get deleted if Dorthy complains.

Sept. 4, 2006 issue - In the early morning of Oct. 1, 2003, Secretary of State Colin Powell received an urgent phone call from his No. 2 at the State Department. Richard Armitage was clearly agitated. As recounted in a new book, "Hubris" Armitage had been at home reading the newspaper and had come across a column by journalist Robert Novak. Months earlier, Novak had caused a huge stir when he revealed that Valerie Plame, wife of Iraq-war critic Joseph Wilson, was a CIA officer. Ever since, Washington had been trying to find out who leaked the information to Novak. The columnist himself had kept quiet. But now, in a second column, Novak provided a tantalizing clue: his primary source, he wrote, was a "senior administration official" who was "not a partisan gunslinger." Armitage was shaken. After reading the column, he knew immediately who the leaker was. On the phone with Powell that morning, Armitage was "in deep distress," says a source directly familiar with the conversation who asked not to be identified because of legal sensitivities. "I'm sure he's talking about me."


Armitage's admission led to a flurry of anxious phone calls and meetings that day at the State Department. (Days earlier, the Justice Department had launched a criminal investigation into the Plame leak after the CIA informed officials there that she was an undercover officer.) Within hours, William Howard Taft IV, the State Department's legal adviser, notified a senior Justice official that Armitage had information relevant to the case. The next day, a team of FBI agents and Justice prosecutors investigating the leak questioned the deputy secretary. Armitage acknowledged that he had passed along to Novak information contained in a classified State Department memo: that Wilson's wife worked on weapons-of-mass-destruction issues at the CIA. (The memo made no reference to her undercover status.) Armitage had met with Novak in his State Department office on July 8, 2003—just days before Novak published his first piece identifying Plame. Powell, Armitage and Taft, the only three officials at the State Department who knew the story, never breathed a word of it publicly and Armitage's role remained secret.

Armitage, a well-known gossip who loves to dish and receive juicy tidbits about Washington characters, apparently hadn't thought through the possible implications of telling Novak about Plame's identity. "I'm afraid I may be the guy that caused this whole thing," he later told Carl Ford Jr., State's intelligence chief. Ford says Armitage admitted to him that he had "slipped up" and told Novak more than he should have. "He was basically beside himself that he was the guy that f---ed up. My sense from Rich is that it was just chitchat," Ford recalls in "Hubris," to be published next week by Crown and co-written by the author of this article and David Corn, Washington editor of The Nation magazine.

Result number: 135

Message Number 224536

Conservatives answer this....... View Thread
Posted by marie on 3/07/07 at 16:41

who told Armitage about Plame and why?

Result number: 136

Message Number 224476

Re: What no Libby verdict discussion? View Thread
Posted by Jim on 3/07/07 at 11:56

Marie,

Once again, you show how biased and liberal you are. Armitage admitted to the Justice Department that he told Robert Novak about Plame three months before the trail began, so there should not have been a trial. Since there was a trial and a jury found him guilty, he should serve time just like Clinton did for perjury and Sandy Berger did for stealing secret documents from the National Archives.

Sorry, I forgot Clinton lost his license to practice law and Berger was fined $50,000 and has to do community service.

Very harsh sentence!

Jim

Result number: 137

Message Number 224328

Re: Michelle View Thread
Posted by Kathy G on 3/06/07 at 11:09


Michelle,

Ironically, yesterday was the first day I did what I have been saying I would do for the last two years. I washed my husband's shirts, which are wrinkle-free. They never are wrinkle-free enough to suit me so I always iron them. Ironing affects my hands, my back and my neck. He wears a jacket and a tie over them so yesterday, I actually put them in the closet without ironing them! A huge, liberating step for me!

Then I read your post about being "anal"about house keeping. It's a lesson those of us with physical limitations have to learn. It's taken me a long time but I've discovered that no one seems put off by the fact that my house isn't as clean as it used to be and it no longer bothers me. I finally believe that friends are coming to visit me; not my house. It's taken a lot of willpower on my part and many days of aching because I did something stupid around the house.

All this will come in time. Start by letting a few things go and learn to pace yourself. That's my big problem - I'm still struggling not to overdo it on a good day but I consider it a work in progress.

As for family understanding, my husband is absolutely wonderful. My children are grown but my twenty-six year old daughter is struggling at accepting that her mother isn't the super-mother she used to be. In her case, it's not lack of compassion but a lack of maturity. She hates to admit that her mother isn't able to do all she used to do.

I have a sister who continues to tell me that I'm "giving in to the pain." "Everybody had osteoarthritis." Yes, they do but when they are fifty-five, the radiologist doesn't call the doctor to see if there was a mistake made on the date of birth because the deterioration in my neck appeared to be as severe as on an eighty year old! My sister will never get it so I never discuss my health with her. She lives out of state and when she comes to visit, I just calmly say I can't do some of the things she wants to do.

People either get it or they don't. Don't bang your head against the wall trying to explain it to them and don't expect their compassion. Chronic pain is something that society tends to downplay because, happily, there aren't many people who experience it.

You know you're not a wimp. That's all that matters. And as for your husband, he's scared. You're very young and his reaction isn't very different from my daughter's. He loves you and he can't control what's happening to you. Give him time and he'll come around. Just don't beat yourself up about it. Be calm and don't let him talk you into doing too much but if you're having a good pain day, by all means, do something with him. Once they get your pain under control, hopefully the good pain days will become more frequent.

Result number: 138

Message Number 223590

Economics 101 View Thread
Posted by john h on 2/25/07 at 12:47

You may not be a fan of Thomas Sowell but his is an economist who will bring economics down to the working mans level:



By Thomas Sowell





With all the advances in sophisticated analysis by professional economists, very little of even the basic principles of economics has gotten down to the average citizen and voter.


Many, if not most, of the economic policies advocated by politicians today would never pass muster if the average voter understood as much economics as an economist like Alfred Marshall understood 100 years ago or David Ricardo 200 years ago.


Nothing is more basic in economics than prices and yet the role of prices is repeatedly ignored or even misrepresented by politicians and the media.


What do prices do?


Prices impose the most effective kind of rationing self-rationing. Why is rationing necessary? Because what everybody wants always adds up to more than there is.


It doesn't matter whether you are talking about a capitalist economy, a socialist economy, a feudal economy or whatever. Resources are limited but desires are not. That is the basic and defining problem of economics.


Prices force you to limit your claims on what other people have produced to the value of what you have produced for other people. Prices force you to limit how much of product A you buy because you need to keep some money to buy product B.


While prices convey these limitations, they do not cause them. No economy capitalist, socialist, feudal or whatever ­ can keep consuming more than it produces. Producing more of product A means using up resources needed to produce product B.


Simple and obvious as all this may seem, politicians blithely ignore it when they promise to make the prices of housing or health care or other things "reasonable" or "affordable."


Nothing is easier for any government than to impose price controls. Governments have been doing that for thousands of years. What governments cannot control are the underlying realities expressed through prices.


What does the history of thousands of years of price controls tell us?


The first thing undermined or destroyed is self-rationing. When you pay the full price of going to a doctor, you go there when you have a broken leg but not when you have the sniffles or a minor skin rash. When the government makes health care "affordable," you go there for sniffles and a minor skin rash.


The underlying reality has not changed, however. The doctor's time is still limited, and the time that you take up with your sniffles or skin rash is time that somebody else with a broken leg or perhaps cancer has to wait to get an appointment.


Government-run health care systems in countries around the world have longer waits sometimes months ­ to get medical attention. In other words, the rationing goes on, but more haphazardly, because prices do not force people to ration themselves according to the seriousness of their problem.


It is the same story when housing prices are controlled by government. Rent control has allowed some people to take up more housing space than they would if they had to pay the full price that reflects other people's demand for housing.


The net result, whether in New York or San Francisco or elsewhere, is a lot of apartments with just one person living in each, and lots of families who cannot find a vacant place to move into. Housing shortages have resulted from rent control in cities around the world.


Housing shortages mean that some people are forced to live far from their jobs and commute, and some become homeless on the street. Homelessness tends to be greater in cities with rent control New York and San Francisco again being classic examples.


Economists have long been saying that there is no free lunch but politicians get elected by promising free lunches. Controlling prices creates the illusion of free lunches.


Prices not only ration existing supplies, they also determine how many new supplies will be forthcoming. When a new pharmaceutical drug costs an average of $800 million to develop, there is no point talking about "affordable" medications.


Either the $800 million is going to be paid or the supply of new drugs will dry up. Controlling prices does not change that.

Result number: 139

Message Number 223064

Re: The imitation-is-the-best-form-of-flattery trade show View Thread
Posted by Esther H on 2/19/07 at 20:42

So true....I have learned so much from you and other experts on this site. I'm always telling my husband, "oh, guess what I heard on heelspurs..." I know he thinks I'm nuts, but I do learn so much. And, for someone like me, I feel like listening to you has saved me so much money because of the advice I have gotten. I feel much more educated about what shoes are right for me. Thanks for your contributions, Jeremy! =)

Result number: 140

Message Number 222848

Re: The imitation-is-the-best-form-of-flattery trade show View Thread
Posted by Jeremy L on 2/17/07 at 14:32

Shoot! I'm not even keeping up to date on my own blog. Much to the chagrin of my dear wife, who set it up for me (as well as made my graphics). Thanks for the kind words.

Result number: 141

Message Number 222814

Re: The imitation-is-the-best-form-of-flattery trade show View Thread
Posted by Dr. David S. Wander on 2/17/07 at 08:24

Jeremy,
As always, thanks for the great information. If you wrote a newsletter, I'd be the first one to order a subscription!

Result number: 142

Message Number 222811

The imitation-is-the-best-form-of-flattery trade show View Thread
Posted by Jeremy L on 2/17/07 at 07:50

Over the years I've grown quite accustomed to the various brands mimicking eachother's good ideas. How many footwear companies introduced sleakly styled clogs after Merrell's success with their Jungle Moc? What's interesting now is the utter speed with which product copying presently exists. Chinese firms can now make product samples in hours instead of days, and the large freight companies now have competitively priced shipping from east Asia ... both standard and overnight (even from remote Thia jungles!).

Last year, the huge copy was in foam clogs. It seemed like EVERYBODY had some version of what Waldies first created 5 years ago. Of course, it's been well documented here that while they all look the same, there are dramatic functional difference among them. Some brands absolutely work better than others.

This year, the pervasive new product concept is functional comfort outdoor shoes. This was a category dominated by Keen and Merrell not too long ago, and Teva certainly did it's part in improving their market stance. Now, there's an influx of several new brand names. What most interests me is that most (if not all) of these new collections are built on combination last shapes. What's also nice is that they all appear to be built well, and should offer good relief for many of the people who frequent this message board. In addition to the brands mentioned quite often on this board in the past, here are some of the brands that impressed me at the show.

Earth Shoe. I know; it's far from a new brand. But their improved footwear selection in fit and design is a far cry from the old 70's stuff. Some of it is actually very cute, as well! They also recognized that there are times where it's functional to offer their negative heel technology in formats for both flexible and firm forefoot patterns. Of course, if you have classic PF heel pain, avoid this brand like SARS. Those with neuromas, metatarsal synovitis, and hallux limitus/rigidus could find success.

Go Lite. I may have mentioned this brand from last years show (and the shoe's inception), but it's worth reiterating it. They have an amazingly effective independent suspension system for their outsole, making them extraordinarily cushioned and stable on uneven surfaces. Their last shape and multiple inlay system also allow for flexibility in fit. Best of all, it's a new technical brand that isn't highly priced. They have good options at suggested prices under $100.

Ahnu. This brand really isn't burning a new trail. In my opinion it's taking what already exists and making a little niche for itself. The looks resemble styles already available from Merrell and Keen. It's function seems like it comes straight from Keen and Montrail. The shoes offer a good fit and the build construction is as good as the other quality brands. People who will fit and appreciate this brand are Merrell wearers seeking something a little different (and maybe fitting a good bit better) and those who have success with Chaco but want a more reasonable shoe look.

Waldies. The original, and still using the best foam available on the planet. They are not always the quickest to respond to market needs, but when they do respond the product is usually done well. Their two best new releases will be a toddler's version of their AT clog. I know, everybody else has one too. But these are more cushioned and durable at similar pricing. They also have a thong sandal coming in a dual color/density PE foam. This one fits/performs better than the few others I have seen.

Olukai. I mentioned these guys last year, too. Just as before they have the best functional thong sandal in production. They also have a far better finish than any sandal brand in existance. Add to that their very thoughtfully contoured footbed, and I can very highly recommend them. Be aware if you want their kingly-made leather version. Suggested price is above $100, but some may crave the way these feel and find value even at that cost.

That's it for this report. Hope you all footwear that makes you smile.

Result number: 143

Message Number 222762

Re: An interesting perspective on Obama. View Thread
Posted by marie on 2/16/07 at 16:55

No larryahem I can't because I don't work for the newspaper but my guess is that she's to obnoxious for the general population. How dare you compare her vitril to one sentence uttered by one member of the Dixie Chicks. There's no comparison.......

If you like her type of vitril then by all means smoochy up to her. It's a free country but for myself and thousands and thousands of Americans no thanks. She made her bed and she can sleep in it with whoever she likes.......it is what it is.

Let's review some of her vitiril shall we?......unlike one sentence she has books preaching HATRED FOR AMERICANS. Iran would certainly welcome this anti-American with open arms. Hatred 101 Ann Coulter Style.......and this is the short list.

"We need somebody to put rat poisoning in Justice Stevens' creme brulee. That's just a joke, for you in the media."

"These broads are millionaires, lionized on TV and in articles about them, reveling in their status as celebrities and stalked by griefparrazies. I have never seen people enjoying their husband's deaths so much." -on 9/11 widows who have been critical of the Bush administration

"We need to execute people like (John Walker Lindh) in order to physically intimidate liberals."

"We should invade their countries, kill their leaders, and convert them to Christianity." (I wonder if Israel is on her list)

"My only regret with Timothy McVeigh is he did not go to the New York Times Building."

"Press passes can't be that hard to come by if the White House allows that old Arab Helen Thomas to sit within yards of the President."

"The swing voters -- I like to refer to them as the idiot voters because they don't have set philosophical principles. You're either a liberal or you're a conservative if you have an IQ above a toaster."
(that's why they don't vote for your side anymore honey)

"it's far preferable to fight [terrorists] in the streets of Baghdad than in the streets of New York (where the residents would immediately surrender)."

"I have to say I'm all for public flogging. One type of criminal that a public humiliation might work particularly well with are the juvenile delinquents, a lot of whom consider it a badge of honor to be sent to juvenile detention. And it might not be such a cool thing in the 'hood to be flogged publicly." (some call that child abuse thank God you have none)

"I really want to hurt him. I want him to feel pain." (Referring to the possibility of running against a Democratic Representative)

"When contemplating college liberals, you really regret once again that John Walker is not getting the death penalty. We need to execute people like John Walker in order to physically intimidate liberals, by making them realize that they can be killed, too. Otherwise, they will turn out to be outright traitors."

"The thing I like about Bush is I think he hates liberals."

"I think there should be a literacy test and a poll tax for people to vote." (apparently she has no respect for the voting rights act and those who died for it)

"Kwanzaa itself is a lunatic blend of schmaltzy '60s rhetoric, black racism and Marxism. Indeed, the seven 'principles'of Kwanzaa praise collectivism in every possible arena of life – economics, work, personality, even litter removal."

"I think we had enough laws about the turn-of-the-century. We don't need any more." Asked how far back would she go to repeal laws, she replied, "Well, before the New Deal ... [The Emancipation Proclamation] would be a good start."

"With their infernal racial set-asides, racial quotas, and race norming, liberals share many of the Klan's premises. The Klan sees the world in terms of race and ethnicity. So do liberals! Indeed, liberals and white supremacists are the only people left in America who are neurotically obsessed with race. Conservatives champion a color-blind society."

Ann Coulter: I take the biblical idea. God gave us the earth.
Democratic Strategist Peter Fenn: Oh, OK.
Coulter: We have dominion over the plants, the animals, the trees.
Fenn: This is a great idea.
Coulter: God says, "Earth is yours. Take it. Rape it. It's yours."
Fenn: Terrific. We're Americans, so we should consume as much of the earth's resources...
Coulter: Yes! Yes.
Fenn: ... as fast as we possibly can.
Coulter: As opposed to living like the Indians.

"Anorexics never have boyfriends. ... That's one way to know you don't have anorexia: if you have a boyfriend."

"People like you caused us to lose the war." (to a disabled Vietnam Veteran)

"I think [women] should be armed but should not [be allowed to] vote. No, they all have to give up their vote, not just, you know, the lady clapping and me. The problem with women voting -- and your Communists will back me up on this -- is that, you know, women have no capacity to understand how money is earned. They have a lot of ideas on how to spend it. And when they take these polls, it's always more money on education, more money on child care, more money on day care."

Without affirmative action, African-American Rep. Maxine Waters (D-CA): couldn't get a job "that didn't involve wearing a paper hat"

"If Gore had been elected president, right now he would just be finding that last lesbian quadriplegic for the Special Forces team."

"I don't know if [former U.S. President Bill Clinton is] gay. But [former U.S. Vice President] Al Gore - total fag."

"Six imams removed from a US Airways flight from Minneapolis to Phoenix are calling on Muslims to boycott the airline. If only we could get Muslims to boycott all airlines, we could dispense with airport security altogether."

"[Canadians] better hope the United States does not roll over one night and crush them. They are lucky we allow them to exist on the same continent."

"The Episcopals (sic) don't demand much in the way of actual religious belief. They have girl priests, gay priests, gay bishops, gay marriages -- it's much like The New York Times editorial board. They acknowledge the Ten Commandments -- or "Moses' talking points" -- but hasten to add that they're not exactly "carved in stone."

(On court ordered desegregation)"Few failures have been more spectacular. Illiterate students knifing one another between acts of sodomy in the stairwell is just one of the many eggs that had to be broken to make the left's omelette of transferring power from states to the federal government."

"The Democrats are giving aid and comfort to the enemy for no purpose other than giving aid and comfort to the enemy. There is no plausible explanation for the Democrats' behavior other than that they long to see U.S. troops shot, humiliated, and driven from the field of battle. They fill the airwaves with treason, but when called to vote on withdrawing troops, disavow their own public statements. These people are not only traitors, they are gutless traitors."

"In the history of the nation, there has never been a political party so ridiculous as today's Democrats. It's as if all the brain-damaged people in America got together and formed a voting bloc."

"The ethic of conservation is the explicit abnegation of man's dominion over the Earth. The lower species are here for our use. God said so: Go forth, be fruitful, multiply, and rape the planet--it's yours. That's our job: drilling, mining and stripping. Sweaters are the anti-Biblical view. Big gas-guzzling cars with phones and CD players and wet bars -- that's the Biblical view."

"I would like evolution to join the roster of other discredited religions, like the Cargo Cult of the South Pacific. Practitioners of Cargo Cult believed that manufactured products were created by ancestral spirits, and if they imitated what they had seen the white man do, they could cause airplanes to appear out of the sky, bringing valuable cargo like radios and TVs. So they constructed airport towers out of bamboo and headphones out of coconuts and waited for the airplanes to come with the cargo. It may sound silly, but in defense of the Cargo Cult, they did not wait as long for evidence supporting their theory as the Darwinists have waited for evidence supporting theirs."

"They're [Democrats] always accusing us of repressing their speech. I say let's do it. Let's repress them. Frankly, I'm not a big fan of the First Amendment."

"I'd build a wall. In fact, I'd hire illegal immigrants to build the wall. And throw out the illegals who are here. [...] It's cheap labor."

"When we were fighting communism, OK, they had mass murderers and gulags, but they were white men and they were sane. Now we're up against absolutely insane savages."

"… as for catching Osama, it's irrelevant. Things are going swimmingly in Afghanistan."

"They're never very high in anyone's caste system, are they? Poor little Pakis."

VESTER: "You say you’d rather not talk to liberals at all?" COULTER: "I think a baseball bat is the most effective way these days."

"[Learning difficulties are a cover for] rich parents with dumb kids...That's why 'Pinch' Sulzberger, the publisher of The New York Times, is alleged to have dyslexia - because he's retarded."

"You don't want the Republicans in power, does that mean you want a dictatorship, gay boy?"

"Which brings me to this week's scandal about No Such Agency spying on 'Americans.' I have difficulty ginning up much interest in this story inasmuch as I think the government should be spying on all Arabs, engaging in torture as a televised spectator sport, dropping daisy cutters wantonly throughout the Middle East, and sending liberals to Guantanamo."

"If Chicago had been hit, I assure you New Yorkers would not have cared. What was stunning when New York was hit was how the rest of America rushed to New York's defense. New Yorkers would have been like, 'It's tough for them; now let's go back to our Calvin Klein fashion shows.'"

"It would be a much better country if women did not vote. That is simply a fact. In fact, in every presidential election since 1950 - except Goldwater in '64 - the Republican would have won, if only the men had voted."

"My libertarian friends are probably getting a little upset now but I think that's because they never appreciate the benefits of local fascism."

Result number: 144

Message Number 221651

Re: Who has diabetes? Ladies, I forgot to metion my health. View Thread
Posted by karen on 2/05/07 at 22:38

Ladies,
I do not have diabetes, and I should have told you that. I have P.N. that is affecting my "quality of life." Heart disease runs in my family though. Which with my artery disease is rather frustrating. I to have gained about 40 lbs. in the past 4 years. Mostly due to the lack of activity with all my physical limitations. Even with that as a factor I am not considered obese, about 30 lbs. above my ideal weight. I am really glad I am somewhat tall. Well I seem to have forgotten my train of thought. Keep the faith,Karen

Result number: 145

Message Number 221162

Re: PLANTAR FIBROMAS View Thread
Posted by Dr. Z on 1/30/07 at 17:39

Dr. Goldstein
Sometimes we aren't explaining this very clearly and if your aren't directly involved in the field of podiatry or some similiar medical field it appears that we are just trying out procedures such as cryotherapy on poor helpless patients. I would like to try and gave another possible example that might help to make this more clear
Today I used a laser called a Flashlamp Pulse Laser for the treatment of warts. It is FDA approved for vascular lesions and has been tested for that specific indication. It is however used for spider viens, dark discolorations of the skin tatoo's and other pigmented lesions.
I use if for warts because I understand and know the effects this specific laser has on specific pigmentations and therefore I am able to apply this to warts due to undestanding the specific effects this type of laser has on the skin .
So with cyrotherapy you are applying the effects that you know happen on other parts of the human body ie prostate cancer to the bottom of the foot ie plantar fibroma.
Dr. Goldstein experience with cryotherapy and understanding of the technology allows him to apply what he knows, has experienced to the foot
So cryotherapy can be used and applied to other parts of the body so long as you understand the benefits of its effect and it limitations.
Now as for the heel it dangerous and I would never use it due to its ability to kill the plantar fascia. Just joking I wanted to see if anyone is reading this beside Dr. Wander, Goldstein and Ralph and maybe Dorothy if there is a spelling problem Seriously I am very impressed with so far with the potential that cryotherapy has. One more thing. Dr Goldstein did you read Dr. Norykye sp post about his problems with cryotherapy and neuroma's I was surprised any thoughts??

Result number: 146

Message Number 220365

Re: THE HUMAN FOOT IS PREY TO ACTION—A STEP AT A TIME View Thread
Posted by Jeremy L on 1/22/07 at 14:41

Just for clarification, there are many orthotic designs that maintain healthy elasticity without being made of silicon. One of the main reasons there has been a practical movement away from Root designs is due to the use of rigid subortholenes and carbon graphite in casts modified to elevate the first metatarsal. I tend to practice in the ranges of thought presented by Ritchie and Smith, which do not place too much limitation on the windlass effect. Therefore, the treatment is in the correct cast modification and the shell material is selected based on criteria such as body weight and activity/activity level.

Result number: 147
Searching file 21

Message Number 219653

Dwight D. Eisenhower won the White House after he promised to halt fighting View Thread
Posted by marie on 1/13/07 at 17:42

on July 27, 1953.

We were so deeply and profoundly wounded after Vietnam. We all still feel the pain of those years. Iraq has moved us once again. It's the burden of the next generation. Let's hope they will remember 30 years from now so they can prevent this from happening in the future. The greatest catastrophy of this war is our inability to take on our real enemies.

http://news.yahoo.com/s/ap/20070113/ap_on_go_co/iraq_congress_at_war

But the 1970 invasion simply drove the North Vietnamese deeper into Cambodia. Five years later, both South Vietnam and Cambodia fell under communist rule.

Nevertheless, the showdown over Cambodia cast a long shadow over American politics for a generation.

The invasion enraged Congress, triggering legislative battles that culminated in the War Powers Act of 1973 that sets limits on a president's power to wage war without congressional approval.

Although the act's constitutionality has never been fully tested in court, Congress has invoked it on several occasions, setting conditions and limitations on the use of U.S. forces in the Middle East, Africa, Haiti and the Balkans.

Result number: 148

Message Number 219529

Re: To Brian G View Thread
Posted by Esther H on 1/12/07 at 13:41

Thanks for the support, Jeremy! =)

Brian, what happened, if you don't mind telling us what it was that has you sure your feet were ruined by a podiatrist. I know when I push myself too much I have pain again. I have had to learn my limitations. I know that I will never be able to run again, or even take a 2-3 mile walk again. I am starting to figure out the things I can and can't do, and use that information as my basis for choices in activities that I do. (I can bike, swim, and use the eliptical as well as lift some weights)

Good luck to you, I really hope that your feet can heal and be better. I wouldn't give up if I were you. I know you may not be interested in seeing someone else, but have you considered it? Maybe ask around and get a good referal? Take care....

Result number: 149

Message Number 219213

Who says they were "underage"? View Thread
Posted by Tim M. on 1/09/07 at 16:45

Only the "righty writers" for newspapers like the NY Post use this underage adjective. If they were truly underage, it was a federal crime and since the statute of limitations had not run out, for either Foley or Crane, a congressional censure would have been the least of their problems as they were handcuffed up on Capitol hill and brought up on charges.

Result number: 150

Message Number 219202

Re: You are so right, marie View Thread
Posted by Dorothy on 1/09/07 at 15:21

john h -

Auto workers' (and other) union accomplishments are often made the scapegoat for business (or other) problems. I will freely grant that unions are not free of corruption and greedy self-interest; not by a long shot. But they have also brought middle-class prosperity to labor and the families of those workers. And if you compare those hard-won benefits to the pay and perks of CEOs and other high-level corporate entities, they pale. If you compare their health care to the health care enjoyed by the president and all members of Congress, they pale. Do you not think that those outrageous CEO and related salaries are also reflected in the cost of automobiles? In less than one century,after hundreds of years of virtual enslavement, the relationships between "labor and management" changed; labor in this country went from being little more than serfs in persistent indebtedness and impoverishment working for robber barons to being middle-class workers with decent standards of living - owning homes, buying cars and other consumer goods, sending kids to college, and so on. Health improvements ensued, too, with health care coverage being an increasingly negotiated feature of labor contracts. Why was that? Because it is so doggone expensive and hard to get! It was not health care benefits that has killed/is killing the U.S. automobile industry - and I grieve and mourn about that, as a matter of fact, in spite of their many sins - it was things like the truly evil NAFTA agreements, the auto execs'and stockholders' short-sightedness and greed, and now, in my opinion, their intentions to transfer those health care costs onto the federal government(which means you and me) - without any concomitant reduction in their own personal wealth! By the way, we drive Ford products and have for about 30 years and think that Ford has gotten a bad rap in the press and popular opinion. The Ford Taurus and Mercury Sable were/are great automobiles that, in reality but not in myth, can hold their own with any Japanese car.
As for health care - I have long been a proponent of single-payer, universal health care. Hillary did NOT advocate that, although myth holds that she did. Those plans she was supposedly working on seemed primarily to be the work of people intent on protecting the interests of the insurance industry, major donors to her and Bill, while ostensibly always, always looking out for "the children". Children - and adults - do best when the adults have good jobs with good benefits for their labor! However, as more recent versions and interpretations of universal health care are emerging, it is not what I advocate. These new versions seem more likely to continue to foster poor health care and health care coverage, while enriching insurance companies, stockholders, doctors, and CEOs - while everyone else, other than the most affluent with the greatest access, suffers the consequences. When Ford Motor Co. and major insurance companies start to "promote" government sponsored health care coverage, you can just watch and anticipate the latest transfer of wealth from your wallet to the wallets of CEOs, in this case of the insurance and auto industries.
You read the stories of people on this website, people who suffer not only the agony of their various health problems, but the added agony of dealing with doctors (if they have one), with access to proper doctors, hospitals, insurance companies, employers and so on. The auto workers' contracts gave workers some balance of power in the marketplace of health care coverage, but that is fast disappearing. With Wal-Mart being the largest employer and no health care coverage on the one hand and Ford and GM failing and whining about health care coverage of their workers on the other (while CEO pay and perks keep growing), that disappearing is happening fast.
You can add cost to automobiles or you can add cost to tax bills; either way, you will pay for Ford, GM, IBM, and on and on, to continue to enrich the top, move to poorer and poorer countries for labor - while blaming U.S. labor for wanting "Cadillac" health care coverage and "causing" all these woes. We are only starting to see the modern version of the consequences of greed. It took less than a century for a semblance of a balance of power to occur - just a semblance - it probably won't take that long for its demise. Some years hence we will be able to compare conditions under the old way and the newly emerging way. Maybe a better system will emerge but I don't think we know what it will be yet. HMOs, PPOs and such SEEMED like such a good idea at their inception, but then greed reestablished itself as the driving force and HMOs and PPOs and such ARE a big part of the problem they were established to eliminate. I have several doctor friends and to a person, they are wealthy beyond belief. They enjoy "lifestyles" that most of us cannot imagine. I happen to think it is wrong for the Ford and GM CEOs and doctors and hospital CEOs and insurance company CEOs to be wealthy beyond belief, for the president and Congress to have the best quality health care on YOUR dime, while so many Americans really, truly struggle with health care issues - whether it's getting it or paying for it. So I find it very disingenuous to blame the autoworkers' unions - they are one little cog in a very big, very shiney wheel.

Result number: 151

Message Number 219197

Re: PLEASE, go see a doctor FIRST View Thread
Posted by Brian G on 1/09/07 at 14:42

I disagree. First of all, most people are smart enough tounderstand the limitations of this activity- they just come here looking for insight. Secondly, the more horror stories accumulate here, the more evident it becomes that most doctors don't really know any better than the next cyberspace know-it-all.

Result number: 152

Message Number 219065

Re: Stitches are out, and p.t. scheduled View Thread
Posted by Kate on 1/07/07 at 13:51

I've been known to pull a prank or two at work.

I've heard of your surgery and know several people who have had it and all did very well. Neck surgery is most certainly not a piece of cake but this one happens to be more common so it should all go well. Be sure that you know what limitations you will have post-op for such things as showering and hair washing so you can think about your options.

Keep in touch!

Result number: 153

Message Number 218881

Complications from ESWT - damage in foot View Thread
Posted by BrianG on 1/04/07 at 18:23

Hey Mike D,

Sorry about all your troubles. I have read many times on these pages, from the contributing podiatrists, that it's not always the type of equipment used, but how well trained the doctor is, in the procedure.

Do you know how many procedures your Pod performed, before yours? It's important to know. Also, you should think about the statute of limitations in your state. From what I've seen, they run between 2-3 years. You might want to talk to an attorney well before your time runs out.

I'm not saying that you have RSD, but did you realize that RSD can be caused by a needle stick! What if you just happened to be this doctor's frst patient? Who's to decide if he was properly trained, hence the attorney. There are a group of Podiatrist / Attorneys at:

http://www.footlaw.com/news/eswt.html

You can read what they have to say about ESWT at their web site. They have said on this board in the past, that they take less than 1 in a hundred clients. In other words, they pretty much only take the "sure things". Just something to keep in mind if you decide to contact them. They are certainly not the only malpractice attorney's available.

Good luck
BrianG

Result number: 154

Message Number 217946

Re: 23 y/o with bilateral ankle and rearfoot arthritis View Thread
Posted by Brian G on 12/26/06 at 18:21

Dr. Wander,

With no disrespect intended, having researched the pathophysiology of OA extensively over the last year, it is clear to me that the eitiology of primary OA is a subject of controversey in academic medicine, and at this point nobody can claim to be "well aware" of it based on any length of time in practice. The passage I quoted represents one possible cause of OA that happens to summarize exactly the couse of events that led to the onset of my symptoms.

Please understand that I am not questioning your medical skills, which do not depend on an understanding of the etiology of OA. However, this is an extremely sensitive subject with me, since it has ruined my life utterly, and admittedly I have become highly annoyed with all of the doctors who dismiss my belief that my condition was caused by the treatment I recieved from the podiatrist. I believe that they take this position because, as skillful as they may be, they really don't understand the etiology of OA.

It is now fairly well established that the conventional model of OA understood by most physicians, the notion that it results from "wear and tear" over many years, is wrong. Normal joints are not suceptible to wear. Rather, primary OA occurs as a result of weakening of the chondral tissue and a resulting suceptibility to damage. Why this weakening occurs in OA patients is not understood, but there are certain things which, althought not necessarily linked to OA, are known to cause cartilage weakening, and these are highly relevant to my situation.

You may already be aware of some or all of this information, but I will present it anyway for the purpose of defending my belief that I developed OA as the result of treatment I recieved from an incompetent podiatrist:

It is well known that articular cartilage depends on regular, cyclic mechanical loading for maintenence of its biomechanical and biochemical properties. In the absence of regular loadbearing activity, such as which occurs during prolong periods of disuse, the cartilage atrophies and becomes weakened- its proteoglycan content decreases, its collagen network becomes disorganized, and the tissue becomes soft. Joint immobilization (casting) is particular devastating to chondral tissue since it prevents the circulation of synovial fluid, effectively suffocating the chondrocytes. Through the reintroduction of loadbearing activity, the changes associated with immobilzation and unloading may be partially or fully reversible depending their severity. However, in its weakened state, the cartilage is suceptible to damage from forces that would normally be easily tolerable. This is what I believe (or actually know for a fact) happened to me.

First, the podiatrist misdiagnosed my injury- he insisted that my shin splints were caused by tendonitis of the tibialis posterior tendon, even after an MRI showed a perfectly normal TP tendon. Subsequent to this misdiagnosis, the incompetent podiatrist told me that the tedon required absolute rest in order to heal properly, and thus he prescribed a treatment protocol that essentially amounted to extreme disuse in the forms of prolonged cast immobilization, drastically overcorrective (UCLB) orthotics which virtually immobilized my rearfoot, and minimal weightbearing activity. I did not experience normal, unassisted ambulation for four months. After becoming frustrated with his worthless treatment I sought the advice of a more qualified sports medicine physician, who was disgusted with the treatment I recieved from the podiatrist and recommended exactly the opposite- a regimen of aggressive remobilization and physical therapy. As soon as I attempted to resume normal activities without the orthotics, however, I immediately began experincing pain in both feet and ankles. Prior to this I had never experienced a twinge of foot or ankle pain in my life.

Therefore, I believe that my podiatrist caued me to develop OA by prescribing unnecessary treatments which induced such a severe disuse syndrome that my weakened joints were permanentnly damaged when I discontinued his treatment and attempted to resume normal activities. I have talked to several other highly qualified sports medicine professionals since then and, while none of them seem to appreciate the link between disuse and OA, they all agree that I was misdiagnosed and mistreated by the podiatrist.

Regarding the diagnosis of OA: a bone scan in June showed abnormal uptake at the joint level in the ankles, subtalar joints, midtarsal joints, and transverse tarsal joints of both feet. The radiologist commented that the findings were consistent with "early arthritic changes", but since bone scan is nonspecific, my physician did not accept this diagnosis. A month later, an MRI and a CT scan both revealed mild degenerative changes in the talonavicular and calcaneocuboid articulations. At that point I was "offcially" dianosed with osteoarthritis in my feet. Although the subtalar and ankle joints appeared normal, I believe that this was only because the damage was not significant enough to appear radiographically at that time (no imaging method is sensitive to very early arthritic changes except for bone scan, which of course has the limitation of being nonspecific).

I have not been back to the doctor for any more studies since then, so I have not yet been diagnosed with ankle or subtalar OA. However, I have the same symptoms in these joints as I do in my midtarsal joints- pain, stiffness to motion, and a very audible crepitation.
These symptoms have become SIGNIFICANTLY worse since the last time I saw a doctor, so much so that my ankle and subtalar joints are now
worse than my midtarsal joints. I am absolutely certain that, if I were to get another MRI or CT, it would confirm my "self" diagnosis of OA in my ankle and subtalar joints. In fact, I think it would show up on a crude X-ray, the least sensitive imaging method.

I will no doubt have more studies performed when I get back in to see the doctor next month. In the meantime, however I thought it might be useful to submit a query on this board, if for nothing other than educational/informational purposes. Supposing I am correct and that I have debilitating OA in both my rearfoot and ankle joints, I am anxious to know what options he might present. I don't know how I could live with fusions of both ankles and both rearfoot joints.... as recently as a year ago I was a highly competitive runner, and up until July I had every intention of returning to that level of fitness. To go from that to this...... I could put a gun in my mouth........

Result number: 155

Message Number 217613

World's smallest political quiz... View Thread
Posted by Dr. Ed on 12/21/06 at 09:14

http://www.theadvocates.org/quiz.html

There are limitations tothe above but it remains a good discussion piece.

Result number: 156

Message Number 217588

Re: tarsel tunnel View Thread
Posted by Dr. Ed on 12/20/06 at 21:59

You are correct in requesting more testig and/or evaluation. You have mentioned 3 to 4 different problems that can cause neurologic symptoms such as numbness, paresthesia (pins and needles) and possibly pain in the feet. Tarsal Tunnel syndrome affects the posterior tibial nerve which is the nerve that provides sensation to the soles of the feet. TTS is thus most likely to cause symptoms on the soles of the feet. Hyperthyroidism or hypothyroidism causes a "metabolic" neuropathy and is more likely to affect the tops of the feet as well as the soles. MS is the "great imitator" and can mimic TTS. It is important that you have an accurate diagnosis so you know what you are treating.

Result number: 157

Message Number 217341

Re: Amputation View Thread
Posted by Geri L on 12/16/06 at 19:27

Martin: I am 3 yrs. post op TTS. I was one of the "desperate" ones with pain. The minute my eyes open the pain begins, even without moving a hair, to this day. I have to get my foot calmed down from the days walking by massaging it, take my neurontin and elevil(25mg) and go to bed. If I get up in the night to go to the BR, I wear slipon shoes and hurry, as the pain will start up again. I never in 3 years have touched my foot on the floor. Of course the pain is much less now than before surgery. I always have a shoe with a good arch support during the day. I was 64 years old when I had surgery. It was done by a plastic surgeon. It was the best I could find in the area. I had a hard time getting my diag. This Doctor did 3 or 4 a month of tarsal tunnel surgeries, and also Carpal Tunnel surgeries. What he did not do is aftercare beyond the incision healing. This was a real problem as none of the local foot Doctors, including the MD's. would take me as a patient. I have a restricted great life now. It's been a long road. You do not get instant results from TTS surgery. It is a long process, but many have a good life after surgery with limitations. Others zip right through and within a year aare ok.

Result number: 158

Message Number 217322

Re: Trypanophobia, help! View Thread
Posted by Ralph on 12/16/06 at 14:54

Sara,
At many facilities prior to inserting an IV they will numb the area
with Xylocaine, then insert the IV. If they don't offer it ask if they can do that. You'll feel a tiny pick from the Xylocaine but not feel the IV being inserted afterward. This is often used with older children as well as adults.

Also tell them you have a rule and that rule is they get ONE try to get the needle in position. If they fail they must call someone else to insert your IV.

I've found the untalented folks that usually are hit or miss happily go off and get someone else. They know their limitations.

Result number: 159

Message Number 215804

Re: Jeremy-New Brooks models for Spring 2007? View Thread
Posted by Jeremy L on 11/18/06 at 07:35

I left the PFA Symposium impressed with some changes made by a couple athletic companies.

First, Brooks will be releasing MOGO versions of both the Adrenaline and Glycerine this February. They currently do not have that compound in a shoe that I an test; however, both their test results and early reactions from a few of my patients are impressive. Now if they will start offering the Glycerine in a B width, so I can also get my perfect fit (without additional modification on my part) out of that shoe.

Second, Spira is finally addressing their fit limitations. I considered their last shapes to be adequate, but something in the upper pattern never quite got the majority of wearer's feet properly secured. Redesigns in both the Del Sol and Volare were fantastic during my brief runs in them. The midfoot in both provided greatly enhanced fit, and that also enabled the heel to hold better. There's also a change within the midole's forefoot of the Del Sol, making it feathery soft during propulsion. While that's probably not the sensation I prefer for scaling these hills at home, for fast, hard flats it's a challenge for me to think of a shoe I would like better on that kind of surface.

One new introduction will be an unusual racing flat. There is virtually no shank, and a pair of wavespring units will be imbedded in the forefoot. A totally inappropriate shoe for my weight and gait type, but I'm hoping to get an appraisal from one of my docs who was an elite collegiate distance runner. Intimate testing or not, this is an intriguing design.

Spira will also have women's casual shoes coming with their wavespring imbedded in the heel. Styling and lasting look to be versatile, and I'm looking forward to dispensing these to patients I already have in mind.

I'll post on some other products and aspects of the show, later.

Result number: 160

Message Number 215568

Re: How Does One Live With All The Pain? View Thread
Posted by DavidW on 11/13/06 at 20:02

Linda, I live with the pain because I have to. I listen to my pain and do only what I can, accepting my current limitations because I realize that this is reality. I will never give up trying to find a solution though, even if I die trying. I try not to get too depressed and dwell over what I cannot do, but rather find things that I can do, which makes me feel better. I stay positive by looking forward to the day when this curse is behind me, a day that I must believe is coming.

Stay positive...that is the only hope.

Result number: 161

Message Number 214756

A SAD DAY FOR ME BUT I MUST LEAVE THIS SITE FOREVER THIS WILL BE MY LAST POST View Thread
Posted by Bryan W. on 11/01/06 at 18:08

So sorry to report this most unfortunate development but the management of this board and I do not see “eye to eye” I quote the following management post…

“Bryan W, I like having visitors to my heelspurs.com message board and i don't normally allow links to competing message boards. In the past year 6 different web sites have tried to use this message board to advertise for a competing message board. I've counted 46 'advertisements' to your competing TTS/PF message board in the last few months which is of course a lot. I was OK with it at first since it was just case histories of TTS, but now it has a plantar fasciitis board, so I've placed a block on yours also.”

Because of my new forum for TTS (which is not a commercial endeavor) the management here see it as a threat to this board’s existence! Even though I have always maintained and stated numerous that it was to augment and not compete with this fine “daily message board”

It is a shame that this has come to be but I am committed to having a forum on TTS where one can post there entire story and photos and such as that I personally believe that: 1) A forum is a better format for posting in that one can return and add additional posts to their original thread. 2) One can post photos and diagrams and drawings. 3) Internet wise the forum is an evolution into the modern “cyber-world” resulting from the “message board” that were the first methods used back in the late 80’s and 90’s.

But most importantly I felt it was important to the sufferers of TTS that we have a forum that would allow us to “library” all of our different and unique experiences with TTS in their chronological order!

Despite my repeated statements that I was not doing this to compete the management here must think differently. So I have elected to go it alone on the other site.

I know I will miss reading the posts here and answering them with my thoughts and comments from all that I have read and learned about TTS and a great amount of it right here in fact.

But just like life itself sometimes CHANGE IS INEVITABLE and life goes on!

Perhaps I will regret my decision later but that is the chance I take because I stand on my convictions as stated all along: THAT IF WE WANT THE WORLD TO STAND UP AND TAKE NOTICE OF TTS WE NEED A FORMAT THAT IS MODERN AND UTILIZES ALL THAT THE INTERNET HAS TO OFFER! That is to say visual format (photos), superior indexing, and ease of returning to “ONE’S OWN THREAD” and adding additional information as time marches on with the ability to allow all others to see that new info has been added by bringing the thread back up to the top of the list. Something a message board can never do because of inherent design limitations. Those of you familiar with forums will know exactly what I mean by this!

I extend one final offer to the Management here that they should embrace my noble efforts and work with me of the success of the new TTS forum and embrace it and we could easily co-exist together in a united front and not be divided! You know how to reach me if you want to do such ever in the future! E-mail wb9mcw at gmail.com

I promise three things about the new TTS forum.

1) It is run and moderated by actual TTS patients!
2) It will never be a “commercial site” with ad’s of profiteering by the management
3) We will embrace new technology of the internet as it evolves (not chat rooms and web cams but modern forum formatting)

Who knows maybe I am completely off base and you all prefer it this way and that is fine if that is the case. Perhaps you all are not as willing to share your entire stories with the world and prefer to just post “little tidbits” at a time on a daily or weekly basis and do not desire the continuity of the forum format. But I truly believe that a forum will allow the “POOR NEW TTS PATIENT” a great resource in forum format to research each individual TTS case, which is not impossible with a board format, but just a PITA to say the least. I know (and maybe some of you do too) because I did just that with this board when I got my DX of TTS and it took me days when it could have been so much less work with a forum design. BUT THE MOST IMPORTANT REASON IS IT WILL BE A LOT BETTER FORMAT AND WILL SERVE AS A LIBRARY FOR THE MEDICAL COMMUNITY TO SEE EACH CASE AS AN INDIVIDUAL THREAD WITH MULTIPLE POSTS OVER TIME IN ONE SPECIFIC THREAD AND HELP TO FURTHER OUR CAUSE OF “TTS AWARENESS” TO THE WORLD WHEN DONE THIS WAY! Just my opinion and hey I could be wrong! I think most of you know where it is at (the hyper links have now been blocked) I look forward to any of you visiting me there. If you forgot to bookmark it just go to Bambi/Helen’s site (http://www.tap4tts.co.uk/ ) and she has a link to it under ‘Nerve Pain Sufferers Stories’ and also under “External Links” in “Wikipedia”(http://en.wikipedia.org/wiki/Tarsal_tunnel_syndrome) where I even took the time to post this board as a resource!

I wish you all the best here and it has been lots of fun chatting with you all but I will just hang out on the new forum and do my “chatting over there”. If I cannot show active hyper links to the forum when I wish to point others to already existing posts that well cover their exact question one ends up posting the same information again and again. This is exactly why I prefer the modern format of a forum where it is easy to find the old posts and just link & direct someone to the already previously posted information.

Result number: 162

Message Number 214563

Re: "Good Feet" Store and Arch Supports View Thread
Posted by Happy Alzner User/seller on 10/30/06 at 14:31

OK,
I am very sad to see so many of you that have had problems. I have been wearing the same Alzner Orthotics for 11 years now. I put them on day one and didn't take them off (Not normal I know). Now I liked them, bought a pair for my Father. He did the same thing, he has been wearing his for 1 year less than I as I told him I wanted to try them out first. I then went and sold them at my Office. In the 5+ years I ran my office I think I had 1 person that had an issue with them and I did give the money back. I saw these people on a regular basis and can speak for them wearing them there after.

The issue here, as in anything, there are those that take advantage of others/ elderly etc, and are only in it for the $$. Then there are those that care about the people and have a working knowledge of anatomy and physiology. I have been an assistant Chiropractor and Massage Therapist and have a very good knowledge of the foot. The "tests" you talk negatively about are actual test and can be repeated - see/search for "Applied Kinesiology". Now I can not speak for all of the people selling the orthotics, but I found one that sold me my pair, then I sold them to others. I still have mine checked with a Chiro but they have yet to cause me any weakness. There are many imitators, and it is indeed something that has stopped my back from "going out" as it has for my father (who has spina bifida).

Arches without both arches in the foot (Longitudinal and Metatarsal)are substandard and are very much like the "Custom-made" orthotics.
Let me ask you a question- If a highway bridge was sagging and falling down, do you think any engineer would 'OK' supports to be used as a permanent fix to hold it where it was or would put the bridge back into it's proper location and then add supports AFTER?!

Your food is the base of your body, if it is off, your feet (like shock absorbers) can not function as they were designed. Your body being an amazing adaptable machine will 'adjust' bone/muscle tension in order to make up for this - leading to spine misalignments and strain on muscles and bone in order to make up for the loss.

I don't have time or space to go into all details of this and you can either take it or leave it.
If someone is giving you orthotics that are custom made to your misaligned foot, they are only supporting your bad body mechanics, not really helping you (unless you consider not making things worse helping) while something that moves your foot back into it's proper shape will. Now that is the key, upon what basis is the arch created? Anatomically correct are the baseline, I recognize VERY VERY few people have this 'perfect' foot, but they can be used as a baseline to align your foot back into the closest you will come.

Now, this leads to another point, when you get home, do you rush to take your shoes off? Do your feet feel better with them off than on? My feet feel better with the orthotics than without.

Since the majority of us walk on hard firm surfaces (as apposed to natural earth/dirt) our feet take severe abuse. Arch supports should be hard to prevent themselves from being beaten out of shape. Most of my clients would start out 2 hrs a day, see how then felt after 3-4 days of wearing them and adjusted the time they wore them until they were able to wear them all day. This did take over 30 days for most, and some did buy 2 or more as their foot got smaller (make any flat line curved and the 2 endpoints of that line MUST get smaller) over the years but none had any problem with this as their feet were MUCH better and their visits to me were made with less frequency due to their bodies ability to function properly and not go "out" with small actions as they would before.

Last thought – let any foundation sink unevenly and cracks WILL form in the structure. Your feet are like that foundation, and when they are out- the cracks will be the musculoskeletal adjustments your body makes.

Result number: 163

Message Number 214561

Re: Plantar splints. Sock or Box? View Thread
Posted by Dr. David S. Wander on 10/30/06 at 13:07

It is really a personal preference. I can tell you that in MY practice, the overwhelming majority of patients have preferred the Strassburg Sock, and my patients have obtained the greatest benefits from the use of the Strassburg Sock. There are many imitations of this product, so if you choose to use a sock type product, I would highly recommend that you purchase the Strassburg Sock. By the way, I have absolutely NO financial interest in the company, I just think it's a great product.

I do however recommend one modification if you purchase the product. Many of my patients complained that they did not feel they obtained enough "stretch" at the ankle when using the sock. I've modified the instructions a little bit and I feel that this makes the sock more effective as well as more comfortable. When applying the sock, I have my patients maximally dorsiflex their foot (bend the foot up toward the ankle) BEFORE they tighten the strap. This allows for more stretch at the ankle, and less pulling of the toes. Anyone that's used the product will understand what I'm talking about. If you don't bend your ankle FIRST, and simply pull the strap, the toes tend to pull back too much and the ankle doesn't bend much, and the more the ankle bends, the better the sock works.

Result number: 164

Message Number 214382

Re: To Hope View Thread
Posted by Ralph on 10/27/06 at 09:13

Hope,
When you say that you are trying to get into a support group do you mean you are having internet difficulties or the whole process is sooooo difficult and sooooo selective you are not able to join?

Have you seen this doctors website? http://www.rsdrx.com/index.html

From reading Dr. Hooshmand wrote the bible on RSD. I don't know if everything he's written about holds true today or not but once again it will give you questions to ask your doctors.

I definitely agree that you need to find another doctor. What I would do if I were you is call around to Major Medical Centers closest to you and try and find a doc that specalizes in RSD Cases.

I've not had any experience with Disability myself but having seen others apply for it it's not an over night process. Some people have had to get an attorney to secure it for them. The decision to move forward with this is certainly up to you. If your attorney is good he should be able to tell you if this would be a good move for you.

I would imagine that when Workmans Comp is concerned every detail and step that you take is watched carefully so you need to know what steps benefit you and which steps make it look like you are improving so that you loose benefits. I probably didn't explain myself very well but maybe you get what I'm trying to say. You need to make certain that everyone on YOUR TEAM is working for your good and not to make life easier for themselves.

I realize working through Workmans Comp you are limited but you also have an Attorney so maybe it's time for him to kick into high gear and start helping you seem other doctors.

From what I've read on Dr. Hooshmand's site I don't think amputaion
is really a choice. The Nervous system doesn't seem to work that way but then again you need to remember I'm not a doctor. You'd certainly need expert advice from someone like that other doctor that I posted about.

RSD seem to have a mind of it's own and although it's highly active in one area of the body ie your foot and ankle your entire peripheral nervous system it would seem to me is still very much involved.

You'd really need expert advice before you go ahead with amputation and even talk to other RSD patients that did this.

The reason your counceler wants you to get out is because getting back to a somewhat "normal" social routine is healthy, inspiring and mentally healing but you can do only what you can do. I think by now you know your limitations. You need to try some of the things she is telling you within your limitations and those outings right now may be very short outings rather then overnight camp outs. Hope you can only do what you can to the best of your ability with this condition.

I don't know if your doctors have given up on you or not but you need doctors that will be your cheerleaders and maybe it's time as your attorney says to move on. Do your homework and find the best docs in your area even if it means a bit of travel for you. You need to pick your doctors after you've done some research on them.

I'm still very surprised that your PM wanted your OS doc to take over your meds. Maybe this happens in smaller towns but I can tell you it doesn't happen where I live. The PM I saw wants contol of those meds and in no way was he going to give that responsibility back to my Ortho.

Keep the faith even though it's sooooo difficult to do and begin to work on plan B. I realize that you are between a rock and a hard place dealing with Workmans comp. but I wonder if there is a possibility for you to self-pay for an initial assessment from another doctor so that you could be seen faster. You'd have to ask your attorney how this would be seen by Workmands comp. because I know every move is monitored.

I'll try and see what I can find about ampuation and RSD but I don't think if you did this you'd be cured my guess is that the RSD would go to another location, but again I'm not a doctor or an expert on RSD.
Ralph

Result number: 165

Message Number 213403

Re: Miracle Treatment or New Job? View Thread
Posted by R. Parker, DPM on 10/16/06 at 11:14

Unfortunately, many podiatrists here also have a reflex which causes them to prescribe orthotics. They do so here for one of at least two reasons . . Either because they lack the capability of or have not taken the time to establish a real and relevant diagnosis, and orthotics are accepted and thought by lay folks to cure any and all foot problems . . and there is the seduction of the making of an easy buck, which is hard to deny. It is typical of those who make shoot-from-the-hip diagnoses to give up when their one and only treatment fails. But in my view there is too much emphasis on relying on sophisticated electronic tests for the making diagnoses which most experienced doctors should be able to make from basic, low-cost physical examination and the taking of a good history. In my view, MRI's, ultrasound, scans, etc. are employed far more often than is needed. In my view, there are a number of reasons for this:

1. Lack of basic diagnostic skill by the doctor, causing him/her to rely on "electronic tests rather than their knowledge and experience.

2. Pressure from patients, especially those with good medical insurance, to spare no expense in their diagnoses.

3. Pressure from threats of litagation if medical misadventures occur and all possible tests were not performed.

4. Pressure from hospitals for their visiting and house-based staff to utilize expensive machinery which has been purchaced and must earn its keep.

I would judge that the VAST majority of cases of PF can be adequately diagnosis without such high-tech epuipment, and it is often questionable as to whether the use of such equipment and the information so-gleaned will modify the treatments administered.

I do not know the statistic which you request in reference to PF being confused with TTS and Baxter's Nerve entrapment, but both of these condition are relatively rare and should be considered mainly when there has not been the typical response to repeated attempts at conservative care of PF. It should be noted that these condition may exist concomitantly with actual PF.

I cannot support your doctor's statement that nerve conduction tests are not of value in foot condition, but as with any other diagnostic test or method of examination, they do not provide iron-clad results. Finally, neuropathies of all kinds are rather common both within the foot and affecting the feet, so I am amused at your doctor's amusement.

Result number: 166

Message Number 213379

Re: Miracle Treatment or New Job? View Thread
Posted by R. Parker, DPM on 10/16/06 at 08:18

Without knowing precisely what was attempted in your previous treatment, and how consistent with good principles of care such was applied, it is impossible to offer a meaningful prognosis. It is not uncommon in medicine that a repeat of what seemed to have been failed care, sometimes in new hands, but often by the same hands, proves successful. As far as your job being the cause of your problem, it might play a substantial factor in it, but it is more likely an exciting or exacerbating cause rather than a basic underlying condition which in lieu of faulty foot mechanics or other intrinsic factors would cause problems. That being said, the successful treatment of PF is most always one of control and maintenance rather than cure, and MAY require modification of activities on a case by case basis.

The other and obvious aspect on which the answer you request may hinge is the accuracy of the diagnosis, as other condition may present symptoms which may both simulate and can existent concomitantly with PF.

Result number: 167

Message Number 213252

Re: Question for Dr. Zuckerman View Thread
Posted by R. Parker, DPM on 10/14/06 at 10:38

Making no sense has been a notable, defining and consistent feature of your postings, Z-Man. And THEY, at least in NAME, are in English. But with your legendary inability to express yourself in what is your native tongue, do you now really wish to opine as to whether my French meets your same "standards," such as they might be? It is evident that you are willing to argue over just about anything, other than real medical issues for which your knowledge is so sparse, and I'm not going to buy into your attempts to create new diversions on this site which you might believe will obfuscate your lack of such knowledge in subjects and areas truly pertinent here. I might say, "good try at spinning comment away from your professional limitations," Z-Man . . but it WASN'T, and I WON'T.

But the fact that you and a few others are so very anxious to challenge me, even in areas which are clearly intended for fun and games, simply ratifies your general respect for my authoritative correctness in most arenas. As so often is the case, exceptions prove the rule. So, once again . . I thank you for your support.

Do you and your aliases and your cronies never tire of putting your feet squarely in your mouths?

Result number: 168

Message Number 212980

Re: shoes that contribute to plantar fasiitis View Thread
Posted by R. Parker, DPM on 10/11/06 at 12:07

When I speak of heel rises in the ongoing treatment/prevention of PF, I am not speaking of anything more than employing a normal heel height. Flat shoes and going barefoot can be "death" even for someone who has just a predilection for the condition, and such will sometimes be the major exciting factor in a full-blown recurrance. Certainly, there are negative consequence, seen almost exclusively in women who constantly or exclusively wear high heel shoes, both in terms of contractures of the Achilles tendon, subsequently limitating the range of painless plantarflection at the ankle and in problems related to abnormal posture and its effect on the rest of the body. But periodic stretching of the Achilles tendon is a good idea for anyone who is or has suffered from PF, and in my view, this should be done both actively and passively, but essentially non-weight-bearing.

Result number: 169

Message Number 212870

Re: possible baxter's nerve entrapment View Thread
Posted by R. Parker, DPM on 10/10/06 at 15:20

It is generally held that TTS will only be picked up by a nerve conduction test/EMG if about 50 percent or more of the tibial nerve function is gone. So one must rely of the confluence of a number of signs and symptoms to make such a diagnosis. As you mentioned resthesias/burning sensations on the outer edge (lateral side) of your heel, Baxter's nerve entrapment may well be on the differential diagnosis list. However, this is a condition whichmay also be difficult to diagnose, and it does exist concomitantly on occasions with PF. I would suggest that you look up the information on Baxter's nerve entrapment on the Internet so as to familiarize yourself with its characteristics and generally employed presumptive tests. It is very possible that your podiatrist has only a passing knowledge of this condition.

Result number: 170

Message Number 212648

Re: Statistical Question -ScottR anyone please help me View Thread
Posted by SA on 10/08/06 at 18:45

Dr. Z,
I have some stats training, but Dawn has pretty much summed it up. It's not really a stats question, as there are no hard "fixed" cutpoints, but mail surveys in health research have a notoriously poor response rate overall (20-40% is what I usually see in the literature). What this means is, while researchers may report on survey findings based on a low response rate, the results can not be generalized beyond the study sample (meaning that you could only draw conclusions about the people who responded, not about anyone else with that condition). The reason is that in these cases, "responders" are often very different from "nonresponders" on a variety of characteristics, and this can bias the results. Physicians may report findings from a particular group of their patients; this is considered a case-series and is subject to the same limitations (but can still be useful as descriptive research).

Result number: 171

Message Number 212391

Re: Best Doc in USA to Perform Surgery? View Thread
Posted by R. Parker, DPM on 10/05/06 at 21:04

I may have to frame your post for my office wall.

I'll be happy to tune in and see if I can add to the conversation. I don't often go on the TTS Message Board here because, although I see and treat TTS from time to time, generally with reasonable success, it is not one of the areas about which I feel most qualified to comment upon. As you may have noted from my posts, I like to, as they say in sports, "play within myself" rather than shooting from the hip and/or extending myself beyond my real competence. I'd much rather say "I don't know." when I don't know, than fake it, even in a forum venue. That became increasingly easier to voice as time in practice passed and experience grew, as, when you know much of what you need to know and have seen much of what you are expected to have seen, it should not longer be considered a pejorative to freely admit not knowing everything. Fortunately for me, I practice in a hospital environment, and I have become use to a cooperative team-approach to diagnosis and treatment, in which we tend to lean on each others best assets and expertise rather than going it alone. This has decided advantages for the patient, and the doctors do not have to be expert Jacks of all Trades. One of the problems in treating TTS is that the diagnosis is often a judgment call based on the concomitant presence of multiple signs and often vague symptoms, and both the conservative treatments and the surgical treatments are often basically empiric in nature. It takes a certain amount of guts to take a patient to surgery for an elective procedure with the lack of complete certainty inherent in such a diagnosis.

Result number: 172

Message Number 212328

Re: Fracture of Calcaneous View Thread
Posted by R. Parker, DPM on 10/05/06 at 13:30

Fractures of the calcaneus can be quite difficult. Even the diagnosis can sometime be tricky. Crushing/compression/comminuted fractures, as might be occasioned from a fall from high place and landing directly on the heel, especially with the leg fully extended at the knee can be devastating. But the precise method of reduction/stabilization of fractures of the calcaneus, as well as any estimation as to the prognosis would be based upon a careful and learned evaluation of the damage. The choice of anesthesia may be dictated by your general health or specific chronic ailments and/or the choice of the surgeon and the anesthesiologist. If you have preferences or concerns regarding the anesthesia, such should be discussed with the doctors referenced above. I would caution you to infer neither encouragement nor concerns from what those here who have no way of examining your foot or knowing the nature of the fracture or what other concomitant damage may have been done might specifically offer. Yours is a question that clearly cannot be answer here to the extent that you seem to desire. As most always, your own attending doctor would be the best source of the answers to the questions you pose.

Result number: 173

Message Number 211876

Re: has anyone used this "splint" product View Thread
Posted by Dr. David S. Wander on 10/01/06 at 11:01

I like and recommend the Strassburg Sock for my patients. The product that you are considering and that you have supplied a link to, I DO NOT recommend. In my personal opinion, it is a very poor "copy"/imitation of the Strassburg Sock. However, this product does not really seem to accomplish much other than bending your toes back. Although the Strassburg sock does pull your toes back, it also dorsiflexes (bends back) your ankle. By doing this, it allows your Achilles tendon to stretch. Bending back your toes, without dorsiflexing your ankle will really not accomplish anything, since the plantar fascia itself can not stretch. The "stretching" has to be accomplished at the level of the Achilles tendon. Bending the toes in conjunction with the ankle does increase the stretch due to the "windlass" effect, however simply bending the toes back by themselves, such as the product in the link you provided, in my mind is a waste of money.

Stick with the Strassburg Sock or a traditional night splint. The one in the picture does not have my vote.

Result number: 174

Message Number 211798

Re: NB / RYKA View Thread
Posted by Jeremy L on 9/30/06 at 09:00

With your "goos clothes", have you considered perhaps Aravon or Naturalizer? Most of the Aravons will have similar mechanical as your 992's, and have a fairly similar fit. They also very easily accomidate orthotics. You'd need to be more selective about Naturalizer. There is a wide variety of shapes used by that brand, and not all their styles will provide sole or heel elements which will work well for you. However with some careful evaluation on your part, you can likely get a good shoe for you from this brand for not a lot of money.

There are two additional caveats in regards to Naturalizer. One is that the leather quality is not all that great when compared to finer orthopedic brands. SoftWalk has the same kind of limitation. This is one of the reasons you can get a shoe from these brands that have awesome sole construction for less than $100 msrp. Also with these brands, the inlay is glued. Be slow and careful in removing it for use with your chosen insert, so you don't leave too much latex debris still adhered to the shoe.

Result number: 175

Message Number 210641

Re: to all of you View Thread
Posted by MUF on 9/19/06 at 09:12

Well I am most definitely not young anymore and if someone told me to quit running, I'd just laugh since I wouldn't run across a street to see Denzel naked before TTS!

I've have bilateral TT release with partial plantar fasciectomy. I was back in a shoe and walking with a slight limp in less than 6 weeks - before my tendons blew out the outside of my ankle.

You MUST laugh at TTS or it wins! Lyrica helps me (with nasty side effects), alternative medicine did not help and was a money drain. PT did nothing - another money drain. My orthopedic surgeon- fellowship trained in foot/ankle - has made the TTS much better (not gone). I'm lucky.

But to all of us with TTS - we have TTS, we are not TTS ourselves. I can do everything that I did before TT release if I am willing to pay the price of discomfort. My only limitation is that I must stop and rest my feet regularly. I refuse to accept anything else. I've worked with a pain specialist for inoperable back pain and you really can learn to ignore the pain to an amazing degree especially with medications like Neurontin and Lyrica. This has been a benefit and a curse for me since I ignored my foot pain too well.

Keep trying to find your magic combination of treatments! I really believe that it can be made better for each of us.

Result number: 176
Searching file 20

Message Number 209587

Re: RSD!!! Ralph View Thread
Posted by Ralph on 9/07/06 at 20:28

Hi Hope,
I'm glad you have a good support system. It must be very difficult as a mom of 3 to be the one on the sideline. I can see how you'd feel
some guilt from that picture, but whether it's RSD or a stroke things happen that are out of our control. We have to grieve our disability or illness. We have to learn how accept what is going on. We have to learn what we think may not really be what others are thinking at all, and we have to live one day at a time to the best of our ability. That's not saying it's going to be great. It's just saying we'll cope the best that we can. We can't ask any more of ourselves.

When my son was younger his best friend's mom had a stroke. She was only 38 at the time. It was very difficult on the family because their plans didn't include "mom having a stroke".

My wife still keeps in touch with Joan. My wife asked Joan how she learned to cope and make the necessary adjustments in her life while trying to be a mother to 2 children and a wife.

Her response included some of the same things that I said earlier. Her children learned that mom had limitations and everyone needed to adjust to them, most of all mom.

Her children like mine are grown today. One is a doctor the other an Attorney.

I think both of us will find the person hardest on us is really ourself.

Didn't do much in P.T. today because of increased pain and swelling. I completed upper body exercises, had ultrasound and came home and iced most of the day. I've got to work to keep the inflammation down. I have ice pads in many different sizes and shapes that I keep in freezers. I had my son bring his old college refrigerator and put it in our bedroom. We turned it up to high and because it's cheap it freezes things which is exactly what I needed.

This works out well not only for me but for my wife too because she doesn't have to keep running up and down the stairs for ice pads. I've numbered them so if I want a specific one because of size she has an easier time finding it and I know which ones are upstairs and which ones are down. Never thought I'd be tracking ice pads.

Before I figured out this system we'd play get me the medium ice bag. She go downstairs to get it and when she'd get upstairs it wasn't the one I wanted soooo down she would go again. That game got old real fast so implementing the new improved ice bag system got a praise.

I've noticed that my down time has not only affected me but her as well. Somedays I'm short with her and somedays it's just the opposite. We both learned to say we are sorry for the edgeness. It happens it's just part of any long term health condition.

Man I could tell you stories about her having to bring dinner up every nignt and me having to lay on my side to eat. Same old, same old she'd want me to eat and I couldn't. We'd go round and round.

I guess no one said life would be easy. Enough babble for now.

Take care,
Ralph

Result number: 177

Message Number 209176

Re: Just a quick update View Thread
Posted by kconnell on 9/03/06 at 21:57

Maria,
I had to take a term off when I had my brain surgery, it is hard to face but you will do just fine when you go back. I got straight A's the term I returned and graduated with honors. You will be better able to face the challenges of school when you don't have the physical limitations and pain hanging over you. Good luck, keep positive. kconnell

Result number: 178

Message Number 209091

Re: "Good Feet" Store and Arch Supports View Thread
Posted by Jade on 9/02/06 at 16:28

Are you that stupid, how can a scam persist for more than so and so years? Lol? How do business that oppress the poor like Microsoft, Smiths or Walmart rise to the top? By lying scheming and strong arming. If your employees are clever and ruthless enough, JUST LIKE THE ROMAN EMPIRE, you can stay in power for a very long time. Your question is just as stupid as asking, "How could Saddam stay in power for so long if he was corrupt?" or other stupid questions like that.

On top of that, go to http://www.thedenverchannel.com/7newsinvestigates/4979919/detail.html

What they discovered was the same I discovered before even seeing that website. The owner in my area said they can correct blah blah with the insoles. BULL. I told the scammer about a pair of insoles I got off tv and he said it wouldn't work because they just ask for your shoe size. LOL, THAT IS PRETTY MUCH ALL HE DID TOO AND GAVE ME A CHOICE OF TWO INSOLES AND WOULD NOT TELL ME THE DIFFERENCE WHEN I ASKED. ONE WAS GREY ONE WAS WHITISH. The only difference was that one seemed barely to flex a little more or either one was formed better. Guess what? While staring at his pile of thrown away insoles from convinced customers (nice tactic) and trying to see if I could find the ones I bought, I FOUND THEM, SHOWED THEM TO HIM AND HE SAID OH THEY GOT SUED, AND I REEXAMINED THEM WHILE HE WAS AWAY. I waited for him to bring me or show me the insoles he wanted me to buy, GUESS WHAT? THE INSOLES HE WAS TRYING TO SELL ME WERE THE SAME AS THOSE $24 ONES I GOT ON TV WHICH GUESS WHAT? WERE CAUSING ME THE SAME PAIN AS THOSE INSOLES! And what was his magical method of masking the pain lol? THE SAME I CAME UP WITH!: PLACING THE INSOLES OVER THE HARD ONES HE WAS SELLING ME. And ooooh, his generic black cover-up were better tho cuz uh, well he didn't say, but said they'd last six months, which is shorter than the amount of time others have lasted me.

He wanted $369 not including tax in the price for his set up. Lol, I still have my imitation? azzner alzner whatevers and can easily buy a pair of Dr. Scholls and place them over them for less than $369 that's for sure.

Check out http://lulu.com/newkingdom

Result number: 179

Message Number 208971

Wilson Plame lie View Thread
Posted by larrym on 9/01/06 at 08:51

End of an Affair
It turns out that the person who exposed CIA agent Valerie Plame was not out to punish her husband.

Friday, September 1, 2006; A20



WE'RE RELUCTANT to return to the subject of former CIA employee Valerie Plame because of our oft-stated belief that far too much attention and debate in Washington has been devoted to her story and that of her husband, former ambassador Joseph C. Wilson IV, over the past three years. But all those who have opined on this affair ought to take note of the not-so-surprising disclosure that the primary source of the newspaper column in which Ms. Plame's cover as an agent was purportedly blown in 2003 was former deputy secretary of state Richard L. Armitage.

Mr. Armitage was one of the Bush administration officials who supported the invasion of Iraq only reluctantly. He was a political rival of the White House and Pentagon officials who championed the war and whom Mr. Wilson accused of twisting intelligence about Iraq and then plotting to destroy him. Unaware that Ms. Plame's identity was classified information, Mr. Armitage reportedly passed it along to columnist Robert D. Novak "in an offhand manner, virtually as gossip," according to a story this week by the Post's R. Jeffrey

Smith, who quoted a former colleague of Mr. Armitage.

It follows that one of the most sensational charges leveled against the Bush White House -- that it orchestrated the leak of Ms. Plame's identity to ruin her career and thus punish Mr. Wilson -- is untrue. The partisan clamor that followed the raising of that allegation by Mr. Wilson in the summer of 2003 led to the appointment of a special prosecutor, a costly and prolonged investigation, and the indictment of Vice President Cheney's chief of staff, I. Lewis "Scooter" Libby, on charges of perjury. All of that might have been avoided had Mr. Armitage's identity been known three years ago.

That's not to say that Mr. Libby and other White House officials are blameless. As prosecutor Patrick J. Fitzgerald has reported, when Mr. Wilson charged that intelligence about Iraq had been twisted to make a case for war, Mr. Libby and Mr. Cheney reacted by inquiring about Ms. Plame's role in recommending Mr. Wilson for a CIA-sponsored trip to Niger, where he investigated reports that Iraq had sought to purchase uranium. Mr. Libby then allegedly disclosed Ms. Plame's identity to journalists and lied to a grand jury when he said he had learned of her identity from one of those reporters. Mr. Libby and his boss, Mr. Cheney, were trying to discredit Mr. Wilson; if Mr. Fitzgerald's account is correct, they were careless about handling information that was classified.

Nevertheless, it now appears that the person most responsible for the end of Ms. Plame's CIA career is Mr. Wilson. Mr. Wilson chose to go public with an explosive charge, claiming -- falsely, as it turned out -- that he had debunked reports of Iraqi uranium-shopping in Niger and that his report had circulated to senior administration officials. He ought to have expected that both those officials and journalists such as Mr. Novak would ask why a retired ambassador would have been sent on such a mission and that the answer would point to his wife. He diverted responsibility from himself and his false charges by claiming that President Bush's closest aides had engaged in an illegal conspiracy. It's unfortunate that so many people took him seriously.

Result number: 180

Message Number 208811

Re: Active Release Technique? View Thread
Posted by Robert J. Sanfilippo, DC, CCSP, ART on 8/30/06 at 08:18

Dan you are right, the technique(s) are utilized to break up scar tissue and in a way we are reinjuring the tissue. So when you developed this bout of plantar fasciosis over time your body laid down fibrotic(scar) tissue due to the inflammatory agents and stresses applied to that tissue. When that occurs, the grade of scar tissue is very poor and very inflexible. So the theory behind what we do falls along the line of Wolff's Law. If you "stress" a tissue it will respond by forming stronger linkages and will have the flexibility of normal tissue. So by breaking up the bad scar tissue we are encouraging the body to lay down a superior grade of tissue. We are trying to restore that tissue to full function before the injury occurred. Also, scar tissue can "wrap" around nerves and other structures that will cause pain and limit function as well. As a soft tissue practitioner we are trained to feel for these limitations and correct them with our methods; ART or Graston, or both.

Hope this answered your question....be well

Dr. Rob

Result number: 181

Message Number 208449

Re: black NB shoes View Thread
Posted by Jeremy L on 8/26/06 at 08:30

The shoe your patient describes is the New Balance MK706B. Mail carriers can wear whatever they want, as long as it's black. Now if they expect USPS to pay for the shoe out of their uniform fund, it also needs to be manufactured in the US. Lot's of luck finding those, these days. Due to the exportation of shoe labor, and trade agreements with Asian countries, this policy is set to be updated. There will still be certain limitations, but will allow more brands/models of shoes than previously accepted.

From my understanding, USPS employees in sorting facilities are not under the same uniform constraints. Most wear some sort of running shoe on those solid concrete surfaces.

Result number: 182

Message Number 208298

Re: Is TTS pain a sign you should listen to? View Thread
Posted by Bryan W. on 8/24/06 at 17:52

I agree with the above comments. The pain meds will allow you to go further but there is a reason the pain exists..to tell your brain enough now rest. When the nerve is agitated it feeds back via the pain message. so if you cover it with meds...well now you are going to really make things worse in the long run. Will you cause more damage to the nerve that is not reversable??? maybe I do not think even a Pod or Dr. will advise it is a good thing. But sometimes you want to go the extra yard so you use the meds...for me it is Ibuprofen since it works pretty well and I have a good tummy for it! I agree with Bambi the strong meds are good in the begining but one should ween off ASAP since the longterm is as she said not a good outcome typically. Some might argue about Lycra but so far I have resisted going on it since i am able to tollerate my pain levels with just Ibuprofen. From Wikipedia I copy/paste.....
_____________________________________________________________________
Pregabalin (INN) (IPA: [prɪˈgæbələn]) is an anticonvulsant drug used for neuropathic pain, as an adjunct therapy for partial seizures, and in generalized anxiety disorder. It was designed as a more potent successor to gabapentin. Pregabalin is marketed by Pfizer under the trade name Lyrica.

In the U.S., it is considered to have dependence liability if misused, and is classified as a Schedule V drug.[1]

History

Pregabalin was initially developed by biochemist Richard Silverman at Northwestern University in the United States. The drug was approved in the European Union in 2004. Pregabalin received U.S. Food and Drug Administration (FDA) approval for use in treating epilepsy, diabetic neuropathy pain and post-herpetic neuralgia pain in June 2005, and appeared on the U.S. market in fall 2005.

Pharmacology

Like gabapentin, pregabalin binds to the α2δ subunit of the voltage-dependent calcium channel in the central nervous system, blocking channel action and thus calcium influx. However, the exact mechanism of action is unknown.

Clinical use

Indications

Pregabalin is indicated for:

* Treatment of neuropathic pain in adults
* Adjunctive therapy in adults with partial seizures with or without secondary generalization

In the European Union, it has also been approved for the treatment of generalized anxiety disorder (GAD).[2]

Adverse effects

Adverse drug reactions associated with the use of pregabalin include:[3][4]

* Very common (>10% of patients): dizziness, drowsiness
* Common (1–10% of patients): visual disturbance (including blurred vision, diplopia), ataxia, dysarthria, tremor, lethargy, memory impairment, euphoria, weight gain, constipation, dry mouth, peripheral edema
* Infrequent (0.1–1% of patients): depression, confusion, agitation, hallucinations, myoclonus, hypoaesthesia, hyperaesthesia, tachycardia, excessive salivation, sweating, flushing, rash, muscle cramp, myalgia, arthralgia, urinary incontinence, dysuria, thrombocytopenia
* Rare (<0.1% of patients): neutropenia, first degree heart block, hypotension, hypertension, pancreatitis, dysphagia, oliguria, rhabdomyolysis

Drug interactions

No pharmacokinetic interactions have been demonstrated in vivo. The manufacturer notes some potential pharmacological interactions with oxycodone, lorazepam and ethanol (alcohol). Concurrent use may increase the central nervous system effects of these medications (e.g. drowsiness, effects on concentration).[3]

References

1. ^ Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: placement of pregabalin into schedule V. Final rule. Fed Regist 2005;70(144):43633-5. PMID 16050051
2. ^ Pfizer (2006-03-27). Pfizer's Lyrica Approved for the Treatment of Generalized Anxiety Disorder (GAD) in Europe. Press release. Retrieved on 2006-06-02.
3. ^ a b Pfizer Australia Pty Ltd. Lyrica (Australian Approved Product Information). West Ryde: Pfizer; 2006.
4. ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
___________________________________________________________________

Ibuprofen (INN) (IPA: [ˈaɪbjuprofɛn]) is a non-steroidal anti-inflammatory drug (NSAID) widely marketed under various trademarks including Act-3, Advil, Brufen, Motrin, Nuprin, and Nurofen. It is used for relief of symptoms of arthritis, primary dysmenorrhoea, fever, and as an analgesic, especially where there is an inflammatory component. Ibuprofen was developed by the research arm of Boots Group.

Clinical use

Low doses of ibuprofen (200 mg., and sometimes 400 mg.) are available over the counter (OTC) in most countries. Ibuprofen has a dose-dependent duration of action of approximately 4–8 hours, which is longer than suggested by its short half-life. The recommended dose varies with body mass and indication. Generally, the oral dose is 200–400 mg (5–10 mg/kg in children) every 4–6 hours, up to a usual maximum daily dose of 800–1200 mg. Under medical direction, a maximum daily dose of 3200 mg may sometimes be used.

Off-Label and investigational use

* As with other NSAIDs, ibuprofen may be useful in the treatment of severe orthostatic hypotension.[1]
* In some studies, ibuprofen showed superior results compared to placebo in the prophylaxis of Alzheimer's disease, when given in low doses over a long time.[2] Further studies are needed to confirm the results before ibuprofen can be recommended for this indication.
* Ibuprofen has been associated with a lower risk of Parkinson's disease, and may delay or prevent Parkinson's disease. Aspirin, other NSAIDs, and paracetamol had no effect on the risk for Parkinson's.[3] Further research is warranted before recommending ibuprofen for this use.

Ibuprofen lysine

In Europe, Australia, and New Zealand ibuprofen lysine (ibuprofenlysinat, the lysine salt of ibuprofen) is licensed for treatment of the same conditions as ibuprofen. Ibuprofen lysine has been shown to have a more rapid onset of action compared to base ibuprofen.[4]

Mechanism of action

Ibuprofen is an NSAID which is believed to work through inhibition of cyclooxygenase (COX), thus inhibiting prostaglandin synthesis. There are at least 2 variations of cyclooxygenase (COX-1 and COX-2 ), ibuprofen inhibits both COX-1 and COX-2. It appears that its analgesic, antipyretic, and anti-inflammatory activity are achieved principally through COX-2 inhibition; whereas COX-1 inhibition is responsible for its unwanted effects on platelet aggregation and the GI mucosa.

Main article: Non-steroidal anti-inflammatory drug

Adverse effects

Ibuprofen appears to have the lowest incidence of gastrointestinal adverse drug reactions (ADRs) of all the non-selective NSAIDs. However, this only holds true at lower doses of ibuprofen, so over-the-counter preparations of ibuprofen are generally labelled to advise a maximum daily dose of 1,200 mg.

Main article: Non-steroidal anti-inflammatory drug

Reported adverse drug reactions

In low single doses (200 to 400 mg) and daily doses of up to 1,200 mg the incidence of side effects is low. However, in patients treated on a long-term basis with more than 1,200 mg daily discontinuation rates are as high as 10 to 15%.

Common adverse effects include: nausea, dyspepsia, gastrointestinal ulceration/bleeding, raised liver enzymes, diarrhoea, headache, dizziness, salt and fluid retention, hypertension.[5]

Infrequent adverse effects include: oesophageal ulceration, heart failure, hyperkalaemia, renal impairment, confusion, bronchospasm, rash.[5]

Photosensitivity

As with other NSAIDs, ibuprofen has been reported to be a photosensitising agent.[6][7] However, this only rarely occurs with ibuprofen and it considered to be a very weak photosensitising agent when compared with other members of the 2-arylpropionic acids. This is because the ibuprofen molecule contains only a single phenyl moiety and no bond conjugation, resulting in a very weak chromophore system and a very weak absorption spectrum which does not reach into the solar spectrum.

Cardiovascular risk

Along with several other NSAIDs, ibuprofen has been implicated in elevating the risk of myocardial infarction, particularly among those chronically using high doses.[8]

Stereochemistry
3D model of (R)-ibuprofen
Enlarge
3D model of (R)-ibuprofen

Ibuprofen, like other 2-arylpropionate derivatives (including ketoprofen, flurbiprofen, naproxen, etc) contains a chiral carbon in the α-position of the propionate moiety. As such there are two possible enantiomers of ibuprofen with the potential for different biological effects and metabolism for each enantiomer.

Indeed it was found that (S)-(+)-ibuprofen (dexibuprofen) was the active form both in vitro and in vivo.

It was logical, then, that there was the potential for improving the selectivity and potency of ibuprofen formulations by marketing ibuprofen as a single-enantiomer product (as occurs with naproxen, another NSAID).

Further in vivo testing, however, revealed the existence of an isomerase which converted (R)-ibuprofen to the active (S)-enantiomer. Thus, due to the expense and futility that might be involved in marketing the single-enantiomer, most ibuprofen formulations currently marketed are racemic mixtures. A notable exception to this is Seractiv (Nordic Drugs).

Human toxicology

Ibuprofen overdose has become common since it was licensed for over-the-counter use. There are many overdose experiences reported in the medical literature.[9] Human response in cases of overdose ranges from absence of symptoms to fatal outcome in spite of intensive care treatment. Most symptoms are an excess of the pharmacological action of ibuprofen and include abdominal pain, nausea, vomiting, drowsiness, dizziness, headache, tinnitus, and nystagmus. Rarely more severe symptoms such as gastrointestinal bleeding, seizures, metabolic acidosis, hyperkalaemia, hypotension, bradycardia, tachycardia, atrial fibrillation, coma, hepatic dysfunction, acute renal failure, cyanosis, respiratory depression, and cardiac arrest have been reported.[10]. The severity of symptoms varies with the ingested dose and the time elapsed, however, individual sensitivity also plays an important role. Generally, the symptoms observed with an overdose of ibuprofen are similar to the symptoms caused by overdoses of other NSAIDs.

There is little correlation between severity of symptoms and measured ibuprofen plasma levels. Toxic effects are unlikely at doses below 100 mg/kg but can be severe above 400 mg/kg;[11] however, large doses do not indicate that the clinical course is likely to be lethal.[12] It is not possible to determine a precise lethal dose, as this may vary with age, weight, and concomitant diseases of the individual patient.

Therapy is largely symptomatic. In cases presenting early, gastric decontamination is recommended. This is achieved using activated charcoal; charcoal absorbs the drug before it can enter the systemic circulation. Gastric lavage is now rarely used, but can be considered if the amount ingested is potentially life threatening and it can be performed within 60 minutes of ingestion. Emesis is not recommended.[13] The majority of ibuprofen ingestions produce only mild effects and the management of overdose is straightforward. Standard measures to maintain normal urine output should be instituted and renal function monitored.[11] Since ibuprofen has acidic properties and is also excreted in the urine, forced alkaline diuresis is theoretically beneficial. However, due to the fact ibuprofen is highly protein bound in the blood, there is minimal renal excretion of unchanged drug. Forced alkaline diuresis is therefore of limited benefit.[14] Symptomatic therapy for hypotension, GI bleeding, acidosis, and renal toxicity may be indicated. Occasionally, close monitoring in an intensive care unit for several days is necessary. If a patient survives the acute intoxication, he/she will usually experience no late sequelae.

Availability

Ibuprofen was made available under prescription in the United Kingdom in 1969. In the years since, the good tolerability profile along with extensive experience in the community (otherwise known as Phase IV trials), has resulted in the rescheduling of small packs of ibuprofen to allow availability over-the-counter in pharmacies worldwide. Indeed there has been an increasing trend towards descheduling ibuprofen such that it is now available in supermarkets and other general retailers. The wider availability has meant that ibuprofen is now almost as commonly used as aspirin and paracetamol.

Slang names
This section does not cite its references or sources.
You can help Wikipedia by introducing appropriate citations.

A standing joke about some athletes' regular use has produced "Vitamin I"[1] as a slang term for ibuprofen.

In the military, "Grunt Candy" is used as a generic name for ibuprofen, paracetamol, or naproxen.
[edit]

See also

* Paracetamol

References

1. ^ Zawada E (1982). "Renal consequences of nonsteroidal antiinflammatory drugs.". Postgrad Med 71 (5): 223-30. PMID 7041104.
2. ^ Townsend K, Praticò D (2005). "Novel therapeutic opportunities for Alzheimer's disease: focus on nonsteroidal anti-inflammatory drugs.". FASEB J 19 (12): 1592-601. PMID 16195368.
3. ^ Chen H, Jacobs E, Schwarzschild M, McCullough M, Calle E, Thun M, Ascherio A (2005). "Nonsteroidal antiinflammatory drug use and the risk for Parkinson's disease.". Ann Neurol 58 (6): 963-7. PMID 16240369.
4. ^ Geisslinger G, Dietzel K, Bezler H, Nuernberg B, Brune K (1989). "Therapeutically relevant differences in the pharmacokinetical and pharmaceutical behavior of ibuprofen lysinate as compared to ibuprofen acid.". Int J Clin Pharmacol Ther Toxicol 27 (7): 324-8. PMID 2777420.
5. ^ a b (2004) Rossi S Australian Medicines Handbook, 2004, Australian Medicines Handbook. ISBN 0-9578521-4-2.
6. ^ Bergner T, Przybilla B. Photosensitization caused by ibuprofen. J Am Acad Dermatol 1992;26(1):114-6. PMID 1531054
7. ^ Thomson Healthcare. USP DI Advice for the Patient: Anti-inflammatory Drugs, Nonsteroidal (Systemic) [monograph on the internet]. Bethesda (MD): U.S. National Library of Medicine; c2006 [updated 2006 Jul 28; cited 2006 Aug 5]. Available from: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202743.html
8. ^ Hippisley-Cox J, Coupland C (2005). "Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis.". BMJ 330 (7504): 1366. PMID 15947398.
9. ^ McElwee NE, Veltri JC, Bradford DC, Rollins DE. (1990). "A prospective, population-based study of acute ibuprofen overdose: complications are rare and routine serum levels not warranted.". Ann Emerg Med 19 (6): 657-62. PMID 2188537.
10. ^ Vale JA, Meredith TJ. (1986). "Acute poisoning due to non-steroidal anti-inflammatory drugs. Clinical features and management.". Med Toxicol 1 (1): 12-31. PMID 3537613.
11. ^ a b Volans G, Hartley V, McCrea S, Monaghan J. (2003). "Non-opioid analgesic poisoning". Clinical Medicine 3 (2): 119-23. PMID 12737366.
12. ^ Seifert SA, Bronstein AC, McGuire T. (2000). "Massive ibuprofen ingestion with survival.". J Toxicol Clin Toxicol 38 (1): 55-7. PMID 10696926.
13. ^ (2004). "Position paper: Ipecac syrup.". J Toxicol Clin Toxicol 42 (2): 133-43. PMID 15214617.
14. ^ Hall AH, Smolinske SC, Conrad FL, Wruk KM, Kulig KW, Dwelle TL, Rumack BH. (1986). "Ibuprofen overdose: 126 cases.". Ann Emerg Med 15 (11): 1308-13. PMID 3777588.

Result number: 183

Message Number 207457

Re: DRX9000 - Question View Thread
Posted by Chad F on 8/16/06 at 11:21

Here is a quote directly from Cert Health Sciences who is the manufacturer of the SpineMED machine.

"One of the many unique aspects of the SpineMED is the Pelvic Restraint system, which eliminates the need for traditional pelvic harnesses. This patent-pending system provides a number of improvements to patient comfort, patient suitability, clinical efficiency, and cannot be found on any other decompression table. Traditional pelvic harnesses create a number of problems and limitations with regard to patient suitability and comfort, and in addition, limit the accuracy and efficiency of the application of force to the patient’s lumbar spine.
Traditional harnesses are cumbersome, and most often have to be secured so tight to prevent slippage, that they are uncomfortable to the patient. The Pelvic restraint system captures any patient physique comfortably and accurately, with a very light application against the pelvis and are completely unnoticeable to most patients. Those familiar with conventional systems, which employ pelvic harnesses to capture the patient’s pelvis will agree that it is difficult to comfortably capture the wide spectrum of patient sizes, and regardless of how secure the harnesses are applied, they will often slip over the hips, causing an interruption in treatment. The pelvic restraints cannot slip over the patient’s pelvis, so that treatment interruption is eliminated with the SpineMED.
Conventional systems, which employ pelvic harnesses attached to a traction device through a nylon strap, are limited in their efficiency of applying the force to the patient’s spine, as there is significant loss and absorption of energy through this ‘system’. The ‘system’ described consists of all components between the force generation device (electric motor), and the patient’s spine. Within these belts, gears, pulleys, drum and nylon strap inside the traction unit, along with the straps and pelvic harness external to this unit, there is a loss of force through the stretching and absorption of energy of the various material components. (nylon has a 12-14% stretch factor) In addition, the traditional pelvic harness has to deliver the distraction force (energy) through the patient’s fat, muscle and tissue surrounding their lower torso to be delivered to the skeletal structure. The Pelvic Restraints, on the other hand, capture the patient’s pelvis directly, and are directly connected to the drive mechanism, which is a high-speed electrical actuator. Through the elimination of a complex “system” of belts, pulleys and gears, this efficient system has removed virtually all of the loss and absorption of force found in older technology, such that the treatment tensions on the SpineMED are only a fraction of what is required on devices utilizing pelvic harnesses. The treatment protocol on the SpineMED ranges from ¼ body weight minus 10 lbs. to ¼ body weight plus 25 lbs., which is approximately 60% of the typically tensions required on other decompression tables. The significantly lower tensions dramatically improve patient comfort and tolerance to the treatment, resulting in much wider patient suitability and conformance, where sub-acute, frail, and geriatric patients are now more likely to tolerate the therapy.
The Pelvic Restraint System also facilitates a rate of adjustment within the load control system that simply cannot be duplicated by conventional systems. In all of the sophisticated decompression tables, an electronic system is utilized to monitor and adjust the tensions that are applied to the patient during treatment (load control system). In older technology, where straps, pulleys and pelvic harnesses are utilized, the ability of this system to quickly respond and adjust the prescribed tensions is limited, and in most cases requires up to two seconds to make these adjustments (load control) to where the actual tension being applied to the spine
…/2
is changed. Ie. The load control system would have to signal the circuit to turn the electric motor either clockwise, or counter-clockwise to either bring in, or let out the nylon strapping on the drum assembly in the traction box to modify the tension on the belt assembly. With the SpineMED system, where the patient’s pelvis is directly connected to the drive mechanism through the unique pelvic restraints, the electronic control system measures the instantaneous tension being applied to the patient’s spine every 2.5 milliseconds. After sampling this measurement eight times, the system will make adjustments if the tension is outside the prescribed tolerances. The SpineMED therefore has the ability to adjust applied tensions every 20 milliseconds, where the neurological response of the human body to fire the erector muscles is approximately 50 milliseconds. The SpineMED load control system has been designed to be faster than the human body. The SpineMED utilizes a state of the art high-speed electrical actuator as the force generation drive mechanism.
To accurately target specific pathology, the device has a ‘tilting pelvic section’ that the pelvic restraints are mounted to. Based on earlier research, the tilting section will tilt the patient’s pelvis between 0 and 25 degrees to change the focal point of distraction to more accurately target specific pathology. The tilting mechanism is electronically controlled through the touch screen Treatments menu."

Result number: 184

Message Number 207351

I get SO tired of wearing shoes!!! View Thread
Posted by Auntie on 8/15/06 at 10:54

I agree with you in part...I believe if we had grown up walking barefoot everywhere, we wouldn't be having this problem, and we definitely need to do strengthening exercises to combat it. I'm doing the "towel scrunch" one, only I'm not using a towel, just digging my toes into the carpet. I do it about 70-80 at a time, first thing in the morning and whenever I'm sitting down during the day.

BTW, I stretch my calves and achilles tendons, but (to anyone) what exactly are the hamstrings? I'm not sure if I'm stretching those. :)

As for orthotics...right now I have to have them. (Powersteps) Anytime I wear dress shoes to church (approx. 2-3 hours), it really aggravates my feet. I only have ONE pair of shoes I can wear (Skechers Bikers Straightaway with insoles removed and Powersteps inserted), and I get REALLY tired of them. I do walk barefoot some during the day, but only on the carpet, which is really thick and feels good to my feet. It's uncomfortable to walk barefoot on the kitchen or bathroom floors (which I do occasionally anyway because I don't want to put on shoes just to get a drink of water or pee), but my mom says she can't walk barefoot on a hard floor either, and she has never had foot trouble. That's just part of aging...we lose some fat padding on the bottoms of our feet as we get older.

Someone mentioned arthritis...I posted a message about arthritis and foot pain on the Social Board about a week ago. Some of you may never go there (it's weird!), but if you have arthritis or fibromyalgia or some such condition, go over there and put your two cents' worth in. (Resist the urge to respond to the weirdo.) :)

I realize doctors have their limitations, and there are some really awful ones, but there are some really good ones, also. The ones who post here seem to really care about helping people and I am very appreciative of them. (My urologist is a jewel, too!)

Result number: 185

Message Number 206020

Re: BC/BS colonoscopy coverage View Thread
Posted by Ralph on 8/02/06 at 08:10

Autumn,
The way I look at it is that Hospitals need to make up for the "free"
care they must give to others by law. Someone has to pay for it.
The Gov. gets its money from our taxes so basicly we pay for it now and if managed care came in we'd pay for it then too. There is no magic money floating around. We'd pay but with many cuts and more limitations.

There is no way that I'd want Managed Health Care. It's great when your well or have a cold but when you need serious care those with private insurance head to the states for treatment.

I needed an MRI recently as I mentioned and got it in 2 days time, no long waiting list nor fear of being bumped. There are several free standing locations in my city and every hospital has their own machine. I don't have to travel miles to find treatment.

This is my personal feeling so I hope it doesn't insite an arguement. I realize others feel differently. We are all entitled to our own opinions.

My friend in Baniff needed a vitrectomy. After several visits
with his general Optho. his doctor finally agreed to make an appointment for him with a specialist. The doctor he saw was in Vancouver not by his choice, but by the doctors selection. When he got to Vancover he was notified he was bumped so he hung around town spending additional money in motels because the doctor said he'd get him in later that week.

After his surgery he found out that the doctor that was suppose to
perform his surgery, that his own doctor had selected and the reason he traveled to Vancouver in the first place didn't do it. Some other doctor did his vitrectomy.

We all hear horror stories and dismiss them because we're told they are the exception but Americans will only believe they happen when they begin to happen here.

Result number: 186

Message Number 205640

Judy - the posting agreement says "be nice" and "stay on topic" View Thread
Posted by scott r - moderator on 7/28/06 at 09:59

Judy, I reviewed your previous 50 or so posts and could find only 3 where you were discussing feet and not attacking someone. Please try to stick to the posting agreement. I've had 3 doctors complain about you committing libel against them in various online message board forums (not just this one and not just doctors here). Don't forget that if i get subpeonaed i have to turn over the internet tracking information. And NO, Dr Z and i have no formal or informal contact besides what everyone sees here in the message board. No, Dr Z is not your worst nightmare.....he's a doll compared to the 3 I'm talking about. Today Dr Z got my first email in maybe a year. We haven't talked on the phone in maybe 5 years. Your postings here are just giving them ammunition as to your libelous personality and it's all recorded, easily searchable, printable, traceable (if i'm subpeonaed), and admitable. For example, your accusations that Dr Z and heelspurs.com have financial connections...we'll here's the post disclaiming that and giving them more evidence for your unusually libelous personality. Haven't you noticed my anti-ESWT posts lately? Can you imagine the kind of affidavit I'd have to give as an unpaid, unbiased, anti-ESWT, unconnected message board moderator who's sole job is to break up fights? You are giving them ammunition everyday. I have agreed to NOT block your posts. I am not on your side or the doctors' side, i just want a clean message board and no subpeanas. If i was on your side, you would have been blocked a long time ago.

Result number: 187

Message Number 205572

Re: study about the use of MBT shoes for PF Jeremy, Doctors please comment View Thread
Posted by Jeremy L on 7/27/06 at 21:52

I've heard of this study, but up till now had only seen the summary. Having read it in completion, I'm a bit disappointed. It's clearly a student paper, and lacks several components to ensure authenticity.

First is the comment regarding a lack of scientific study in shoe mechanics. Being orthopedic students, they may have overlooked the years of clinical evidence from the podiatric discipline. This doesn't even go into another 60 years of pedorthic-specific study, and several hundred years of anecdotal experience in northern Italy and Germany.

In addition to the drastically low study population, having used shoes as the control is not really a control. At the very least there should have been a new condition brand/style of shoe available for true control.

These things said, the results they achieved were to me what would be expected. If you take any functionally negative heel shoe and compare it to a shoe with a positive heel pitch, there will always be reduced peak heel pressures in something like the MBT. The reverse is that if someone has forefoot pressure, metatarsalgia, etc wearing a MBT would have bad results. Lastly, adding a SACH heel or additional heel spring will also reduce peak heel pressure in a traditional trainer, while still maintaining a reduction in pressure at the forefoot.

I have faith in what MBT makes, but there are limitations (like with any product). Before shelling out over $200 for something like this, ensure that it matches your biomechanical needs.

Result number: 188

Message Number 205507

Re: Need feedback from people who have had ESWT View Thread
Posted by Dr. Z on 7/27/06 at 15:30

We all know the benefits of ESWT. Its in Scott book and there is alot of posts about the benefits. What I have been saying is ESWT is the best alternative when conservative therapy has been exhausted and you have pain with limitation of function and activity. Now you could live with is state if you wanted too but that is the only alternative. People have foot surgery because of pain and the in ability to function in life without pain. ESWT avoid this surgery along with none of the risks.

Result number: 189

Message Number 205241

Re: The verdict: Cros vs Waldies vs. Nothinz? View Thread
Posted by Jeremy L on 7/24/06 at 17:31

I can only relate what we do here in the office. We get great results from Waldies. Quite often we have patients who wear Crocs into the office, then leave with a pair of Waldies.

That said, it's not a product for everyone. If someone has very sensitive soles of their feet, most of these foam clogs should be avoided. waldies distribution also alcks greatly in comparison to the mega brands. If someone needs to try on something like this prior to purchase, it's going to be far easier to do so with Crocs.

I have not had direct experience with Nothinz. Although since all foam clogs are copies off the original Waldies design, I would not imagine there's a world of difference. There's soemthing to be said for compliments through imitation.

Result number: 190

Message Number 205040

Re: Need feedback from people who have had ESWT View Thread
Posted by Dr Ben Pearl on 7/22/06 at 12:03

everyone has a particular bias, thats why we have collective opinions
it is not correct,however, to assume that everyone on this site is a pitchman or trying to line their financial pockets

I have expressed my own biased views of the limitations of eswt from the get go, so there are less glowing views as to the efficacy of the treatment from providers who render the procedure on this site as well

Result number: 191

Message Number 204207

Re: Hallux Limitus View Thread
Posted by cwk on 7/15/06 at 08:45

I am not a medical professional but read your post because, although I had no pain, I had some limitation of the hallux flexor. I learned this from my chiropractor who was treating my pf with Graston and Active Release. After six weeks of Graston treatment, twice a week, the scar tissue is almost completely gone and I have normal range of motion. I am also pain free. I discovered that Graston is most effective with regular treatments, once or twice a week for a course of treatment. Last year my hectic life prevented a regular treatment schedule so I stopped treatment until I could schedule 2 visits a week for three months. I am so glad I pursued Graston and committed my time to the treatment. If you are hesitant to commit to surgery you might want to consider Graston.

Result number: 192

Message Number 203465

Re: anyone in the minority with atypical symptoms ever find anything that helps? View Thread
Posted by DavidW on 7/09/06 at 13:00

AmberK, the LMT I am seeing has many years of experience and is a very gentle and quite man, so he does not talk about all of his techniques by name. He simply tells me that he uses all sorts of techniques and then waits for how I respond. He continues techniques that work and does not for those in which I do not report positive feedback.

Basically he works the feet and lower legs. He has never worked my thighs or hamstrings. He also does very gentle lymph drainage. This is where he gently rubs the skin all the way from the feet to my pelvis, and from my neck down. This has been very effective at minimizing the burning and swelling sensations that I get. The messages and stretches he does on my feet are similar to both what a PT would do (tons of stretches / flexes) and also very similar to what Dr. Kiper does on his video (hard and deep pressure / message). He really concentrates on each individual area of the foot and gets in really deep with his fingers and elbows. I know he goes deep because my feet are always sore for a day or two afterwards. He alternates techniques quit often as well.

He explains the whole theory to me basically as having very unhealthy tissue in my feet caused over time. The message brings bloodflow to the tissue, restores flexibility and slowly increases health to the areas being treated.

As you know, I have been doing this for 11 months now. I started with two sessions a week (8 weeks), and I honestly believed this was the most affective approach, but I could not afford it so I dropped to once a week. Around 4 months ago (when I started Graston), I dropped to one session every two weeks.

I definitely think that the message has greatly helped me with my recovery, but it is a long and slow road. There are other benefits to it, many times when I am there I ask him to loosen up my neck or back, and it feels great. He has also taught me many different stretches and strengthening excercises over the past 11 months (he has been doing yoga for years). I am greatful for his time and for not giving up on me. I know it has worked for me because I spent over 3 years trying everything and never got even 5% better. Over the last 11 months I have decreased my daily pain by at least 85% or so (Graston has definitely helped as well and has brought me to a new level of healing). The LMT sessions are 60 minutes.

Today I alterate between LMT and Graston, doing each once a week on alternating weeks.

I still have symptoms, but they are much less than ever. I can basically be on my feet intermitantly all day with little pain. I can get myself ready in the AM, go to lunch with co-workers, stop off at the supermarket on the way home, and play in the yard for an hour or so with my daughter until I finally start to feel the PF pain. Then I quit, go inside and rest.

Result number: 193

Message Number 202912

Re: Is it hard to do ART in the arch area by the heel??? View Thread
Posted by DavidW on 7/03/06 at 20:23

AmberK, apologies for always butting my nose in. Graston is a weapon that you can use in this PF battle, why not give it a try. If you have scar tissue buildup, the Graston will definitely help to break it down and your feet will slowly heal. If it does not work, you are a little less heavy in the pocket book, that's it.

It has helped me alot. The deep message (similar to ART) has helped me tremendously over the past 11 months. I think Graston has pushed me a little closer to resolution, so for me, it is definitely worth it. Just remember that no matter what you try, if it helps at all even just a little, then it is worth it. Our symptoms are almost exactly the same and I still live with limitations, but in much less pain than ever. If I think back to last summer it scares me how little I was able to do and how I was in constant pain. I used to live on the floor because of the pain.

This is a long and hard road to PF recovery, but I think as long as you are making progress, you are on the right road. I think that Graston can help you. I thought you were already doing Graston sessions?

Result number: 194

Message Number 202853

Re: nurse with heel pain. View Thread
Posted by Jeremy L on 7/03/06 at 11:27

I'm also a big believer in the cushioning technology offered by Spira. Although they have limitations (awkward last shape, lack of comparable forefoot flexibility, limited width availability), for those that fit these shoes well they can provide some with immediate relief. Having worn a pair for a couple trade shows on bare concrete, I can attest to their amazing cushioning.

It's no suprise at all that they were effective for your friends with calcaneal fractures.

Result number: 195

Message Number 202681

Re: Jeremy question about Aravon sandals View Thread
Posted by Jeremy L on 7/01/06 at 17:28

I have placed several posts in regards to sandal brands which I fully endorse for their build quality and function is reducing forces which aggrivate n=most types of heel pain. For what you are decribing, that list needs to be trimmed. As you already discovered, that firm cork insert isn't too soft against a tender, inflamed heel.

Brands which offer a softer (yet still supportive) insert include Helle Comfort, Drew and Kumfs. It's also conceiveable that having a professional modify the insert with either a heel excavation or strategic placement of good quality urethane or visco-gel cushioning will get you where you need to be.

Regarding the Aravon Katy, I have limitations on offering a full recommendation for it. It has a significant heel pitch, which provides two biomechanical problems. One is that it thrusts more pressure to the forefoot; that extensive heel raise also inverts the heel creating significant instability for some. One of the reasons I suggested the Lauren out of their selections what because the pitch is less dramatic. It also has a removeable, modifiable insert, as well as enhanced rockering characteristics. All this adds up to a shoe which is more reliable in reducing painful symptoms to a greater consumer audience.

That said, the other brands listed above all have models with similar graphic design and strap configuration as the Katy. However, they all have better mechanics and protection of the heel.

Happy shopping, and I hope you find something that meets your needs and wants.

Result number: 196

Message Number 202085

Re: Jeremy View Thread
Posted by Jeremy L on 6/25/06 at 09:52

There are chains that have a very limited selection of product brands (in a local vein, Foot EFX is one of those), sometimes as few as one or two brands represented. In the case of Foot Solutions, they possess a very broad approved product base. There's enough variety that there will be brands stocked at one location, not to be found at another. Franchise owners also have certain flexibility to work with other brands which they feel warrant exposure, but may not yet have the FS corporate stamp.

I do have one note of interest in regards to Foot Solutions. I am very happy to see that Dr Margiano requires all locations to have at least one staff pedorthist. Like all practicing pedorthic centers, there are varying degrees of experience and expertise among them. One difference is that most Foot Solutions professionals perform their coursework at FS corporate, where the curricula centers around the techniques preferred by the franchiser. An example is that all are well-trained in the operation of the Amfit digital casting machine; however, few have knowledge or experience in other casting methods. This limitation is still a minor concern, considering that their training still exceeds most chain retail settings. Closer to me, I also have strong faith in the skills and product variety offered by Ritchie Shoes.

Have fun shopping, and best hopes in you getting the very best results for your needs.

Result number: 197

Message Number 201018

Re: Dr Wander thanks View Thread
Posted by Dr. David S. Wander on 6/13/06 at 08:39

The boot in that picture is fine, or the Aircast Foam walker in a low top is also fine. The mechanism of how it helps involves the limitation of bending/dorsiflexion at the ankle and the toes. By limiting your ability to bend/dorsiflex the ankle and toes, the plantar fascia and Achilles tendon are not stretching, therefore they are at "rest" and are allowed to heal, taking stress off of those structures. The "rocker bottom" of the boots allows your foot to roll, without your ankle or toes having to bend. The boot is in essence doing the "work" so your ankle and toes don't have to. Additionally, the weight is distributed more evenly while in the cast, and when standing up straight, the weight is sometimes actually taken off of the heel due to the rocker design. Hopefully, this will have answered most of your questions.

Result number: 198

Message Number 201013

Re: Dr Wander thanks View Thread
Posted by Dr. David S. Wander on 6/13/06 at 08:17

The boot in that picture is fine, or the Aircast Foam walker in a low top is also fine. The mechanism of how it helps involves the limitation of bending/dorsiflexion at the ankle and the toes. By limiting your ability to bend/dorsiflex the ankle and toes, the plantar fascia and Achilles tendon are not stretching, therefore they are at "rest" and are allowed to heal, taking stress off of those structures. The "rocker bottom" of the boots allows your foot to roll, without your ankle or toes having to bend. The boot is in essence doing the "work" so your ankle and toes don't have to. Additionally, the weight is distributed more evenly while in the cast, and when standing up straight, the weight is sometimes actually taken off of the heel due to the rocker design. Hopefully, this will have answered most of your questions.

Result number: 199

Message Number 200290

Orthotics View Thread
Posted by Don on 6/03/06 at 04:44

Since reinjury usually happens upon first steps in the morning, do orthotics the prevent this, elimitating the morning steps thus preventing reinjury?
What are the best orthotics to get besides just custom? I have some customs that are rigid plastic 3/4 but no padding on them which they seem hard on the heel and move around after removing the shoe...

Result number: 200

Message Number 200117

Re: Tarsal tunnel release next week.... how bad is it? View Thread
Posted by messed up foot on 5/31/06 at 17:14

My surgeon does a big release and I had a partial pf release too. My incision was huge - 8" of staples and sutures and then the lymphedema made it spread. Actually is it sort of a cool looking scar and it makes people gasp.

TTS was painful in an odd way - the pf was the worst pain. Post TTS surgery I got a lot of what I called "shoots" - staccato nerve pains but that passed. I was on pain killers longer than I like but I went back to a desk job in 2 weeks.

With 6 surgeries in 18 months, I am the queen of crutches and find myself mentally commenting on the form of other crutch users. You get stronger but you need to get your hands toughed up (you get blisters on your palms) and your arms need to get stronger. The good thing is that you lose the middle aged bat wing flab!under your arm if you have it. I lost 20# using crutches (found it all again dang it). I'm a big advocate of having a PT session before surgery to learn stairs and other things (like getting in/out of a car). I was no weight bearing for 4 weeks and had limitations on walking and standing for the next 8 due to the pf release. All in all the TTS incision was only ugly but more tender than painful. It's the nerve that gave me the shoots.

Result number: 201

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