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Sunday, November 25, 2012

Unresponsive Plantar Fasciitis: Email Advice

Dr. Blake,
I had surgery on both of my big toes in Feb. 2009. It seems to be a hereditary issue since my brother had the same surgery a few years earlier. My father and grandmother had arthritis here too. I had cracked the toe while running for only 3 years. I cracked the bone on my left foot and it also had numerous bone spurs. Since the swelling did not go down after 6 weeks, surgery was performed. I had them xray the right foot, which also had spurs, so I opted to have both of them done. Yes, it was a painful surgery. I got a general and not a local so when I woke up I was in terrible pain. I blame the Dr. on that one. 

Dr Blake's comment: I feel that the first surgery was rushed, since inadequate time was given to let the injury completely heal. 1 year with rehabilitation of a big toe joint injury before surgery is not abnormal. The delay helps with understanding of the problem as the various aspects of rehabilitation are put into play. Surprisingly, some do heal avoiding surgery and the possibility of surgical problems. The other foot surgery was in the realm of preventative surgery. You are getting surgery since the problem will only get worse down the line. I personally do not buy into that approach, although many smart people do. I believe surgery should be your last resort, and not done until your present disability warrants that. I know I have strong biases in this regard, and it is important that you know where I am coming from when giving advice.

In 2010, a year later, after training for a triathlon I developed Plantar Faciitis. It came on very slow but by 201i and now 2012 it has stopped me dead in my tracks. I have had pain for two years. I finally got an xray that showed a heel spur also. I have have tried everything, constant exercises, scraping, orthodics (OTC)and have stopped running. Nothing helps. 
Question? Did my surgery have anything to do with this issue?I am afraid of cortizone shots. Should I have an MRI? 
Dr Blake's comment: Big toe joint stiffness with loss of normal bending allows the plantar fascia to tighten and makes it prone for injury. You can usually combat that problem with plantar fascial stretching, especially the towel and rolling exercises described in my blog. You may be been tighter from your surgery, but maybe not. An MRI is needed to rule out a plantar fascial tear. Tears give unresponsive plantar fasciitis a bad name. Plantar Fasciitis normally gets better with stretching, icing, orthotics, activity modification, etc. If plantar fasciitis does not get better, I think of tear, fracture, nerve entrapment, bursitis. The MRI should definitely point you in the right direction. 

I am 59 yrs. old. Running was my new hobby. It kept me off of antidepressant after my husbands death in 2006. 
What do you suggest?

Dr Blake's comments: Pam, there is nothing better than running for the adrenaline, feelings of emotional well being, etc. Get the MRI and hopefully a new course of action will be recommended. For right now, try biking in one of its many forms. It is the best at helping keep the leg strength up needed to get back into running. I wish you well. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.