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SECOND OPINION

EPISODE #903

FOOT PAIN

 

 

Announcer:

 

MAJOR FUNDING

FOR "SECOND OPINION"

IS PROVIDED BY THE BlueCross

AND BlueShield ASSOCIATION,

AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,

AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.

FOR MORE THAN 80 YEARS,

BLUE CROSS AND BLUE SHIELD COMPANIES

HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE

ACROSS THE COUNTRY

AND SUPPORTED PROGRAMS

THAT IMPROVE

THE HEALTH AND WELLNESS

OF INDIVIDUAL MEMBERS

AND THEIR COMMUNITIES.

THE BlueCross AND BlueShield ASSOCIATION'S MISSION IS

TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO ALL AMERICANS.

NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM

AND ON TWITTER

@BCBSAssociation.

 

 

"SECOND OPINION" IS PRODUCED

IN ASSOCIATION WITH

THE UNIVERSITY OF ROCHESTER MEDICAL CENTER,

ROCHESTER, NEW YORK.

 

 

 

Salgo:

 

WELCOME TO "SECOND OPINION,"

WHERE YOU GET TO SEE,

FIRSTHAND, HOW SOME OF THE

COUNTRY'S LEADING HEALTH CARE

PROFESSIONALS TACKLE HEALTH

 

ISSUES THAT ARE IMPORTANT

TO YOU.

I'M YOUR HOST, DR. PETER SALGO,

AND TODAY WE'RE HAPPY TO WELCOME

PHYSICAL, OCCUPATIONAL, AND

MASSAGE THERAPIST BOYD BENDER.

OUR "SECOND OPINION" PRIMARY

CARE PHYSICIAN, DR. LISA HARRIS.

DR. JUDY BAUMHAUER FROM THE

UNIVERSITY OF ROCHESTER

MEDICAL CENTER.

DR. DOUGLAS HALE FROM THE

FOOT AND ANKLE CENTER OF

WASHINGTON.

AND DAVE HELLER, WHO'S HERE TO

SHARE HIS CASE WITH US.

BY THE WAY, THIS IS A CASE THAT

OUR PANELISTS, ALONG WITH YOU

AT HOME, WILL BE HEARING

FOR THE FIRST TIME.

SO LET'S GET RIGHT TO WORK.

DAVE, SEVERAL YEARS AGO, YOU

WERE TRAINING TO GO -- AND I'M

NOT MAKING THIS UP -- AN EXTREME

ELK HUNT?

 

Heller

 

CORRECT, YES.

AND YOU HAD TO HIKE IN

60 MILES. CORRECT.

YOU WANT TO TELL ME

ABOUT THIS?

 

 

Heller

 

WELL, ACTUALLY, A FRIEND OF

MINE WHO LIVES IN COLORADO,

IN THE NORTHWESTERN PART, DOES

AN ANNUAL ELK HUNT, WHERE THEY

GO INTO FEDERAL LANDS AND HIKE

ALL THE WAY IN AND SPEND ABOUT

TEN DAYS TO TWO WEEKS.

AND IN PREPARATION, I DECIDED TO

START WORKING OUT -- PROBABLY

ABOUT SIX MONTHS

BEFORE THE HUNT.

SO, DOING REGULAR PHYSICAL

ACTIVITY -- I AM A PLUMBING

CONTRACTOR -- I'M IN PRETTY GOOD

SHAPE AND DECIDED THAT I NEEDED

TO WORK ON STRENGTH OF MY LEGS,

AS WELL AS INCREASING MY

LUNG CAPACITY, WIND, BECAUSE

WE'LL BE AT 11,000 FEET.

SO I STARTED WORKING OUT, AND

ONE OF THE WORKOUTS WAS

ON A TREADMILL, AND I BECAME

QUITE PROFICIENT ON THE

TREADMILL AND DECIDED THAT I

WOULD PUT IT ON AN INCLINE

AND THEN START TO RUN ON AN

INCLINE ON THE TREADMILL.

BUT THE THING IS THAT, WITH

WORKING OUT ON THIS TREADMILL,

AFTER PROBABLY ABOUT 2½ MONTHS

OR SO, I SUDDENLY GOT A

TREMENDOUS PAIN

IN MY RIGHT FOOT

AND DECIDED I SHOULD GO TO OUR

LOCAL PODIATRIST AND SEE WHAT'S

GOING ON WITH THE FOOT.

 

 

Salgo:

 

NOW, HAD YOU -- WELL,

 

FIRST OF ALL, WHAT DID THE

 

PODIATRIST TELL YOU?

 

 

Heller

 

WELL, HE TOLD ME THAT I HAD

PINCHED A NERVE

IN THE FRONT PART OF MY FOOT,

JUST BELOW MY TOES.

 

 

Salgo

 

ALL RIGHT, AND HAD YOU EVER

HAD ANY FOOT PROBLEMS

PRIOR TO THAT?

 

Heller

 

ACTUALLY, NO.

I WAS BORN FLAT-FOOTED.

I'VE WORKED IN CONSTRUCTION

SINCE I'M 14 YEARS OLD, WHICH

INCLUDES JUMPING INTO DEEP

EXCAVATIONS AND JUMPING OFF OF

SCAFFOLDING AND LADDERS AND

TRUCKS AND THINGS LIKE THAT.

SO I WANT TO STOP FOR A

MINUTE, BECAUSE EVERYBODY I KNOW

HAS HEARD THE PHRASE,

"FLAT FEET."

WE HAVE A PICTURE OF A FLAT

FOOT.

THAT'S WHAT A FLAT FOOT

LOOKS LIKE.

WHAT ARE WE LOOKING AT?

ANYBODY WANT TO HELP ME OUT

HERE?

 

Baumhauer

 

WELL, IT'S A FOOT THAT IS

SORT OF SAGGING IN.

WE CALL IT "PRONATING."

AND ESSENTIALLY, THE STRUCTURE

OF THE FOOT IS QUITE FLAT, SO IF

YOU WALKED ALONG THE SAND,

INSTEAD OF HAVING A LITTLE ARCH

IN YOUR FOOTPRINT IN THE SAND,

YOU'D NOTICE YOUR WHOLE

"FLINTSTONE" FOOT WOULD BE

SITTING THERE.

SO I WANT TO TALK ABOUT THE

TREADMILL FOR ONE SECOND.

SO, THE TREADMILL, THE

REPETITIVE, CONTINUED WALKING AT

THE EXACT SAME SPEED,

WITH THE EXACT SAME STEP,

MAKES ANYBODY WHO HAS ANY NEAR

FOOT PROBLEM VULNERABLE.

IT WOULD BE BETTER TO WALK

OUTSIDE.

CHANGE YOUR TERRAIN, CHANGE

THINGS AROUND SO THAT YOU'RE NOT

DOING THE EXACT SAME THING.

 

Harris:

 

YOU ACTUALLY HAVE

AN ABNORMAL GAIT ON THE

TREADMILL BECAUSE OF THE

STRUCTURES IN THE FRONT.

YOU CHANGE YOUR NATURAL GAIT,

AND WE SEE A LOT OF PROBLEMS

THAT OCCUR WITH PEOPLE --

 

 

Bender:

 

WELL, ALSO, PETER,

YOU'VE MENTIONED THAT HE CHANGED

TWO VARIABLES AT THE SAME TIME.

YOU INCREASED THE INCLINE OF THE

TREADMILL AND THEN STARTED

RUNNING, WHICH CAN OFTENTIMES

CAUSE A PROBLEM.

 

 

Hale:

 

YEAH, ON A TREADMILL

WITH THE ELEVATION, YOUR HEEL

CORD GETS TIGHTER, YOUR FOOT'S

GOING TO FLATTEN OUT MORE,

YOU'RE GOING TO PUT A LOT MORE

FORCE THROUGH YOUR FOOT, ALSO

THROUGH THE FRONT OF YOUR ANKLE

AND YOUR FOREFOOT, WITH GOING ON

AN INCLINE ON A TREADMILL.

 

 

Salgo:

 

AND NOW YOU'VE GOT

FOOT PAIN.

AND SOMEBODY'S TOLD YOU YOU'VE

GOT A PINCHED NERVE.

NOW, YOU'RE ON YOUR FEET ALL

DAY, AND YOUR FEET ARE HURTING.

 

 

Heller:

 

CORRECT.

 

Salgo:

 

WHAT HAPPENED?

 

Heller:

 

I WENT TO, AGAIN, A LOCAL

FOOT DOCTOR, PODIATRIST,

DETERMINED IT WAS A PINCHED

NERVE IN THE FRONT OF THE FOOT,

WHICH HE GAVE ME A SHOT OF

CORTISONE, I BELIEVE, SOMETHING

LIKE THAT, AND SAID, "BY THE

WAY, YOU HAVE REALLY FLAT FEET."

AND I SAID, "YEAH, I'VE BEEN

TOLD.

I NOTICE HOW MY WORK BOOTS WEAR

OUT, YOU KNOW, ON AN ANGLE,

AND SO FORTH, LIKE THAT."

AND HE SAID, "I'D REALLY LIKE TO

FIT YOU WITH ORTHOTICS."

 

Salgo:

 

ALL RIGHT, SO, LET'S

STOP AGAIN.

BECAUSE YOU'VE SEEN YOUR

PODIATRIST.

DID YOUR PODIATRIST GET ANY

X RAYS, ANY STUDIES?

JUST LOOKED AT YOUR FOOT?

 

Heller:

 

ACTUALLY, HE DID X RAYS.

 

Hale:

 

I WOULD ASK, WHERE WERE YOU

HURTING AT, WHAT LOCATION WAS

YOUR PAIN?

 

Heller:

 

THE FRONT PART OF MY FOOT,

JUST BELOW MY TOES,

WAS WHERE MOST OF THE PAIN WAS.

JUST IN ONE FOOT AT THAT

PARTICULAR TIME.

 

Harris:

 

AND WAS IT CONTINUOUS, OR

JUST OCCURRED WHEN YOU WERE

EXERCISING?

 

Heller:

 

NO, THAT WAS CONTINUOUS --

AFTER I HAD DONE WHATEVER DAMAGE

I DID, THEN THAT WAS IT, THAT

WAS START OF.

 

Salgo: EVEN AT REST?

 

Heller:

 

YES.

 

Salgo:

 

EVEN SITTING OR LYING IN

BED, IT WOULD HURT?

 

Heller:

 

IT ACTUALLY -- I GUESS

SITTING OR LAYING IN BED, IT

WASN'T BAD, EXCEPT WHEN YOU

GOT UP.

THEN IT WAS BAD.

 

Salgo:

 

OKAY, SO, IF SOMEONE

CAME INTO YOUR OFFICE WITH FOOT

PAIN, HOW WOULD YOU WORK IT UP?

 

Harris:

 

WELL, THE FIRST THING

IS TO GET SOME OF THE HISTORY

THAT WE'VE ALREADY ASKED -- WHAT

WERE THE ACTIVITIES?

ONE OTHER QUESTION WOULD BE,

DID YOU BUY NEW SHOES?

OR WERE YOU USING OLDER SHOES?

I'D WANT TO EXAMINE

THE SHOES THAT YOU BROUGHT IN

THAT YOU WERE WEARING DURING

YOUR EXERCISE

AND THE ONES THAT YOU WEAR

DURING THE DAY.

AND THEN A GOOD EXAMINATION OF

THE FOOT, INCLUDING A SENSORY

EXAMINATION, SO WE WOULD CHECK

TO SEE IF THERE WAS ANY LOSS OF

SENSATION ANYWHERE

IN THE FOOT.

 

Hale:

 

I WOULD DO EXACTLY THAT.

I THINK EVERY PATIENT, YOU HAVE

TO START WITH A GOOD HISTORY.

YOU CAN'T DO TUNNEL VISION.

YOU HAVE TO FIND OUT, DO THEY

HAVE ANY ARTHRITIS THEMSELVES OR

IN THEIR FAMILY, ANY OTHER

MEDICAL ISSUES

YOU MAY BE DEALING WITH?

AND THEN EVERY PATIENT NEEDS

AN EXCELLENT PHYSICAL.

SO YOU NEED TO LOOK AT THEIR

SKIN, YOU NEED TO LOOK AT THEIR

BLOOD SUPPLY, YOU NEED TO LOOK

AT THEIR NERVE STATUS.

AND THEN YOU NEED TO DO A GOOD

MUSCULOSKELETAL EXAMINATION

TO FIND OUT EXACTLY WHAT

STRUCTURE IS HURTING, WHERE

THEY'RE HURTING AT, TO MAKE THAT

DIAGNOSIS.

SO A DIAGNOSIS NEEDS THE PROPER

EXAM TO GET THAT DONE.

 

Bender:

 

 I WOULD TAKE IT EVEN FURTHER

WITH THE PHYSICAL EXAMINATION.

WITH THE COMPLAINT OF JUST --

THE PROBLEM ON THE ONE SIDE --

IS, PEOPLE ALWAYS HAVE A HISTORY

OF OLD INJURIES, NOT JUST AT THE

FOOT OR ANKLE, BUT

AT THE LOW BACK.

AND THERE COULD HAVE BEEN

AN OLD DISK INJURY THAT HEALED A

LONG TIME AGO, BUT NOW IT'S

MANIFESTING ITSELF IN A WAY

WHERE THERE'S A LOT OF WEAKENED

MUSCLES IN THE LOWER LEG,

THAT MAY CAUSE THAT FOOT TO

FLATTEN MORE THAN IT NORMALLY

WOULD.

 

Salgo:

 

WHAT I'M HEARING IS VERY

INTERESTING.

YOU'VE LOOKED AT THE FOOT.

BUT YOU'VE THOUGHT BEYOND

THE FOOT.

 

Harris:

 

YOU HAVE TO.

TO THINK OF OTHER THINGS

 

Salgo:

 

WHICH MIGHT BE IMPIN-- THAT'S

VERY INTERESTING.

IMPINGING ON THE FOOT.

WOULD YOU DO ANYTHING ELSE?

 

Baumhauer:

 

 THINK WHAT'S INTERESTING

ABOUT THE STORY IS, HE SAYS,

"WHEN I'M AT REST, I'M DOING

BETTER, AND WHEN I GET UP AND

USE IT, IT HURTS MORE."

SO I ALWAYS THINK THAT'S

MECHANICAL FOOT PAIN.

AND NOT -- IT TAKES ME A LITTLE

BIT AWAY FROM NERVE PAIN.

 

Harris:

 

NERVE, THAT'S RIGHT.

 

Baumhauer:

 

SO I'M THINKING MORE, IT'S

BONES, JOINTS, THAN THE NERVES,

THAT ARE PRIMARILY THE PROBLEM.

 

Salgo:

 

ALL RIGHT.

BUT DAVE GETS CORTISONE

AND GETS AN ORTHOTIC.

WHAT'S AN ORTHOTIC?

WHEN DO YOU PRESCRIBE IT?

WHAT'S IT SUPPOSED TO DO?

 

Harris:

 

AND, ACTUALLY, I JUST

WANT TO JUMP IN WITH MY

NON-ORTHO EXPERTISE.

STARTING AN ORTHOTIC WHEN HE HAS

ACUTE FOOT PAIN

THAT'S UNRELATED TO, YOU KNOW,

HIS FLAT FEET.

I'D WANT TO TAKE CARE OF THE

CURRENT PROBLEM BEFORE I STARTED

PRESCRIBING ORTHOTICS FOR

A CHRONIC PROBLEM.

 

Salgo:

 

WHAT IS AN ORTHOTIC?

 

Baumhauer:

 

AN ORTHOTIC IS SOMETHING THAT

YOU APPLY TO THE BOTTOM OF THE

FOOT -- IT CAN BE DISPENSED OVER

THE COUNTER OR CUSTOM-MOLDED.

 

Salgo:

 

IT'S AN INSERT.

 

Baumhauer:

 

IT'S AN INSERT.

 

Salgo

 

GOES IN THE SHOE.

AND IT'S SUPPOSED TO STRAIGHTEN

YOUR GAIT AND MAKE EVERYTHING

BETTER.

 

Baumhauer:

 

IT'S SUPPOSED TO SUPPORT THE

FOOT IN AREAS THAT REQUIRE IT,

TO TRY AND DECREASE PAIN

OR IMPROVE FUNCTION.

IN HIS PARTICULAR CASE,

I'M NOT CLEAR EXACTLY WHAT THE

ONGOING DIAGNOSIS WAS, BUT I'M

SUSPICIOUS THAT THEY THOUGHT IT

WAS A NEUROMA

OR SOMETHING LIKE THAT,

WITH THAT CORTISONE INJECTION

DISCUSSION.

AND SOMETIMES, AN

OVER-THE-COUNTER ORTHOTIC

WITH A LITTLE PAD CAN HELP SPLAY

THE FOREFOOT OPEN A LITTLE BIT

AND ALLOW THE NERVES TO BE A

LITTLE LESS SQUISHED,

IF YOU WILL.

 

Salgo:

 

BUT THAT'S DEPENDING ON THE

DIAGNOSIS OF THE NERVE

IMPINGEMENT.

SO THE $64 TRILLION QUESTION IN

TODAY'S HEALTH CARE ECONOMY,

HOW DID THOSE ORTHOTICS WORK OUT

FOR YOU, DAVE?

 

Heller:

 

WELL, NOT WELL AT ALL.

I THINK THE ORIGINAL, FIRST SET

OF ORTHOTICS -- BY THE WAY, THEY

WERE --

 

Salgo

 

OH, I KNOW WE'RE GOING TO

HEAR ABOUT MORE.

OKAY, MADE THE PAIN BETTER,

WORSE?

THE PAIN GOT WORSE? WHAT?

 

Heller:

 

WELL, THE INITIAL PAIN SEEMED

LIKE IT WAS IMPROVING.

I MEAN, BECOMING LESS.

BUT I DON'T THINK IT HAD

ANYTHING TO DO WITH THE

ORTHOTICS, BECAUSE THE ORTHOTICS

WEREN'T DEALING WITH THE INITIAL

REASON WHY I WENT THERE.

 

Hale:

 

DID YOUR INJECTION

TEMPORARILY RELIEVE YOUR

SYMPTOMS?

 

Heller:

 

I HAD THREE DIFFERENT

INJECTIONS.

 

Hale:

 

BUT FOR, LIKE, AN HOUR AFTER

YOUR INJECTION, DID YOUR PAIN

GO AWAY?

 

Heller:

 

IT NUMBED IT FOR A WHILE.

OR IT FELT A LITTLE BETTER.

 

Hale:

 

SO, IF YOU LOOK AT, IF WE DO

A DIAGNOSTIC INJECTION, WHETHER

IT'S ON A JOINT OR ON A NERVE,

IF YOUR PAIN GOES AWAY 100% FOR

AN HOUR, THERE'S A GOOD CHANCE

YOU'RE AT THE RIGHT SPOT.

IF YOU INJECT A NERVE AND YOU

SAY, "MY PAIN DOESN'T GO AWAY,"

IT MAY BE THE JOINT THAT'S AT

ANOTHER AREA OF YOUR FOREFOOT.

SO THE BIG QUESTION IS, DOES

THAT DIAGNOSTIC INJECTION

RELIEVE YOUR PAIN?

'CAUSE IF IT DOESN'T, MAYBE IT'S

NOT THE NERVE, MAYBE IT'S

YOUR JOINT.

FOREFOOT PAIN IS COMMONLY

JOINT ISSUES ALSO.

I'LL BACK UP ON THE ORTHOTIC

ISSUE -- SO, A LOT OF PEOPLE

COME IN, THEY'RE NOT COMING IN

BECAUSE THEY FEEL FINE.

THEY'RE COMING IN BECAUSE THEY

HAVE A FOOT-PAIN ISSUE.

SO YOU'RE TRYING TO HELP THEM

RESOLVE THAT PROBLEM.

SO THE FIRST THING TO LOOK AT IS

SHOES -- A LOT OF TIMES, THEY'RE

WEARING AN UNSTABLE SHOE.

THEY'RE WEARING A SHOE THAT'S

NOT PROPERLY FITTING FOR THEM.

SO IT'S GIVING THEM PAIN IN A

CERTAIN AREA BECAUSE OF THEIR

SHOE GEAR.

SO A LOT OF TIMES, WE CAN CHANGE

THE SHOE AND MAKE THEM MUCH

BETTER.

THE OTHER THING IS AN

OVER-THE-COUNTER INSERT, AND A

LOT OF TIMES, WE ARE REBALANCING

THE FORCES IN THE FOOT.

SO WE'RE USING AN

OVER-THE-COUNTER INSOLE

INITIALLY TO REBALANCE THOSE

FORCES, TO MOVE FORCE TO AN AREA

THAT DOESN'T BOTHER THEM.

 

Salgo:

 

NOW, I WAS LISTENING

TO YOU, DAVE -- I CAUGHT A WHIFF

OF, YOU WENT TO THE FIRST ONE,

YOU TRIED THE ORTHOTIC, IT

REALLY DIDN'T WORK VERY WELL,

TIME WENT BY, I HEARD THERE WAS

AT LEAST ONE OTHER ORTHOTIC.

WAS THAT WITH A SECOND

PODIATRIST?

 

Heller:

 

CORRECT.

 

Salgo:

 

OKAY, AND THAT DIDN'T WORK

VERY WELL?

 

Heller:

 

THAT DIDN'T WORK VERY WELL.

 

Salgo:

SO LET ME GUESS.

YOU WENT TO A THIRD PODIATRIST.

 

Heller:

 

WENT TO A THIRD.

THIS PARTICULAR FOOT SPECIALIST

ALSO DID SPORTS MEDICINE, AND HE

WORKED WITH A LOT OF PEOPLE WHO

RAN MARATHONS AND THINGS

LIKE THAT.

SO HE AGREED THAT YES, I HAVE

FLAT FEET, AND YES, I COULD USE

ORTHOTICS.

AND OF COURSE THE OTHER ONES

WERE NOT PROPERLY ADMINISTERED.

BUT IN THE MEANTIME, HE DECIDED

THAT I ALSO HAD HEEL SPURS.

 

 Salgo:

 

A BONE SPUR

ON YOUR HEEL?

BOTH FEET.

 

Salgo:

 

IN THE INTERESTS OF

EDUCATING AMERICA, WE'VE GOT

A BONE SPUR.

CAN WE PUT THAT UP

AND HAVE A LOOK?

THERE IT IS.

WHAT ARE WE SEEING HERE?

SOMEBODY WANT TO --

 

Hale:

 

WE'RE SEEING A SPUR AT

THE BOTTOM WHERE YOU TYPICALLY

SEE PLANTAR FASCIITIS.

 

Salgo:

 

PLANTAR FASCIITIS IS

WHERE THAT FASCIA, SOME OF THE

CONNECTIVE TISSUE IN THE FOOT,

HOOKS ON.

 

Hale:

 

SO THE CONNECTIVE TISSUE ON

THE BOTTOM OF THE FOOT HOOKS ON

AND PULLS, AND YOU GET THAT

SPUR.

SO WE KNOW HEEL SPURS ARE COMMON

WITH AGING, FROM STUDIES.

PEOPLE WHO HAVE HEEL PAIN HAVE A

HIGHER CHANCE OF HAVING

A HEEL SPUR.

BUT YOU DON'T HAVE TO

TAKE THE HEEL SPUR OFF

TO GET THEM BETTER.

 

Salgo:

 

LET'S PAUSE FOR A MINUTE,

BECAUSE THAT'S A HEEL.

AND IF YOU FOLLOW THE BOTTOM,

THERE'S THAT LITTLE HOOK-Y

THING ON THE BOTTOM.

THAT'S THE BONE SPUR.

 

Hale:

CORRECT.

 

Salgo:

AND THAT HURTS.

 

Harris:

WELL...SOMETIMES.

 

Hale:

 

IT MAY OR MAY NOT.

MAY OR MAY NOT.

 

Harris:

 

RIGHT, SO GETTING

AN X RAY AND SEEING A BONE SPUR

DOES NOT TRANSLATE INTO

FOOT PAIN.

 

Baumhauer

 

AND THE OTHER THING IS,

PATIENTS SHOULD REALIZE THAT YOU

DON'T HAVE TO HAVE

YOUR BONE SPUR OUT.

SO 35% OF PEOPLE HAVE AN X RAY

JUST LIKE THAT AND NO PAIN

WHATSOEVER.

SO DON'T TREAT THE X RAY.

 

Salgo:

 

SO BONE SPURS DON'T

NECESSARILY NEED TREATMENT.

BONE SPURS DON'T NECESSARILY

CAUSE PAIN.

JUST FINDING A BONE SPUR ON AN

X RAY, DAVE, DOESN'T NECESSARILY

MEAN THAT'S WHAT'S CAUSING YOUR

TROUBLE, CORRECT?

 

Heller:

 

CORRECT. HOWEVER, I BELIEVE

THAT, WITH WEARING THE

ORTHOTICS, NOW BOTH FEET HURT.

OKAY, REMEMBER, I STARTED OFF

WITH ONE FOOT WITH WHAT I

THOUGHT WAS A PINCHED NERVE.

NOW BOTH FEET HURT.

 

Salgo:

 

SO NO GOOD DEED

GOES UNPUNISHED.

 

Heller:

 

BY THE TIME I GOT TO THE

THIRD FOOT DOCTOR, OKAY,

HE IS NOW SAYING, "YES, THEY'RE

FLAT, YES, YOU NEED THIS, BUT

YOU'RE ALSO --" AND I WAS

EXPERIENCING PAIN IN MY HEEL.

BOTH HEELS.

SO THIS IS WHEN HE DETERMINED

THAT I HAD HEEL SPURS.

 

Salgo:

 

BUT THERE'S NO GUARANTEE THAT

THAT PAIN IS FROM THE SPURS, IS

WHAT I'M HEARING FROM MY PANEL.

 

Hale:

 

THE SPUR IS A SECONDARY\

THING, NOT A PRIMARY THING.

 

Salgo:

 

WHAT TREATMENT DID YOU

GET FROM YOUR THIRD DOCTOR?

 

Heller:

 

WELL, ACTUALLY, I WENT

TWICE A WEEK FOR, I WOULD SAY,

FIVE OR SIX MONTHS, BUT THERE

WAS ALL TYPES OF, YOU KNOW,

CERTAINLY THE WHIRLPOOL THING.

YOU KNOW, THERE WAS DIFFERENT

TYPES OF STIMULATION.

 

Salgo:

 

THIS IS YOUR AREA OF

EXPERTISE, ISN'T IT?

DOES THIS STUFF WORK?

THERE'S MASSAGE

AND ELECTRIC STIMULATION...

 

 

Bender:

 

IT CAN WORK IN THE ACUTE

PHASE, BUT IT'S CERTAINLY NOT

SOMETHING THAT'S GOING TO HEAL

THE PROBLEM.

AGAIN, YOU HAVE TO GET BACK TO

WHAT IS CAUSING THE PROBLEM.

OKAY, AND ALL OF THESE OTHER

THINGS MAY BE WAYS OF TREATING

IT, INITIALLY.

 

 

Salgo:

 

OKAY, SO THE ACUTE

PHASE MEANS IT CAN MAKE YOU

FEEL BETTER, BUT IT DOESN'T

NECESSARILY FIX THE PROBLEM.

 

Bender:

 

 IT DOES NOT FIX THE PROBLEM.

 

Harris:

 

WHEN HE'S

FIRST HURTING.

 

Salgo:

 

WHEN YOU'RE

FIRST HURTING.

 

 

 Harris:

 

HE'S NOW INTO

CHRONIC PAIN.

 

Salgo:

 

YOU'RE NOW INTO –

YEARS INTO THIS.

WHERE DID YOU GO NEXT?

 

Heller:

 

WELL, THAT PARTICULAR

SPECIALIST FINALLY DECIDED THAT

HE COULD GO NO FURTHER WITH ME

AND THEN RECOMMENDED A

RHEUMATOID GUY.

MAYBE I HAD SOME R.A. IN MY

FOOT.

 

Salgo:

 

 "R.A." MEANING

"RHEUMATOID ARTHRITIS."

 

Heller:

 

MEANTIME, YOU KNOW,

THE FOOT -- BOTH FEET ARE NOW

TO THE POINT WHERE I'M KIND OF

HOBBLING A LITTLE BIT.

 

Baumhauer:

 

I THINK

WHERE HE'S FALLING SHORT --

SO APPLYING SOMETHING TO THE

BOTTOM OF HIS FOOT, SENDING HIM

OFF TO PHYSICAL THERAPY,

YOU KNOW, WE'RE ALL SORT OF

QUESTIONING, WHERE'S THE

DIAGNOSIS, AND WHERE

IS IT GOING?

YOU KNOW, THERE ARE A LOT OF

OPTIONS HERE.

IF IN FACT YOU HAD HEEL SPURS,

PLANTAR FASCIITIS, IF IN FACT

THAT WAS THE CASE, YOU KNOW, THE

MAINSTAY OF TREATMENT IS

STRETCHING EXERCISES THAT YOU DO

AT HOME.

SO THAT COSTS YOU NOTHING BUT

YOUR TIME, BUT IMPORTANT FOR YOU

TO GET BETTER.

AND, YOU KNOW, I ALSO WANT TO

INTERJECT, BECAUSE

THE CARE GIVERS THAT YOU'RE

TALKING ABOUT ARE ALL DIFFERENT

PEOPLE, SO THERE'S PODIATRISTS

AND THERE ARE ORTHOPEDIC

SURGEONS THAT ARE FOOT AND ANKLE

SPECIALISTS, AND THE

RHEUMATOLOGISTS ARE INTERNAL

MEDICINE SPECIALISTS.

SO YOU HAVE ACTUALLY SORT OF

MIXED AND MATCHED, I BELIEVE,

TO MANY DIFFERENT PEOPLE.

 

Salgo:

 

WHICH IS NOT

NECESSARILY A BAD THING,

IF THEY WERE GETTING SOMEWHERE.

 

Hale:

 

I THINK THE MOST

IMPORTANT THING IN ANY MEDICAL

CASE -- WE SEE A LOT OF THIS,

WHERE PEOPLE ARE GETTING

TREATED, BUT YOU REALLY NEED TO

GET AN ACCURATE DIAGNOSIS.

SO YOU HAVE TO DO WHATEVER IT

TAKES TO GET THE DIAGNOSIS,

WHETHER IT'S FURTHER DIAGNOSTIC

STUDIES, BUT THE MOST IMPORTANT

THING IS LISTENING TO THE

PATIENT, HEAR WHAT THEY'RE

TELLING YOU, WHERE THEY HURT,

DOING THE PHYSICAL EXAM, DOING

THE APPROPRIATE STUDIES AND

WORKUP TO GET THEM A DIAGNOSIS.

ONCE YOU GET THEM A CLEAR

DIAGNOSIS, NOW YOU CAN SET A

TREATMENT PLAN IN PLACE, VERSUS

TREATING BUT NOT REALLY

HAVING A DIAGNOSIS.

 

Harris:

 

HAD YOU HAD ANY OTHER

STUDIES DONE?

I HEARD THE ONE X RAY, BUT DID

YOU HAVE AN MRI

OR ANYTHING ELSE DONE?

 

Heller:

 

YES, SOMEWHERE IN BETWEEN THE

THIRD PODIATRIST/FOOT DOCTOR AND

THE RHEUMATOID GUY, I DID GO IN

TO MENTION THE HOSPITAL OF

SPECIAL SURGERY IN NEW YORK,

WHICH IS EXTREMELY PRECISE

WHEN IT COMES TO ANY TYPE OF

ORTHOTIC SURGERY AND THINGS

LIKE THAT.

AND I SAW ONE OF THEIR TOP

FELLOWS, AND WE DID THE --

STARTING OFF WITH THE REGULAR

X RAYS, CAT SCANS, MRIs,

SO FORTH AND SO ON.

AND NOW WE WERE STARTING TO GET,

YOU KNOW, WHAT THE REAL

SITUATION AND THE REAL

PROBLEM WAS.

 

Salgo:

 

 SO WHAT I'M HEARING

IS THAT NOW, FOR THE FIRST TIME,

YOU'RE GETTING A BATTERY OF

STUDIES ON THIS FOOT, OTHER THAN

JUST A PLAIN X RAY.

 

Heller:

 

CORRECT.

 

Salgo:

 

AND YOU'RE DOING WHAT

EVERYBODY ELSE HERE HAS ASKED

YOU TO DO -- OR ASKED THEM TO

DO -- GET THE RIGHT DIAGNOSIS.

IF YOU'RE TREATING THE WRONG

DIAGNOSIS, YOU'RE NOT GOING TO

GET BETTER.

SO WHAT DID THEY TELL YOU AT THE

HOSPITAL FOR SPECIAL SURGERY?

 

Heller;

 

WELL, BASICALLY, BECAUSE OF,

I ASSUME, BEING BORN

FLAT-FOOTED, THAT THE TENDONS ON

BOTH FEET WERE TORN, AND IT

WOULD REQUIRE A SURGERY THAT

SOUNDED QUITE EXTENSIVE, WHERE

THEY ACTUALLY CUT THE BONE AT

THE BOTTOM OF THE FOOT,

AND THEN THEY TAKE A BONE FROM

MY HIP, PUT IT INTO THE BOTTOM

OF MY FOOT, AND THEN I GUESS THE

TENDON WOULD REATTACH ITSELF

OR WHATEVER.

WELL, THE PROCEDURE FOR EACH

FOOT IS ABOUT EIGHT MONTHS.

 

Salgo:

 

WELL, THE PROCEDURE ISN'T,

RIGHT, IT'S THE RECOVERY?

 

Heller:

 

WELL, THE RECOVERY IS ABOUT

EIGHT MONTHS, SO WE'RE TALKING,

YOU KNOW, OVER A YEAR AND A HALF

OF MY LIFE TO BE, YOU KNOW,

DEDICATED TO THESE FEET.

SO, AT THAT POINT, I SAID,

"UH, MAYBE NOT."

HE RECOMMENDED TO WEAR THESE

SMALL BRACES AND TRY THEM OUT TO

SEE IF THEY WOULD EASE PAIN.

THEY'RE NOT GOING TO CORRECT THE

PROBLEM, BUT THEY MAY MAKE IT

MORE BEARABLE FOR YOU TO

FUNCTION, TO WALK AROUND.

 

Salgo:

 

I WANT TO STOP YOU

RIGHT HERE, BECAUSE NOW WE'VE

DESCRIBED AN OPERATIVE

PROCEDURE.

THIS IS THE FIRST TIME

SOMEBODY'S SAYING, "I'VE DONE

ALL THE STUDIES, I'VE GOT A

DIAGNOSIS, AND I'M GOING TO FIX

YOU WITH SURGERY."

DOES THIS SURGERY SOUND

RATIONAL?

 

Baumhauer:

 

WELL, I HAVE TO

TELL YOU, YOU HAVE ME,

LIKE, OFF BALANCE HERE,

BECAUSE YOU STARTED OUT WITH

FOREFOOT PAIN.

OKAY, FOREFOOT PAIN, PAIN IN THE

BALL OF YOUR FOOT.

THEN YOU SAID, "NOW I HAVE

HEEL PAIN."

I DON'T KNOW IF IT WAS FIRST FEW

STEPS IN THE MORNING PAIN, THAT

KILLED YOU WHEN YOU GOT OUT OF

BED, LIKE PLANTAR FASCIITIS IS,

BUT NOW YOU'RE MOVING INTO, "I

GOT POSTERIOR TIBIAL

TENDINITIS," WHICH IS THE TENDON

ON THE INSIDE ASPECT OF YOUR

FOOT, THAT ALLOWS YOU TO -- WHEN

IT RUPTURES OR ELONGATES,

FALLS IN.

SO THEN YOU GOT THREE DIFFERENT

THINGS GOING ON.

 

Salgo:

 

I CHEATED -- I READ A LITTLE

BIT OF YOUR STORY.

I KNOW YOU GOT A SECOND OPINION

FROM ANOTHER ORTHOPEDIC SURGEON,

WHO ALSO RECOMMENDED SURGERY.

 

Heller:

 

CORRECT.

 

Salgo:

 

AND THEN, ON THE VERGE OF

DOING THE SURGERY, SOMEBODY

SAID, "DON'T."

SOMEONE SAID TO YOU, "YOU KNOW,

MAYBE AT YOUR AGE, EIGHT MONTHS

PER FOOT, NOT SUCH A GREAT

IDEA."

AND YOU DECIDED TO FORGO THE

SURGERY, AND YOU WOUND UP --

YOU'RE WEARING BRACES NOW.

CAN YOU SHOW US THE BRACES

THAT YOU'RE WEARING?

 

Heller:

 

YEAH, THEY'RE A STRAP-ON.

THEY GO UNDER THE FOOT.

I BASICALLY HAVE TO WEAR

THESE -- ACTUALLY,

I WEAR THEM ALL THE TIME.

THEY'RE DOING NOTHING TO CORRECT

THE PROBLEM, THEY'RE JUST MAKING

IT LESS PAIN.

 

Baumhauer:

 

THEY'RE SUPPORTING YOU.

 

Heller:

 

SO, TO ME, IT'S GIVING ME

SOME SUPPORT DOWN THERE, AND

THEREFORE TAKING AWAY

DISCOMFORT.

 

Salgo:

 

SO LET ME SUMMARIZE

WHERE WE ARE, IF I MAY.

YOU HAD AN INJURY.

THEN YOU WENT TO -- I'M COUNTING

HERE -- THREE PODIATRISTS,

TWO ORTHOPEDIC SURGEONS.

YOU'VE HAD A LOT OF ORTHOTICS,

MASSAGE, ELECTROTHERAPY,

ACUPUNCTURE, CORTISONE,

LOTS OF OTHER TREATMENTS,

AND YOU'RE STILL IN PAIN.

THIS HAS BEEN QUITE A STORY.

SO I WANT TO BE SURE WE'VE

SORT OF SUMMED UP WHERE WE ARE.

A THOROUGH EVALUATION TO

DETERMINE THE CAUSE OF FOOT PAIN

IS NECESSARY IF YOU'RE GOING TO

GET SUCCESSFUL TREATMENT.

WHEN IT COMES TO THE TREATMENT

OF FOOT PAIN, ONE SIZE DOES NOT

FIT ALL.

AND THE CAUSE IS EVERYTHING.

IF YOU'RE TREATING THE WRONG

CAUSE, IT'S NOT GOING TO GET

BETTER.

FAIR ENOUGH?

CORRECT.

ALL RIGHT, SO WE NEED TO

MOVE ON.

OF COURSE, DAVE IS HERE WITH US

TODAY.

YOU'VE HAD FOOT PAIN NOW

FOR MANY YEARS.

NO TREATMENT SO FAR HAS BEENABLE

TO MAKE YOUR PAIN REALLY GO

AWAY.

IS IT FAIR TO SAY THAT SOME

PEOPLE SIMPLY HAVE TO PUT UP

WITH FOOT PAIN?

IS DAVE GOING TO HAVE TO PUT UP

WITH FOOT PAIN FOR THE REST

OF HIS LIFE, IS THAT IT?

 

Baumhauer:

 

WELL, I THINK YOU'VE NOW

TRIALED HIM.

YOU'VE PUT HIM IN BRACES, AND HE

SAYS, "I'M BETTER IN THE

BRACES." RIGHT?

 

Heller:

 

CORRECT.

 

Baumhauer:

 

SO HE IS BETTER.

SO NOW HE'S BETTER IN THE

BRACES, SO YOU'VE -- YOUR

HYPOTHESIS IS THAT IT WAS

A TENDON PROBLEM.

AND HE SEEMS TO BE SUPPORTED

WITH THAT TENDON PROBLEM.

AND THAT'S -- AND NOW HE HAS TO

DECIDE, "AM I GOING TO LIVE IN

THESE BRACES?

IS THERE ANOTHER TYPE OF BRACE

OPTION OR ORTHOTIC OPTION FOR ME

TO SORT OF STEP DOWN INTO?

OR SHOULD I HAVE SURGERY FOR

THIS PROBLEM?"

THAT'S REALLY WHERE HE IS IN THE

DECISION MODE.

 

Salgo:

 

RIGHT. I WANT TO COME BACK

TO YOUR PROBLEM.

NOW, LISA, SHOES.

CAN YOU SHOW US THE SHOES YOU'RE

WEARING TODAY, PLEASE?

 

Harris:

 

I GUESS SO.

 

Salgo:

 

THANK YOU.

THEY HAVE HEELS.

VERY HIGH HEELS.

ARE THESE GOOD SHOES TO WEAR

ALL DAY, EVERY DAY?

 

Baumhauer:

 

I WOULD TELL YOU THAT NO

MATTER WHAT YOU SAY, IT'S LIKE,

"COULD YOU STOP WEARING THOSE?"

WELL, SOME PEOPLE FEEL GOOD

IN THOSE.

AND IT'S ABOUT HOW YOU FEEL.

SO I BELIEVE THAT WE'RE GOING TO

HAVE PEOPLE WEAR HIGH HEELS.

SO WE'RE GOING TO HAVE TO

DEAL WITH IT.

WHAT YOU WANT TO DO IS HAVE THEM

WEAR THEM OCCASIONALLY, NOT

THEIR EVERYDAY SHOES,

JUST TO EVENTS,

JUST WHEN THEY LOOK GOOD

ON SITTING ON A CHAIR.

BECAUSE SHE'S NOT WEIGHT-BEARING

ON HER FOOT WITH THOSE

HIGH HEELS.

SHE JUST LOOKS GREAT.

 

Salgo:

 

I'LL ASK THE

PROVOCATIVE QUESTION -- YOU WEAR

THESE ALL DAY, DON'T YOU?

 

Harris:

 

ALL DAY, EVERY DAY.

 

Hale:

 

I'LL ADD TO THAT -- A

LOT OF FOOT SYMPTOMS ARE CAUSED

BY A TIGHT ACHILLES TENDON,

OR THE TENDON ON THE BACK OF

YOUR LEG, SO A LOT OF PEOPLE

GET FOOT PAIN BECAUSE OF THAT.

SO A LITTLE BIT OF HEEL LIFT

WILL TAKE FORCE OFF YOUR FOOT,

SUCH AS YOUR PLANTAR FASCIA,

YOUR MIDFOOT.

SO A LITTLE BIT OF A HEEL

HELPS A LOT OF PEOPLE.

 

Salgo:

 

NOW, LET ME JUST RATTLE OFF

VERY QUICKLY, NOW, A COUPLE OF

THINGS.

CROCS -- YOU LIKE THEM?

 

Baumhauer;

 

I THINK IF THEY FEEL GOOD ON

YOUR FOOT, IT'S FINE WITH ME.

 

Salgo:

 

EARTH SHOES? BIRKENSTOCKS?

 

Hale:

 

EARTH SHOES HAVE A NEGATIVE

HEEL ON THEM, WHICH MEANS THE

HEEL IS LOWER THAN THE FOREFOOT,

SO FOR MOST PATIENTS, THAT'S NOT

A GOOD SHOE FOR THEM.

FOR SOME PATIENTS WHO HAVE A LOT

OF MOTION IN THEIR ANKLE,

THAT SHOE WORKS FOR THEM.

 

Salgo:

 

PEDICURES -- GOOD OR BAD?

 

Baumhauer:

 

 I THINK PEDICURES, YOU'VE GOT

TO MAKE SURE YOU HAVE A PLACE

THAT IS CLEAN AND STERILIZES --

OR AT LEAST CLEANS -- THEIR

EQUIPMENT.

SO YOU HAVE TO BE A LITTLE

CAREFUL WITH THAT.

 

Harris:

 

AND I JUST WANT TO

DOVETAIL ON SOMETHING THAT JUDY

SAID ABOUT CROCS, OR EVEN IF YOU

TALK ABOUT FLIP-FLOPS

OR OTHER SHOES LIKE THAT.

IT'S IMPORTANT THAT YOU DON'T

HAVE PAIN, BECAUSE WHAT A LOT OF

PEOPLE DO IS GRIP WITH THEIR

TOES TO KEEP THE SHOE

ON THEIR FOOT, AND THEN THEY

START DEVELOPING FOOT PAIN.

 

Salgo:

 

 I WANT TO GET ONE

RECOMMENDATION, MAYBE, ONE

SENTENCE FROM THIS WHOLE GROUP,

THE BEST THING YOU CAN DO TO

KEEP YOUR FEET HEALTHY.

 

Hale:

 

 I THINK THE ONE THING IS

A GOOD SHOE.

AND EVERYBODY'S FOOT

STRUCTURES DIFFERENTLY.

DIFFERENT PEOPLE LIKE DIFFERENT

TYPES OF SHOES.

BUT A GOOD, SUPPORTIVE SHOE,

A SHOE THAT DOESN'T CAUSE YOU

PAIN, IS THE BEST SHOE FOR YOU.

 

Baumhauer:

 

A GOOD SHOE, DON'T SMOKE,

WATCH YOUR WEIGHT, I MEAN,

ALL THESE THINGS LOAD

ONTO YOUR FOOT.

 

Salgo:

 

 I JUST WANT TO COMMENT

ON THAT -- THAT'S REALLY

IMPORTANT.

WE HEAR THIS ON ALMOST

EVERY BROADCAST.

DON'T SMOKE -- BAD VASCULAR

DISEASE CAUSES BAD FOOT DISEASE.

DON'T GET TOO HEAVY -- NOT ONLY

DOES IT PUT PRESSURE ON YOUR

FEET, BUT IT CAN LEAD TO

UNCONTROLLABLE DIABETIC

PROBLEMS, FOOT ULCERS, SEPSIS,

LOSING YOUR FOOT.

BAD. OKAY.

 

Bender:

 

AND EVEN IF YOU WALK 20 TO 30

MINUTES A DAY, THAT'S GOOD

ACTIVITY FOR YOUR FEET.

 

 

Salgo:

 

EXCELLENT.

 

LET'S STOP FOR A MOMENT AND

WE'LL SUM UP WHERE WE'VE BEEN,

THEN WE WILL GO FORWARD A LITTLE

BIT AFTER THAT, BUT THIS IS

A COMPLICATED SUBJECT.

THAT BEING SAID, THERE IS A LOT

YOU CAN DO TO KEEP YOUR FEET

HEALTHY AND PAIN-FREE,

SUCH AS WEARING

GOOD SHOES APPROPRIATE

FOR THE SEASON, LISA.

NOT SHARING THE PEDICURE

TOOLS -- THEY'VE GOT TO BE

CLEAN.

FINALLY, LISTEN TO YOUR FEET.

THEY DO TALK TO YOU.

YOU SHOULD CONSULT A

PROFESSIONAL WHEN UNRESOLVED

PAIN OR OTHER PROBLEMS IMPACT

YOUR ABILITY TO WALK AND TO

PERFORM YOUR EVERYDAY

ACTIVITIES.

YOU KNOW, DAVE, I UNDERSTAND

THAT PEOPLE WHO KNOW YOU SAY

THAT YOU'RE ALWAYS UP.

YOUR SPIRITS ARE HIGH, AND THEY

WOULD NEVER KNOW THAT YOU HAVE

FOOT PAIN.

HOW DO YOU GET THROUGH THE DAY

LIKE THAT?

 

Heller:

 

 WELL, ONE OF THE THINGS I'VE

REALIZED ABOUT PAIN IS THAT YOUR

BODY AND YOUR MIND WORK VERY

WELL TOGETHER WHEN IT COMES TO

SOMETHING THAT

DOESN'T FEEL GOOD.

I HAD JUST HAD ROTATOR-CUFF

SURGERY, I HAD FALLEN OFF AN

EXTENSION LADDER, I HAVE AN

INDIRECT HERNIA,

I HAVE AN ENLARGED PROSTATE, I

HAVE ABOUT FIVE OR SIX THINGS

GOING ON.

SO, YOU KNOW, THE FEET ARE

IMPORTANT, 'CAUSE THEY GET ME

FROM POINT "A" TO POINT "B,"

BUT THEY'RE NOT MY WHOLE LIFE.

 

 Salgo:

 

ALL RIGHT, WELL, I

WANT TO THANK YOU VERY MUCH FOR

BEING HERE, BRACES AND ALL.

 

Heller:

 

 BRACES AND ALL.

 

Salgo:

 

UNFORTUNATELY, WE'RE OUT OF

TIME, AND I HOPE THAT YOU'LL

CONTINUE THE CONVERSATION

ON OUR WEB SITE.

THERE, YOU WILL FIND THE ENTIRE

VIDEO OF THIS SHOW, AS WELL AS

THE TRANSCRIPT AND LINKS

TO THE RESOURCES THAT WE CAN

PROVIDE.

THE ADDRESS IS

SecondOpinion-tv.org.

AGAIN, THANK YOU FOR WATCHING.

THANK ALL OF YOU FOR BEING HERE.

I'M DR. PETER SALGO.

I'LL SEE YOU NEXT TIME

FOR ANOTHER "SECOND OPINION."

 

 

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