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I feel desperate in the wait up to seeing a podiatrist

Discussion in 'Ask your questions here' started by maddy, Oct 27, 2009.

  1. maddy

    maddy New Member


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    I live in the UK in a London suburb. I am heavily dependent on a car (automatic needing right foot to press both accelerator and brake) as I drive my child to school for 30 min and then I drive to work on the other end for another 45 min. Past use of taxis has not gone down well with child as feels claustrophobic in others’ cars.

    My right foot pain started last winter in January 2009, acutely triggered with wearing my first pair of tall boots with 2-inch heels for just 3-4 days. While walking, I felt my right foot bearing down all the weight of my body on the two large toes. It started hurting in the 2nd toe more than the great toe. I stopped wearing those boots within just 5 days, then bought another pair with apparently flatter heels, then gave them up as the pain persisted.

    Since then, no high heels have been worn and I went back to my old practice of wearing flat court shoes. But the problem has worsened over the months, some of the worsening I presume being due to various devices bought from retailers and inserted into my shoes (insoles inserted, with arch support pads from Boots stuck on them in the arch area, gel pads available in Tesco stuck in the arch area when the previous arch supports did not work etc, also a foam padding cut into shape and stuck onto the insole in the area of the ball of the foot). I have always had flat feet with nothing done to support my arches previously. I have seen an association of the pain with driving—I drive an automatic car using the right ball of the foot and right great toe mainly to press the accelerator and brake both. I have been wondering about using the left foot to brake to reduce as much impact as possible on the right foot, but this was not what the driving instructor taught me in an automatic car and I am worried of going against protocol. At present I have stuck dish-cleaning sponges on the accelerator and brake pedals but that sounds ridiculous, doesn’t it?

    So now, especially since resuming driving after the summer holidays, the pain in my toes has spread to the ball of the foot and gradually in the area of the arch on the inside aspect of the foot through nearly the entire front half of the foot I can say. It is a mild aching pain, no swelling, my worries about the chronicity and functional impairment of this are bothering me more than the actual pain. Now weight-bearing while walking even if I were to use public transport seems somewhat painful. I saw my general practice (GP) doctor today, his referral to the podiatrist will take 4-6 weeks for me to have an appointment. He (GP) has no answer but to give rest to the foot, e.g not drive. But should I not walk as well? I would understand if he cannot answer that, it is a difficult question.

    In my last visit to the GP in July, he gave me a leaflet on plantar fascitis, I have done those exercises, given rest to the foot, and taken painkillers at his advice. But problem returns on driving.

    I am feeling quite desperate at present as not driving will mean too much a problem with childcare, school runs and work. I have tried a couple of trainer shoes at JD Sports yesterday. I need advice about whether to buy running trainers with aircushions or just with a spongy rubber sole. One or two of them have “midsole with air unit”, should I go to buy that or just the middle range rubber sole ones (Nike Nside Run) which felt comfortable when tried. If I buy these, should I insert the Boots arch supports or leave it be? Are there any ideas of how I can adapt my driving or car accelerator /brakes? I tried valgus pads as a teenager, made by a physiotherapist and they were quite large for the shoe. Should I buy my usual size of trainers now and then when the podiatrist sees me, he/she can advise what to buy next? Any other advice in the interim before a podiatrist sees me?

    Thanks ever so much……
     
  2. FootDoc

    FootDoc New Member

    A diagnosis is the only reasonable starting point for offering anything definitive regarding your complaints. The only interim advice that I might offer is to avoid as best you can activities which you know to exacerbate your problem. Once you have obtained a diagnosis, I might be able to discuss your situation and its possible treatment further.
     
  3. maddy

    maddy New Member

    Thanks, I appreciate your integrity in not jumping in with diagnoses all over the place and having looked at your posts on the forum, I have observed that you do give specific diagnoses and advice where appropriate to do so. I will wait for the podiatrist consultation. In the meantime, I have discovered today that it is not only driving, today standing and walking for an hour or more that exacerbated my pain. If you feel appropriate to advise on this question, please do so: while I wait for the podiatrist (which in the UK National Health Service means another month or two!), should I take pain-killers to at least enable me to walk comfortably for public transport, or will that only serve to injure me further as the "highlighting the injury" function of pain will be dampened down with painkillers?
    Thanks anyway even if you feel you should not answer that right now.
     
  4. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    You've hit upon a constant conundrum in medicine. Pain certainly serves a purpose both in alerting one to a problem and causing one not to further aggravate the site of a problem. In most cases of foot pain, analgesics in moderation are appropriate and generally safe to use, as they are not generally of such power so as to allow one to block pain sufficient to enable one to unknowingly cause severe harm to the part. It would, though, be probably unwise to take them immediately before an initial physical examination, as that might mitigate some symptom critical to the diagnosis or cause the examiner not to appreciate the full extent of your problem. At any rate, even if the analgesics do significantly mitigate the pain, you should employ both good sense and good judgment in not doing something foolish or over-stressing the foot until examined and cleared by a doctor.

    I appreciate the fact that, unlike some who come here looking for any answer, you understand that shoot-from-the-hip responses and treatment recommendations without basis in diagnosis are irresponsible.
     
    Last edited: Oct 27, 2009
  5. maddy

    maddy New Member

    Thanks Foot Doc, I will revert back to you with what the podiatrist says---I am going for a private consultation in the next couple of days as I don't think I should wait for a month or two.
    Maddy
     
  6. maddy

    maddy New Member

    Footdoc, you might remember me having communicated with you re. this in Oct-Nov. Since then, I have been under treatment from a private podiatrist--she stuck some padding on the ball of the foot and arch weekly for the past 5 weeks, which gave me much relief. I also started wearing New Balance trainers as recommended by her. After 5 weeks of this padding treatment, she has now made orthotic inserts for my shoes and I have see how I get on. The orthotic has wedges under the heel to correct the flattening of the arch and to prevent overpronation, as also a padding under the ball and middle section of the foot to cushion these painful areas.

    As regards diagnosis, she did not give one label as such---she thought that the genesis of the problem was a pre-existing flat foot with overpronation, which perhaps would have not caused any acute trouble if I hadn't worn those high heels. In addition, there is a neuroma under the second metatarsal head, which she thinks is due to wearing narrow foot wear. Her assessment is that the flat foot when in contact with the ground becomes quite wide as the arch presses down on the ground.

    Although the relief was great, the pain has not completely gone. My question to you would be--is this something that will improve over time, what might be the prognosis?
     
  7. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    Making the assumption that the diagnosis of a neuroma is correct, in my experience they just about always only respond permanently to some form of invasive procedure where the neuroma is excised, decompressed, repositioned or destroyed. Again, in my experience, conservative treatment with padding, orthotics and/or corticosteroid injections may offer relief, but which is most often temporary, and even without any medical intervention, pain of a neuroma often remits and exacerbates. So, periodic improvement and worsening with or without treatment is often the case, generally until some definitive procedure is performed. Of course, as I began . . the above assumes that you indeed have a neuroma . . a diagnosis which is difficult to definitively prove unless and until it is removed and examined histologically.
     
    Last edited: Dec 17, 2009
  8. maddy

    maddy New Member

    Hello again Footdoc, you might remember my queries from Oct-Dec last year. Since then, I have seen a senior Podiatrist--he has said it is unlikely to be a neuroma, he thinks there was synovitis under the metatarsals due to the high heels I wore. In addition, there is a structural flat foot which also becomes a functional flat foot when I stand and walk.

    The symptom of pain under the ball of the foot due to the synovitis has resolved quite well, although it seems I have developed pain on the lateral aspect of the sole and sometimes under the heel due to the wedge orthosis prescribed by the previous junior podiatrist.

    Anyway, the senior podiatrist has advised that I buy some good quality shoes with good support, with a good quality rubber sole.He said leather soles are not advisable as leather is less forgiving to feet. Today, the best shoes I found were described to me by the shop assistant as having a rubber sole and I bought them. Now on their internet website, I have discovered they are described as having a PU light (polyurethane light) sole. Now, is this better than rubber or less kind to my foot? Please could you advise? Many thanks in advance
     
  9. FootDoc

    FootDoc New Member

    I'm not a big advocate of using shoes as anything but a minor adjunct in treating foot problems.
     
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