How do you ask for Narcotics?

[Sombeech]

So I've got a minor break in my foot.

http://www.bogley.com/forum/attachment.php?attachmentid=44233&stc=1&d=1305164206

I've been walking around with the injury for a month and a half and finally decided to get an X-ray. Sesamoid bone is completely broken. Anyway, the doc brings the X-ray in and we discuss a possible surgery and junk like that. He's poking the foot, asking where it hurts, of course I'm in pain.

We're wrapping up and I get that feeling that he's just going to tell me to "take it easy, wear this boot, yadda yadda...." and not give me anything for the pain. I've been taking variations of Aleve, Ibuprofen, Tylenol, Advil...... for the past month.

I said I didn't want to sound like I was begging for pain pills, but I could really use something for the pain since I'm walking around on it all day. He was pretty hesitant, stating he didn't like giving out narcotics, but finally caved in and got me something "between Tylenol and Lortab".

That's fine, no complaints, but why do I have to act like a drug seeker just to take care of the pain? A couple of years ago when I cracked my ribs, I got the same reaction from another doc, he gave me 800mg of Ibuprofen (wow thanks a lot, I'm glad I paid a copay for this prescription).

So, is there etiquette for asking for pain killers? I mean jeez, they had the X-ray right there, no way I'm faking that.

I guess my mistake was saying I've been "dealing with it for a month", but to be honest the pain has increased so much that it drove me to getting it checked out.

[ratagonia]

So I've got a minor break in my foot.

http://www.bogley.com/forum/attachment.php?attachmentid=44233&stc=1&d=1305164206

I've been walking around with the injury for a month and a half and finally decided to get an X-ray. Sesamoid bone is completely broken. Anyway, the doc brings the X-ray in and we discuss a possible surgery and junk like that. He's poking the foot, asking where it hurts, of course I'm in pain.

We're wrapping up and I get that feeling that he's just going to tell me to "take it easy, wear this boot, yadda yadda...." and not give me anything for the pain. I've been taking variations of Aleve, Ibuprofen, Tylenol, Advil...... for the past month.

I said I didn't want to sound like I was begging for pain pills, but I could really use something for the pain since I'm walking around on it all day. He was pretty hesitant, stating he didn't like giving out narcotics, but finally caved in and got me something "between Tylenol and Lortab".

That's fine, no complaints, but why do I have to act like a drug seeker just to take care of the pain? A couple of years ago when I cracked my ribs, I got the same reaction from another doc, he gave me 800mg of Ibuprofen (wow thanks a lot, I'm glad I paid a copay for this prescription).

So, is there etiquette for asking for pain killers? I mean jeez, they had the X-ray right there, no way I'm faking that.

I guess my mistake was saying I've been "dealing with it for a month", but to be honest the pain has increased so much that it drove me to getting it checked out.

Elect Rand Paul (and a Libertarian Congress), then we won't have this silly war on drugs and people can get the pain meds they need and deserve, without Doctors being worried about getting in trouble for applying the most effective remedy when it is called for.

But realistically, you can call him back, and say what he gave you is not doing it, and you need something better because the pain is making it impossible for you to work.

Tom - who was on Morphine for 3 months, then Percocets for another 6 months (when I broke my back) and is not a drug addict.

[greyhair biker]

I couldn't get oxycodon without signing for it in person and even then I was getting flak with a perscription - right after I came home from getting my arm put back together. I understood that but then I got the same when I was switched to Loratab. I'm sure it's all about liability but I agree....if it's obvious that you need the drugs(and you do) then the doctor should pony up rather than making you just 'take it'. Pain management is essential to good mental health:mrgreen:
I would rather be well medicated than being so on edge with pain that you go postal at the drop of a hat. I think you can see that I support you on this but I would have your wifey drive you around so if anything were to happen you wouldnt get blamed because you were on drugs.

[jman]

Although I agree with what Tom is saying, it really depends on the Dr.

My ankle dr at McKay Dee (when I broke my left ankle talus bone) was more than ready to prescribe percocet, and that was when my pain level was a 1 out of 10. The funny part was that he said right after that "are ya sure??!". And I said no thanks - I don't wanna be a narcotic addict.

Little did I know at that time, that I have a high addictiveness (for lack of a better word) to narcotics. Percocet makes you feel really, really good. Scary!

[canyonphile]

[puts old dusty foot doctor cap on]

Broken sesamoid bone, eh? And you've had it for a while, you say? If it isn't getting any better in that cam-walker, there's a good possibility it won't heal. Sesamoid fractures are bitches like that.

My unsolicited medical advice? Have the thing taken out. It's one of those surgeries where you'll be back to regular activities sooner than if you wait for it to heal. The pain is probably from it being a delayed union. If they take one of the pieces out, you'll be better off. That is what I'd do if it were my foot.

And as far as asking for some narcotic analgesics, just ask for them. I'd tell the doctor you've been trying the NSAIDS and they aren't helping enough. Now, you shouldn't be taking Lortab/Vicoden or Percocet and driving or working. But, if the pain keeps you awake at night, then ask for something.

When I was practicing, I was never skimpy with the narcotics after surgery. I gave them freely for the first few weeks, and 95% of people never took them all or needed a refill. I had a few dopers who tried taking advantage of that, and a few that lied and were double or triple dipping to get prescriptions filled from different doctors. A call from the pharmacist ended that quickly :lol8:.

Seriously, though - just ask your doctor. I never understood colleague's reluctance to prescribe narcotics for pain; studies have shown that for people that are in pain, they are not likely to become addicted. I think it is cruel to withhold narcotics to someone in pain just because of unwarranted concerns about opiate dependency.

[/doctor cap]

Speaking from my personal experience, I was given Percocet for minor surgery 3 1/2 years ago. I didn't even need it for post-surgical pain, but have used it for bouts of severe pain (of a type men can never experience) subsequently when things like Alleve don't work. The euphoria (which I attribute to the relief from the pain) is fine for about 5 min. and then I want it to end. When I take it, 4 hrs. of my day is totally ruined, because I can't do jack shit because of that annoying narcotic haze. Works great for the pain, but I'm definitely not a fan of the narcotic feeling. Thankfully, it's been a few months since I've had to take one.

I'd ask for Vicoden/Lortab - it's not quite as strong, so you may be able to still work if you took it. With Percocet, forget it - you'll be useless.

[Sombeech]

They had me schedule the surgery while at my first visit, I scheduled it a month out while planning on just cancelling it. I got a call from their office saying they thought surgery wouldn't be necessary, that the sesamoid, now two separate bones, may grow some healing sinews to help insulate around them.

I think he gave me Ultram (Tramadol?), which really is enough, I don't need a stronger narcotic if that even qualifies as one. It just really bugs me that I had to go through something like that to get something stronger than the stupid 800mg Ibuprofen. I can take 4X200mg on my own, I passed 4th grade math.

The boot, which I initially complained about the hideous appearance of, is actually very comfortable. I even tried it out on my bike today and it works. :mrgreen:

[stefan]

The boot, which I initially complained about the hideous appearance of, is actually very comfortable. I even tried it out on my bike today and it works. :mrgreen:
sorry to hear about your foot, 'beech. and it's great the boot helps! hope it heals quickly.

[ratagonia]

The euphoria (which I attribute to the relief from the pain) is fine for about 5 min. and then I want it to end. When I take it, 4 hrs. of my day is totally ruined, because I can't do jack shit because of that annoying narcotic haze. Works great for the pain, but I'm definitely not a fan of the narcotic feeling. Thankfully, it's been a few months since I've had to take one.


Thank you Sonya, very interesting.

I guess there is a wide range of experiences on narcotics. One Percocet does not send my flying, I was always wondering what the big deal was. I can work just fine, drive, etc. When recovering from back surgery, I would wake up in pain at 6 am, take a Perc, then have the most delightful sleep until 9 am and wake up refreshed.

They make me feel good, but at about the level of a hot shower good. They do work on pain.

Tom

[tanya]

First I have to say how cool it is to have our very own Bogley Doc! You rock Sonya~~~ :hail2thechief::hail2thechief::hail2thechief::hail 2thechief::hail2thechief::hail2thechief::hail2thec hief::hail2thechief::hail2thechief::hail2thechief: :hail2thechief:

:afro: Sounds like you need TLC. :naughty: You just look so :stud: and healthy, you Doc thinks you can tough it out. :haha:

:moses: When/how did you break your back? Bo did it too. You too have a lot in common. :bandit: Tom, I think its what Sonja said. Pain pills don't send you flying when you are actually in pain. It's those that take them when not in pain and in excess that get in trouble. Is that right Sonja?

[blueeyes]

I guess there is a wide range of experiences on narcotics.
Tom

I hate percoset. When I tore my knee up the ER doc gave me percoset I typically won't take anything for pain unless it is truly unbearable so I did not take one that night. The next morning when my dad came to check on me. He made me take one, said it was better to stay on top of the pain then just deal with it. He left and I was at the house by myself. I had to pee, bathroom was just across the hall from my room. Got up and hobbled to the bathroom, when I came to I was in the bathtub with my head against the back end looked around the bathroom tried to get up, came to and my head was next to the faucets. "I thought this is ridiculous!" Manage to get out of the bathtub hobbled back to my room and the next time I came to I was at least lying sprawled across the bed. Crawled back in the covers crying because I couldn't stand the way the drug was making me feel not because of my jacked up knee. Mom came over after work to help take care of the kids I still felt like snot almost 6 hours after taking the drug. Decided a shower would make me feel better. The shower was downstairs. Told mom about passing out earlier so she walked right beside me. I hobbled down the stairs and became super dizzy had to rest my head against the wall at the bottom of the stairs. Made it to the bathroom and felt like throwing up. I NEVER throw up not even when I was pregnant. I passed out again only somehow mom was able to sit me on the toilet when I came to she had the garbage can there ready to catch the puke. Luckily that never happened. I decided a shower probably was not a good idea. Hobbled to my daughters bedroom which was right next door and passed out again hitting the floor hard as my mother was behind me this time and not in front of me.

I will NEVER take that stuff again!!! Last year strained my back skiing, the doc gave me loratab. Took one pill and hated the daze it left me in, couldn't even sleep. It was just an awful sick daze that felt like the room wouldn't quit spinning. Alleve is my friend and if it doesn't work too bad! I hate those narcotics or anything stronger. I have found a good shot of tequila works wonders.

So Justin you have never said HOW you broke your sesamoid bone?

[savanna3313]

I understand the feeling of being looked at as a "drug addict" because of the medication you have to get. In my case, the meds aren't for me, but for my mother. She doesn't drive and is barely ambulatory, so I have to pick up everything for her. She's on some strong stuff and I have to basically bring in my life's history when I sign for her meds even though I have been going to the same pharmacy for nearly 10 yrs. Last November, I moved her from Utah down to Louisiana where I have two more sisters who can help care for her and just finding a doctor who prescribes her level of medication was almost impossible. I was made to feel like a "doctor shopper" from most of the ones I contacted and it literally took two months to find the doctor she sees now. We were fortunate that her doctor in Utah continued to prescribe her meds to us until we found the new doctor. My mom lives with a number of debilitating issues and she needs her meds just to deal with daily life, but if I took her dosage of meds for the day it would most likely kill me.

Pain meds can be a good thing when you actually need them, but I personally will hardly touch an aspirin unless I truly need it. My youngest sister died in 2003 because of drugs. She was an addict but it came about due to numerous surgeries she had during her life. She would be just getting herself clean and something else would come up where she would have to undergo surgery, then back on the pain meds. It was a vicious circle until she passed away - basically from liver failure.

Good luck with your foot Beech! Instead of paying for Ibuprofin 800 just take 4 Ibuprofin from the bottle you get at the store. Same thing.

[canyonphile]

They had me schedule the surgery while at my first visit, I scheduled it a month out while planning on just cancelling it. I got a call from their office saying they thought surgery wouldn't be necessary, that the sesamoid, now two separate bones, may grow some healing sinews to help insulate around them.
If the fracture forms a fiberous union (that is - non-bone healing) and it doesn't cause pain, then I'd agree that surgery wouldn't be necessary. Really, the only reason to do 99% of foot surgery is because of pain. Since a sesamoidectomy is minor surgery with only soft tissue healing time, I would weigh that against the prolonged pain of a slow or non-healing fracture.


I think he gave me Ultram (Tramadol?), which really is enough, I don't need a stronger narcotic if that even qualifies as one. It just really bugs me that I had to go through something like that to get something stronger than the stupid 800mg Ibuprofen. I can take 4X200mg on my own, I passed 4th grade math.

The only time I ever Rx'ed Ultram was when I was a resident dealing with the inner city population of medical welfare patients in San Francisco 15 years ago. They were always trying to get Tylenol #3's, and if we'd give them a prescription, they'd be back in a few days telling us they needed a new one because their bottle fell into the toilet. :roll: Me: "Sure, it did...well, that's too bad. Here's some Ultram instead." Idiots. Ultram, you see, doesn't have any street value like the narcotics do :lol8:.

I'm actually not sure if it's a narcotic or not myself; we never got a straight answer about that. It never seemed to work for the inner city junkies for their pain :haha:.

I also don't think I ever gave an Rx for 800 mg Motrin, either, unless someone specifically requested it. Why? As you said, just buy some OTC at the store and take 4 of them no more than 3x/day :ne_nau:. My favorite prescription NSAID was Celebrex - the Pfizer rep used to come into my office all the time and drop off samples. I'd give them to patients, but I ended up keeping many for myself (to treat the severe monthly pain I had), and they were a lifesaver. I could double the dose and have no problems with GI irritation like I did when I tried that with OTC Aleve (naprosyn sodium).

Tom, how lucky that you could sleep well after taking a Perc. That was my biggest hope is that I could take one at night and then sleep through the narcotic effect. Unfortunately, like Chere, I can't sleep when I take one. I think I have like 4 left of the #20 that were given to me 3 1/2 years ago, and only take it as a last resort when the Alleve isn't kicking in fast enough. But, they do work, and really well and usually pretty quickly.

I definitely have no tendency whatsoever towards becoming addicted to any type of opiate. No appeal whatsoever. THC is okay, everything is really funny when you are stoned - haven't used it in 20 years, though. Caffeine....now, we're talking! :haha: Definitely my chemical of choice :2thumbs:.

Sorry, 'beech - didn't mean to derail your thread by talking about personal experience with drug use :mrgreen:. Those walking boots are amazing, aren't they? Not much to look at, but when they work, who cares?

Hope you're back to full activities sans boot and foot surgery really soon! :nod:

[canyonphile]

First I have to say how cool it is to have our very own Bogley Doc! You rock Sonya~~~ :hail2thechief::hail2thechief::hail2thechief::hail 2thechief::hail2thechief::hail2thechief::hail2thec hief::hail2thechief::hail2thechief::hail2thechief: :hail2thechief:
:lol8:

Thanks, Tanya! I retired from that profession at the end of '06 after 8 years trying to make it work, but I still remember a thing or two of the $180,000 education I received from it. Glad it can be of use from time to time :wink:.



Tom, I think its what Sonja said. Pain pills don't send you flying when you are actually in pain. It's those that take them when not in pain and in excess that get in trouble. Is that right Sonja?

That's my experience and what studies show. If someone was still requesting #30 vicoden a week for toe surgery that happened a month ago, I'm going to cut them off. But, if they just had ankle or bunion surgery, they can have as much as they want or need (within reason...don't want to blow out someone's liver with too much tylenol from percocet) for at least the first week.

Wade is right about pain taking its toll on your mental health. People heal faster when they aren't in pain or depressed from being in pain, and are certainly more pleasant for nurses to deal with, so I never skimped on the MS04 or Demerol for those people when I was managing them in the hospital after major foot or ankle surgery.

Here's an interesting excerpt from Wikipedia on Dilaudid (aka oral morphine):


A possible and likely side effect associated with hydromorphone is a very powerful euphoria, achieved dually through a perceived transition from a state of pain to a state of pain-relief, or through direct stimulation of the μ opioid receptor (μ1 and μ2) [of which hydromorphone, related to the morphine molecule, is a primary μ agonist]. Although this can lead to addiction and reward-seeking behavior, it has been demonstrated that, when opioids are taken for pain relief, patients are very unlikely to misuse the drug.

I can definitely relate to that first sentence about the euphoria from the pain being gone.

[ratagonia]

I'm still on the "people have a wide range of reactions" theme. Even without pain above "6", Percocets don't get me high. I used to use them for back spasms after carrying a heavy pack. One before bed, sleep like a baby, wake up with a non-spasm'd back. (The doctor did not want to give me Percocets for my recent back spasm, did not want to consider it). I had Dilaudid in the hospital, and did not really sleep, but had vivid semi-sleep mind-wanderings, solving the world's problems... Caffeinated coffee effects me strangely too.

Tom

[Sombeech]

A huge cause of death with Narcotics is dying in your sleep so I keep in mind not to take any within several hours of bed time.

But when I'm feeling the effects during the night, I love how it can seem like you've been asleep for hours and you wake up, look at the clock, and it's only been 15 minutes.

[jman]

A huge cause of death with Narcotics is dying in your sleep so I keep in mind not to take any within several hours of bed time.

But when I'm feeling the effects during the night, I love how it can seem like you've been asleep for hours and you wake up, look at the clock, and it's only been 15 minutes.

You know what's scary is that after my ankle surgery, I was "maxed out" on Narcotics and just fallen asleep. Next thing I remember was be awoken by the nurse and she said "well we won't be given you such and such again. [I wish I coul remember what it was...I'll have to go through the paperwork and find out]". I remember walking up and feeling just fine...not out of breath or anything. Apparently my O2 stats dropped significantly as well as my heart beat (down to 35 the nurse said). Once I woke up, everything returned back to normal...very scary!

It's true that narcotics supress the CNS which lowers your heart rate and respirations...

Good thing I was in the hospital when that happened however...

[bbennett]

Percocets don't get me high.

Me either. The only thing I ever got out of them was a lot of itching. Couple Lortabs and a few beers have always done the trick though :nod:.

[heatheraball]

I think it all depends on the doctor. I had to ask for pain meds and my PCP let me know that Tramadol can be addictive and he was not very excited about letting me have any. I have Chiari and get some pretty bad pain from time to time and Tramadol is the only thing I have found that helps me. On the other hand, my neurosurgeon has absolutely no problem letting me have pretty much any type of pain reliever I want or need, but he is in Denver and I am in S Utah. I hate that I need to justify to my doctor why I am in pain, and that over-the-counter drugs just don't take care of it. I think he figures since I have constant pain, I ought to be able to deal with more; which is what it sound like you are dealing with. I have found that you just need to ask, and let the doctor deal with his or her own addiction issues.

[Felicia]

I even tried it out on my bike today and it works. :mrgreen:

Careful or you will soon have a bad knee. :nono:

Take it easy and recover quickly!!! :2thumbs:

[denaliguide]

i always thought you just pulled up to the corner and when the guy comes over, you say "got any stuff?"

[Iceaxe]

I just give my kids $20 and tell them to pick me up some Percocet's while they are at school today.

:cool2:

[Sombeech]

I got my checkup today. He says @ 6 weeks with the boot. Fortunately I discovered last night that I can bike with it the boot on no problem. :mrgreen: Doesn't even put pressure on the foot, the way the boot is designed. Walking around on it is actually harder on my foot than biking.

So he gave me about a week's worth of Tramadol / Ultram. Nothing at ALL is coming up on "how is it feeling, how's the medication treating you...." - nothing. And to be honest it's pretty tender when I take the boot off and I can't keep that thing on 24/7. So here I go again like a low-life asking for drugs;

I didn't come right out and say it yet but he could tell it was coming. He beat me to the punchline and said "A lot of these pain meds relieve the pain but they also stop some of the healing process. The pain instinct accelerates healing too"

So, yeah. Give me a reason to ever come back to you. I don't need to be a genius to "take it easy" on my foot, and to know I can take the boot off when it's feeling better.

[Sombeech]

oh, here's the x-ray. Cell phone photo on a fluorescent background, hence the lines.

Just a small bone, but it's split right in half. Annoying little sucker.

44481

[canyonphile]

I didn't come right out and say it yet but he could tell it was coming. He beat me to the punchline and said "A lot of these pain meds relieve the pain but they also stop some of the healing process. The pain instinct accelerates healing too"
Sorry, I call complete bullshit on what he says. I have never heard that pain meds slow down the healing process, and I think that's something they would have shared with us in medical school. And that "pain accelerates healing"? WTF did he hear that?

If you've got a fracture, and it hurts, that means one of two things: 1) it is in the acute phase of injury and thus the inflammatory process is causing the pain; 2) if it's been longer than a week since you did it, there is movement between the broken bone pieces, which.....





wait for it.....











....DELAYS HEALING!

So, if it hurts, it means it is NOT HEALING QUICKLY.

Please tell me this guy is not a podiatrist....even though I'm not practicing anymore, I want to shove my head in the sand every time I hear a comment like this come from a "colleague" :facepalm1:. And the profession wonders why it gets no respect from MD's and gets treated like the red-headed stepchild in hospitals :roll:?

Regarding your x-ray - that is one helluva huge fibular sesamoid! It's almost 2x the size of the other one. Of course, I can't tell that much from a single photo of an x-ray, but I honestly wouldn't be surprised if it is not in fact a bipartate sesamoid (formed in two pieces connected by a ligament) that got sprained rather than a true "fracture". See how the edges are rounded; you don't get that with a fracture, at least not one I've ever seen.

Looks like there's a bone spur coming off of the proximal piece of that sesamoid off to the lateral (left) side. That's neither here nor there, but it usually suggests that there's some mechanical pulling from the soft tissue attachments that caused it. Interesting :nod:.

Well, bone normally heals in 6 weeks. So, if it still hurts then, I'd consider having surgery to take out one of those pieces. The good news is that since both are so big, it won't have any biomechanical consequences: we were taught in school that removing the fibular sesamoid may accelerate bunion formation (which you don't have). Of course, at some point, it makes an existing bunion formation even worse, so it sometimes came out during a bunion surgery.

Anyway, good luck to ya :cripple: Justin. I'd consider getting a second opinion if I were you....just sayin' :whistling:

[Sombeech]

Yeah, I would have thought the pharmaceutical reps would be begging him to push their stuff. Who knows, but the 2 guys in this particular office really don't like the idea of people living pain free.

[Sombeech]

So I ended up getting a second opinion after hearing some negative feedback.... Plantar Fasciitis; NOT a broken foot.

And this new Podiatrist happens to be in favor of pain management. :cool2:

That Sesamoid bone that is in 2 parts could have been broken years ago, or even from birth.

[canyonphile]

That Sesamoid bone that is in 2 parts could have been broken years ago, or even from birth.
Dude...did I not tell you that in the last post I wrote? :facepalm1: "...but I honestly wouldn't be surprised if it is not in fact a bipartate sesamoid (formed in two pieces connected by a ligament)." It didn't look fractured to me from the x-ray.

Plantar fasciitis, eh....that sucks. It's a pain in the ass (or heel, I should say) to get rid of. It occurs in two main groups of people: big fatties and really athletic people. Cortisone shots hurt like hell (or so I've been told by hundreds of patients), but they work really well. Pain meds of any kind don't do JS for plantar fascial pain, and I never Rx'd narcotics for it.

[Brian in SLC]

Plantar fasciitis, eh....that sucks. It's a pain in the ass (or heel, I should say) to get rid of. It occurs in two main groups of people: big fatties and really athletic people.

I think you just described sombeech to a "T"...ha ha!

Uhh, count me in that group too...

Foot pain sucks. I've gone to several pod's. Good to get that second opinion. I have a good friend who's a podiatrist, and, I had to go to another just to make sure. Knock on wood, been ok for awhile, but, after a 20 mile day last weekend, a bit of limping that seems to be easing off. Whew.

Lortab seems to work for me, but, most opiates make my skin crawl. If I'm in pain, though, I'll pop one. Got me out of the Tetons a few years ago with bad foot pain. Gettin' to the car was sweet. Not crying enroute was even sweeter.

A guy at work got the surgury for PF. Scheduled to get both done, got one, and, cancelled the other. Didn't work that well for him.

In the words of Bill, "I feel your pain".

Good luck.

[Sombeech]

It occurs in two main groups of people: big fatties and really athletic people.

I'm not sure exactly how you're profiling me here. You left out SEXY.

[Scott Card]

No she didn't. :lol8:

BTW, I have had plantar fasciitis. Hurts like the dickens. Mine went away by doing nothing athletic and by eating chocolate Dunford donuts which may have headed me in the direction of the fatty category.

[erial]

Got pf in my right heel in Apr 2010. By July, the pain had moved from the heel to the achilles tendon. By November it surrounded my knee and that really shut me down for a few months, but now I'm somewhat back to where i was pre-pf. Ice, heat, wraps were employed, but in the end stretching and lots of walking/hiking as opposed to running seemed to help the best for me.

[erial]

heel pain being discussed as well over on summitpost:

http://www.summitpost.org/phpBB3/viewtopic.php?t=58660

[canyonphile]

heel pain being discussed as well over on summitpost:

http://www.summitpost.org/phpBB3/viewtopic.php?t=58660

Hyadventure's post on that forum pretty much sums up the best treatment protocol for it. Even though as a podiatrist I would do the fancy-pancy high-end custom orthotics, I'd often recommend a good OTC insert (like Superfeet - I have those in my hiking boots and they are great!) to start out with.

Night splints worked great for some patients, but others couldn't sleep in them. Cortisone shots, not mentioned, also work very well, but they don't "cure" the problem - they are potent anti-inflammatories that work at the site while the other things (stretching, weight loss, if applicable, reduced activity, inserts, etc.) are working.

This was probably the single most common condition I'd treat in practice, and I'd tell patients we'd go with the "shotgun therapy" approach: that is, don't try one thing at a time, see if it works, then try another. Do all the cheap, free, easy, non-invasive things all at once, and then work up the treatment triangle from there.

I also do not consider it a surgical condition. Be very, very wary of any surgeon who suggests that it can be easily fixed through surgery. It can often result in more (different) problems down the line if you aren't careful. I've seen that happen with my own eyes through the hands of hack surgeons when I was in training.

One of the surgeons I trained with at Kaiser Permanent during my residency used to say that only 1-2% would require surgery. And, in his opinion, by that time, there were probably other issues going on. There is a condition called Baxter's neuritis that mimics the mechanical heel pain of plantar fasciitis. It is in the same location, and my own thoughts were that it happens as a result of the plantar fascia thickening over time due to the chronic inflammation, and impinging the nerve. In a case like this, surgery to address the impingement can help, although I never did this particular surgery in practice.

But, your doctor needs to know the condition exists in the first place, and I'm guessing many/most don't.

BTW, I think our definition of "fatties" is probably a bit different :haha:. I'm talking about these 275 lb. 5'7" women that used to waddle into my office in flip-flops or $10 Walmart shoes and wonder why they had heel pain :roll:. I'd tell them that their heel pain would magically go away if they'd lose 100 lbs....but, oddly, they weren't interested in doing that. They wanted a quick fix for their problem, and telling them to lose weight, stretch 2-3x/day, and buy better shoes just had no appeal. Since probably 95% were on the state funded medical welfare program of AZ, that didn't help the mentality. In addition to being professional welfare recipients, they were also professional victims as well.

Not issues with this crowd!:2thumbs: