Ask Dr. Gott » foot pain

A patient’s need to know

Dr. Gott — Sat, 03 Jul 2010 05:01:44 +0000

DEAR DR. GOTT: I have been diagnosed with peripheral neuropathy. I am a 73-year-old female in generally good health. I’ve had gall-bladder surgery, a hysterectomy, cataract repair, and knee and shoulder replacements.

I noticed a tingling feeling in my left middle finger, left foot and then my right foot. I went to a podiatrist, who prescribed gabapentin. I am now taking 300 milligrams three times a day, but it doesn’t seem to be helping. It is a disturbing feeling that keeps me awake at night until I finally fall asleep from exhaustion. During the night, the tingling seems to go away, but as soon as I start walking, it starts up again.

I read an article that mentioned a person taking a statin drug for more than five years can develop peripheral neuropathy. I was on 40 milligrams of Zocor that was increased to 80 milligrams five years ago. I’ve been cutting the pill in half for a year following a cholesterol reading of 163 and now take L-thyroxine, furosemide, aspirin, folic acid, fish oil, vitamin C, potassium, calcium with vitamin D, iron with calcium, and vitamins B6 and B12. The neuropathy began six months to a year ago. Muscle and nerve biopsy tests showed no damage, nor do I have diabetes according to the blood work ordered.

If peripheral neuropathy results from statin drugs, why aren’t patients told this when they are given them? If I stop taking the statin, would or could the neuropathy go away?

DEAR READER: I am surprised your physician did not advise you of the possible side effects of the Zocor he prescribed. A year or more ago, there was a great deal of media coverage regarding debilitating calf-muscle cramping and tingling that resulted from the use of statin drugs. In the defense of drug companies, not everyone will experience similar side effects. Some people can successfully be prescribed almost any medication without side effects. However, others can’t tolerate them and must find alternative control for their medical issues. There is no need to alarm patients needlessly; however, they do have a right to know what they might expect.

This brings me to a related issue. When a physician prescribes any medication, it is his or her obligation to verbalize any possible side effects. Should that not happen, the patient should ask what to expect when taking something new. When this is accomplished, the patient and physician can make an educated decision as to whether a drug is appropriate or simply not worth the risk.

You list the surgical procedures you underwent but don’t indicate whether you have any cardiac issues that your physician is attempting to micromanage. I occasionally get criticized by my colleagues when I indicate a reading is normal, only to find there are extenuating unknown circumstances for wanting levels substantially lower. That said, I don’t know what your cholesterol readings were prior to the Zocor, but you certainly might be managed on a lower dose than the 80 milligrams. That decision is best left to your physician, who knows your complete medical history.

Give your doctor credit for testing you for diabetes, which carries the symptom of peripheral neuropathy, and kudos to you for supplementing B6 and B12 for possible deficiencies.

To provide related information, I am sending you a copy of my Health Report “Understanding Cholesterol.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Is surgery always appropriate for bunions?

Dr. Gott — Fri, 18 Jun 2010 05:01:38 +0000

DEAR DR. GOTT: I have had a bunion on my right foot for a long time. It is very painful. My foot doctor has cut the side of my shoe off so the bunion can extend out. This is the only pair of shoes I can wear.

I may have to have surgery, but some of my friends have told me the bunion will probably grow back. Do you know of any ointment that I can put on it? Or what else would you suggest I do?

DEAR READER: A bunion is a bony protrusion on the joint at the base of either big toe. There are a number of reasons for them to form, the most common of which are poorly fitting shoes, congenital deformities, foot injury and arthritis. Symptoms include the obvious bulge of the bunion, intermittent or constant pain when wearing footwear, swelling and skin thickening at the base of the great toe. The toenails may grow into the sides of the nail bed, and some bones may bend permanently at the joint.

Treatment commonly begins with a conservative approach, such as wearing shoe inserts, using appropriate padding, taking over-the-counter pain relievers and wearing better-fitting shoes. As your physician apparently pointed out and took measures to correct, cutting the shoe at the site of the bunion is yet another means of accommodation; however, if you live in a cold climate, this could certainly present its own set of difficulties during the winter.

When conservative measures fail to be effective, surgery might be appropriate. A podiatrist has several options, depending on the severity of the deformity. In some instances, a patient will be able to walk as soon as the procedure is completed. In other cases, it may take two months or longer before complete recovery occurs. Recurrence occurs post-surgery if a patient continues to wear ill-fitting shoes. Thus, appropriate footwear is vital. This may be what your friends refer to when they indicate a bunion can grow back.

I recommend you make another appointment with your podiatrist to determine what might be best for you, based on your age and possible medical conditions. Get all your questions answered before making any decision to undergo even the simplest surgical procedure. If questions still remain, request a referral to another podiatrist for a second opinion. Until a firm decision can be made, consider using bunion pads, icing the area a couple of times each day and using ibuprofen or acetaminophen.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Plantar fasciitis painful

Dr. Gott — Fri, 21 May 2010 05:01:08 +0000

DEAR DR. GOTT: I had a bout with plantar fasciitis several years ago. The treatment at that time was cortisone shots in my feet to help ease the pain until it went away. I have developed another case, but this time my doctor will not do the shots. He has given me exercises to do and pain medication to ease the pain. However, it is not working, and I do not understand why he cannot give me the shots, which were like a miracle last time.

I am on my feet on concrete most of the day. Do you know of any other remedies to help with this so I don’t have to miss work?

DEAR READER: Plantar fasciitis is a painful foot condition marked by inflammation of the band of tissue running from the heel along the arch of the foot. It is seen in middle-aged men and women and is common in athletes and runners. Symptoms are typically worse early in the morning, when first awakening, but once a person is walking and the foot is stretched and the ligaments loose, the pain generally subsides. The pain can be worse with prolonged periods of walking or standing.

Your physician is appropriately declining more cortisone injections, because there are potentially serious problems injecting the heel area with cortisone. Fat-pad atrophy and plantar-fascial rupture can occur. The possibility of either occurrence is small but could result in a worsening of symptoms.

Recommendations for care include ice packs, stretching exercises, over-the-counter anti-inflammatory medications, shoe inserts, properly fitting shoes and rest. A new treatment known as extracorporeal shockwave therapy is being investigated. This uses pulses of energy to induce micro-trauma to the tissue of the plantar fascia. The treatment is believed to encourage repair of the tissue and is recommended for patients who fail to get relief from other methods, despite reports of conflicting results. Then there is tarsal-tunnel release, which is about 80 percent effective in relieving pain in patients who don’t experience relief with conservative measures.

Reader questions long-term effects of steroids

Dr. Gott — Wed, 05 May 2010 05:01:38 +0000

DEAR DR. GOTT: My lady friend has had problems with arthritis and plantar fasciitis for about five years. She is 51 and postmenopausal. Her doctor prescribed methylprednisolone, which has helped both problems, but we are concerned about the underlying soreness that is a sort of weakness of bones and muscles. She is sore slightly but worse when poked or bumped. What are the long- and short-term side effects of this drug? Is a multimineral program best?

DEAR READER: Arthritis is pain and stiffness of the joints. You don’t specify what type she has, so I will generalize because there are actually more than 100 forms.

Osteoarthritis is pain in the joints accompanied by progressive stiffness without extensive inflammation, chills or fever. It is a chronic disease of the joints resulting from a cartilage breakdown. Rheumatoid arthritis has pain, inflammation, swelling and stiffness that typically occurs symmetrically on both sides of the body. The infectious form includes symptoms of inflammation, chills, fever and pain, and may be linked to another illness. Then there’s gout, Behcet’s Syndrome, CREST syndrome, fibromyalgia and a whole host more.

Some patients respond to topical ointments with capsaicin or castor oil rubbed onto painful joints; purple grape juice and liquid pectin mixtures; or omega-3 fish oils.

Plantar fasciitis is pain and inflammation in a dense band of tissue of the foot that connects the heel bone to the toes. It is common in runners, overweight people, pregnant women and in those who wear shoes without adequate support.

The methylprednisolone your friend has been prescribed is a steroid that prevents the release of substances in the body that cause inflammation. It is also used to treat several allergic disorders, arthritis, psoriasis, ulcerative colitis and a number of other conditions.

Steroids can weaken a person’s immune system, thus making him or her more susceptible to infection. They also have the ability to reactivate recent infection. Steroids should be reduced slowly and not discontinued abruptly because of potential side effects from withdrawal. Your friend should avoid being near people with chickenpox, measles, active infections or who are otherwise sick. She should not receive any “live” vaccines while on the drug. The drug can also alter certain medical testing, so she should be sure to make her usage known to avoid being misdiagnosed.

Side effects of high doses include hypertension, heart arrhythmias, muscle weakness, chest pain, shortness of breath, visual problems, tarry or bloody stools, pancreatitis and more. Long-term use can lead to easy bruising, acne, facial hair, loss of libido, headache, insomnia, nausea, changes of body fat and more.

The bottom line is that she should take the drug precisely as it is prescribed. Modifications (which are obviously acceptable) might be made by her prescribing physician. Should she develop kidney disease, osteoporosis, glaucoma, cataracts, congestive heart failure or a number of other conditions, her doctor will likely make dose adjustments and order special testing while she is on the medication.

To provide related information, I am sending you copies of my Health Reports “Consumer Tips on Medicines” and “Fibromyalgia.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Hammertoe surgery a same-day procedure

Dr. Gott — Tue, 23 Mar 2010 05:01:21 +0000

DEAR DR. GOTT: I am a 59-year-old female. I have developed two hammertoes on my left foot and one on my right foot during the past three months. I went to a podiatrist, who advised me to use a cold pack for 20 minutes three times a day and to wear only athletic shoes. He also advised me not to go barefoot. I paid $23 for a pair of shoe inserts made of compressed foam, which he made during my visit. I am still experiencing the same level of discomfort. The stabbing pains are in the affected toes and the balls of my feet. The pain even awakens me during sleep. Can this condition be surgically corrected? Do you have any suggestions for a less invasive treatment?

DEAR READER: Hammertoe is a condition in which the affected toe or toes become bent at the middle joint. The middle joint bends upward, while the tip curls downward into a characteristic hammer or clawlike shape.

The most common cause stems from wearing shoes that are too small or heels that are too high. These types of footwear do not provide adequate space for the toes to lie flat, thus pushing one or more forward in an unnatural, bent position. Some cases may be inherited and will develop no matter what kind of shoes you wear.

The early sign is a toe that curves abnormally but is still flexible and lies flat when not wearing improper footwear. Over time, the repeated use of these shoes will cause the tendons to contract and tighten, causing the toe to become bent and stiff permanently. Other symptoms include pain and difficulty moving the affected toe, pain with walking or other foot movements and the development of corns or calluses caused by the constant rubbing against the shoe.

Treatment depends on the severity of the deformity. In the early stages, simply wearing more comfortable, wider shoes and using special shoe inserts or pads may be all that is necessary; however, once the hammertoe has become inflexible, surgery is recommended. There are two types of procedures, depending on the remaining flexibility. If movement is possible, the surgeon may simply release the affected tendon though an incision in the toe. If the toe is completely rigid, a more complicated procedure might be performed. In this case, the affected tendons will need to be cut or realigned, and portions of the bone may be removed to allow for straightening.
The good news is that both are relatively minor procedures, and most patients will be discharged on the same day. Once you’re home, it is important to take proper care to avoid further damage to the toe. Specifically, don’t repeat the same mistakes that caused the hammertoe in the first place. Wide, flat shoes, such as sneakers, are preferable during recuperation and afterward. Stretching the toe muscles and performing strengthening exercises, such as picking up marbles with your toes, may be recommended.

If your pain persists following the podiatrist’s suggestions, return to him to discuss further treatment options. Or you could get a second opinion.

To provide related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Give foot pain the boot

Dr. Gott — Sun, 21 Feb 2010 05:01:09 +0000

DEAR DR. GOTT: My 63-year-old mother has complained every day for three months about a sore heel. It feels better when I massage it for her, and it also helps if she stays off her feet. She believes it’s only the sole that hurts but refuses to see her doctor, so we would appreciate your thoughts on the matter.
DEAR READER: There are a number of reasons for a person to complain of foot pain, whether it presents in the heel or in the sole. Unfortunately, I didn’t get a full history from you, such as whether your mother is still employed and stands on her feet all day, whether she is dedicated to fitness and jogs to stay in shape, whether she is somewhat sedentary and has recently gained or carries excessive weight, or whether she simply prefers to wear shoes that don’t support her feet properly. Therefore, I will discuss several of the more common conditions that might provide some answers.
A condition known as plantar fasciitis occurs when a ligament known as the plantar fascia, which runs the full length of the bottom of the foot, is stressed, causing the tissue to tear. Irritation and inflammation of the fascia can result in bruising and extreme pain. Causes for the tear are sudden weight gain, repetitive or excessive stress, or wearing shoes without adequate support.
Achilles tendonitis is similar to plantar fasciitis, yet differs because of the location of pain, because it affects the tendon that runs down the calf, along the back of the foot and connects to the heel bone. Severe pain can result when the Achilles tendon or a calf muscle is stressed. Often seen in middle-aged recreational athletes, the condition is common when people fail to stretch and bend prior to strenuous physical activity. Other causes are repetitive movements and excessive physical stress.
Heel spurs are bony projections that occur along the edge of the heel bone. They typically develop on the front of the heel bone and point toward the arch of the foot. They often irritate the plantar fascia and cause inflammation but don’t always cause pain.
Morton’s neuroma is a benign growth of fibrous tissue around a nerve, commonly between the third and fourth metatarsal heads. The pain experienced is commonly the result of wearing high-heeled shoes.
Metatarsals are the long bones at the base of each toe. Excessive pressure on the ends of the toe bones can cause pain and symptoms in the ball of the foot. The medical term for this is metatarsalgia and is primarily the result of tight shoes and from wearing shoes with high heels. People suffering from this condition should forgo shoes that are narrow or have pointed toes or high heels and opt for wider shoes that will allow the foot ample room to stretch appropriately.
Without knowing the true cause of your mother’s pain, I recommend you begin simply. Purchase a nonsteroidal anti-inflammatory over-the-counter pain medication. If you have any questions about the numerous brands available, speak with your pharmacist for his or her recommendation. If shoes are the issue, depending on her general activity, have your mother purchase a pair of relatively flat or athletic shoes designed to cushion and provide extra support. She may wish to purchase cushioned shoe inserts and/or arch supports that can relieve stress. She can likely benefit from using a whirlpool-type foot bath at home and might relax in the evening with her feet propped up on a foot stool or pillow. An ice pack, either the real thing or one made from a frozen bag of vegetables placed against the foot, might also lessen the pain.
If all my recommendations fail to provide relief, attempt to convince her to see her physician or a podiatrist. A noninvasive X-ray, CT scan or MRI can be performed that will likely provide the answers her doctor needs to determine the correct diagnosis. While her doctor can make recommendations, your mother (perhaps accompanied by you) should be in complete control and call all the shots. She should be the one, with the guidance and knowledge of a healthcare professional, to decide what should or should not be done. Good luck.
To provide related information, I am sending you a copy of my newly revised Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.