Rroof? Shawn? Any podiatrist types? (sorry, this is long)

Triathlon Forum
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Okay, I’ll start off by saying I’m not looking for a diagnosis over the 'net. And I’m not trying to get some one in trouble with the AMA. I just have my doubts about this being an appropriate treatment recommendation.

Diagnosis was “strained plantar fascia” last week (7/18). I’d been running on fairly rocky trails here at work in my Nike Waffle Racers for a few weeks. On a Thursday (7/5), I stepped on a good sized rock (about golf-ball size) just behind the ball of my foot (more medial, but that’s the location fore-aft wise). I could feel my foot deform around it, and it hurt, but I continued running, finishing out 40 minutes (it happened about half-way through). I ran long on Saturday (Nike Air Max 360’s) with no issues. On Monday (7/9), I ran at work again (Waffle Racers), and must have hit the SAME damn rock in the SAME damn place… Again, felt my foot move, and it did hurt, and again I finished out the run. It was hurting more after the run. I tried to run on Wednesday (7/11), but there was more pain than I wanted to try to run through. I waited, not running (but still riding) for a week, and with no improvement, I went in to see the podiatrist. I have been on prednisone for a fairly long time (currently 10mg/day), and it was felt that the prednisone was compromising my healing ability there.

So I’ve been in a “boot” for the last week, except at night. I can swim, but no biking or running. I’ve also been doing a lo-di taping for the last two days, which is helping keep the tension off the fascia.

So first follow up is today. She palpates the fascia – no pain. I ask about using a golf ball to roll it. She says to use a frozen water bottle instead.

Then comes the recommendation – keep the boot on for another week, then go to just the taping. No riding or running for two weeks, but can swim. So far so good. Then she says “I’m not going to try to fit you for orthotics today, but I think in two weeks when you come back we should. Oh, and more supportive shoes.”

I was shocked. I told her “I find it interesting that you’re suggesting orthitocs when I have ZERO history of overuse injury related to this. This whole thing was brought on by trauma. It’s like you think ‘I’m a podiatrist, so the world needs orthitics.’”

She looks very surprised, then turns around to look at my chart. Then she starts talking about how, now that I’ve had the injury, I’m more susceptible to further injury, and that running is very hard on the feet and knees, and that she feels that all runners should have orthotics.

I think I lost all respect for her at that exact moment. The old “when all you have is a hammer, the world becomes a nail.” She has no clue what my foot strike is, the wear pattern on my shoes (classic midfoot strike), anything.

Does this seem appropriate? I’d really love to hear others’ input on this, especially podiatrist types…

Thanks. And sorry for this being so long, but I thought I should be thorough.

2

I’m certainly not a podiatrist, but I slept at a Holiday Inn…nevermind. Anyway, there are still podiatrist out there that believe everyone should be in orthotics. Like you said, this is not a biomechanical issue but was trauma-induced injury, so I fail to see how orthotics are going to fix this problem. BTW, you may want to consider a racing flat or lightweight trainer, something with a bit more cushioning, so that this doesn’t keep happening.

3

Yeah, I was actaully going to do some shoe shopping this afternoon, but since I’ll be in the boot for another week, I’ll put it off. Thinking maybe the Nike Considered Humara… But the Air Max 360’s are fine off-road, I just wanted a knock-around pair to keep at work, so I didn’t have to drag shoes back-and-forth to work on the bike commute (and didn’t want to have to buy another pair of $130 shoes). But I agree – something with a little more between the ground and my foot is a better choice.

4

I’m not a podiatrist, but I did earn a Certified Pedorthist credential, but have since let it lapse. (A C.Ped. is the credential required, only in some states, in order to take a doctors prescription and manufacture an orthotic appripriate to the diagnosis. Note that most states require no credential in order to fit orthotics.)

So now I am just an engineer/triathlete. Her take that every one needs orthotics is certainly not a recommendation supported in any of the academic literature with which I am familiar, but is common in the trade; and is largely a reason I decided to not pursue the business any further.

If I had to guess, she was going to fit you with a soft orthotic, which can only address pressure distribution issues. Soft orthotics can change the velocity of pronation, but only rigid orthotics have ever been clinically proven to reduce the range of pronation. Rigid orthotics are very difficult to fit, and often the patient finds them uncomfortable to the point that they refuse them.

So soft orthotics are over prescribed as best I can tell, because they do offer comfort, are easily accepted by the patient, don’t actually change range of motion, and provide a substantial profit center.

I agree, your injury was trauma, and orthotics are not required unless there is something we are not hearing.

-------EDIT---------
I thought about this a few more minutes. Maybe her take is that you are a suppinator, and you need a soft orthotic to provide more cushioning. That would also help prevent a recurrence of this type of injury. Possible it seems. Using that logic, maybe she puts all her supinators into soft orthotics, and all over-pronators in rigid orthotics, and she never sees neutral runners (?). So everyone needs orthotics :slight_smile:

Seriously, if you are a suppinator, I could rationalize the logic. I would not agree with it, if as you indicate, this was a one off occurrence in a long history of injury free running.

Paul

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"I thought about this a few more minutes. Maybe her take is that you are a suppinator, and you need a soft orthotic to provide more cushioning. That would also help prevent a recurrence of this type of injury. Possible it seems. Using that logic, maybe she puts all her supinators into soft orthotics, and all over-pronators in rigid orthotics, and she never sees neutral runners (?). So everyone needs orthotics :slight_smile:

Seriously, if you are a suppinator, I could rationalize the logic. I would not agree with it, if as you indicate, this was a one off occurrence in a long history of injury free running."

You know, if she’d looked at my shoes, or seen me run, or had ANY information, I’d be a lot more accepting of a diagnosis. The fact that the recommendation was made in a total VACUUM of any of this information shocked me, and the later statement that “I feel that all runners need orthotics” jist confirmed it.

So I’m thinking I’ll give myself the two weeks, cancel the follow up, and never go back there again.

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Yes, any physician that has a “general” recommendation like that (all runner need orthotics for example), you should look elsewhere. If she has ruled out bad things, her job is done, now move on. You would have best been served in a trail running shoe it sounds like :wink: Honestly, I’ve said a million times, it is much better to find someone who shares your passion/interests - you will be much better served.

Back to your diagnosis - your contusion should respond with a little time/rest/ice. All you should need. BTW, why are you on 10mg or prednisone daily? Sarcoid? Lupus? RA? Breathing issues? Poison Ivy? Just curious. Does the low-dye taping help? That does “simulate” an orthotic BTW.

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Did she do a diagnostic ultrasound? I assume not since you said she palpated the fascia.Diagnostic ultrasound is indicated specifically for soft tissue pathology and many DPM’s have it. It’s real time tons cheaper than MRI too.

PM me where you live I may know a DPM who has it. My dad is retired from podiatry but was a Fresno State team doc and used ultrasound all the time.

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The prednisone is for ulcerative colitis. I’ve found that, unless I go on VERY gradual tapers, I flare up pretty easily. So it’s been a long journey from 40mg down to where I am now, and I have another 6 months before I’ll be off completely. Hopefully at that time the Colazal will control it, or I’ll have to turn to something like Imuran or Remicade.

I’ve got a short list of loca Sports Med docs, if needed.

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No ultra-sound. In fact the only thing she did was palpate and go by my pain level.