Thinking it through

[cjsmith]

Problem:
- The foot surgery didn't work and I am now back to feeling moderate pain with every step
- In a very short conversation, my doctor mentioned "PT and orthotics" for the non-neuroma foot problems
- My insurance won't pay for any more PT or any more orthotics this year
- PT (4 different bouts) and orthotics (multiple designs) have been demonstrably useless so far anyway

The tools I have available without spending lots of time or money:
- Cushiony insoles
- Metatarsal pads
- Massage
- Anti-inflammatory meds
- My adjustable Chaco sandals
- My post-op shoes

Tools I will have available later, once I've healed more fully from surgery:
- Discuss my ideas with my podiatrist
- Find (HOW??) a doctor who treats professional athletes and thus is less likely to wave away the problem
- See an orthopedist

Here are a few possible theories, with data that seem to support or contradict them and what action I should take if the theory happened to be right. It's quite possible that more than one of these guesses is right. It's also possible they're all completely wrong. Trying things might give me more information. It's something to do while I'm waiting.

1. Despite the MRI image not showing inflammation, the problem is inflammation
Support: the pain *acts* like classic chronic inflammation
Action: big buckets of anti-inflams
Contradiction: anti-inflams have done zilch the last several times I have had this thought and tried them

2. Pain is triggered by impact, not pressure
Actions: snug down the straps on my sandals, add LOTS of cushiony insoles, add metatarsal pads, use post-op shoes sometimes
Test: stand up without walking, for a very long time, and see whether this pain flares up

3. Pain is triggered by pressure, not impact
Actions: loosen sandals, add metatarsal pads, use post-op shoes sometimes
Test: while seated, strike the ball of my foot on the floor a bunch, and see whether this pain flares up

4. Pain is triggered by twisting/turning
Support: square dancing for two hours seems to be much worse than walking all afternoon
Actions: get snug, supportive shoes?
Test: walk at a moderate pace mostly in a straight line for a long time and see whether this pain flares up

5. Pain is made worse by correcting my pronation
Support: I had much less pain in the post-op shoes with no arch support at all
Actions: wear post-op shoes sometimes, cut out the arch area or whole medial portion of some insoles (to counteract my sandals' arch support) and wear those
Cautions: this will not be good for my ankles or knees, I shouldn't attempt to run this way

6. Pain is due to tissue damage which can be healed
Support: flexor tendons and plantar plate are the only remaining things that looked wrong on the MRI
Actions: deep tissue massage, vitamins, alternating heat and ice
Contradiction: tissue that can heal usually will and yet this hasn't for nearly two years

7. The pain is because my third and fourth metatarsals ride very low and have no fat pad underneath
Support: well, they do ride very low and have no fat pad underneath
Actions: orthotics with a "hole" under those metatarsal heads, add metatarsal pads, add LOTS of cushiony insoles, try to stretch the intermetatarsal ligaments by pushing on the bones multiple times a day
Alternate actions for later: discuss this with my podiatrist, find an orthopedist and discuss this idea

8. The pain will get better when some scar tissue goes away
Support: well, scar tissue IS abnormal
Actions: scar massage, waiting
Contradictions: much of the pain is far away from the scar tissue, I had this pain before surgery

Comments

[lesliepear.livejournal.com]

I did a google on sports medicine san francisco and got this:

http://www.stoneclinic.com/
http://www.iasm.com/
http://www.physsportsmed.com/clinics.htm
http://www.ucsfhealth.org/adult/cgi-bin/prdListDoctorAlias.cgi#Sports%20Medicine

[cjsmith.livejournal.com]

There's a sports medicine clinic in Palo Alto, too, not too far from me. They might know who treats the professionals -- the people who have to change careers if they're not cured.

[firecat]

That reminds me, because the OH's mother is a Feldenkrais practitioner who has worked at a sports performance clinic - have you tried Feldenkrais at all?

[cjsmith.livejournal.com]

Mmm, no! Heard of it, haven't ever tried it. I guess I sort of lumped it in my head with yoga, a thing I *do* intend to start. I suspect it really doesn't truly fit there. :-)

[firecat]

http://en.wikipedia.org/wiki/Feldenkrais_method

[cjsmith.livejournal.com]

Yeah, I got there this morning, googling based on your comment. :-) It sounds potentially very interesting.

Diagnosis of the day -- my completely untrained guess, that is -- is flexor tendinitis. I'm sure I'll have a new one tomorrow!

[ambar.livejournal.com]

Funny, I have been in and out of the sports medicine dept at PAMF for my shoulder. I know they have a podiatrist on the team. And Dr. King, who worked on my shoulder (hence not a podiatrist) has creds with the Raiders, many Stanford teams, etc.

FWIW: http://www.pamf.org/sports/staff/saxena.html