First appointment with Dr. Cornelison

[cjsmith]

Kudos

HUGE KUDOS to rfrench for preparing so well for this appointment. We brought a synopsis of everything that had been tried so far, a copy of my X-rays from 12/2003, and all my MRI films. Big kudos also for coming along with me and thinking of questions I didn't think to ask.


First visit inspires confidence

This doctor took the time to look through the synopsis and said, basically, "hey, you've already been really thorough here; you've tried all the obvious stuff". He was very thoughtful, obviously applying logic to the problem, and he was very willing to talk to us about his thoughts.

He also mentioned a couple of times that my case was unusual in various ways. This is reassuring; if he saw me as "just another ________" I'd be pretty sure he was wrong like everyone else.


Mechanical problem

Like my first podiatrist, he too seems to think that there is basically a mechanical problem underlying all this.

1) He notes that I'm very flexible (I have "ligamentous laxity" aka double-jointedness) almost everywhere EXCEPT in the middle of my foot where the metatarsals meet all the little bones of the midfoot, where I am remarkably rigid. If I were flexible there too, he says, my arches would have collapsed long ago and my foot would be a pancake. He guesses one of my parents comes from double-jointed flatfeet and the other comes from people with high rigid arches. Anyhow, this combination of rigidity in one place and hyperflexibility everywhere else leads to the angle of the long bones in the foot ("metatarsal declension") being markedly high, stretching out the flexor tendons and the plantar plate (the structures showing damage on my MRIs) and grinding the ball-of-foot joints into the ground harder than normal as the foot rolls during walking.

2) I also don't have a good transverse arch. Several doctors have noted this. Correlating with this, he can tell where I bear weight from my calluses; on the ball of the foot behind the big toe my skin is as soft and smooth as it is on the top of my foot. That should be taking a bunch of the load and it isn't.

3) I also have almost zero padding under the metatarsal/phalangeal joints. Most people can't count their forefoot bones by feel from the bottom of the foot. I can.

Interesting side notes on the mechanical stuff:
- My calves and Achilles tendons AREN'T tight any more. Guess that's what I get for wearing shoes with a low heel and raised toe for a year. (He says he's never before met anyone who has worn those shoes for a year.)
- I also don't pronate any more. I had no idea it was possible to train oneself out of it, but apparently wearing these shoes has done just that.
- My forefoot varis isn't unusually high/large any more, either.


First Theory

He has a "first guess" as to what's going on. He taped up my foot and asked me to tell him what hurts more, less, or differently, and those results will confirm or refute his theory.

He theorizes that my plantar plate is in the process of being destroyed, and that if I weren't so darn flexible, it would have ruptured long ago. People have a lot of pain when it's stretched and pounded. When it tears, which usually happens very soon after the onset of symptoms, they are suddenly pain-free (and massively prone to toe dislocations). I still have pain because, his theory says, mine simply hasn't broken under the abuse. In three years.

If his guess is right I'm not sure what can be done. (I asked. HE doesn't yet know.) There's a surgery to help stabilize the toes of people who have the tear. (I hope I don't need that. It involves wrapping a tendon from the bottom of the foot over the top of the toe to hold it in place. This does not inspire confidence for a long lifetime of running and square dancing and backpacking.)

The tape he put on each foot is keeping my second and third toes from bending back. If this theory is right the pain should decrease while wearing the tape. I have to try it without my post-op shoes, of course. Barefoot or in regular shoes will do it.


Other Things To Try

He has ordered blood work to rule out systemic problems such as rheumatoid arthritis, lupus, etc. He considers this unlikely but worth checking for peace of mind.

He has also found me SHOES! I have long suspected that the two benefits of my post-op shoes were 1) leaving the heel low when I stand, so my forefoot isn't bearing much weight, and 2) not allowing the toes to bend back when I walk. These shoes do both those things. (Doctor handing me brochure: "I've been waiting forever to find someone to give this to.") I have not yet gone to try any on; it is quite possible, even likely, that they don't come in wide, which means there's absolutely no way I can ever wear them. But hey, it's a really good thought.


Tentative Results

Walking down the hall in sock feet I notice that the pain has moved dramatically. Particularly on the left foot, where I feel the tape is more aggressive in holding the toes down, the pain is suddenly under the ball of the FOURTH toe... an untaped toe. It's a pretty bad level of pain, too. Under the second and third toes there's little to no pain, at least in such a short walk. That's a very dramatic result. I don't have a good memory of walking in sock feet without the tape (I'm no dummy! I don't DO that any more!) so I'll try that in the morning and compare.


To Do Soon

Get blood drawn
Write up detailed impressions of tape versus not tape
Try out MBT shoes
Order MRI report for Dr. Cornelison
Bring in all previous orthotics for Dr. Cornelison


Summary

I like his attitude. I respect his obvious intelligence. I am heartened that there are more things to try in an effort to diagnose this.

Comments

[mactavish.livejournal.com]

One of my favorite things about my GP is her willingness to see things as a puzzle to be worked on, rather than, taking mad stabs, or giving up.

I once had a doctor test me for yeast, when I had a horrible genital itch, then say, "Well, it's not yeast!" I said, "So what should I do?" He said, "I dunno, but it's not yeast." He sent me on my way.

(Turns out I'm allergic to laundry detergent, but I figured that out on my own.)

[cjsmith.livejournal.com]

"I dunno, but it's not yeast." He sent me on my way.

Sheesh. Yes, seeing diagnosis as a puzzle is a big step. I felt that way about Dr. Turrel at the veterinary oncology practice in Pacifica. She obviously saw Princess's diverse and seemingly unrelated symptoms as a puzzle, and she used diagnostic tools and found the answers. (Then she cured her, which was cool too.) My regular vet had simply gently suggested euthanasia.

[wooddragon.livejournal.com]

Moron. :p

[cjsmith.livejournal.com]

Yep. My regular vet was way out of her depth on that one.

[wooddragon.livejournal.com]

Not to mention insensitive. It's okay to say you don't know. Not so okay to recommend euthanasia when you don't have an effing clue what to do.

[cjsmith.livejournal.com]

Well, at least she was gentle about it, and the cat was older than any the vet had ever seen in her life. I figured it wasn't too unreasonable to assume she was just plain falling apart... but I got a second opinion anyway.

[lkeele.livejournal.com]

Yep, I recently had a doctor do the exact same thing to me. I hate that. I now have a new gyn.

(I'll have to pay attention to laundry detergent.)

[perfect-autumn.livejournal.com]

I recommend ALL Free and Clear and Method. I'm extrememly sensative to detergants, and neither bother me.

(if you find it's a problem)