by Dr. Steven Waldman
What to do when someone has a problem that no one else can fix? I find that I need to get back to basics; a doctor needs to stop, look, and listen. Get a through history from each person that they see. We can all get busy and rushed, but it is really important to listen – hear what each person has experienced and continues to experience.
For example, I recently took care of a patient with chronic heel pain. This patient had received multiple cortisone injections, had two surgeries, and was convinced that she had a very common diagnosis – Plantar Fasciitis. She had tried multiple pairs of orthotics and various shoes with no success. The easy thing for me to do would have been to believe her previous doctors’ diagnosis, and simply give her another cortisone injection.
I reviewed the previous tests, which did not support the Plantar Fasciitis diagnosis. Simple x-rays in the office showed no fractures, but an alarming reduction in the thickness of the fat pad under her heel. The foot that she had surgery on had this reduction as well – but even worse! I performed a diagnostic ultrasound on both heels, which allowed me to see the heel fat pad, plantar fascia, and surrounding tendons. A diagnostic ultrasound is safe, inexpensive, and has instant results – all right in the office. It allows you to see many things that you can’t on an x-ray.
For this patient, the information I received from the diagnostic ultrasound was critical. Her past surgery had indeed corrected her Plantar Fasciitis, but it had also caused nerve damage. Her other foot had extreme atrophy of the heel fat pad, as well as severe Plantar Fasciitis. Instead of giving additional cortisone injections, which could be detrimental to her already compromised heel fat pad – she is currently receiving successful shockwave, or ESWT, therapy. We are currently addressing her symptoms with a multi-part approach. None of this would have been possible without a correct diagnosis!