Last week the Well blog featured a special report from the staff of Science Times called “Decoding Your Health,” which focused on how to navigate in a sea of health information.
One of the featured stories was from my colleague Denise Grady, who went on a personal health quest of her own, using the Internet to try to find out the source of her foot pain. That effort, and a visit to a doctor, led to an odd-sounding diagnosis of winkle picker’s disease, which leads to painful, stiff toes.
The story generated a surprising response, resulting in dozens of e-mails from fellow toe-pain sufferers. For the Best of Well podcast this week, I spoke to Ms. Grady about her painful toes and what she learned about researching personal health information.
“The first thing I found out is that it’s really hard to diagnose yourself on the Internet,” Ms. Grady begins.
To hear our conversation, click the podcast link below.
Listen to the Podcast (mp3)
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From 1 to 25 of 33 Comments
Foot pain is difficult to diagnose, especially if you are female and in complete denial about healthy footwear! Years of wearing high heels, pointy toes, and featherweight sandals, especially in the city, has a cumulative effect. The first place I look when I have foot problems is in my closet. The Internet won’t tell you any different.
— UrsulaThe cause of foot pain is evidently hard to diagnose. One doctor told me I have Achille’s tendonitis, while another said it is Plantar Fasciitis. Nothing they have suggested has worked, and I am at the place that sometimes it is nearly impossible to walk, due to the increasing pain. I don’t know if I have ever experienced anything this painful.
— bevDoes anyone know why this so difficult to treat?
Bev, Did you go to a podiatrist? It is always more effective to go to one for foot problems in my experience. ~Mary Ann
— Mary Ann GrayHaving gained weight since my last standing job I feel a major difference in foot comfort. Purchasing sturdy leather shoes, and not cheap ones, makes a huge difference as has losing weight. Spending half an hour very carefully examining each foot I was able to determine the specific joint that is bothering me and choose shoes that will provide cushioning for that area.
— S. SmithWhat I’ve learned from reading Ms. Grady’s article and from being a fellow toe sufferer, is the same as what I’ve learned about other illnesses. First, do no harm and then secondly, try the most conservative treatment.
Third, anyone who trys to doctor themselves is a fool. It’s always best to get professional advice.
I saw my foot doctor and she recommended OTC anti inflammatories and rocker sole shoes. Within weeks, my pain disappeared. As I told Ms. Grady, I now mourn the loss of shopping for “nice” shoes, but it’s okay as long as my feet don’t hurt. Before visiting the doctor, I’d just look at shoes and my toe would hurt.
Rocker sole shoes ROCK!
— voracious readerI developed Achilles tendinitis as well as tendinitis in a nearby tendon (posterior tibialis, for anyone who may be curious), to the extent that my ankles were continuously stiff and sore. A visit to a sports orthopedist recommended by my superb internist, resulted in the diagnosis, recommendation of using ice and OTC anti-inflammatories, custom-made orthotics, home exercises, and physical therapy.
Now, after twenty hour-long sessions of intense physiotherapy, the pain in my tendons has nearly subsided, but more p.t. is still needed. And I discovered that I walk on the outside edges of my feet–don’t pronate at all– hence the need for orthotics (which have really helped).
I’m sure my obesity has had a great deal to do with my situation, but it is disheartening to see that I developed these problems even though I have NEVER worn pointy shoes, shoes with high heels, flip-flops (except at the beach as a child), or other notorious shoes. Not that I would choose those kinds of shoes, but still, I thought I was doing all the right things. Rats!
Thank goodness for excellent doctors and therapists. If I had tried to diagnose myself, I would not have come up with the need for these therapies.
— kirinWhat are foot doctors called in the US? Here they would be just orthopaedic (yes that spelling) surgeons who specialise in feet. The upside to that is they are good at looking at the whole patient and seeing referred pain and posture as part of the problem.
Diagnosing yourself on the internet isn’t hard, its just silly. See a professional, that’s what they did years of training and exams and study to do. If you find a dud get another Dr.
I’ve had chronic foot issues just as I’ve had chronic eczema and ear infections. The best Drs are those who say “This is probably chronic and incurable but we can try some things to alleviate/solve a particular episode”. In the case of the eczema and ear infections they went on to cure it (if 20 years without an incident can count as a cure, in my book it can). Saying you can’t cure it and then doing so is a lot more professional than saying you can when you should know cure is nearly impossible. Foot pain is an obvious example.
— JillyflowerI had painful bunions as a young child and the podiatrist (after an x-ray) said that was the normal formation of my feet. Hmmm. Pain is normal? In my 20’s I discovered the Alexander technique, a postural retraining method. Even if you are not heavy you can be heavy on your feet. This method teaches you to walk more upright. One bunion disappeared. I still have one big ugly bunion that hurts with some shoes. Now in my 40’s I have other toe pain which I solve with yoga and a product called yoga toes that exercises the feet.
— LauraAfter developing foot pain in my mid 40s I turned to yoga..my feet after 2 dedicated years are much better..I credit a good yoga practice that includes daily sitting on my heels with my toes up so that I am stretching them …painful at first necessary now!!
— caroleI do not have any foot problems, but have noticed when shopping online for Earth shoes (zappos.com) that many women with problems remark how wonderful these shoes feel to them.
— ame6 years of Achilles tendinitis due to bone spurs in both heels. 2 podiatrists and my internist recommend against actual surgery: VERY painful and slow to heal.
Many different pt sessions with no relief; morning stretching exercises with instant relief as long as I keep moving (and on my feet) all day long.
3 weeks in a walking cast, rendering 1 ankle immobile: no more pain in the tendon, but dramatically increased hip, knee, and back pain on opposite side (despite new shoe with thick sole). I won;t even try with the other foot .
A pt friend recommended ultra sound treatments to zap the bone spurs that cause the Achilles tendinitis. I’m waiting to see if my insurance provider can be persuaded to let me go to the local best podiatrist.
— Anne SlaterThis mini-memoir by Denise Grady combined with that of 10/14/08 by Gina Kolata on MRIs demonstrates the folly of both levels of excess technology and, “the rise of the machines” (sorry, a title from another cautionary tale, but related to the financial fiasco). Both denigrate the role of your physician - and a GOOD physician (not a god physician.)
Both demonstrate the attempt to diagnose oneself - in a way. There is a hubris to think that access to knowledge (aka the internet) is equivalent to the knowledge (both scientific as well as clinical or practice experience) of a physician. (Personally, I am a bit surprised that Ms. Grady’s original physician was not aware of the limited Range of Motion on exam and point tenderness with likely diagnosis. She, Ms Grady, likely would not have believed the diagnosis without the xray. Note that the podiatrist knew the diagnosis even without the xray, but used the xray to explain it to Ms. Grady. WOULD she have believed the diagnosis without the imaging? This is the real question.)
The Kolata article demonstrates the common hubris of academia - that only the academic and superspecialized physician can diagnose anything. The real difference is the misperception that all MRIs are created equal. It’s no different than to think that all cameras provide the same quality of picture. From this latter, you know from experience that this is not true - there is difference in resolution, focus, area of view, etc etc, as well as that from the view - is it a 1 inch pic or magnified to a 20 inch view. Does one provide a better view? undoubtedly, but it also depends upon what you are looking for. This demonstrates the fallacy of people who think that OPEN MRIs are the same as closed MRIs. By definition, open MRis have much less powerful magnets - they are the equivalent of Barbie cameras compared to academic closed units which are like the professional DSLRs (generally a difference of a 0.3Tesla versus a 4Tesla magnet - think of it as the difference of 1megapixel versus 10 megapixel with difference in software for acquisition and processing of the data collected, i.e. the lenses and the development/printing process.)
For Kolata’s premise that academics are better, then you would have to have the academic radiologists try to read the original MRI. In all likelihood, their reading would be nearly the same due to resolution problems. (Also, by definition, the stress fracture may or may not have been clearly visible initially. Her continued use of the foot likely increased the stress fracture. The most that would have been visible initially was likely a difference in the bone as “inflammation” - was the appropriate magnetic field manipulation done, was there adequate resolution to look at the bone marrow which would be the earliest sign.)
I point to both of these articles as evidence that there is a growing expectation of medicine a la Star Trek - here, lie on this bed, let’s “image” or otherwise use some means other than talking to you (to get inside your body - what EXACTLY did/do you notice - and examination, actually sensing you (vision/touch/sound - rarely smell). More importantly, there is demonstrated this impatience for results which is simply not how the body works. This is most clearly noted with back pain and ankle sprains - the demand for imaging as if that will automatically make a difference. This obviates the need for a physician would can tell you the likely cause or extent of the problem and what to do as the body tries to adjust (heal) - which is not instantaneous.
— susanAfter turning 50 and gaining 20 lbs., I developed really bad arch/heel pain. The Podiatrist recommended orthotics (at a staggering price) and possibly surgery. What helped me is visiting a good therapeutic shoe store. They correctly measured my feet (I do think the old idea that one’s arches fall is correct), which were found to be larger than in years past. I wore Birkenstocks and New Balance for a year (I’ve also managed to lose the weight). Since then I’ve moved on to Danskos (some of them are cuter than others) with an occasional evening off in “nicer” shoes. I still sadly ogle the beautiful high heels, but they are not for me. I have no more heel pain, just bruised vanity.
— Jilli read ms. grady’s story, and had thought of emailing
her about my experience, so i’m delighted to see this
follow-up here (and maybe she’ll read my response).
bev (#2), your story is my story. in the spring of 2000,
i began to experience sudden, mysterious foot & ankle pain. i think the podiatrist’s dx was plantar fasciitis, but
my symptoms were more diffuse and didn’t quite match
the descriptions of pf i read. over SEVEN YEARS of misery,
i thought i had tried everything: custom orthotics, pt, picking-up-marbles-with-my-toes, $200 non-custom orthotics, … all of little help. my previously active life was
a sad memory, walking for more than ten minutes was out of the question, and i often lay awake nights w/ aching feet.
in 2005, i also developed excruciating arthritis (xray-confirmed by another podiatrist) in my left big toe.
in the summer of 2007, searching an exercise forum for something i could do to regain some lower body fitness, i found a reference to what proved my salvation: an improbable device called yogatoes, which passively exercises the feet and ankles. (i know; sounds ridiculous; read on!) hoping only for some pain relief, w/in a week i noticed that my toes actually looked different (!) a complete transformation of feet & ankles came w/in 6 months. i am still improving a year later, but i can walk for hours now, and no more pain, not even in the arthritic toe.
go to http://www.yogapro.com, read the testimonials (yes, i used to think they must be exaggerations, too), note the money-back-guarantee, google for a $15-off ecoupon, get them
to your door for under $50. oh, and if you’re a woman,
ignore their advice and get the larger size unless your
feet are really small/narrow and/or toes very short.
not only the best $50 i ever spent, but my favorite product of all time. those of you w/ foot and/or ankle pain/disability will understand that; regaining health in that area has been priceless.
now that my feet are “healed”, i still use them regularly, if my feet are sore or tired from extended standing or walking on hard surfaces. they give my feet a fantastic stretch that just feels great. it’s not a massage, but i don’t feel like i need one after using them, they’re that good.
i’ve taken so long to write this (trying in vain not to sound like an infomercial!) that i see laura (#8) has already mentioned her use of yogatoes. (laura, if you have the smaller size, the larger size might give you even more relief - if you bought them from yogapro, they might even allow you to exchange them.)
kirin (#6), i too was a “supinator”, and i too counted achilles tendonitis among my foot woes - any time i stood on tiptoe, i felt as though my tendons might snap! thanks to google, i also discovered that my posterior tibialis tendons were in the wrong place on both feet - alongside my ankle bones, instead of behind them (ie, posterior) , as they should be. now my tendons are in their proper places, my stance is balanced, and i do 100 calf raises daily!
jillyflower (#7), i did “see a professional” - four in fact: two
podiatrists, physical therapist, and orthotist. sadly, so did most of the posters so far, and likely most of those who will read this blog topic. their answer was “chronic and
incurable” as you say (also “not unusual in middle-aged
women” - groan), and included the stern admonition to wear orthotics in closed-toe, lace-up shoes every day for the rest of my life. besides being hideously uncomfortable in the summer, it really didn’t help. i’m happy to say that i spent this past summer orthotic-free, my feet breathing easy in my birkenstock thongs!
one final point: nobody - me included - saw anything wrong with my feet or ankles. they looked completely normal. it wasn’t until after “the miracle of yogatoes” (as my friends and family eye-rollingly refer to it) that i could see how my feet were apparently supposed to look: my arches are higher, my toes are straighter and lie flatter, and my insteps and achilles tendons curve differently. ( i still marvel at the changes!)
— Hippo CratesPLEASE provide the transcripts to podcasts!
— kI have had bunions for years (tall, big feet, shoes don’t fit), multiple musculoskeletal problems affected by my feet or vice-versa, and now a horrible big toe injury that will not heal.
Do Yoga Toes really work? Any others who have benefitted from the Alexander Method?
— keh, I self-diagnosed chillbains online………then went to my GP who had no idea what i was talking about and went to look it up himself…………….so, I’m a fan of self-care and partnership endeavors. I found the article helpful and will look into the medication mentioned.
— AsterWhether you use the internet for self-diagnosis or education, you can’t go wrong learning more about your symptoms. The web has a wealth of information out there to help you learn about your health. Research can either lead you to self-treatment or to becoming a well informed patient when you go see your doctor.
A great source of information on foot and ankle problems is http://www.myfootshop.com. There are hundreds of articles on foot and ankle conditions, as well as a library of anatomy and surgical photos that are very helpful. There are foot and ankle products to browse also.
Once you’ve educated yourself, you can go to your physician ( a podiatirst has the most foot and ankle expertise) for a diagnosis and treatment plan.
— thaliaI’m also a believer in consulting both the internet and a competent specialist. Neither alone is anywhere near foolproof.
Aster (#17), chilblains is an example of that. I myself once thought the word quaint and extinct (like “consumption” to mean tuberculosis-type diseases). But in fact chilblains are merely poorly understood. Exposure to cold causes the swelling and other symptoms that go away, but the permanent sensitivity has not been successfully explained nor treated to date. Doctors tend not to learn what medical science can’t explain or treat.
Jillyflower (7), American foot doctors are very different than in other nations. Indeed, many or most Americans don’t even know that podiatrists are not MDs; they usually have BA degrees and then go through a podiatric medical college and 1-2 years of “fellowship” (internship), depending on state law. Many or most failed to gain entry to medical school (MD programs). Others just like being able to charge cash for cosmetic foot procedures, which can be hugely profitable if done in an office. Their great advantage is that they are so familiar with feet, and the good doctors among them (honest and studious) can often work wonders with orthotics, exercises, and other “conservative” treatment. That’s because the foot is by far the most bio-mechanically complex part of the body that bears weight (dozens of moving parts). Foot MD’s (orthopedic surgeons) mostly don’t specialize in feet, or else have the high overhead costs of an MD (education loans, hospital affiliations, malpractice insurance, office staff, higher-tech equipment), so they can’t make a living on conservative treatments. The best foot specialists in orthopedic surgery do many expensive surgeries to make a living and then patiently use conservative therapies for those patients who need that.
Anne (11), the intense ultrasound that pulverizes bone spurs of the heel is an “off label” use of “shock wave lithotripsy” machines. Perhaps that’s why orthopedists don’t use it while some podiatrists learn to. The technique has been FDA- approved for 15-20 years to pulverize kidney stones, allowing them to be passed without surgery. For heel spurs, the success rate is about 60% (with almost half the rest succeeding only after a second treatment). But list price is $1000-$2000, and insurance rarely pays. Partly, that depends on how talented at persuasive insurance paperwork the doctor is. Another problem is that heel spurs do re-grow, sometimes in only a year or two, and repeat shockwave treatments are less effective. Despite all this, it could be one’s best choice if the orthopedic surgical alternative involves severe disruption of the achilles tendon (depending on exact size and location of the heel spur). That’s because all Achilles rehab post-op is relatively risky, painful and slow.
K (16) - You may have bigger problems than feet if your toe injury that won’t heal is in the flesh, or if it’s infection in the bone. Simple medical tests can determine that. Untreated diabetes or osteomyelitis (deep bone infection) become increasingly hard to stop, and could become life-threatening. A deformity caused by an injury, as opposed to a persisting injury itself, may be medically harmless. But otherwise, better see a doctor for a foot injury that won’t heal!
My favorite advice from all you commenters is: wear sensible shoes, maintain proper weight, and do healthful exercises. With feet, prevention is just so superior to treatments that it’s a no-brainer. I’m grateful to be educated about the prevention.
— AvonPodiatrists are too often overlooked for foot and ankle injuries. In my case I went through about a dozen M.D.’s who failed to correctly diagnose a problem (and in some cases actually made it worse by providing bad medical advice) before going to a local podiatrist who diagnosed the issue immediately and had me feeling better within two appointments.
For some reason orthopedists (including those affiliated with top orthopedic hospitals) tend to miss a lot of problems that a good podiatrist can pick up right away.
— nnbYes, Internet plus conservative practicioners such as Podiatrists & Orthopedic surgeons.
I also tried acupuncture and homeopatic remedies.
Since I was diagnosed with Hallux Rigidus,and serious pain
and a joint which was “frozen” in a poor position with spurs as well, I opted for one type of sugery offered by a well known podiatrist in S.F.I followed his suggestions explicitly, only to find that a year and a half passed, with NO success! An Ex-professional dancer with toes of steel and no way to look forward to even a small heel.
Like many of you who have commented, one eve while continuing my search, I ran into Yoga toes on Yogapro.com.
I avidly read every bit of info, including all testimonials.
I thought,”I have invested so much time, money, and surgery. This yoga Toe was worth a $50 - discount GO!!
It’s only been 2 weeks, but I am positive that not only can I feel a comforting difference, but I am ready to wear them to bed all night! ….no partner at this moment….. Therefore, I’m sharing another Yoga toes testimonial to those of you with “open or opening minds” to experiment for a small price
rather than not! I will promise to stay in touch every couple of months or so, if that might be helpful.
Blessings, Marjori
— marjori Starkin case of any errors, my comments are above, signed by me,
— marjori StarkMarjori Stark.
I would also like to see transcripts of verbal “articles” as there are many of us that can’t listen to these files or don’t want to.
Some of us are hard of hearing!
As to shoes, I am one of the lucky ones. At the age of 13, I remember my mother buying me a stylish pair of orange suede shoes. Within a week, my feet were killing me. My arches “fell” (whatever that means) I was taken to a podiatrist, who recommended brutally ugly shoes (old lady shoes) but the foot pain went away, and for the rest of my life, (I’m in my 50’s now) I have always bought shoes for comfort and foot health. I am currently wearing “Nike Free”, a shoe that allows your foot to flex and bend naturally while you are walking.
eschew shoes!
mimi
— MimiTranscripts please~
— LucrezaBorgiaIn the early 1990s I started suffering very severe pain in my big toes, to the point that I sometimes had trouble walking. I consulted an orthopedist, who referred me to a podiatrist in their practice. The podiatrist diagnosed Hallux rigidus, a form of osteoarthritis, and prescribed first orthotic implants for my shoes and then a bilateral debriding procedure to remove the fragmented cartilage. Since then, I have continued to wear the orthotics and have been almost entirely pain-free. It’s surprising how much pain can be caused by pain in the toes - also a salutary reminder on how important our feet are!
As someone above said, please don’t try to diagnose yourself. Seek out competent professional care. And look after your feet, otherwise you aren’t going to be able to walk.
— Thomas Beck