Therapy or surgery?

by CS

I am a 48 year old female. I have had fallen arches since my teen years. For at least the past 15 years I often get a sharp pain deep inside my left ankle; there is no pattern as to when the pain occurs. The top of my feet (over the arch) also hurts at times. I sometimes get blisters beneath my toes of the left foot. This past year I have noticed that my gait is changing. I had surgery on this foot in 1998 for a painful bunion, at which time the surgeon also shortened one of my toes by removing a piece of bone.

The last podiatrist I have seen wants to perform surgery to alleviate my pain and correct some problems. He said the tendons on the inner part of my legs/feet have given out. He wants to rotate my heel to provide more arch support then at a later time deal with the foot deformities.

Bad feet run in my family. I am on my feet most of the time when I work, so I have been unable to work as often as I would like. Do you think I should try chiropractic therapy first? I think my insurance only covers 15 chiropractic appointments per year. Does the surgery seem sound? I would appreciate your input.

Hello CS,
You are asking someone with a vested interest; I'm afraid I can't promise a totally unbiased reply.

That's major surgery that's being suggested, and always no matter what the problem, a more conservative course of treatment makes sense. You've little to lose from going for the chiropractic treatment; it's most unlikely to make the condition worse and you might just get considerable relief.

I think it's important to decide up front what you would be satisfied with. With surgery or for chiropractic, for that matter. What I can tell you is that neither are likely to achieve a 100 percent cure. Would you be happy with 60% less pain?

Under the toes it sounds like you are experiencing a condition called metatarsalgia; it almost always responds well to chiropractic.

The sharp pain within the ankle joint is more complicated; it may just be a chronic subluxation in the ankle mortice or subtalar joints, both of which cause sharp stabs of pain. That responds well to chiropractic adjustments.

But you may have advanced arthritis in one or more of those joints; then it's a good deal more complicated and you may only get say 50 percent relief. Can surgery do better than that? I don't know, you'll have to ask the surgeon.

Look for a chiropractor with a FICS qualification; sports chiropractic. Your local chiropractic association may be able to guide you.

All in all a qualified yes, see a chiropractor who works daily with feet. Don't get sucked into expensive orthotics initially; and accept that 50 percent less pain is perhaps all you can expect with a long history like that. You would be able to continue with your work, whereas after major foot surgery you are looking at a layoff of several months most likely. The surgeon will tell you.

Spend some time talking to friends and family; not all chiropractors work with feet, and finding the right person is important.

Start our foot and ankle exercises which you'll find using the search function at Chiropractic Help.

I hope this contributes; let us know how you get on.

Dr B

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

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