In highly exciting news, I have recently had occasion to visit a podiatrist for the first time.
Relatedly, I want to talk about my foot. The thought of doing so bores me almost to tears, so I feel deep empathy for YOU, whose foot it is not. The thing is, it has been causing me enormous grief for months now and I better just talk about it and get it over with.
Sometime in December of 2021, I started having heel pain when I woke up. It would be worst when I first got out of bed, then would gradually subside throughout the day. My runner friend told me it sounded like plantar fasciitis, which is a term with vowels that look incorrect even when I know they’re in the right places. I looked up plantar fasciitis and found some stretching exercises to do; I did them; they seemed to work.
But then after maybe a week or so, the exercises stopped being effective. And the pain got worse and worse, so that any time I sat down (and as a person who writes for most of the day, I sit a LOT) and then tried to stand, I would hobble around with serious pain. It started waking me up in the night. It started affecting my ability to drive (I would get sharp shooting pains in my arch when I pushed on the gas or the brake). It made it difficult/painful for me to do my preferred type of exercise (walking).
I went to a podiatrist, who seems very knowledgeable and who came highly recommended. But it seemed to me that the podiatrist relies a little too heavily on ME and not heavily enough on measurable facts. I suppose that’s how most of medicine is, isn’t it. If I say I have sinus pain and I’m miserable, and the doctor presses on my forehead and under my cheekbones and asks if it hurts, she has to take my word for it that it does. A gastroenterologist has to rely on your report of stomach/intestinal pain. But I hate that. I do. I want to be able to go to a doctor and say, “I am in pain” and for them to be able to VERIFY that, scientifically. I want them to have calipers that measure the pain so they can nod and say, “Yes, I see, this is clearly a Level 5 pain.” rather than making me the sole reporter of painfulness. For one thing, I feel like I have a low threshold for pain, so that what might be excruciating for me would be just a little twinge for you. And I don’t want to overreact to pain, or come across in any way like I am overexaggerating. I want it to be quantifiable. It’s NOT, but oh well.
The podiatrist did press on my foot to see if I reacted, which I did. And he used an ultrasound machine to check… something. I’m not sure, but he did measure something and record those measurements. (He also took an X-ray, to ensure I didn’t have any fractures or cancer.) (Brief digression: I have been having pain in both feet, but one is much more severe than the other. When I checked in, I explained this. The receptionist said she would send me for an X-ray right away, and did I want X-rays of both feet or one? Um. I don’t know? I feel like that is not the kind of decision I, the non-doctor, am qualified to make? I did say that I would do whatever the doctor recommended, and the receptionist said, “It’s really up to you.” So I told her we could focus on just the one because the pain in the other foot is – currently – livable. But then the whole time I was getting my foot X-rayed I was feeling panicky that I had made the wrong choice, and what if I needed to come BACK in a few months and do it all again, and pay extra to get the other foot X-rayed when I could have gotten it all done at once? I had to use some coping thoughts like, “less radiation NOW is better, when I may not ever need a X-ray for the other foot.” And, “I made the best choice I could in the moment, and there is nothing I can do now.” And, “maybe it would end up costing the same anyway; I don’t know if they charge per foot or per visit, so who knows.” And, “I am fortunate to have health insurance and a health savings account, and this is what those things are for.” I had a good hearty wait before the X-ray technician was ready for me, so I got a chance to repeat these coping thoughts several times. (And panickedly wonder whether I could ask the X-ray tech to do both feet, or ask if I could call up to the doctor and alter the order.) It turned out okay, and if I need another X-ray of the other foot at some time in the future, so be it. But I really wish that the DOCTOR would have said, “Well, I really think that we should focus on the one foot that’s causing you the most trouble.” Or “Well, this thing can develop quickly so if you are having even a little trouble, let’s treat the other foot too.”)
This is a very complainy post about my podiatrist, when really he seemed very nice. I guess I just get very anxious about doctors’ visits. I don’t want to waste the doctor’s time, I don’t want to overestimate the problem, or make A Big Deal when it’s not a big deal, I don’t want to spend a lot of health savings account money when I could really just be at home icing my foot, you know?
Anyway. After the podiatrist evaluated my foot, he gave me a little mini lecture about what plantar fasciitis is, using a plaster foot as a visual aid, and I thought it was very useful and interesting and then promptly forgot everything he told me. He then gave me a splint to wear on my foot while sleeping (“gave” – it cost $75; it is possible I could have bought one myself elsewhere for much cheaper, but I did not) and a prescription for a steroid/anti-inflammatory drug, and scheduled an appointment for me to come back in just over a week.
The first day of the steroid, I had excruciating bone pain in ALL my bones. That was deeply unpleasant. But on days two and three, the bone pain had subsided and I had almost NO PAIN in my afflicted foot. It was MIRACULOUS. Then, as I “stepped down” the dosage of the steroid over the next week, the pain returned. It was dispiriting, to say the least.
Not to mention that the splint for my foot is not… super. It wraps around the ball of my foot and then has a stiff arm that goes up the outside of my shin, and tightens around my calf. Kind of like a shin guard, only a bit more flexible. It keeps my foot in a slightly flexed position, which is not uncomfortable. The edges of the Velcro closure scratch my toes though, and I find it very difficult to sleep with the thing on my leg. Plus, I absolutely cannot walk on it, so I have to remove the whole splint every time I get up to go to the bathroom which is at least twice per night. (Each time, I try to undo the Velcro as quickly as possible, so that I don’t wake my husband. I feel like the sound of Velcro reluctantly parting from itself would be a highly unpleasant way to wake up in the middle of the night.)
When I went back to the podiatrist, the medical assistant asked me how things had gone, and I told her: my foot was definitely better than it was before, but it was not great. She said, “What percentage has your pain been reduced?”
What? Ugh. While I was just whining a few paragraphs ago about wanting quantitative measurements of medical issues, I do not want to be the one who provides them. I am at a loss for how to evaluate things like this. If you ask me to rate my pain on a scale of 1 to 10, I usually have NO IDEA how to do that. Like, I have in my head the worst pain I have ever experienced, so I assign that a 10. But then… it’s very difficult to know where other things fall. Primarily because pain is so immediate, and because the perception of pain fades with time. Right now, it HURTS, and it’s bearable or not.
Anyway, I told her that maybe the pain was 20% better – which was a wild guess on my part – and she said, Wow, okay, that’s not good. If you had said it was a 70% improvement, maybe we could give you another round of the steroid, but the next step is usually an injection.
Now, I had heard about the injection before I ever made my first appointment with the podiatrist. The person who recommended him had had an injection for my exact problem, and it seemed like that was the treatment, so the steroid/splint treatment I received was a surprise to me. I’d been prepared from the get go for an injection, and the podiatrist had mentioned at my first appointment that if the steroid/splint didn’t work, I would probably need an injection. So I was anticipating an injection.
The medical assistant left and when the doctor came in, he said, “I hear you were begging for the injection.” Which made my eyes go all wide until I realized he was joking. THEN he told me that a lot of people say the injection is the worst pain they have ever had; that women who have delivered multiple children say it’s much worse than childbirth. (Not the most reassuring way to begin the injection discussion, Doc!) But, he went on, he has never had any patient say that to HIM. HIS injections are painless, and he uses a specific method that makes them so.
So now I had two things to hold in my head: 1. That some people find this injection to be excruciating and 2. That I could not in any way tell this guy if it WAS, because he would not believe me.
He put up a little curtain, separating my eyes from from my foot, which is a weird way to phrase that but I am leaving it, and sprayed my foot with what he called a “cold spray.” THAT was pretty uncomfortable, but bearable. And then he started the injection, which took several minutes and was also fairly uncomfortable but bearable. I had to do some deep breathing, and had to clutch my arms across my chest quite tightly to get through it, and there was some tear-prickling at my eyes, but no actual tears. (At one point, he asked if I was doing Lamaze breathing back there, which made me feel quite embarrassed. He went on to say if I left with a baby, we’d each have a lot of explaining to do, har har har, and as I mulled THAT ONE over for awhile, while trying not to breathe so audibly, I came to the conclusion that I probably wasn’t breathing THAT hard, and that instead the Lamaze thing was probably a bit he does for lots of his patients.) (I feel as though, in describing this to you, I am describing this doctor quite unfavorably. I definitely do NOT jive with his sense of humor, although I can see how many patients would find him hilarious and delightful. But I did feel that he was a good listener, and that he cared that I was in pain, and that he wasn’t judging my particular level of pain tolerance, and that he was determined to resolve the problem. AND that he was an experienced and knowledgeable practitioner.)
Anyway. The injection was FAR from the most painful thing I’ve endured. Dental procedures are much, much worse. But afterward, my foot was sore and I kept getting these little shooting pains in my heel and walking was about as uncomfortable as it had been before I saw the podiatrist.
The injection did HELP, for a while. The next day, my foot felt significantly better. But I am nearly a week out from the first injection and I am back to hobbling around when I wake up/stand up after sitting for awhile.
And yes, I said “first injection” because the podiatrist mentioned that, for a LOT of people, one injection resolves the issue completely. But for some people, it doesn’t. And that we needed to resign ourselves (he didn’t say resign; I think he said “commit.” Resign feels more accurate for me, though.) to THREE injections before we pursued a different path. He didn’t even mention what the next path would be, so I’m trying to borrow some of his confidence that the second or, gulp, third injection will do the trick. I am NOT looking forward to another injection. Last time, I had the added anxiety of not knowing what to expect. But now I have a different type of anxiety because I DO know. And it’s hard to go into something, knowing it will result in pain.
This feels like the kind of thing I had better get used to, as I age. More and more parts of me are going to fail. More and more parts of my body are going to experience pain. I am not pleased about it, but I recognize that this is just A Part of Aging. And I’m really very lucky. I can still walk. I can still exercise, even if doing so is slower and causes residual pain. I can afford to treat it. Hopefully my marriage can withstand my ongoing crankiness/hobbling.
life of a doctor's wife 