Seek specialist for chronic foot pain

Dear Dr. Roach: I am a 73-year-old male with continued pain in my right foot and ankle for the past five years. I try to stay active by golfing two days a week in season, and I walk 3 miles four times weekly around the neighborhood. The pain started about five years ago after a very active week of walking five days straight. My family doctor recommended I try some arch support inserts for my athletic and golf shoes, which I did try for one year. I stopped after that because they did not help.

He also referred me to a foot doctor, who I saw for two years. We tried a steroid shot and measured orthotics, but the pain continued. The foot doctor treated me for plantar fasciitis, and an X-ray indicated I may also have some arthritis. He recommended I massage the foot and plantar area, which does help. The third solution is surgery on the plantar fascia, or possibly on the joint with arthritis. I’m currently trying an over-the-counter gel for arthritis called Voltaren as a last resort before possible surgery. My questions are: What is your opinion of Voltaren, and is there anything else I should consider before surgery?

M.L.

Answer: Plantar fasciitis is a common cause of foot pain. My experience is that when the symptoms have gone on a very long time, it takes a very long time to effectively treat. Early referral to a specialist is indicated for symptoms that do not promptly resolve.

When my own patients have been treated by an expert, I sometimes see the use of night splints or casting Ultrasound shockwave is used, but may not be effective. Platelet-rich plasma is not well-enough studied to comment on its effectiveness. Diclofenac gel (Voltaren) is not likely to solve the problem: It’s a good anti-inflammatory for issues that are superficial, but I’m afraid your problem is too deep for the gel to have much benefit.

I have never had a patient undergo surgery, but the literature does show that it is used as a “last resort” treatment for plantar fasciitis. It seems reasonable to consider, but I strongly urge you to carefully research how much experience your surgeon has with this condition.