An extremely pleasant female runner came to my office last week. Before I met her I was looking over her chart and saw that she was seeking help with her foot pain. I read through the rest of the file and noticed she also suffered from back pain. No matter, I thought, I will deal with her foot and if there is any time I will ask her about her back issues. I proceeded to the reception area and was introduced to her by one of my assistants. When she got up from her chair she was completely bent over at the waist. She followed me to the examination room hardly able to straighten up. “I know your file says you are here for your foot but you obviously have a pretty significant lower back problem” I said. She admitted she did explaining it had been like this for days. I asked “Have you seen any other doctor’s for either your foot or lower back”? She replied “I went to my doctor the other day for my foot. When I originally made the appointment my back was fine. By the time I got to the appointment my back was in a lot of pain and I was bent over like this. The doctor told me I had Plantar Fasciitis and not to run”. I let that sink in for a moment then asked “But he saw you bent over like this? Did he not ask about your back”? She replied “He did say it looks like you have a back problem but that was about it”. I sat back and thought about what kind of doctor would let a patient stand in front of them twisted over in obvious pain and say “It looks like you have a back problem”. Really genius! How about helping her with that back problem! I said to her “I know you are here to see me about your foot, and I will address it, but your back problem is infinitely more important at this time so I am going to examine your back if that is Ok with you”? She said it was. After a thorough orthopedic and neurologic exam I determined she had a herniated disc at her L4-L5-S1 regions (lower lumbar spine). I told her I could treat and help her but an MRI would be necessary to at least see if she might be a surgical candidate. She agreed and I treated her.
When she returned two days later she was standing erect and her back pain was decreased but not gone. At this appointment I examined her foot. After a thorough exam it was obvious her foot pain was actually part of her nerve pain from her back. After careful questioning she admitted that the pain radiates from her back, down her leg and then into her foot. What her doctor had diagnosed as Plantar Fasciitis was actually nerve pain. That should have been obvious as she had none of the “textbook” signs and symptoms of Plantar Fasciitis.
Bulging, protruded and herniated discs in the lower back cause predictable symptoms in most everyone that suffers from them. Because of this it is a simple process to diagnose the patient and predict the exact location of the disc problem as well as the severity of the bulge. Plantar fasciitis also has predictable symptoms that most all patients will suffer from. One of those is arch/heel pain that is worse when getting out of bed in the morning. When a patient does not complain of this symptom typically they DO NOT have plantar fasciitis. When a patient is bent over at the waist and complains of lower back pain and radiating pain into their foot it is obviously NOT a foot problem. More and more the art of diagnosis is being lost in the traditional medical model. Diagnosis means ‘to know”. By performing a thorough history and examination “to know, to discern, to distinguish’ is quite easy. It is a little like being a detective. You have to eliminate “suspects” and you do this by process of elimination and using your experience and common sense. When you take a patient’s history and they tell you where it hurts you can eliminate most other area