What to ask a podiatrist?

Posted by Ray Kemble @ray666, Jun 8, 2023

Hello!
I am a 78-year-old man with idiopathic polyneuropathy. Otherwise, I'm healthy. I was diagnosed only last August. It appears my PN is either sensory, motor, or a mix of the two, Oddly enough, I have no pain, but my balance and gait are terrible. I have been wearing orthotics for decades, starting long before my PN diagnosis. Some have suggested I talk to my podiatrist (he doesn't know yet about my PN) to get his advice on PN and foot care. I'm wondering if others here have met with their podiatrists and whether your meeting proved to be of some help, especially with your balance and gait. For any stories you might share, thank you!
Ray (@ray666)

Interested in more discussions like this? Go to the Neuropathy Support Group.

@dbeshears1

It sounds like we’re all having similar issues, with or without hammer toe activity. For me, just alternating between wearing thick socks in the house to having to wear shoes to go out is a major activity change. And I CANNOT have 2 different styles of shoes in my life or that’s another Olympic event with consequences. Just removing socks in the house to walk completely barefoot into the shower is yet another obstacle course.
When I was a very active runner and would need competitive feet, gait, and stride, there were (are) athletic shoe stores that would test you, measure & analyze your feet in action, and could connect you to the best engineered shoe for your foot health and performance. Now, while my end goal has changed, I’m still looking for the optimally engineered shoe for MY foot health and performance, but have been unsuccessful in finding the medical discipline or whatever who can do the same analysis as the athletic shoe people who regularly enabled me (and other athletes with all kinds of different feet) to run 26.2 miles!!
Our needs are so much more necessary today, and I would love to continue hearing your stories and experiences that might help me in my quest for more direction. I do PT and home exercises regularly. I’ve had a couple of Podiatrists but their focus wasn’t on footwear or gait solutions, just general advice and hammer toe surgery options. I haven’t found a go-to for a Total Foot function analysis and solution. Please continue sharing successes or watch-outs!

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We used to have several excellent shoe stores here in Denver. Since my last long-standing theater work was in Boulder––Boulder, along with Eugene, Oregon, a gathering place for world-class runners from all over––I'd buy all of my shoes at a little shop in Boulder: a fantastic place where the staff was the best in the business, I'd gotten my best shoes there. But I no longer have reason to go to Boulder (only 35-ish miles, but with PN … well, you understand), and the decent stores we once had here in Denver have all been replaced (all but one, but the staff there are not very knowledgeable) by online stores, like Zappos.

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@dbeshears1

Ed - Oddly enough, I was able to get a nerve biopsy referral from my Neurologist to a Neurosurgeon who did it 2 years ago. His first question was “Why wouldn’t he do an MRI first, it’s less invasive?” But he did the biopsy - sent results to my Neurologist who always lost or misfiled things. After 2 weeks of not getting results from my Neuro, I had a wound follow up with the surgeon, the surgeon handed me a copy of the results, saying he couldn’t “review” it with me, but my Neurologist should follow up on the “inflammation” noted. A month later my Neurologist finally reviewed the biopsy with me and said it confirmed axonal PN no evidence of further degenerative something or other, and he said the “inflammation” found was insignificant.
So the biopsy confirmed axonal PN like nerve conduction tests, but left me with 2 pestering wonders.. (a) Why did neurosurgeon hint significance re: inflammation of something and my scattered Neurologist dismiss it? and (b) Why won’t they do a Neurological MRI on me?
Anyone who has followed me on here knows I’ve been at awe that I seem to be the only one on here that has not had an MRI, despite asking for it. My doctors have absolutely no clue as to what exactly I have or how I got it, but are absolutely 100% certain an MRI will tell us nothing!!! I think it’s become a conspiracy with doctors as I moved to different states that if the first doctor said No to MRI, they’re not going to disrespect his opinion. To me, it can’t be 100% deemed useless unless they had all or most of the medical questions answered about my PN.
Oh well, as much as I have focused on symptom management and quality of life maintenance and improvement, and try to accept the end of efforts in trying to diagnose me, can you still tell I’d like an MRI to help prove to me one way or another and help provide closure for me?? 😊

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I'm surprised that your doctors were so sure that an MRI would tell you "absolutely nothing." For the most part, my MRIs told me nothing*, but that "nothing" was comforting in itself. (*My cervical MRI revealed a "borderline" disk problem, but not one that called for right-away surgery, and not something that had bearing on my PN. I'll go back in the fall for another MRI to learn if that borderline problem is no longer borderline and requires surgery.) I'm no fan of MRIs! Who likes to spend 30-40 minutes in an oversized toothpaste tube anyway? LOL But my MRIs appear to have narrowed the suspects in my search for the cause of my PN (a cause I may never find).

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@ray666

I'm surprised that your doctors were so sure that an MRI would tell you "absolutely nothing." For the most part, my MRIs told me nothing*, but that "nothing" was comforting in itself. (*My cervical MRI revealed a "borderline" disk problem, but not one that called for right-away surgery, and not something that had bearing on my PN. I'll go back in the fall for another MRI to learn if that borderline problem is no longer borderline and requires surgery.) I'm no fan of MRIs! Who likes to spend 30-40 minutes in an oversized toothpaste tube anyway? LOL But my MRIs appear to have narrowed the suspects in my search for the cause of my PN (a cause I may never find).

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Asked, almost begged, 3 different Neurologists, even complaining of constant lower pack pain for 3 years. I have had a revered MRI of the brain for something else, that’s it. I don’t know who else I can “ask” for an MRI - need a specific order….

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@ray666

We used to have several excellent shoe stores here in Denver. Since my last long-standing theater work was in Boulder––Boulder, along with Eugene, Oregon, a gathering place for world-class runners from all over––I'd buy all of my shoes at a little shop in Boulder: a fantastic place where the staff was the best in the business, I'd gotten my best shoes there. But I no longer have reason to go to Boulder (only 35-ish miles, but with PN … well, you understand), and the decent stores we once had here in Denver have all been replaced (all but one, but the staff there are not very knowledgeable) by online stores, like Zappos.

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I ran the Bolder Boulder once.. made a vacation of it. Saw a lot of world class runners training in that altitude.

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@ray666 - I learned with my Medicare plan, the insurance will cover visits to the podiatrist I think every 10 weeks or so due to a dx of PN. He clips nails and does a very good inspection. And, if something comes up it's easy to get an appointment plus, he is on the forefront of new things coming down the pike. I feel folks with numbness should see a podiatrist on a frequent basis.

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@dbeshears1

Asked, almost begged, 3 different Neurologists, even complaining of constant lower pack pain for 3 years. I have had a revered MRI of the brain for something else, that’s it. I don’t know who else I can “ask” for an MRI - need a specific order….

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Maybe, with technology changing our world as rapidly as it appears to be, one of these days, we'll walk into our local supermarket, and there, beside the Redbox DVD dispenser and blood pressure machine, will be a do-it-yourself MRI cylinder: "Slide in slowly and hold very still!" LOL

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@dbeshears1

I ran the Bolder Boulder once.. made a vacation of it. Saw a lot of world class runners training in that altitude.

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I'm sure you're familiar with Frank Shorter. He lives in Boulder. It was Shorter's win in the Olympics marathon that inspired my love of running. I've thanked Shorter for that. I give him partial credit for my still being in reasonably good shape (except for this PN). If I weren't in reasonably good health (I have to say again: except for my PN), I suspect I'd be struggling even more now (one more mention) because of my PN.

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@njed

@ray666 - I learned with my Medicare plan, the insurance will cover visits to the podiatrist I think every 10 weeks or so due to a dx of PN. He clips nails and does a very good inspection. And, if something comes up it's easy to get an appointment plus, he is on the forefront of new things coming down the pike. I feel folks with numbness should see a podiatrist on a frequent basis.

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So far, I have found Medicare to be pretty cooperative. The only exception was one time when I was pressing my luck over-extending PT sessions that weren't helping me worth a damn. I really couldn't blame Medicare for saying, "Enough's enough!"

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@ray666

Maybe, with technology changing our world as rapidly as it appears to be, one of these days, we'll walk into our local supermarket, and there, beside the Redbox DVD dispenser and blood pressure machine, will be a do-it-yourself MRI cylinder: "Slide in slowly and hold very still!" LOL

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You’re funny! I see those Red Box Dispensers and I honestly have no idea what to do with a DVD anymore! I will say though that my Fitbit watch will take an EKG. I’ll impatiently wait for the MRI function 😀

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@ray666

So far, I have found Medicare to be pretty cooperative. The only exception was one time when I was pressing my luck over-extending PT sessions that weren't helping me worth a damn. I really couldn't blame Medicare for saying, "Enough's enough!"

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That’s the irony of Medicare. While we are happy to go to PT expertise just to maintain our ability, Medicare expects the PT to improve our ability. So we get cut off, then regress, then start the PT process over again, hoping it’s just one step back then one step forward again instead of 2 steps back and 1 step forward.

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